On-Scene Predictors of Injury Severity, Deterioration, and Death Following Road Injury: A Systematic Scoping Review of Information Available to Responders and Its Use in Triage Tools
Road injury casualties frequently receive assistance from bystanders – members of the public, and emergency first responders such as police, fire & rescue – who may have little or no first-aid training. Bystanders may help by recognising injuries, calling for help, and providing immediate lifesaving treatment.
Emergency care resources are limited, and their allocation occurs through a process called triage, where casualties’ injuries are assessed to determine the urgency and type of medical response required. Under- or over-estimation of casualties’ injuries may result in the inappropriate use of emergency medical services.
Casualties are triaged by emergency services based on the answers to a series of questions, often provided by bystanders. We conducted a review of available evidence to determine other ways in which bystanders may assist with this triage process.
Triage is usually conducted by medically trained professionals using triage tools to assist decision-making. We found evidence suggesting similar tools may be used by bystanders to assess casualties, with accuracy approaching that of trained professionals. However, whether the accuracy of bystander triage is sufficient to be useful to emergency care services remains unclear. Many existing tools rely on the measurement of patients’ vital signs. Newer tools rely on clear observable signs such as talking, breathing, and walking, which may be more appropriate for bystander use.
Medical professionals may use accident scene descriptions to triage casualties. Factors such as airbag deployment, seatbelt use, and vehicle deformity are predictors of casualty outcomes. One small study suggested that bystanders can identify most of these factors with similar accuracy to trained medical professionals.
Bystanders may also assist by providing live video streaming from a smartphone to emergency medical services. Several studies suggest that video improves injury recognition, influences decision-making, and helps emergency medical services offer advice to bystanders. Video streaming appears to be acceptable for both bystanders and emergency medical service personnel. However, some technical challenges, such as video quality and network connection, remain. It is unclear whether video streaming improves casualty outcomes.
We believe future research should prioritise three key areas:
1. Determining whether greater involvement of bystanders in triage can improve emergency service resource use or casualty outcomes.
2. Identifying which injuries and signs bystanders can reliably recognise and report to emergency medical services.
3. Assessing the psychological impact of greater bystander involvement in assisting road injury casualties.
Authors
George Russam1, Jake Gluyas-Harris2, Nicholas Aveyard3,4, Tim Nutbeam5,6
1Anaesthetic Department, Darlington Memorial Hospital, Darlington, UK. 2Emergency Department, Derriford Hospital, Plymouth, UK. 3Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK. 4Faculty of Health & Life Sciences, University of Exeter, UK. 5IMPACT; Centre for Post-Collision Research Innovation and Translation, Exeter, UK. 6University of Plymouth, Plymouth, UK.
