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Pre-hospital Care of Trauma Victims and Triaging on Arrival
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Ashish Aditya, Tanvir Samra, Anjuman Chander, Harshit Singla
Field triage is practised in disaster scenarios, usually done by rescuers, and the objective is to do the greatest good to the greatest number of patients. Simple Triage and Rapid Treatment (START) followed by Secondary Assessment of Victim Endpoint (SAVE) is done in such scenarios.
Triage
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Pre-hospital triage systems can broadly be divided into field triage systems for use in determining the most appropriate facility to take individual trauma patients to, or major incident triage systems. Field triage systems (Figure 3.2) will use a combination of anatomical and physiological information, the mechanism of injury and certain additional criteria in order to determine the need for transport to a major trauma centre. Additionally, within hospital similar criteria may also be used to determine the criteria for trauma team activation (Table 3.4). Accurate triage using an anatomical system requires a full secondary survey of an undressed patient so that all injuries are identified and assessed, individually and collectively, before a priority is assigned. Anatomical systems require experienced clinicians, time and a warm, well-lit environment—all of which may be lacking at the scene of an incident. In anatomical terms once the incident has occurred, a patient’s injuries will not change. As a result, anatomical systems are static and are of use only in hospital with small numbers of patients to assess. Anatomical information may be used by experienced triage officers to modify other triage systems.
Ethics, legal and humanitarian issues
Published in Ian Greaves, Military Medicine in Iraq and Afghanistan, 2018
The use of the patient’s triage category as a marker simply of the severity of his1 injury has become commonplace, in other words, not to prioritise them against other casualties (they may in fact be the only one) but to warn receiving facilities that they are indeed very unwell (if T1) or relatively stable (if classed as T2 or T3). This equates to what is commonly referred to as field triage in the United Kingdom, a process that can be used to determine whether an individual casualty has to go to a major trauma centre or whether they can safely go to a less capable facility such as a trauma unit. Although the desire to use the Triage Sieve in this way this can be clearly understood, the tools are far too simplistic compared with the processes used in the United Kingdom, and they do not perform well enough to be of significant value in this context.
Impact of Trauma Center Designation Level on the Survival of Trauma Patients Transported by Police in the United States
Published in Prehospital Emergency Care, 2022
Ghassan Bou Saba, Rana Bachir, Mazen El Sayed
EMS field triage uses physiology, anatomy, and mechanism of injury criteria and is based on the Centers of Disease Control and Prevention field triage guidelines (25). Field triaging for police transport varies with US geographical locations and department-specific internal protocols. For example, according to Stockton’s police regulations, the need for immediate transport “when waiting for paramedics would be impractical” is determined by Police based on the severity of the injury with no triaging directives regarding specific transport destination (10). On the other hand, in Philadelphia, Law enforcement policy details transport of trauma patient to the nearest hospital except for serious penetrating or blunt trauma that should be transferred to the nearest accredited trauma center (9). Decreasing transport time should be prioritized in policies regardless of trauma level designation level as our study did not find any difference in survival outcomes when comparing them. Moreover, these protocols can be improved through future research by more precisely detailing situations where Police transport could be more beneficial than waiting for EMS.
The Use of Field Triage in Disaster and Mass Casualty Incidents: A Survey of Current Practices by EMS Personnel
Published in Prehospital Emergency Care, 2018
Kevin Ryan, Douglas George, James Liu, Patricia Mitchell, Kerrie Nelson, Ricky Kue
Multiple studies examining the relationship between EMS triage practices in training versus actual MCIs have suggested discrepancies in triage use as well as inconsistency in triage tag use given the infrequency of MCIs to allow for adequate practice (21–23). Given the unpredictable nature of major MCI's, it is unclear if triage methods learned via training are effectively utilized during actual MCIs. The objective of this study was to determine if gaps exist in both field triage practices and triage tag use by surveying EMS personnel experiences in both the training environment and during actual MCI's as well as to identify perceived barriers to field triage and triage tag use.
Does Mechanism of Injury Predict Trauma Center Need for Children?
Published in Prehospital Emergency Care, 2021
E. Brooke Lerner, Mohamed Badawy, Jeremy T. Cushman, Amy L. Drendel, Nicole Fumo, Courtney M. C. Jones, Manish N. Shah, David M. Gourlay
The Field Triage Decision Scheme is intended for use with both adult and pediatric patients. This Scheme is made up of four steps; 1) physiologic criteria, 2) anatomic criteria, 3) mechanism of injury criteria, and 4) special patient or system considerations (2). However, when triaging children, the Field Triage Decision Scheme has been found to have a high rate of under-triage which could result in severely injured patients not being identified in the field as needing transport to a trauma center (3–6). The recommended under-triage rate is typically 5%, but applying the guidelines to pediatric patients has been shown to under-triage as many as 35% of children (3).