Russam George Stephen, Gluyas-Harris Jake, Aveyard Nicholas, Nutbeam Tim
Anaesthetic Department, Darlington Memorial Hospital, Darlington, UK.
Emergency Department, Derriford Hospital, Plymouth, UK.
Scand J Trauma Resusc Emerg Med. 2025 Aug 21;33(1):142. doi: 10.1186/s13049-025-01455-7.
Bystanders have the potential to be a critical component of the Road Injury Chain of Survival, particularly in the early phases of injury recognition, scene assessment, and emergency service activation. Their potential role in trauma triage remains underexplored. This scoping review aims to examine the existing evidence of the use of bystanders in triage-both laypersons and non-clinical professionals-during the prehospital phase of road injury and other trauma scenarios.
A systematic search was undertaken across MEDLINE, CINAHL, and the Psychology & Behavioural Sciences Collection using the EBSCO Host platform, with supplementary hand searches via Google Scholar and reference screening. Articles were included if they addressed triage by lay or professional bystanders (e.g. police, fire and rescue) in prehospital trauma settings. Data were extracted and synthesised using a descriptive analytical approach.
Twenty-three studies were included. Bystanders demonstrated the ability to apply basic triage tools with moderate accuracy, although over-triage was common and under-triage rates often exceeded accepted thresholds. Several trauma training programmes in low-resource settings included triage components, leading to improvements in knowledge and confidence. Long-term retention and real-world clinical utility remain uncertain. Only one study directly evaluated bystander assessment of crash parameters; lay performance approached that of health professionals in some domains. Technological innovations such as video live-streaming from bystanders to emergency call handlers showed potential to enhance triage and situational awareness, though operational and ethical barriers remain.
Bystanders may have an expanded role in the triage and early assessment of trauma casualties, particularly in settings where formal EMS is limited or delayed. Within the Road Injury Chain of Survival, empowering bystanders through structured training and technology-enabled support could strengthen early links in the chain. Future research should focus on validating simplified triage approaches, evaluating training impact, and assessing outcomes related to both patient care and system efficiency.
旁观者有可能成为道路伤害生存链的关键组成部分，尤其是在伤害识别、现场评估和紧急服务启动的早期阶段。他们在创伤分诊中的潜在作用仍未得到充分探索。本范围综述旨在研究在道路伤害和其他创伤场景的院前阶段，旁观者（包括非专业人员和非临床专业人员）参与分诊的现有证据。
使用EBSCO Host平台在MEDLINE、CINAHL和心理学与行为科学数据库中进行系统检索，并通过谷歌学术进行补充手工检索和参考文献筛选。纳入的文章需涉及非专业或专业旁观者（如警察、消防和救援人员）在院前创伤环境中的分诊情况。采用描述性分析方法提取和综合数据。
纳入了23项研究。旁观者能够以中等准确度应用基本分诊工具，不过过度分诊很常见，且漏诊率往往超过可接受阈值。低资源环境下的一些创伤培训项目包含分诊内容，从而提高了知识水平和信心。长期留存率和实际临床效用仍不确定。只有一项研究直接评估了旁观者对碰撞参数的评估；在某些领域，非专业人员的表现接近卫生专业人员。旁观者向紧急呼叫处理人员进行视频直播等技术创新显示出增强分诊和态势感知的潜力，尽管仍存在操作和伦理障碍。
旁观者在创伤伤员的分诊和早期评估中可能发挥更大作用，尤其是在正规紧急医疗服务有限或延迟的情况下。在道路伤害生存链中，通过结构化培训和技术支持增强旁观者的能力可以加强该链条的早期环节。未来的研究应侧重于验证简化的分诊方法、评估培训效果以及评估与患者护理和系统效率相关的结果。
