Prehospital Care and Triage Systems
Keywords:
prehospital care, emergency medical services, triage systems, patient outcomes, mortality rateAbstract
Prehospital care and triage systems are essential components of emergency medical services (EMS), directly impacting patient survival and outcomes. Despite advancements in basic and advanced life support (BLS, ALS) and pharmacological interventions, disparities in implementation persist, particularly across Asia and in Thailand. This review aimed to (1) evaluate the effectiveness of prehospital interventions (BLS, ALS, pharmacological management) on outcomes and mortality, (2) compare and assess the accuracy, efficiency, and resource utilization of prehospital triage systems, and (3) explore current challenges and future directions, with a focus on Thailand and the Asian region. A systematic review was conducted according to PRISMA 2020 guidelines. Literature from 2000 to 2024 in English and Thai was searched in PubMed, EMBASE, Cochrane Library, CINAHL, Scopus, and Google Scholar. Eligible studies included randomized trials, observational studies, and systematic reviews assessing prehospital interventions or triage systems with measurable outcomes. Data extraction and quality assessment were performed using standardized tools (RoB 2, ROBINS-I, Newcastle–Ottawa, AMSTAR-2). Early interventions such as CPR, AED use, and hemorrhage control significantly improve survival in out-of-hospital cardiac arrest and trauma cases. ALS procedures including advanced airway management and prehospital thrombolysis for STEMI and stroke improve outcomes but require system readiness and skilled personnel. Pharmacological treatments like aspirin and tranexamic acid are associated with reduced mortality. Triage systems (e.g., RTS, MGAP, START, STM, ESI, CTAS) vary in utility; physiological tools excel in trauma, while hybrid models enhance accuracy in mass casualty incidents. Technology-driven solutions telemedicine, AI, wearable monitors, and prehospital ultrasound show promise but remain underutilized. In Asia, systems vary widely, with Thailand progressing yet facing urban rural disparities, workforce shortages, and limited equipment. Strengthening EMS infrastructure, expanding training, and integrating emerging technologies are crucial for improving prehospital care, especially in resource-limited settings like Thailand
References
Sasson C, Haukoos JS. Is prehospital advanced life sup port harmful? Ann Intern Med [Internet]. 2015 [cited 2024 Jun 17];163(9):721. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4867468/
Thind A, Hsia R, Mabweijano J, Hicks ER, Zakariah A, Mock CN. Disease control priorities, third edition (Vol 1): chapter 14: prehospital and emergency care [Internet]. 2015 [cited 2024 Jun 17];245–62. Available from: https://www.ncbi.nlm.nih.gov/books/NBK333513/
Lerner EB, Fernandez AR, Shah MN. Do EMS professionals think they should participate in disease prevention? Prehosp Emerg Care [Internet]. 2009 [cited 2024 Jun 17];13(1):64–70. Available from: https://www.tandfonline.com/doi/abs/10.1080/10903120802471915
Cone DC, Koenig KL. Mass Casualty Triage in CBRN Environments. Eur J Emerg Med [Internet]. 2005 [cited 2024 Jun 17];12(6):287–302. Available from: https://pubmed.ncbi.nlm.nih.gov/16276260/
Sittichanbuncha Y, Prachanukool T, Sarathep P, Sawanyawisuth K. An EMS System in Thailand: providers’ perspectives. J Med Assoc Thai [Internet]. 2014 [cited 2024 Jun 17];97(10):1016–21. Available from: https://www.researchgate.net/publication/271596009_An_emergency_medical_service_system_in_Thailand_providers’_perspectives
Patsadu P, Pholtana S, Srichan P, Jonglertmontree W. Factors Affecting survival outcome among hospital cardiac arrest: a systematic review. J Emerg Med Serv Thailand [Internet]. 2021 [cited 2024 Jun 17];1(2):184 97. Available from: https://he03.tci-thaijo.org/index.php/Jemst-01JHS/article/view/99
Zachariasse JM, van der Hagen V, Seiger N, Mackway- Jones K, van Veen M, Moll HA. Performance of triage systems in emergency care: a systematic review and meta-analysis. BMJ Open [Internet]. 2019 [cited 2024 Jun 17];9(5):e026471. Available from: https://bmjopen.bmj.com/content/9/5/e026471
Clark M, Severn M. Artificial intelligence in prehospital emergency health care: CADTH horizon scan [Internet]. 2023 [cited 2024 Jun 17]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK596747/
