Injuries are the leading cause of death for children and adults in the U.S. between the ages of 1 and 44. So when an injury does occur, getting the right patient to the right place at the right time really matters. The National Study on the Costs and Outcomes of Trauma reported a 25% reduction in death for severely injured patients who received care at a Level I trauma center rather than at a non-trauma center.(1) When do we have an opportunity in EMS—or in all of medicine for that matter—to reduce the number of deaths by 25%?
In 2006, the Institute of Medicine published The Future of Emergency Care in the United States. One of the volumes of this report, “Emergency Medical Services at the Crossroads,” describes the fragmentation of EMS. The report recommends working toward regionalization and the development of prehospital care protocols for the treatment, triage and transport of patients using the best evidence available.(2)
Therefore, the Centers for Disease Control and Prevention (CDC), in collaboration with the American College of Surgeons Committee on Trauma and with the support of the National Highway Traffic Safety Administration (NHTSA), convened the National Expert Panel on Field Triage to reduce fragmentation by examining the latest evidence and making recommendations regarding the field triage of injured patients. The results of this panel’s effort were published as the “Guidelines for Field Triage of Injured Patients: Recommendations from the National Expert Panel on Field Triage,” in CDC’s Morbidity and Mortality Weekly Report: Recommendations and Reports.
A Good Idea?
This was a first for EMS. The only other federally supported EMS clinical protocol we’re aware of is the recent H1N1 protocols for EMS.(3) Although this achievement was significant, it isn’t enough to just develop recommendations; the recommendations must also demonstrate achievement of improved health outcomes for patients. Guidelines must be developed, disseminated, implemented and evaluated. The important challenge is to translate evidence into practice for real-life situations that occur daily.
Some may prefer that federal agencies not be involved in the development of EMS clinical protocols. Issues of local preferences and practice patterns, state regulations versus guidelines, differing opinions among medical professionals and the role of the federal government in EMS come into play.
Knowing this, some may question why we should try to get all EMS providers to make the right transport decisions every time. Others may emphasize that the guidelines are far from perfect. So why use or adopt them?
These guidelines are designed to serve as a tool that EMS providers, along with the rest of the trauma system, can use to identify patients who are severely injured. Adopting the guidelines is in the best interest of our patients and will likely save lives.
Adopting national guidelines developed through federal leadership may be a new frontier, but implementing them could significantly decrease EMS system fragmentation. They’ll also provide a platform for us to gather uniform data on the triage of injured patients, which will lead to improving the evidence base, facilitating regionalization and allowing for use of the best evidence (albeit limited) available.
We all have a responsibility to get an injured patient to the right place at the right time. In addition to trauma, many other EMS protocols need to be developed, disseminated, implemented and evaluated. It’s important to not just watch but to also be a part of these pioneering efforts of trying to put a national EMS clinical guideline into practice.
We, the acute care community, needs to figure this out. The process we undertake with the guidelines is a crystal ball into the future of our nation’s EMS system. And with a potential 25% decrease in deaths, it’s in your patients’ best interest. JEMS
1. MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354:366–378.
2. Institute of Medicine. Committee on the Future of Emergency Care in the United States in the United States Health System. Board on Health Care Services. Emergency Medical Services at the Crossroads. The National Academies Press: Washington, D.C., 2006.
3. Centers for Disease Control and Prevention. Interim Guidance for EMS Systems and 9-1-1 PSAPS for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. www.cdc.gov/h1n1flu/guidance_ems.htm
This article originally appeared in February 2011 JEMS as “Triage to Transport: A case for national field triage guidelines.”