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Journal of Trauma and Injury 2013;26(3):89-98.
Evaluation of the Triage by Emergency Medical Technicians by Using Trauma Score for Occupant Injuries Caused by Motor Vehicle Collisions
Sang Chul Kim, Byung Woo Kim, Yang Ju Tak, Sang Hee Lee
1Department of Emergency Medicine, School of Medicine, Konkuk University Chungju Hospital, Chungju, Chungbuk, Korea.
2Department of Paramedic science, Korea National University of Transportation, Jeungpyeong, Chungbuk, Korea. yjtak@ut.ac.kr
자동차 탑승자 사고에서 외상계수를 이용한 구급대원의 중증도 분류 평가
김상철, 김병우1, 탁양주1, 이상희1
건국대학교 의학전문대학원 응급의학교실, 1한국교통대학교 응급구조학과
Received: 11 June 2013   • Revised: 22 August 2013   • Accepted: 26 August 2013
The assessment of trauma patients in the prehospital setting is difficult, but appropriate field triage is critical to the prognosis of trauma patients. We sought to evaluate the triage given by the emergency medical technicians (EMTs) using the trauma score to patients injured in motor vehicle collisions (MVCs).
From June 2012 to July 2012, questionnaires were distributed to EMTs, who had transported injured patients to the study hospital. Scene records, photos of the damaged vehicle, and ambulance run sheets were used to provide physiologic, physical, and mechanistic information about the MVC. To evaluate the appropriateness of the injury assessment by EMTs, we compared their impressions with the hospital's final diagnosis within a 3 level triage system comprising both the maximum abbreviated injury scale (MAIS) and the injury severity score (ISS). Kappa (k) was calculated to evaluate the agreement between the triage by EMTs and the triage based on hospital's final diagnosis.
A total of 91 patients were analyzed by 31 EMTs. The percentage of males was 57.1%, the mean age was 44.5, and the mean MAIS and ISS were 2.7 and 16.6 respectively. While EMTs correctly diagnosed patient injuries to the extremities in 35.7%, and to the neck in 32.1%, pelvic injuries were missed in 80.0%. The agreement between the triage by the EMTs and the triage based on the hospital's final diagnosis was 62.6%(k=0.366) by the MAIS and 50.5%(k=0.234) by the ISS. The kappa value was higher in EMT-I than in EMT-II.
In MVC, the assessment of injured patients by EMT-I was more appropriate, and the 3-level triage method based on the MAIS could contribute to a more accurate triage. Prospective studies to search for appropriate methods of field triage are required for programming practical education for EMTs.
Key Words: Triage; Emergency medical technicians; Emergency medical services; Injury severity score; Abbreviated injury scale
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