Defining major trauma: a pre-hospital perspective using focus groups.

Area of Science:

• Emergency medicine
• Trauma care
• Pre-hospital care

Background:

• Pre-hospital trauma care presents unique challenges due to limited clinical exposure and lack of a standardized definition for major trauma.
• Existing retrospective scores, like the injury severity score, quantify trauma severity but do not capture pre-hospital perspectives.
• This study addresses the need to understand how pre-hospital trauma care providers define major trauma.

Purpose of the Study:

• To explore pre-hospital trauma care providers' perspectives on major trauma.
• To establish a working definition of major trauma from a pre-hospital viewpoint.

Main Methods:

• Qualitative study utilizing three focus groups (40-60 minutes each).
• Participants included paramedics, ambulance technicians, police, firefighters, and emergency dispatchers.
• Verbatim transcripts were coded for thematic analysis using constant comparison.

Main Results:

• Three key themes emerged: clinician factors, patient factors, and situational factors.
• Clinician factors involved experience, exposure, communication, and the complexity of pre-hospital trauma.
• Patient factors included physiological derangement, injury severity, need for surgery/rehabilitation, age extremes, and medical history. Situational factors emphasized the uniqueness of each trauma event and mechanism of injury.

Conclusions:

• A proposed working definition of pre-hospital major trauma is any potentially life-threatening or life-changing injury.
• This definition encompasses low-energy mechanisms in vulnerable populations (elderly, comorbidities, frailty).
• It considers significant physiological compromise (hemodynamic instability, reduced consciousness, respiratory compromise) and/or anatomical abnormality requiring immediate intervention.