142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

309570
Prehospital trauma triage decision-making: What really happens between the 911 call and the hospital

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014 : 1:00 PM - 1:15 PM

Courtney Marie Cora Jones, PhD, MPH , Department of Emergency Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, NY
Manish N Shah, MD MPH , Department of Emergency Medicine, University of Rochester, Rochester, NY
Susan Fisher, M.S., Ph.D. , Department of Clinical Sciences, Temple University School of Medicine, Philadelphia, PA
Peter Veazie, PhD , Department of Public Health Sciences, University of Rochester, School of Medicine and Dentistry, Rochester, NY
Christopher Seplaki, PhD , Department of Public Health Sciences, University of Rochester, School of Medicine and Dentistry, Rochester, NY
E. Brooke Lerner, PhD , Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
Jeremy T Cushman, MD MS , Department of Emergency Medicine, University of Rochester, Rochester, NY
Kelly Bellenger , Department of Emergency Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, NY
Matthew Doyle , Department of Emergency Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, NY
Background

To determine the appropriate destination hospital for injured patients emergency medical services (EMS) providers engage in a complex decision making process referred to as trauma triage. This decision can impact both patient outcomes and the efficiency of the emergency care system. Research has focused on accuracy of trauma triage; however, little is known about how these decisions are actually made by EMS.  

Methods

We conducted separate focus groups with advanced and basic life support providers from rural and urban/suburban regions.  Focus groups were moderated by an experienced qualitative researcher using a standardized guide to facilitate discussion.  Responses were audio-recorded and transcribed. An interdisciplinary team coded and categorized data into larger domains to describe how EMS providers approach trauma triage and how national protocols are applied.

Results

Four focus groups were conducted with 27 EMS providers.  Participants agreed that trauma triage is complex and there is often limited time to make destination decisions. Four overarching themes were identified: 1) initial gestalt assessment drives choice of destination hospital; 2) providers emphasize  efficiency rather than absolute accuracy; 3) current local and national protocols do not mirror providers’ natural decision-making process; and 4) hospital resource availability and patient preference, not just trauma center designation, influence triage decisions.

Conclusion

This study suggests the current tools available to assist providers in making trauma triage decisions may be inadequate.  Future research is needed to verify these findings and to determine if protocols can be revised to better align with the decision-making process used by EMS providers.

Learning Areas:

Clinical medicine applied in public health
Other professions or practice related to public health
Provision of health care to the public
Public health or related research

Learning Objectives:
Define trauma triage and explain how trauma triage decisions made by EMS providers can impact patient outcomes and the emergency care system. Identify why trauma triage decisions are complex. Discuss the ways in which EMS providers in our sample think about trauma triage decisions. List the major themes identified within the focus groups and explain the implications of these findings.

Keyword(s): Decision-Making, Emergency Medical Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am currently an Assistant Professor of Emergency Medicine and Public Health Sciences and have extensive experience conducting both epidemiologic and qualitative research. I have worked in the field of emergency medicine research for the past 7 years. My current research foci include prehospital ambulance-based emergency medical services (EMS) and how care delivered in this setting can impact both patient outcomes and the efficiency of the overall emergency care system.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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