SD15 - Statewide Pre-Hospital and Inter-Hospital Trauma Triage Plan


Executive Summary:
The 1996 General Assembly charged the Commissioner of Health to convene a task force to develop a draft statewide pre-hospital and inter-hospital trauma triage plan. This study was precipitated by a 1995 Joint Commission on Health Care study on Pre-hospital Triage of Trauma Patients. Utilizing 1994 Virginia Statewide Trauma Registry data, the Joint Commission on Health Care noted that the vast majority of most critically injured patients were admitted to trauma centers. However, a significant number (24% statewide) of seriously injured patients were not admitted to trauma centers, with variations existing in triage practices among Emergency Medical Services (EMS) Regions. In review of trauma center research, the Joint Commission report concluded that some of Virginia's more seriously injured patients may be experiencing less than optimal outcomes and that statewide trauma triage protocols may enhance the effectiveness of Virginia's trauma system.

In order to develop statewide pre-hospital and inter-hospital trauma triage guidelines, it was imperative to complete a comprehensive review of the literature on trauma care, trauma care systems, and trauma triage tools. Existing research, duplicated in many areas of the United States and abroad, demonstrates the effectiveness of organized trauma care systems and utilization of pre-hospital and inter-hospital triage guidelines to maximize patient outcomes. Trauma system plans, legislation and triage guidelines from other states were reviewed.

In addition to a review of the literature, the Virginia Department of Health's Office of Emergency Medical Services (EMS) convened a statewide task force to draft a statewide pre-hospital and inter-hospital trauma triage plan. Per guidelines in SJR 58, the following were asked to appoint representatives to the Trauma Triage Task Force: the State Emergency Medical Services Advisory Board; the State Office of EMS; the Critical Care Committee; the regional EMS councils (8 councils); the Virginia Hospital and Healthcare Association; the American College of Surgeons Committee on Trauma, Virginia Chapter; the Virginia College of Emergency Physicians; the American Academy of Pediatrics, Virginia Chapter; the Virginia Emergency Nurses Association; the Virginia Association of Volunteer Rescue Squads (pre-hospital care provider); the Virginia Governmental EMS Administrators (pre-hospital care provider); and the State Medical Direction Committee.

The Trauma Triage Plan which follows is a task force product. Experts within their respective fields, whose membership was specifically identified in the Senate Joint Resolution, have arrived at a consensus of what Virginia's Pre-hospital and Inter-hospital Triage Plan would ideally include: a set of criteria which delineate those critically injured pediatric and adult patients who would benefit from the services of a trauma center, and a method for implementation and monitoring of the system. It was the consensus of the task force that all parties participating in the care of trauma patients are responsible for the quality of care delivered, and should participate in the triage and quality assurance process.