Thompson Lee, Hill Michael, McMeekin Peter, Shaw Gary
North East Ambulance Service NHS Foundation Trust; Northumbria University; Northern Trauma Network: ORCID iD: https://orcid.org/0000-0002-0820-1662.
Northumbria University.
Br Paramed J. 2019 Dec 1;4(3):16-23. doi: 10.29045/14784726.2019.12.4.3.16.
Pre-hospital trauma is complex and challenging, with limited clinical exposure for clinicians. In addition, there is no standardised definition for major trauma, and retrospective scores commonly quantify injury severity, such as the injury severity score. This qualitative study aimed to explore the pre-hospital perspectives of major trauma and how pre-hospital trauma care providers define major trauma.
Three focus groups of 40-60 minutes' duration were conducted with paramedics, ambulance technicians, police, firefighters and emergency dispatchers. Digital recordings were transcribed verbatim, coded and reviewed to identify emerging themes. Constant comparison was undertaken throughout and codes were identified for qualitative thematic analysis.
Three overarching themes emerged: clinician factors, patient factors and situational factors. Clinician factors highlighted issues of experience and exposure (or lack of) to major trauma and its relationship to clinical concern, communication issues and the complex nature of pre-hospital trauma. Patient factors identified deranged physiology, actual injuries, life changing trauma, potential need for surgical intervention and rehabilitation as defining major trauma. These variables are often complicated by the extremities of age as well as previous medical history and medications. The situational factors identified that every traumatic encounter is unique, requiring bespoke management where high and low energy mechanisms of injury should be considered.
Based on the analysis of the focus groups, a working pre-hospital definition is: Any injury (or injuries) that have the potential to be life-threatening or life-changing, including those sustained from low energy mechanisms in people rendered vulnerable by extremes of age, comorbidities or frailty, resulting in significant physiological compromise (haemodynamic instability, reduced consciousness, respiratory compromise) and/or significant anatomical abnormality that may require immediate intervention.
院前创伤情况复杂且具有挑战性，临床医生接触此类病例的机会有限。此外，对于重大创伤尚无标准化定义，回顾性评分通常用于量化损伤严重程度，如损伤严重度评分。本定性研究旨在探讨重大创伤的院前观点以及院前创伤护理人员如何定义重大创伤。
与护理人员、救护车技术员、警察、消防员和紧急调度员进行了3个时长为40 - 60分钟的焦点小组讨论。对数字录音进行逐字转录、编码和审查，以确定新出现的主题。在整个过程中进行持续比较，并确定用于定性主题分析的代码。
出现了三个总体主题：临床医生因素、患者因素和情境因素。临床医生因素突出了重大创伤的经验和接触（或缺乏）问题及其与临床关注的关系、沟通问题以及院前创伤的复杂性。患者因素将生理紊乱、实际损伤、改变生活的创伤、潜在的手术干预需求和康复确定为重大创伤的定义因素。这些变量常常因年龄极端情况以及既往病史和药物治疗而变得复杂。情境因素表明，每次创伤事件都是独特的，需要进行定制化管理，其中应考虑高能量和低能量损伤机制。
基于焦点小组的分析，一个可行的院前定义是：任何有可能危及生命或改变生活的损伤，包括那些因年龄极端情况、合并症或身体虚弱而易受伤害的人因低能量机制造成的损伤，导致显著的生理功能损害（血流动力学不稳定、意识减退、呼吸功能损害）和/或可能需要立即干预的显著解剖学异常。
