title: Protocol of the DENIM study: a Delphi-procedure on the identification of trauma patients in need of care by physician-staffed Mobile Medical Teams in the Netherlands.
abstract: BACKGROUND
  In The Netherlands, standard prehospital trauma care is provided by emergency medical services and can be supplemented with advanced trauma care by Mobile Medical Teams. Due to observed over and undertriage in the dispatch of the Mobile Medical Team for major trauma patients, the accuracy of the dispatch criteria has been disputed. In order to obtain recommendations to invigorate the dispatch criteria, this study aimed at reaching consensus in expert opinion on the question; which acute trauma patient is in need of care by a Mobile Medical Team? In this paper we describe the protocol of the DENIM study (a Delphi-procedure on the identification of prehospital trauma patients in need of care by Mobile Medical Teams).
  
  
  METHODS
  A national three round digital Delphi study will be conducted to reach consensus. Literature was explored for relevant topics. After agreement on the themes of interest, the steering committee will construct questions for the first round. In total, 120 panellists with the following backgrounds; Mobile Medical Team physicians and nurses, trauma surgeons, ambulance nurses, emergency medical operators will be invited to participate. Group opinion will be fed back between each round that follows, allowing the panellists to revise their previous opinions and so, converge towards group consensus.
  
  
  CONCLUSIONS
  Successful prehospital treatment of trauma patients greatly depends on the autonomous decisions made by the different professionals along the chain of prehospital trauma care. Trauma patients in need of care by the Mobile Medical Team need to be identified by those professionals in order to invigorate deployment criteria and improve trauma care. The Delphi technique is used because it allows for group consensus to be reached in a systematic and anonymous fashion amongst experts in the field of trauma care. The anonymous nature of the Delphi allows all experts to state their opinion whilst eliminating the bias of dominant and/or hierarchical individuals on group opinion.
authors.affiliation: Department of Surgery, VU University Medical Centre Amsterdam, P.O. Box 7057, 1081 HV, Amsterdam, The Netherlands. a.harmsen@vumc.nl.
authors.forename: Annelieke Maria Karien
authors.initials: AM
authors.lastname: Harmsen
authors.affiliation: Department of Surgery, VU University Medical Centre Amsterdam, P.O. Box 7057, 1081 HV, Amsterdam, The Netherlands. l.geeraedts@vumc.nl.
authors.forename: Leo Maria George
authors.initials: LM
authors.lastname: Geeraedts
authors.affiliation: Department of Surgery Slotervaart Hospital, Amsterdam, The Netherlands. g.giannakopoulos@vumc.nl.
authors.forename: Georgios Fredericus
authors.initials: GF
authors.lastname: Giannakopoulos
authors.affiliation: Department of Surgery, VU University Medical Centre Amsterdam, P.O. Box 7057, 1081 HV, Amsterdam, The Netherlands. m.terra@vumc.nl.
authors.forename: Maartje
authors.initials: M
authors.lastname: Terra
authors.affiliation: Department of Anaesthesiology, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands. hmt.christiaans@vumc.nl.
authors.forename: Herman Martinus Timotheus
authors.initials: HM
authors.lastname: Christiaans
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands. w.mokkink@vumc.nl.
authors.forename: Lidwine Brigitta
authors.initials: LB
authors.lastname: Mokkink
authors.affiliation: Department of Surgery, VU University Medical Centre Amsterdam, P.O. Box 7057, 1081 HV, Amsterdam, The Netherlands. fw.bloemers@vumc.nl.
authors.forename: Frank Willem
authors.initials: FW
authors.lastname: Bloemers
mesh_terms: D000552:Ambulances; D032921:Consensus; D003697:Delphi Technique; D004632:Emergency Medical Services; D006301:Health Services Needs and Demand; D006801:Humans; D009426:Netherlands; D010819:Physician's Role; D014218:Triage; D000078329:Workforce