Is a maximum Revised Trauma Score a safe triage tool for Helicopter Emergency Medical Services cancellations? - Introduction

A Special Author Introduction
European Journal of Emergency Medicine
ISSN: 0969-9546 • Frequency: 6/year • Subscribe Now • Journal Website

By Giannakopoulos et al

The Revised Trauma Score is used worldwide in the prehospital setting and provides a snapshot of patient’s physiological state. Several studies have shown that the reliability of the RTS is high in trauma outcomes. In the Netherlands, Helicopter Emergency Medical Services (HEMS) are mostly used for delivery of specialized trauma teams on-scene and occasionally for patient transportation. In our trauma system, the Emergency Medical Services (EMS) crew performs triage after arrival on-scene and cancels the HEMS-dispatch if deemed unnecessary. In this study we assessed the ability of a maximum on-scene Revised Trauma Score (RTS = 12) to be used as a triage tool for HEMS cancellation. All patients with a maximum on-scene RTS after blunt trauma (with or without receiving HEMS care) who were presented in the Trauma Resuscitation room (TR) of two Level-1 trauma centers during a period of six months, were included. Information concerning prehospital and inhospital vital parameters, severity and localization of the injuries, and the inhospital course were analyzed. Major trauma patients were classified using the following parameters: ISS≥16, emergency intervention, ICU admission and inhospital death.Four-hundred and forty (440) blunt trauma patients having a maximum RTS were included between 1 July and 31 December 2006. Eighty patients received on-scene HEMS care. Almost 16% of the total study population concerned major trauma patients (n=67), of which only 25 (36%) received HEMS care. In 17 patients (3.9%) the RTS deteriorated during transportation. Major trauma patients sustained more injuries to the chest, abdomen, and lower extremities.
Conclusion

The RTS alone is not a reliable triage tool for HEMS cancellations in our trauma system and will lead to a considerable rate of undertriage with 1 in every 6 cancellations being incorrect. Other criteria based on patient’s vital signs, combined with anatomical and mechanism of injury parameters should be developed to safely minimize triage errors.

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