From research to the road: the development of EMS specialty triage

A recent study in the Journal of Neurosurgery demonstrates decreased mortality rates in patients with subarachnoid hemorrhage (SAH) treated at tertiary care centers with higher volumes of SAH patients.(1) As clinical research in emergency and critical care increases, so will its impact on transport systems. In recent years, advances in cardiology, interventional radiology, surgery, and emergency care all have had major influences in the triage and transport of critically ill and injured patients. The challenge facing modern transport systems is how to integrate research to improve patient care while respecting the logistic, financial, and political issues that are entwined in this process. This article discusses the process undertaken by one medical control zone in the triage and transport of prehospital patients with suspected ischemic stroke. It discusses the transition from initial research and national recommendations for emergent thrombolytic therapy through the development and implementation of prehospital triage protocols. The authors hope it will offer some guidance in dealing with these rapidly emerging and often complicated transport decisions.