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Tenets of trauma triage

ACS to update Field Triage Guidelines: EMS provider feedback needed


AP Photo/John Minchillo

The American College of Surgeons – Committee on Trauma (ASC-COT) recently announced that it has begun the process to review and revise the 2011 Field Triage Guidelines. An important first step is to gather feedback from the very people that use the tool, EMS providers.

The Guidelines were first released by the ACS-COT in 1986 as the Field Triage Decision Scheme. The document was updated every few years by the ACS-COT until it was joined by the Centers for Disease Control and Prevention (CDC) in 2005. With funding from the National Highway Transportation Safety Administration (NHTSA), CDC and ACS-COT seated a national expert panel to review new research articles related to trauma triage, consider the experience of states and communities using the Guidelines and gather recommendations from panel members. The group soon released the 2006 version of the Guidelines, which became known as the “CDC guidelines” by many providers. The guidelines were published by the ACS-COT in its “Resources for the Optimal Care of the Injured Patient: 2006” and the CDC included them in its “Morbidity and Mortality Weekly Report” (MMWR) in 2009. The process began again in 2011 with the current revision of the Guidelines published later that same year.

As stated in the MMWR, “the goal of the field triage process is to ensure that injured patients are transported to a trauma center or hospital that is best equipped to manage their specific injuries, in an appropriate and timely manner, as the circumstances of injury might warrant.” Another take on the Guidelines is that they are offered as a tool for EMS providers to make the best possible triage decision for the patient with the tools we have in the field. The ACS-COT recognizes that we do not generally have X-ray, CT, or lab on scene with us, but that we still must make quick decisions that could make a big difference in the patient’s outcome. These Guidelines are the best option we have currently. They are meant to provide some structure and apply evidence-based medicine to the intuition all EMS providers develop.

Trauma assessment and field triage

An important tenet of the trauma care system is getting the patient to the right place, via the right mode and in the right amount of time. All this starts with a quick and efficient assessment by EMS providers. The injuries and condition must be recognized before the patient can be sent to the appropriate destination. The components of the Field Triage Guidelines match information gathered in the trauma assessment:

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When a patient needs the resources and care of a higher-level trauma but is not transported to one, they are considered to have been undertriaged. Ideally, undertriage rates should be less than 5%. Conversely, a 25-35% rate of overtriage is allowed and even encouraged. The goal is to balance overwhelming our trauma care resources with overtriage while minimizing undertriage. Simply put, overtriage costs the trauma care system and patients valuable time, money and resources, while undertriage costs the patients in terms of complications and worse outcomes.

Share your feedback on Field Triage Guidelines

Now is an important opportunity for EMS providers to let the ACS-COT hear how the Field Triage Guidelines have worked for the last several years. In the invitation to participate in the survey, the ACS-COT states, “we are seeking input on the current guidelines from a broad group of EMS stakeholders, at all levels and in all roles.”

The survey takes 10 - 15 minutes to complete and will be open until Jan. 15, 2021. Click here to participate.

Stay safe out there.

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Michael Fraley has over 30 years of experience in EMS in a wide range of roles, including flight paramedic, EMS coordinator, service director and educator. Fraley began his career in EMS while earning a bachelor’s degree at Texas A&M University. He also earned a BA in business administration from Lakeland College. When not working as a paramedic or the coordinator of a regional trauma advisory council, Michael serves as a public safety diver and SCUBA instructor in northern Wisconsin.