Compliance of a Bypassing Hospital Trauma Protocol Using the Field Triage Decision Scheme between Metropolitan VS Non-Metropolitan Emergency Medical Services

ABSTRACT

PURPOSE: A trauma protocol for transport bypassing hospital for severe trauma patients was developed and implemented in Korea in 2012 using the field triage decision scheme of Centers for Disease Control and Prevention of US. The aim of this study is to evaluate the compliance with the protocol in severe trauma between metropolitan versus non-metropolitan area. METHODS: Severe trauma patients were identified by the new protocol and collected from a trauma registry and EMS run sheet in one metropolitan and one non-metropolitan province from October 2012 (one month). Data variables included demographic, clinical information on vital signs and mental status, injury related variables like mechanisms, geographic information on place of the event, and distance to nearest, bypassed, and destination hospitals. Exposures are metropolitan versus non-metropolitan ambulances defined. Study end point was compliance-direct transport (C-DT), compliance-bypassing transport (C-BT), violation-non-bypassing transport (V-NT), and violation-bypassing transport (V-BT). The protocol violation with number of V-NT and V-BT divided by number of eligible patients were compared between metropolitan and non-metropolitan ambulances. RESULTS: Of the 863 patients with severe trauma were identified by the protocol. No statistical difference in demographics and clinical parameters except injury mechanism and distance to destination hospital. Between metropolitan versus non-metropolitan area. The C-DT, C-BT, V-NT, and V-BT were 27.4%, 18.5%, 20.2%, and 33.4% respectively. V-NT rate was significantly lower in metropolitan than in nonmetropolitan (8.2% versus 30.6%, p=0.001), while V-BT rate was significantly higher in metropolitan than in non-metropolitan (46.2% versus 23.3%, p=0.001), respectively. CONCLUSION: Protocol violation rates were significantly different in non-bypassing and inappropriate bypassing to hospital between metropolitan versus non-metropolitan ambulances when using the bypassing hospital trauma protocol.