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Am J Emerg Med. 2019 Apr;37(4):620-626. doi: 10.1016/j.ajem.2018.06.058. Epub 2018 Jun 27.

Accuracy of pre-hospital trauma notification calls.

Author information

1
Department of Surgery, Jamaica Hospital Medical Center, New York, USA. Electronic address: mjames3@jhmc.org.
2
Department of Nursing, Jamaica Hospital Medical Center, New York, USA; Department of Emergency Medicine, Jamaica Hospital Medical Center, New York, USA. Electronic address: lclarke@jhmc.org.
3
Department of Nursing, Jamaica Hospital Medical Center, New York, USA; Department of Emergency Medicine, Jamaica Hospital Medical Center, New York, USA. Electronic address: rsimpson@jhmc.org.
4
Unity Health-White County Medical Center, Searcy, AR, USA. Electronic address: anthony.noto@unity-health.org.
5
Department of Emergency Medicine, Jamaica Hospital Medical Center, New York, USA. Electronic address: jsclair@jhmc.org.
6
Department of Surgery, Jamaica Hospital Medical Center, New York, USA; Department of Emergency Medicine, Jamaica Hospital Medical Center, New York, USA. Electronic address: gdoughli@jhmc.org.
7
Department of Emergency Medicine, Jamaica Hospital Medical Center, New York, USA. Electronic address: slee@jhmc.org.

Abstract

STUDY OBJECTIVE:

The aim of this study is to determine the accuracy of pre-hospital trauma notifications and the effects of inaccurate information on trauma triage.

METHODS:

This study was conducted at a level-1 trauma center over a two-year period. Data was collected from pre-notification forms on trauma activations that arrived to the emergency department via ambulance. Trauma activations with pre-notification were compared to those without notification and pre-notification forms were assessed for accuracy and completeness.

RESULTS:

A total of 2186 trauma activations were included in the study, 1572 (71.9%) had pre-notifications, 614 (28.1%) did not and were initially under-triaged. Pre-notification forms were completed for 1505 (95.7%) patients, of which EMS provided incomplete/inaccurate information for 1204 (80%) patients and complete/accurate information for 301 (20%) patients. Missing GCS/AVPU score (1099, 91.3%), wrong age (357, 29.6%), and missing vitals (303, 25.2%) were the main problems. Missing/wrong information resulted in trauma tier over-activation in 25 (2.1%) patients and under-activation in 20 (1.7%) patients. Under-triaged patients were predominantly male (18, 90%), sustained a fall (9, 45%), transported by BLS EMS teams (12, 60%), and arrived on a weekday (13, 65%) during the time period of 11 pm-7 am (9, 45%). A total of 13 (65%) required emergent intubation, 2 (10%) required massive transfusion activation, 7 (35%) were admitted to ICU, 3 (15%) were admitted directly to the OR, and 1 (15%) died.

CONCLUSION:

EMS crews frequently provide inaccurate pre-hospital information or do not provide any pre-hospital notification at all, which results in over/under triage of trauma patients.

KEYWORDS:

EMS; Emergency medical services; Pre-hospital communication; Pre-hospital notification; Trauma activation; Trauma notification; Trauma triage

PMID:
30041910
DOI:
10.1016/j.ajem.2018.06.058
[Indexed for MEDLINE]

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