title: The effect of the introduction of a regional major trauma network on triage decisions made by a physician-staffed helicopter emergency medical service.
abstract: BACKGROUND
  A major trauma network (MTN) has been in place in the East of England, with a single hospital operating as the major trauma centre (MTC). The primary aim of this retrospective cohort study was to determine whether triage destination decisions with regard to trauma patients made by a helicopter-based doctor-paramedic team are affected by the introduction of a regional trauma network. In addition, we will describe and discuss the logistics of transfer of injured patients attended by the service.
  
  
  METHODS
  This is a retrospective database review that was carried out over two 12-month periods. The first period was before the introduction of an MTN, and the second was after its introduction. All patients who were conveyed to an MTC were identified. Nontrauma patients were excluded. The MTN trauma triage tool was retrospectively applied. A comparative analysis of the two cohorts was carried out. For the group of patients conveyed to the regional MTC, additional follow-up information was obtained. This included patient survival at 30 days and the final injury severity score for each patient.
  
  
  RESULTS
  A total of 220 cases were identified in which a major trauma patient was conveyed to an MTC. There were 94 cases in the year before the introduction of the MTN (cohort 1) and 124 in the year during which the MTN was active (cohort 2). There was no significant difference in the number of patients conveyed to each MTC between cohort 1 and cohort 2. The trauma triage tool status was 'positive' in 52.1% of cases in cohort 1 and 55.6% of cases in cohort 2 (P=0.60). Advice of the consultant on call was more commonly used for patients in cohort 2 than for those in cohort 1 (66.9 vs. 40.6%; P<0. 01).
  
  
  CONCLUSIONS
  The introduction of a regional MTN has not significantly affected the triage decisions made by our physician-paramedic teams.
authors.affiliation: Pre-Hospital Care, Essex and Herts Air Ambulance Trust, The Business Centre, Earls Colne, Colchester, Essex, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Chesters
authors.forename: Ronan
authors.initials: R
authors.lastname: Fenton
mesh_terms: D000328:Adult; D017732:Air Ambulances / Q000458:organization & administration*; D000488:Allied Health Personnel / Q000458:organization & administration; D002983:Clinical Competence; D000066491:Clinical Decision-Making; D003195:Computer Communication Networks / Q000458:organization & administration*; D016208:Databases, Factual; D004632:Emergency Medical Services / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010820:Physicians / Q000458:organization & administration; D012189:Retrospective Studies; D015996:Survival Rate; D014193:Trauma Centers / Q000458:organization & administration; D016896:Treatment Outcome; D014218:Triage / Q000458:organization & administration*; D006113:United Kingdom