Human errors in (inhuman?) triage

Excerpt

We would like to congratulate Giannakopoulos et al. for their very well designed study concerning the cancellations of mobile medical team (MMT) dispatches in the Netherlands [1]. After being dispatched, the MMT was cancelled one time in two (in half of the cases). After the MMT was dispatched, the amount of cancellations nearly reached 50%. Triage of trauma patients is a complex and challenging issue. The purpose of triage criteria in a trauma system is to properly identify and distribute seriously injured patients and to ensure an appropriate response in personnel, equipment, services and facilities (for example, in daily practice, the need for level I trauma centre care can exceed its availability in many countries). The short limits of MMT leads to EMS dispatch centre, or the on-scene ambulance crew must optimally involve MMT in patients most likely to benefit from improved pre-hospital care and faster transfer from the field to the most appropriate hospital for definitive care. Furthermore, this debate is about the main question: Is the over-triage a result of misinterpretation of the dispatch criteria, or are the criteria not accurate enough and need to be revised? This pre-hospital triage relies on two key factors: accurate triage tools for identifying major trauma cases (in a stressful and dynamic environment) and compliance of medical staff with the triage protocols. We would only point out that, in practice, strict adherence to triage protocol is rare. …