Field triage criteria and trauma team activation: Is there a difference between emergency-physician and emergency technician staffed rescue teams?

The Emergency Medical Service (EMS) in some European countries operates on a two-tiered system, consisting of units staffed with paramedics only (EMT) and units staffed with emergency physicians (P-EMS). Severely injured patients are usually treated by both P-EMS and EMT and Trauma team activation (TTA) is typically initiated by these prehospital rescue teams. This study aimed to investigate the impact of field triage recommendations on TTA and determine if there is a difference in TTA accuracy based on the alerting units, EMT or P-EMS.

Method: Analysis from a 3-month observation period, including adult patients with acute trauma admitted to an emergency department by EMS. A total of 3,753 cases were included. We analysed on-scene criteria leading to TTA. We differentiated between high-risk criteria for severe injuries (HRSI) and moderate-risk criteria for severe injuries (MRSI) and categorized TTA according to national guidelines. The need for emergency department treatment or TTA for each patient was retrospectively assessed using post hoc criteria defined by expert consensus.

Results: TTA was much more common in P-EMS compared to EMT (64% vs. 6%). Trauma team activation occurred in 46% of cases by P-EMS due to HRSI criteria (14% for EMT) and in 25% of cases when MRSI criteria were present (44% for EMT). The positive predictive value (ppW) for TTA by EMT was 50.3%, and over-triage was 49.7%. Under-triage occurred in 35.9%. In the P-EMS group, over-triage was 44.5% and under-triage 15.6%. EMT group had more under-triage cases (84.5%) despite a significantly higher over-triage rate of 76.6%.

Conclusion: P-EMS had a higher percentage of cases with HRSI criteria trigger TTA. EMT treat a higher proportion of cases based on MRSI criteria for TTA. In the retrospective assessment of the need for TTA, differences primarily arise concerning assignment based on HRSI or MRSI. The EMT group exhibits a higher overtriage and undertriage rate compared to the P-EMS group.

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