title: Triage, transportation, and destination decisions by out-of-hospital emergency care providers.
abstract: BACKGROUND
  The effectiveness of a tiered emergency medical services system often hinges upon the ability of initial care providers with little or no formal training to identify emergent patient needs and determine the best means to meet those needs.
  
  
  OBJECTIVE
  To determine if out-of-hospital emergency care providers consistently make appropriate triage, transportation, and destination decisions; and to determine if experience and training have an effect on these decisions.
  
  
  METHODS
  A survey consisting of 14 patient-care scenarios was administered to certified and non-certified out-of-hospital emergency-care providers (n = 311) from 20 randomly selected EMS agencies. These agencies were part of EMS systems that utilize one, two, and three tiered responses by ambulance and fire-based commercial, municipal, and volunteer agencies. Participants were asked to select the most appropriate mode of transport and destination facility using the assumption that they had responded to each scenario in a basic life support ambulance. Answers included transporting the patient to various receiving facilities or requesting a more advanced-level unit to respond to the scene. Transport times to receiving facilities and estimated times of arrival for advanced-level units were provided with each choice. Eight emergency physicians unanimously had agreed upon the most appropriate answer for each scenario. A two-tailed t-test was used to compare the scores of the certified and non-certified groups; and Spearman's Correlation Coefficients were used to test the effects of experience and training.
  
  
  RESULTS
  Non-certified providers (n = 108) had a mean score of 32.6% or 4.6 (SD = 1.84) correct answers; certified providers (n = 203) had a mean score of 41.1% or 5.76 (SD = 2.12) correct answers (p < 0.000001). Spearman's Correlation Coefficients were: 1) individual provider level--(0.3978); 2) agency provider level--(0.2741); 3) hours worked per week--(0.2505); 4) years in EMS--(-0.0821); 5) commercial or volunteer provider--(0.2398); 6) agency call volume--(0.2012); 7) agency location--(0.0685), and 8) transporting versus non-transporting agency--(0.2523).
  
  
  CONCLUSIONS
  A need exists for further education of out-of-hospital emergency care providers with respect to triage, transportation, and destination decisions. Provider experience and level of certification do not appear to affect these critical patient-care decisions.
authors.affiliation: State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Department of Emergency Medicine, 14215, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Billittier
authors.forename: E B
authors.initials: EB
authors.lastname: Lerner
authors.forename: R M
authors.initials: RM
authors.lastname: Moscati
authors.forename: G
authors.initials: G
authors.lastname: Young
mesh_terms: D017028:Caregivers / Q000706:statistics & numerical data; D003657:Decision Making; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D004634:Emergency Medical Technicians / Q000706:statistics & numerical data; D006801:Humans; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014187:Transportation of Patients / Q000706:statistics & numerical data; D014218:Triage / Q000706:statistics & numerical data; D000078329:Workforce