The objective of pre-hospital trauma care is ensuring that the most severely injured persons are transported to the facility best suited to meet their complex needs (Fitzharris, Stevenson, Middleton, & Sinclair, 2011; Hoff, Tinkoff, Lucke, & Lehr, 1992; Leach et al., 2008; Sasser et al., 2012). To support pre-hospital decision making regarding trauma triage destination determinations, the Guidelines for Field Triage of Injured Patients decision scheme (FTDS) was developed as an algorithmic decision tool (Sasser et al., 2012).
The purpose of this study was to examine pre-hospital trauma triage transport decision making by EMS providers from multiple perspectives. This study used a concurrent mixed methods triangulation design (QUAL+QUANT). Mixed methods included: (1) Grounded theory methodology to describe a model of decision making used by EMS providers to make trauma triage determinations and (2) quantitative analysis of secondary data to determine how the FTDS criteria are utilized by EMS providers. The FTDS criteria were also examined relative to trauma outcomes: level of trauma team activation (TTA), patient disposition when leaving the emergency department (ED), and the injury severity score (ISS).
A model of Interpreting Trauma into Action was elucidated to describe the processes used by EMS providers. Pre-hospital providers based their trauma transport decisions on the perceived patient level of injury severity. The FTDS criteria were not explicitly used in this study region, but were interwoven into practice through employer policies and other training. The convergence of these findings indicated congruence between the model and trauma outcomes. The quantitative data indicated relationships (p<.05) between 12 of the 29 FTDS criteria and trauma outcomes. Both sources of evidence supported the relationships between the model of Interpreting Trauma into Action, the FTDS criteria, and specific trauma outcomes.
|Advisor:||NeSmith, Elizabeth G.|
|Commitee:||Anderson, Lori, Gibson, Robert W., Medeiros, Regina S., Waller, Jennifer L.|
|School Location:||United States -- Georgia|
|Source:||DAI-B 79/03(E), Dissertation Abstracts International|
|Keywords:||EMS provider, Field triage decision scheme, Pre-hospital, Trauma center, Trauma triage, Triage criteria|
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