[Prehospital trauma triage before and after deployment of a physician-manned mobile emergency care unit in Nordsjaelland].
BACKGROUND
Prompt and correct triage to a facility capable of providing optimal care is important for survival and functional outcome after major trauma. This study compared the influence of on-scene deployment of physicians with medical telephone counselling of paramedics on the triage of trauma patients.


METHODS
A retrospective study of trauma patients triaged to tertiary treatment outside Frederiksborg County from March 2006 to February 2007. Patients were either triaged directly from the scene of the accident or secondarily transferred from a local hospital. The study period was divided into two intervals. Triage in the first interval was based on telephone counselling of paramedics by consultant anaesthesiologists. Triage in the second interval was performed by the same anaesthesiologists deployed in the field. Triage decisions, Injury Severity Score (ISS) and 30-day mortality were registered.


RESULTS
Among 607 patients, 82 were triaged to tertiary treatment. The proportion of patients triaged directly from the scene of the accident increased from 27.8% to 69.6% after prehospital deployment of physicians, whereas secondary transfers decreased from 72.2% to 30.4% (p = 0.0002). Patients triaged directly from the scene had a significantly lower ISS than secondarily transferred patients (5 (1-17) versus 17 (14-26), p < 0.0001).


CONCLUSIONS
Prehospital, physician-based triage of trauma significantly reduced the need for secondary transfers to tertiary facilities.
Meisler
Rikke
R
Akutlaegebil Nordsjaelland, Anaestesiologisk Afdeling, Hillerød Hospital, DK-3400 Hillerød.
Berlac
Peter Anthony
PA
D000552:Ambulances; D019091:Critical Pathways; D003718:Denmark / Q000453:epidemiology; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D006801:Humans; D015601:Injury Severity Score; D010360:Patient Transfer; D010820:Physicians; D012189:Retrospective Studies; D017216:Telemedicine; D014218:Triage; D000078329:Workforce; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000401:mortality