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首页> 外文期刊>Prehospital emergency care >Evaluation of the Implementation of the Trauma Triage and Destination Plan on the Field Triage of Injured Patients in North Carolina
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Evaluation of the Implementation of the Trauma Triage and Destination Plan on the Field Triage of Injured Patients in North Carolina

机译：评估北卡罗来纳州伤害患者外地特征的创伤分类和目的地计划的实施

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Objective: Timely triage and appropriate destination decision making for injured patients are central challenges faced by emergency medical services (EMS) systems. In 2010, North Carolina (NC) adopted a statewide Trauma Triage and Destination Plan (TTDP) based on the CDC's Field Triage Guidelines to better address these challenges. We sought to characterize the implementation of these guidelines by quantifying their effect on multiple metrics of patient care. Methods: We employed a retrospective pre-post study design utilizing a statewide EMS medical record database. We assessed several metrics of patient careincluding changes in destination choice, appropriateness of EMS destination, transit time to first hospital, transit time to definitive care, and othersin a six-month period in the year before and after the implementation of the guidelines. Results: We evaluated a total of 190,307 EMS encounters pre- (n = 93,927) and post-implementation (n = 96,380). Among all patients, there was not a significant difference in the percentage transported to a community hospital or Level I, II, or III trauma center as their first destination. Among those patients meeting TTDP guidelines for transport to a trauma center, the number transported to a Level I or II trauma center decreased 1.0% from 30.6% (n = 2,911) to 29.6% (n = 2,954) (95% CI: -0.2%, 2.2%). Those transported to a Level I trauma center decreased 0.4% from 21.2% to 20.8% in the post-period (95% CI: -0.7%, 1.5%). There were also no significant changes in EMS scene times (14.0 pre-, 14.1 post-) and transport times (12.9 pre-, 13.0 post-). While scene distance from a Level I trauma center showed a decreased likelihood of transport to that center, there was an overall post-implementation increase of 2.5% from 18.0% to 20.5% (95% CI: -3.6%, -1.3%) in transport to a Level I trauma center among patients meeting anatomic criteria across all distance ranges. Conclusions: We found that implementation of region-specific destination plans based on the Field Triage Guidelines had little effect on selected hospital destination, scene times, transport times, and other metrics of EMS decision making and effectiveness. We suspect this is due to delays in information dissemination and adoption by field providers.
机译：目的：及时的伤害患者的分类和适当的目的地决策是紧急医疗服务（EMS）系统面临的中央挑战。 2010年，北卡罗来纳州（NC）根据CDC的现场分类指南采用了全州的创伤分类和目的地计划（TTDP），以更好地解决这些挑战。我们试图通过量化对患者护理的多元指标的影响来表征这些指导方针的实施。方法：我们采用了一种利用州所有EMS医疗记录数据库的回顾性预研究设计。我们评估了目的地选择，EMS目的地的适当性，在执行指南前和之后的六个月期间，在目的地选择，EMS目的地的适当程度的患者的患者的患者的若干度量，埃姆斯目的地的适当的变化，交通时间为六个月期间。结果：我们共评估了190,307个EMS（n = 93,927）和实施后（n = 96,380）。在所有患者中，与社区医院或I II，II，II，III级或III级创伤中心的百分比没有显着差异作为其第一个目的地。在那些患者符合TTDP转运指南的患者中，运送到II或II级创伤中心的数量从30.6％（n = 2,911）降低1.0％（n = 2,911）至29.6％（n = 2,954）（95％CI：-0.2 ％，2.2％）。运输到I级创伤中心的人在期间下降0.4％至20.8％（95％CI：-0.7％，1.5％）。 EMS场景时间（14.0个，14.1次发行时间）和运输时间（12.9前，13.0次后）也没有重大变化。虽然来自I级的现场距离Trauma中心的距离显示出对该中心的运输可能性降低，但总体实施后增加了2.5％，从18.0％增加到20.5％（95％CI：-3.6％，-1.3％）在满足所有距离范围内遇到解剖标准的患者中的I级创伤中心。结论：我们发现基于现场分类指南的区域特定目的地计划的实施对所选医院目的地，现场，运输时间和EMS决策和有效性的其他指标影响不大。我们怀疑这是由于现场提供者信息传播和采用延迟。

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