PP26 Development of the retrospective assessment tool in emergency trauma dispatch (RATED) for medical trauma incidents: a modified delphi approach

<h3>Background</h3> Deciding which medical resources are needed for trauma incidents often results in over- or under-triage. Evaluation of innovations aimed at improving dispatch decision-making (e.g., video livestreaming) requires retrospective assessment of the appropriateness of these decisions, but no tools currently exist. <h3>Methods</h3> We aimed to develop a tool through expert consensus to assess the need for enhanced medical resources (either critical care and/or Helicopter Emergency Medical Services) for trauma incidents. A modified Delphi approach was used, comprising three meetings with an Expert Panel who developed the criteria iteratively. The resulting criteria – the Retrospective Assessment Tool in Emergency Trauma Dispatch (RATED) - were applied to data from a feasibility randomised controlled trial by research paramedics to test reliability: (i) pilot stage: two cases rated independently by two research paramedics; (ii) all cases (n=58) rated independently by two research paramedics (blind to allocation and resource dispatch). A sub-sample (n=30) of cases were rated by the Expert Panel (blind to research paramedic ratings, allocation, and resource dispatch). <h3>Results</h3> Criteria across four areas of decision-making were developed (i) pre-hospital clinical interventions; (ii) injury pattern/physiology/anatomy; (iii) pre-hospital clinical decision making; (iv) patient disposition and geographical considerations. Reliability of ratings between research paramedics was high (2/2 cases, 100% agreement for pilot application; 56/58, 97% agreement for all cases). Expert Panel members agreed with each other in 24/30 cases (80%) and agreed with the research paramedics ratings in 16/30 cases (53%). Expert Panel members discussed cases that lacked agreement (n=14) until consensus was reached. Final agreed ratings were: appropriate (n=40, 70%), over-resourced (n=10, 17.2%) and under-resourced (n=8, 13.8%) dispatches. <h3>Conclusion</h3> RATED is a novel tool developed to aid evaluation of interventions in the pre-hospital setting. RATED was found to be reliable and easily applied across a range of clinicians. Further evaluation and critique are needed.