Special contributionField triage systems: Methodologies from the literature☆
Section snippets
The core literature
The first study to attempt to develop and validate formal protocols by which field personnel could assign transport options was published by Schmidt and colleagues in 2000.4 Because two subsequent studies have attempted to refine the methods used, this study is described in significant detail here. The study objective was to determine whether it is feasible and safe to develop a set of protocol-based triage criteria for emergency medical technicians (EMTs; at any level of training from EMT-B to
Other studies
A number of studies have examined issues that are somewhat peripheral to the concept of field triage to alternative resources, but have proposed or used triage criteria or outcome measures that could be of value to those considering this type of research.
In 2001, Cone and Wydro published a study examining whether EMT-Bs can safely determine whether ALS is needed.16 Cancellation of inbound ALS units by on-scene EMT-Bs was judged to be inappropriate if any of the following triage criteria were
Discussion and conclusions
No “standard” set of triage criteria have been generated or validated in determining medical necessity in EMS. There are certain themes that emerge from the literature, and these themes can likely form the basis of a consensus on elements of set of medical necessity criteria that need to be validated and refined. For example, many of the studies cited here use vital sign values, chief complaints, and physical examination findings, either to exclude a patient from consideration of anything other
References (25)
- et al.
Hospital follow-up of patients categorized as not needing an ambulance using a set of emergency medical technician protocols
Prehosp Emerg Care
(2001) - et al.
Can paramedics using guidelines accurately triage patients?
Ann Emerg Med
(2001) Undertriage, overtriage, or no triage? In search of the unnecessary emergency department visit
Ann Emerg Med
(2001)- et al.
An emergency medical services program of alternate destination of patient care
Prehosp Emerg Care
(2002) - et al.
Can paramedics accurately identify patients who do not require emergency department care?
Prehosp Emerg Care
(2002) Can paramedics safely decide which patients do not need ambulance transport or emergency department care?
Prehosp Emerg Care
(2002)- et al.
Can basic life support personnel safely determine that advanced life support is not needed?
Prehosp Emerg Care
(2001) - et al.
The emergent problem of ambulance misuse
Ann Emerg Med
(1993) Alternate ambulance transportation destination. National Association of EMS Physicians/American College of Emergency Physicians Joint Position Paper
Prehosp Emerg Care
(2001)National Association of EMS Physicians/American College of Emergency Physicians Joint Position Paper
Prehosp Emerg Care
(2001)
Appropriate emergency medical services transport
Acad Emerg Med
Evaluation of protocols allowing emergency medical technicians to determine need for treatment and transport
Acad Emerg Med
Cited by (19)
Clinician and Caregiver Determinations of Acuity for Children Transported by Emergency Medical Services: A Prospective Observational Study
2023, Annals of Emergency MedicineCitation Excerpt :The primary objective of this study was to determine the ability of each of the 4 stakeholder groups to identify low acuity pediatric patients. Our gold standard for patient acuity, to compare with stakeholder assessment, was a novel composite measure based on the results of the Neely Conference.30–33 The composite measure consisted of a patient: not having unstable vital signs, not requiring any urgent or emergency resources by the EMS or in the ED, and not having a final ED disposition of admission to the hospital or death.
EMS-Initiated Refusal of Transport: The Current State of Affairs
2009, Journal of Emergency MedicineCitation Excerpt :In 2003, “The Neely Conference: Developing Research Criteria to Define Medical Necessity in EMS” convened EMS physicians, researchers, administrators, providers, and federal agency representatives to begin development of uniform triage criteria and outcome measures that could be used in studies examining, among others, pre-hospital triage and need for emergent transport (9). This conference provided at least some consensus on critical questions that need to be answered in order for EMS researchers to further progress in this critical area (10). We look forward to using these recommendations as well as the EMS-initiated refusal of transport protocols from already-established programs to further our goal of developing and prospectively validating an effective pre-hospital triage tool.
Challenges and Opportunities to Engaging Emergency Medical Service Providers in Substance Use Research: A Qualitative Study
2017, Prehospital and Disaster MedicineA modified simple triage and rapid treatment algorithm from the New York City (USA) fire department
2015, Prehospital and Disaster MedicineReasons why patients choose an ambulance and willingness to consider alternatives
2006, Academic Emergency MedicineCitation Excerpt :Overcrowded EDs and busy EMS systems have motivated previous studies that have attempted to evaluate the safety and cost-efficiency of alternatives to ambulance transport. Those studies have used different criteria for determining the safety of field triage.15 To the best of the authors' knowledge, they have not considered whether or not patients would be willing to consider alternatives.
Mobile integrated health and community paramedicine
2021, Emergency Medical Services: Clinical Practice and Systems Oversight: Third Edition
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Presented at The Neely Conference: Developing Research Criteria to Define Medical Necessity in EMS, National Association of EMS Physicians Annual Meeting, Panama City, Florida, January 15, 2003.
Financial support for the Neely Conference project was received from the National Association of EMS Physicians, the National Highway Traffic Safety Administration, U.S. Department of Transportation, and the Neely EMS Research Fund.