Präklinische Sichtung und Schockraumalarmierung

Emergency medical services (EMS) treating critically injured patients can be staffed by emergency physicians (P-EMS) or by paramedics (EMT). The aim of this study was to determine whether P‑EMS or EMT triage affect trauma team alerting (TTA).

Data from a 3-month observation period from 12 emergency departments were analyzed. Included were 3753 trauma patients referred by the EMS. TTA criteria, preclinical parameters, and data on treatment in the emergency department or trauma room were documented. A distinction was made between high-risk criteria for severe injuries (HRSI) and moderate-risk criteria for severe injuries (MRSI) defined in the national trauma guideline (2016 version) as recommendation grades GoR A and GoR B. The need for treatment in the emergency department or trauma room was assessed retrospectively. All data were assigned to the P‑EMS or EMT group.

TTA was more frequent in P‑EMS than in EMT (64% vs. 6%). Activation of the shock room occurred in 46% in the P‑EMS group due to HRSI criteria (14% in EMT) and in 25% due to MRSI criteria (44% in EMT), while 31% of TTA were initiated without a specific criterion. The positive predictive value (ppV) for a TAA by the EMS was 50.3%, with 49.7% of cases being overtriaged and 35.9% of cases under-triaged. In the P‑EMS group, overtriage was 44.5% and undertriage was 15.6%. In the EMT group, we found significantly more undertriage (84.5%) despite a significantly higher overtriage rate of 76.6%.

There is potential for optimization in prehospital triage of trauma patients by both P‑EMS and EMT personnel. The current triage practice leads to a pronounced misuse of expensive hospital resources. In the future, in addition to the pure medical training of emergency physicians and paramedics, greater attention should be paid to the knowledge and correct application of established triage criteria. Appropriate prehospital triage depends on the quality of the triage criteria and the associated risks for the presence of severe injuries. HRSI-based TTA shows a better positive predictive value.