2.3 Protocol for Field Triage

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Description of Indicator

Relationship to Quality  Medical care should be timely and efficient 
Type of Indicator   Prehospital structure, System level
Proposed Data Source   Survey
Definition Trauma systems with a protocol to guide patient field triage 
Numerator Trauma systems with a protocol directing transport of injured patients age 18 years and older to specific hospitals 
Denominator Not applicable 
Risk Adjustment Not applicable 


This indicator is intended to identify trauma systems with protocols for patient field triage.

Panel Review
Panelists noted that appropriate field triage criteria are essential for effective population-based injury care and advocated that this indicator may help evaluate decisions surrounding patient transport. For smaller trauma centers and non-urban centers this indicator may support facilitating direct transport of patients to the appropriate trauma center. Finally, panelists discussed the possible limited value of this indicator for geographic areas with few trauma centers or where all centers have similar resources.

Trauma Center Review
The trauma centers emphasized the importance of this indicator as a means to encourage triage protocol adoption. Difficulties with this indicator that were noted include the challenges that trauma centers face in accessing information relating to triage protocols outside of their own system and the ability of insurance companies to dictate transport decisions and overrule triage protocols in place. Additionally, it was noted that developing and implementing triage protocols for a large geographical area (i.e. State or Province) is challenging.

Review of Literature & Evidence
Face Validity: In one study, 88% of Delphi panel members ranked the need for criteria to match needs of injured patients with hospital resources as very important13.
Construct Validity: No studies identified.
Reliability: No studies identified.
Risk Adjustment: Not applicable.
Utilization: Measures of triage criteria are used as an indicator by a small number of trauma centers: USA 0.5% (1/200), Canada 0% (0/35), Australasia 0% (0/12).
Many field triage protocols exist, but none have been shown to be superior to others16. Protocols for field triage may include physiological and anatomical parameters and mechanism of injury2,12,14. Additional consideration should be given to special populations in triage protocols, such as elderly patients2,15.

Rosengart et al. developed the indicator using a Delphi panel of trauma experts13.


2. American College of Surgeons Committee on Trauma. Resources for Optimal Care of the Injured Patient 2006. Chicago: American College of Surgeons; 2006.
12. Newgard CD, Schmicker RH, Hedges JR, et al. Emergency medical services intervals and survival in trauma: assessment of the "golden hour" in a North American prospective cohort. Ann Emerg Med. 2010;55(3):235-246.
13. Rosengart MR, Nathens AB, Schiff MA. The identification of criteria to evaluate prehospital trauma care using the Delphi technique. J Trauma. 2007;62(3):708-713.
14. Nayduch D, Moylan J, Snyder BL, Andrews L, Rutledge R, Cunningham P. American College of Surgeons trauma quality indicators: an analysis of outcome in a statewide trauma registry. J Trauma. 1994;37(4):565-573; discussion 573-565.
15. Copes WS, Staz CF, Konvolinka CW, Sacco WJ. American College of Surgeons audit filters: associations with patient outcome and resource utilization. J Trauma. 1995;38(3):432-438.
16. Di Bartolomeo S, Valent F, Sanson G, Nardi G, Gambale G, Barbone F. Are the ACSCOT filters associated with outcome? Examining morbidity and mortality in a European setting. Injury. 2008;39(9):1001-1006.