View from the door: Making pediatric transport decisions based on first impressions

The primary goal of the Pediatric Assessment Triangle (PAT) is to objectify the "view from the door." Although the PAT is widely taught to prehospital providers and health-care professionals, the tool has not yet been validated. Before one can study the validity of the PAT, one needs to fully describe the practicality and functionality of the tool by exploring whether it's being used, and if so, how it's being used. The primary objective of this study was to determine if experienced providers can use the information gathered from the "view from the door" to make transport decisions on pediatric patients, and if that information fits in with the PAT.

This is a study using ethnographic analysis strategies for development of themes. A convenience group of 12 EMTs was recruited to observe two videos of pediatric patients and make a transport decision based on their observations.

The mean time to transport decision was 12.25 seconds with a standard deviation of 8.8 seconds. Medics chose to "load and go" in 71% of the cases, and there was no correlation between CUPS status and transport decision as measured by chi square analysis. The information used most frequently to make transport decisions by medics in this study included: a simultaneous airway/breathing assessment, a level of consciousness assessment, a circulatory status assessment, a treatment plan and an anticipation of negative outcomes.

The data from this study support that there are several features of the "view from the door" that experienced prehospital providers are using to make transport decisions on pediatric patients, and they fit in with the PAT. The data also support that the tool is a time-efficient method of triaging patients.