Triage Scheme in Disaster Emergency I have to submit an annotation bibliography of 10 references within the upcoming two days. I should choose a topic abou

Triage Scheme in Disaster Emergency I have to submit an annotation bibliography of 10 references within the upcoming two days. I should choose a topic about Triage scheme in disaster/Emergency management.

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JAMA Surgery | Original Investigation
Accuracy of Prehospital Triage in Selecting
Severely Injured Trauma Patients
Frank J. Voskens, MD; Eveline A. J. van Rein, BSc; Rogier van der Sluijs, BSc; Roderick M. Houwert, MD, PhD;
Robert Anton Lichtveld, MD, PhD; Egbert J. Verleisdonk, MD, PhD; Michiel Segers, MD; Ger van Olden, MD, PhD;
Marcel Dijkgraaf, PhD; Luke P. H. Leenen, MD, PhD; Mark van Heijl, MD, PhD
Invited Commentary page 328
IMPORTANCE A major component of trauma care is adequate prehospital triage. To optimize
the prehospital triage system, it is essential to gain insight in the quality of prehospital triage
of the entire trauma system.
OBJECTIVE To prospectively evaluate the quality of the field triage system to identify severely
injured adult trauma patients.
DESIGN, SETTING, AND PARTICIPANTS Prehospital and hospital data of all adult trauma
patients during 2012 to 2014 transported with the highest priority by emergency medical
services professionals to 10 hospitals in Central Netherlands were prospectively collected.
Prehospital data collected by the emergency medical services professionals were matched to
hospital data collected in the trauma registry. An Injury Severity Score of 16 or more was used
to determine severe injury.
MAIN OUTCOMES AND MEASURES The quality and diagnostic accuracy of the field triage
protocol and compliance of emergency medical services professionals to the protocol.
RESULTS A total of 4950 trauma patients were evaluated of which 436 (8.8%) patients were
severely injured. The undertriage rate based on actual destination facility was 21.6% (95% CI,
18.0-25.7) with an overtriage rate of 30.6% (95% CI, 29.3-32.0). Analysis of the protocol
itself, regardless of destination facility, resulted in an undertriage of 63.8% (95% CI,
59.2-68.1) and overtriage of 7.4% (95% CI, 6.7-8.2). The compliance to the field triage trauma
protocol was 73% for patients with a level 1 indication.
CONCLUSIONS AND RELEVANCE More than 20% of the patients with severe injuries were not
transported to a level I trauma center. These patients are at risk for preventable morbidity and
mortality. This finding indicates the need for improvement of the prehospital triage protocol.
JAMA Surg. 2018;153(4):322-327. doi:10.1001/jamasurg.2017.4472
Published online November 1, 2017.
A
dequate prehospital trauma triage of injured patients
is imperative for optimal trauma care. In an inclusive
trauma system, it is essential to transport patients
with severe injuries to a level I trauma center and patients
without severe injuries to lower-level hospitals. 1,2 Previous
studies have clearly shown lower mortality rates in patients
with severe injuries treated at a level I trauma center compared with patients treated at a lower-level hospitals.1-6
Management of care of the injured trauma patient on
the scene of injury remains challenging, and situations can
be chaotic. After a rapid trauma assessment of clinical and
physiological parameters, emergency medical services
(EMS) professionals must identify patients at risk for severe
injury and select the proper destination. Prehospital triage
322
Author Affiliations: Department of
Surgery, University Medical Center
Utrecht, Utrecht, the Netherlands
(Voskens, van Rein, van der Sluijs,
Houwert, Leenen, van Heijl); Utrecht
Trauma Center, Utrecht, the
Netherlands (Houwert); Regional
Ambulance Facility Utrecht,
Regionale Ambulance Voorziening
Utrecht, Utrecht, the Netherlands
(Lichtveld); Department of Surgery,
Diakonessenhuis Utrecht/Zeist/
Doorn, Utrecht, the Netherlands
(Verleisdonk); Department of
Surgery, St. Antonius Hospital,
Nieuwegein, the Netherlands
(Segers); Department of Surgery,
Meander Medical Center, Amersfoort,
the Netherlands (van Olden); Clinical
Research Unit, Academic Medical
Center, Amsterdam, the Netherlands
(Dijkgraaf).
Corresponding Author: Frank J.
Voskens, MD, Department of Surgery,
University Medical Center Utrecht,
Heidelberglaan 100, 3584 CX,
Utrecht, the Netherlands
(frankvoskens@gmail.com).
protocols are used to help define the patient destination.
