国家创伤分诊协议：急救医疗服务视角如何为指南修订提供信息。
The national trauma triage protocol: how EMS perspective can inform the guideline revision.
作者信息
Fischer Peter E, Gestring Mark L, Sagraves Scott G, Michaels Holly N, Patel Bhavin, Dodd Jimm, Campion Eric M, VanderKolk Wayne E, Bulger Eileen M
机构信息
Department of Surgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Department of Surgery, University of Rochester, Rochester, New York, USA.
出版信息
Trauma Surg Acute Care Open. 2022 Jan 18;7(1):e000879. doi: 10.1136/tsaco-2021-000879. eCollection 2022.
OBJECTIVES
The Field Triage Guidelines (FTG) support emergency medical service (EMS) decisions regarding the most appropriate transport destination for injured patients. While the components of the algorithm are largely evidenced-based, the stepwise approach was developed with limited input from EMS providers. FTG are only useful if they can easily be applied by the field practitioner. We sought to gather end-user input on the current guidelines from a broad group of EMS stakeholders to inform the next revision of the FTG.
METHODS
An expert panel composed an end-user feedback tool. Data collected included: demographics, EMS agency type, geographic area of respondents, use of the current FTG, perceived utility, and importance of each step in the algorithm (1: physiologic, 2: anatomic, 3 mechanistic, 4: special populations). The American College of Surgeons Committee on Trauma (ACS COT), in partnership with several key organizations, distributed the tool to reach as many providers as possible.
RESULTS
3958 responses were received (82% paramedics/emergency medical technicians, 9% physicians, 9% other). 94% responded directly to scene emergency calls and 4% were aeromedical providers. Steps 2 and 3 were used in 95% of local protocols, steps 1 and 4 in 90%. Step 3 was used equally in protocols across all demographics; however, step 1 was used significantly more in the air medical services than ground EMS (96% vs 88%, p<0.05). Geographic variation was demonstrated in FTG use based on the distance to a trauma center, but step 3 (not step 1) drove the majority of the decisions. This point was reinforced in the qualitative data with the comment, "I see the wreck before I see the patient."
CONCLUSION
The FTG are widely used by EMS in the USA. The stepwise approach is useful; however, mechanism (not physiological criteria) drives most of the decisions and is evaluated first. Revision of the FTG should consider the experience of the end-users.
LEVEL OF EVIDENCE
V.
目的
《现场分诊指南》（FTG）为紧急医疗服务（EMS）就受伤患者最合适的转运目的地做出决策提供支持。虽然该算法的组成部分大多基于证据，但逐步方法是在EMS提供者有限的参与下制定的。只有当现场从业者能够轻松应用时，FTG才有用。我们试图从广泛的EMS利益相关者群体中收集关于当前指南的最终用户意见，以为FTG的下一次修订提供参考。
方法
一个专家小组编写了一个最终用户反馈工具。收集的数据包括：人口统计学信息、EMS机构类型、受访者的地理区域、当前FTG的使用情况、感知效用以及算法中每个步骤的重要性（1：生理的，2：解剖的，3：机制的，4：特殊人群）。美国外科医师学会创伤委员会（ACS COT）与几个关键组织合作，分发该工具以尽可能多地覆盖提供者。
结果
共收到3958份回复（82%为护理人员/紧急医疗技术员，9%为医生，9%为其他人员）。94%的回复直接针对现场紧急呼叫，4%为航空医疗服务提供者。95%的地方协议使用步骤2和3，90%使用步骤1和4。步骤3在所有人口统计学的协议中使用频率相同；然而，步骤1在航空医疗服务中的使用显著多于地面EMS（96%对88%，p<0.05）。基于到创伤中心的距离，FTG的使用存在地理差异，但步骤3（而非步骤1）驱动了大多数决策。定性数据中的评论“在看到患者之前我先看到了事故”强化了这一点。
结论
FTG在美国被EMS广泛使用。逐步方法是有用的；然而，机制（而非生理标准）驱动了大多数决策且首先被评估。FTG的修订应考虑最终用户的经验。
证据级别
V级。
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