Can paramedics using guidelines accurately triage patients?

Study objective: We determine whether paramedics, using written guidelines, can accurately triage patients in the field. Methods: This prospective, descriptive study was conducted at an urban coun ty emergency medical services (EMS) system and county hospital. Paramedics triaged patients, for study purposes only, according to 4 categories: (1) n eeding to come to the emergency department by advanced life support (ALS) t ransport, (2) needing to come to the ED by any transport, (3) needing to se e a physician within 24 hours, or (4) not needing any further physician eva luation. Medical records that provided patient treatment information to the point of ED disposition were subsequently reviewed (blinded to the paramed ic rating) to determine which of the categories was appropriate. The protoc ol of the EMS system of the study site dictates that all patients should be transported except for those who refuse care and leave against medical adv ice. Only transported patients were included in the present study. Fifty-fo ur paramedics triaged 1,180 patients. Results: Mean patient age was 43.4+/-17 years; 62.0% were male. Paramedics rated 1,000 (84.7%) of the patients as needing to come to the ED and 180 (1 5.3%) as not needing to come to the ED. Ratings according to triage categor y-were as follows: 804 (68.1%) category 1, 196 (16.6%) category 2, 148 (12. 5%)category 3, and 32 (2.7%) category 4. Seven hundred thirty-six (62.4%) p atients were discharged, 298 (25.3%) were admitted, 90 (7.6%) were transfer red, 36 (3.1%) left against medical advice, and 20 (1.7%) died. The review panel determined that 113 (9.6%) patients were undertriaged; 55 (48.7%) of these patients were misclassified because the paramedics misused the guidel ines. Ninety-nine patients (8.4% of the total sample) were incorrectly clas sified as not needing to come to the ED. This represented 55% of the patien ts (99/180) categorized as 3 or 4 by the paramedics. Fourteen patients (1.2 % of total) were incorrectly classified as category 4 instead of 3. Of the 113 under-triaged patients, 22 (19.6%) were admitted, 86 (76.1%) were disch arged, and 4 (3.5%) were transferred. Conclusion: Paramedics using written guidelines fall short of an acceptable level of triage accuracy to determine disposition of patients in the field .