However, triage of patients without evident abnormality
and instability at presentation remains challenging given
the limited facilities on scene.
In the Netherlands, allocation of trauma patients to the
appropriate level of trauma care is guided by the Dutch
Field Triage Protocol (version 7.1, National Protocol of
Ambulance Services),7 for EMS professionals (Figure 1). This
protocol is based on the Field Triage Decision Scheme established by the American College of Surgeons Committee on
Trauma (ACS-COT).8,9
Quality of prehospital triage can be determined by rates
of undertriage and overtriage. Undertriage is defined as the proportion of patients with severe injuries not transported to a
JAMA Surgery April 2018 Volume 153, Number 4 (Reprinted)
© 2017 American Medical Association. All rights reserved.
Downloaded from jamanetwork.com by Thomas Jefferson University East Falls Campus user on 01/29/2019
jamasurgery.com
Accuracy of Prehospital Triage in Selecting Severely Injured Trauma Patients
level I trauma center. Overtriage is defined as the proportion
of patients without severe injuries transported to a level I
trauma center. Undertriage results in higher mortality and delay of adequate care, whereas overtriage limits the available
level I resources for patients without severe injuries.2,8 To optimize the prehospital triage system, it is essential to gain insight in the quality of prehospital triage of the entire trauma
system or region. The benchmark level in the ACS-COT guidelines is a maximum undertriage rate of 5%, allowing for an overtriage rate of up to 50%.8 In a Dutch population consisting of
high-energy trauma patients only, the undertriage rate was
11%.10 The quality of triage in the complete trauma population is unknown.
This present study aims to evaluate the quality of the
Dutch field triage protocol for identifying severely injured
trauma patients in a population consisting of adult trauma
patients transported by EMS professionals with the highest
priority in the Central Netherlands region.
Methods
Study Design and Setting
The present study was performed in the Central Netherlands region using prospectively collected prehospital and
hospital data of all adult trauma patients transported with
the highest priority by the Regional Ambulance Service
Utrecht to 1 of the 10 hospitals in Central Netherlands
Original Investigation Research
Key Points
Question What is the quality of the field triage system to identify
severely injured adult trauma patients?
Findings This study included 4950 trauma patients and shows
that more than 20% of the patients with severe injuries were not
transported to a level I trauma center.
Meaning A significant group of severely injured trauma patients
does not receive the appropriate level I trauma care, putting these
patients at risk for increased morbidity and mortality;
improvement of prehospital triage is necessary.
between January 2012 and July 2014. The region Central
Netherlands consists of 9 level II and level III hospitals and 1
level I trauma center in a 2418-km2 region with a population
of 1.2 million people. The University Medical Center Utrecht
is designated as a level I trauma center, offering trauma care
at the highest level for severely injured patients. The 9 surrounding level II and III hospitals are designed to treat
patients without severe injuries. This regional trauma network is based on an inclusive and integrated trauma
system.8 The ambulance care system is nurse-based. Ambulance nurses are licensed to administer medical treatment at
advanced life support level, and ambulance drivers are
qualified to provide medical assistance to the ambulance
nurses. The present study protocol was reviewed and
approved by the local medical ethical committee, and
patient consent was waived. Analyses began in 2016.
Figure 1. The Field Triage Protocol for the Distribution of Trauma Patients Over Different Hospitals
ABC unstable
RTS 32 km/h
Vehicle deformity, >50 cm
Vehicle intrusion passenger compartment >30 cm
Vehicle rollover
Passenger ejection from vehicle
Fatality in same vehicle
Car-pedestrian or car-bicycle impact at >8 km/h
Pregnancy at >13 wk
No
Level I or II
No
Level I, II, or III
ABC indicates airway, breathing, and
circulation; GCS, Glasgow Coma
Scale; PTS, Pediatric Trauma Score;
RTS, Revised Trauma Score.
(Reprinted) JAMA Surgery April 2018 Volume 153, Number 4
© 2017 American Medical Association. All rights reserved.
Downloaded from jamanetwork.com by Thomas Jefferson University East Falls Campus user on 01/29/2019
323
Research Original Investigation
Accuracy of Prehospital Triage in Selecting Severely Injured Trauma Patients
Figure 2. Flowchart of Patient Enrollment
6581 Trauma patients transported
with the highest emergency
between 2012 and 2014
1631 Excluded
873 Transferred to a hospital
outside the region
695 Aged 65 y)
Prehospital GCS score
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