Paramedic accuracy and confidence with a trauma triage algorithm: a cross-sectional survey

Abstract

Abstract published with permission. Introduction – Since 2008, the UK has been developing trauma networks, with ambulance services adopting triage tools to support these. So far there has been no published work on how UK paramedics use these algorithms. This study aims to evaluate factors affecting the accuracy and self-perceived confidence of paramedics from one UK Ambulance Trust when applying the Major Trauma Decision Tree. Methods – A quantitative cross-sectional survey was e-mailed to every paramedic within the participating Ambulance Trust, asking for basic demographic data and presenting four case studies. Respondents applied the Major Trauma Decision Tree to the case studies, stating which algorithm steps (if any) they triggered, and their appropriate destination. A Likert scale was utilised to explore respondent views on the Major Trauma Decision Tree. Descriptive and inferential statistics were used to identify linked factors affecting accuracy/confidence. Results – Of the 1132 paramedics employed by the Trust, 178 completed the survey (16% response rate). Sensitivity with the Major Trauma Decision Tree was 77% (95% CI 72–81%) and specificity, 61% (95% CI 56–66%). The trigger most commonly missed was patient age of greater than 55 years. Respondents reported that transport time to a major trauma centre/trauma unit influenced compliance with the algorithm. Self-perceived confidence was low overall, but correlated positively with frequency of exposure to trauma (rs [178] = 0.323, p < 0.0005). Respondents’ concerns about the reception they would encounter from hospital staff correlated negatively with confidence (rs [178] = –0.459, p < 0.0005). Conclusion – Respondent sensitivity when using the Major Trauma Decision Tree was low, which may be due to paramedic concerns about transport time. The most commonly missed trigger was patient age. Future training may benefit from addressing these points. In addition, respondents’ confidence with the Major Trauma Decision Tree was also low and closely linked with exposure to trauma, and the reception anticipated from hospital staff.