EMS andEmergency Department Physician Triage:

Abstract

Background. Many trauma patients who are not severely injured arrive at trauma centers via helicopter emergency medical services (HEMS). Objective. To compare the injury severity of patients sent to trauma centers by HEMS from community emergency departments (EDs) with the injury severity of those triaged by prehospital providers to HEMS directly from accident scenes. Methods. All records were reviewed from trauma-related missions during 1997for a single HEMS system, extracting information on location, time of day, patient age andgender, mechanism of injury, initial vital signs, Revised Trauma Score (RTS), andthe extent of care required during transport. These records were then matched with outcome information routinely supplied to the HEMS system by affiliated trauma centers. Information from patients flown directly from scenes was then compared with that for patients flown from community EDs. Results. Information was obtained for 658 patients flown from scenes and345 flown from community EDs. There were similar proportions of patients in the two groups, with Injury Severity Scale (ISS) scores less than 6 (11.0% vs. 13.5%), between 6 and14 (47.0% vs. 49.3%), andgreater than 15 (42.0% vs. 37.1%); these were not statistically different (p > 0.05). There was also no significant difference between the groups in the RTS, mean ISS score, intensive care unit length of stay, hospital length of stay, or disposition. Conclusions. Scene andinterhospital HEMS trauma missions in this system involve patients of similar injury severities. Prehospital providers may triage trauma patients to HEMS transport with proficiency similar to that of community ED physicians. Key words: triage; injury severity score; emergency medical services; air ambulances; transportation of patients; helicopters.