Trauma Triage: Changes for EMS and
Hospitals
By Jim Chandler (1998 article)
It seems like years in the making, but Senate Bill 551 signed into law during 1998 by Governor Gilmore will change the management of trauma patients. The new law is designed to promote rapid movement of trauma patients to appropriate, organized trauma care. The law requires uniform criteria for prehospital and interfacility triage and transport of trauma patients and it requires development of formal regional plans that become part of the state plan.
The new law also requires monitoring and reporting of the quality of care. This monitoring and reporting, it is expected, will cause public pressure to encourage improvements in trauma management. The trauma system will remain voluntary for the next three years at which time the General Assembly will evaluate the data.
The Tidewater EMS region currently has two trauma centers: Sentara Norfolk General Hospital is a Level I center and Virginia Beach General Hospital is a Level II center. Riverside Medical Center, in the neighboring Peninsulas region, is also a Level II center. The law's main goal is to get the most seriously injured patients to one of these two levels of trauma care in a timely manner, whether directly from the field or from transfer from another hospital.
That usually happens in Hampton Roads, according to Leonard Weireter, MD, associate professor of surgery at EVMS. He co-chaired a state task force which has been working for about three years to improve the effectiveness of the trauma care system. There are large portions of the state without nearby Level I or II centers, however, and the new law looks at the problem statewide. Interviewed by Port Folio Weekly in September, Weireter said that "the goal is provide every Virginian with an equal shot-no matter where they are in the Commonwealth."
Although regional and state plans are in the works, the uniform criteria for prehospital and interhospital triage have been developed. These criteria were developed by Weireter's taskforce, the adopted by the state EMS Advisory Board in consultation with the Virginia Chapter of the American College of Surgeons, the Virginia College of Emergency Physicians, the Virginia Hospital and Healthcare Association and the EMS community. Regional plans will address, among other details, how the uniform criteria are implemented.
The new law addresses legal exposure if physicians and EMS providers deviate from the uniform criteria. The law states that the uniform criteria are a "guide and resource for health care providers and are not, in and of themselves, intended to establish standards of care..." The law goes on to say that a "decision by a health care provider to deviate from the criteria shall not constitute negligence per se."
EMS providers and emergency department physicians will want to be very familiar with the uniform triage and transport criteria, however, and generally plan to follow the criteria unless circumstances require a deviation. From a legal viewpoint, healthcare providers will be judged against what other similarly trained providers would prudently do under similar circumstances.
From a quality monitoring and reporting viewpoint, a decision to deviate from criteria may raise a red flag and cause a "blip" in the region's data. Data, which will sent to regions on an annual basis by the state, and made available to the public, will show aggregate findings of incorrect triage for trauma patients delivered to hospitals and incorrect interfacility transfer.
EMS providers can expect to see the prehospital triage criteria integrated into regional protocols. The accompanying tables highlight the prehospital criteria. For further information contact the Tidewater EMS Council office at (757) 446-5179 or by E-mail at tidewater@vaems.org.
Link to Tidewater Regional Trauma Triage Plan, Adopted in 2000