PT - JOURNAL ARTICLE AU - Peter E Fischer AU - Mark L Gestring AU - Scott G Sagraves AU - Holly N Michaels AU - Bhavin Patel AU - Jimm Dodd AU - Eric M Campion AU - Wayne E VanderKolk AU - Eileen M Bulger TI - The national trauma triage protocol: how EMS perspective can inform the guideline revision AID - 10.1136/tsaco-2021-000879 DP - 2022 Jan 01 TA - Trauma Surgery & Acute Care Open PG - e000879 VI - 7 IP - 1 4099 - http://tsaco.bmj.com/content/7/1/e000879.short 4100 - http://tsaco.bmj.com/content/7/1/e000879.full SO - Trauma Surg Acute Care Open2022 Jan 01; 7 AB - Objectives The Field Triage Guidelines (FTG) support emergency medical service (EMS) decisions regarding the most appropriate transport destination for injured patients. While the components of the algorithm are largely evidenced-based, the stepwise approach was developed with limited input from EMS providers. FTG are only useful if they can easily be applied by the field practitioner. We sought to gather end-user input on the current guidelines from a broad group of EMS stakeholders to inform the next revision of the FTG.Methods An expert panel composed an end-user feedback tool. Data collected included: demographics, EMS agency type, geographic area of respondents, use of the current FTG, perceived utility, and importance of each step in the algorithm (1: physiologic, 2: anatomic, 3 mechanistic, 4: special populations). The American College of Surgeons Committee on Trauma (ACS COT), in partnership with several key organizations, distributed the tool to reach as many providers as possible.Results 3958 responses were received (82% paramedics/emergency medical technicians, 9% physicians, 9% other). 94% responded directly to scene emergency calls and 4% were aeromedical providers. Steps 2 and 3 were used in 95% of local protocols, steps 1 and 4 in 90%. Step 3 was used equally in protocols across all demographics; however, step 1 was used significantly more in the air medical services than ground EMS (96% vs 88%, p<0.05). Geographic variation was demonstrated in FTG use based on the distance to a trauma center, but step 3 (not step 1) drove the majority of the decisions. This point was reinforced in the qualitative data with the comment, “I see the wreck before I see the patient.”Conclusion The FTG are widely used by EMS in the USA. The stepwise approach is useful; however, mechanism (not physiological criteria) drives most of the decisions and is evaluated first . Revision of the FTG should consider the experience of the end-users.Level of evidence V.Data may be obtained from a third party and are not publicly available.