Helicopter emergency medical service registrars do not comprehensively document primary surveys

摘要

OBJECTIVES: In-hospital primary surveys undertaken on traumatically injured patients can be inaccurate and incomplete. This study examined the documentation of prehospital primary surveys conducted by Greater Sydney Area Helicopter Emergency Medical Service registrars on trauma patients. METHODS: A retrospective case sheet review of prehospital trauma primary surveys documented by Greater Sydney Area Helicopter Emergency Medical Service registrars was carried out using previously published methodologies. A 13-item prehospital primary survey score was created and analysed by registrar specialty. A linear mixed model was used to determine whether differences in prehospital primary survey score existed between specialties. A one-point difference in the mean scores was considered clinically significant. RESULTS: A total of 75 charts were reviewed. An unadjusted mean of 9.5±1.6 (SD) items, out of a possible 13, was documented. Documentation was found to be less complete for anaesthetic trainees (adjusted mean score=9.10) than for emergency medicine trainees (adjusted mean score=10.34). The difference in the mean scores was 1.24 (95% confidence interval, 0.25-2.23, t53d.f.=2.52, P=0.01). A significant clustering effect was identified for individual registrars (χ1d.f.=6.03, P=0.01). A very good level of agreement was obtained between the PPSS raters (κ=0.93, 95% confidence interval, 0.87-0.99). CONCLUSION: Helicopter emergency medical service registrars do not comprehensively document prehospital primary surveys on traumatically injured patients. However, emergency medicine trainees document more completely than anaesthetic trainees. Individual registrar variation contributes significantly towards the completeness of prehospital primary survey documentation.