Ebinger M, Lindenlaub S, Kunz A, Rozanski M, Waldschmidt C, Weber JE, et al. Prehospital thrombolysis: a manual from Berlin. J Vis Exp [Internet]. 2013 [cited 2024 Jun 17];(81):e50534. Available from: http://dx.doi.org/10.3791/50534
Chee ML, Chee ML, Huang H, Mazzochi K, Taylor K, Wang H, et al. Artificial intelligence and machine learning in prehospital emergency care: a scoping review. Science [Internet]. 2023 [cited 2024 Jun 17];26(8): 107407. Available from: https://doi.org/10.1016/j.isci.2023.107407
Purvis J. The evolution of pre-hospital emergency care: Belfast and Beyond. Ulster Med J [Internet]. 2018 [cited 2024 Jun 17];87(1):67. Available from: https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC5849963/
Magid DJ, Aziz K, Cheng A, Hazinski MF, Hoover AV, Mahgoub M, et al. Part 2: evidence evaluation and guidelines development: 2020 AHA Guidelines for CPR and ECC. Circulation [Internet]. 2020 [cited 2024 Jun 17];142(16_suppl_2):S358–S365. Available from: https://pubmed.ncbi.nlm.nih.gov/33081525/
Bulger EM, Snyder D, Schoelles K, Gotschall C, Dawson D, Lang E, et al. Prehospital guideline for external hemorrhage control. prehosp emerg care [Internet]. 2014 [cited 2024 Jun 17];18(2):163–73. Available from: https://www.ncbi.nlm.nih.gov/pubmed/ 24641269
Nolan JP, Maconochie I, Soar J, Olasveengen TM, Greif R, Wyckoff MH, et al. Executive summary: 2020 International Consensus on CPR and ECC Science with Treatment Recommendations. Circulation [Internet]. 2020 [cited 2024 Jun 17];142(16_suppl_1): S2–S27. Available from: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000890
Çetiner M, Aydin HE, Güler M, Canbaz Kabay S, Zorlu Y. Predictive factors for functional outcomes after IV thrombolysis in acute ischemic stroke. Clin Appl Thromb Hemost [Internet]. 2018 [cited 2024 Jun 17];24(9_suppl):171S–177S. Available from: https://doi.org/10.1177/1076029618796317
CRASH-2 Trial Collaborators. Effects of tranexamic acid in trauma patients with significant haemorrhage (CRASH-2). Lancet [Internet]. 2010 [cited 2024 Jun 17]; 376(9734):23–32. Available from: https://www.thelancet.com/journals/lancet/article/PIIS01406736(10)60835-5/fulltext
Stub D, Bernard S, Pellegrino V, Smith K, Walker T, Sheldrake J, et al. Refractory cardiac arrest treated with mechanical CPR, Hypothermia, ECMO and early reperfusion (CHEER trial). Resuscitation [Internet]. 2015 [cited 2024 Jun 17];86:88–94. Available from: https://doi.org/10.1016/j.resuscitation.2014.09.010
Martínez-Isasi S, Abelairas-Gómez C, Fernández- Méndez F, Barcala-Furelos R, Jorge-Soto C, Gómez- Gónzalez C, et al. Basic CPR training for blind people: a pilot Study. Resuscitation [Internet]. 2019 [cited 2024 Jun 17];134: 165–6. Available from: https://doi.org/10.1016/j.resuscitation.2018.11.020
Omori K, Roberts I. Prehospital tranexamic acid for trauma victims. J Intensive Care [Internet]. 2023 [cited 2024 Jun 17];11(1):12. Available from: https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-023-00661-8
Navarro V, Dagron C, Elie C, Lamhaut L, Demeret S, Urien S, et al. Prehospital levetiracetam plus clonazepam in status epilepticus (SAMUKeppra): RCT. Lancet Neurol [Internet]. 2016 [cited 2024 Jun 17];15(1): 47–55. Available from: https://pubmed.ncbi.nlm.nih.gov/26627366/
Shakibajahromi B, Borhani-Haghighi A, Ghaedian M, Feiz F, Vardanjani HM, Safari A, et al. Early, delayed, and expanded intracranial hemorrhage in cerebral venous thrombosis. Acta Neurol Scand [Internet]. 2019 [cited 2024 Jun 17];140(6):435–42. Available from: https://doi.org/10.1111/ane.13164
Shaker MS, Wallace DV, Golden DBK, Oppenheimer J, Bernstein JA, Campbell RL, et al. Anaphylaxis — a 2020 practice parameter update. J Allergy Clin Immunol [Internet]. 2020 [cited 2024 Jun 17];145(4):1082 123. Available from: https://doi.org/10.1016/j. jaci.2020.01.017
Gartner BA, Fehlmann C, Suppan L, Niquille M, Rutschmann OT, Sarasin F. Effect of noninvasive ventilation on intubation risk in prehospital patients with acute pulmonary edema. Eur J Emerg Med [Internet]. 2019 [cited 2024 Jun 17];27(1):54–8. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6946102/
Hellenthal KEM, Porschen C, Wnent J, Lange M. Evolving role of point-of-care ultrasound in prehospital emergency care: a narrative review. Scand J Trauma Resusc Emerg Med [Internet]. 2025 [cited 2024 Jun 17];33(1):126. Available from: https://sjtrem.biomedcentral.com/articles/10.1186/s13049-025-01443-x
Sartorius D, Le Manach Y, David JS, Rancurel E, Smail N, Thicoïpé M, et al. MGAP: A simple prehospital triage score to predict mortality. Crit Care Med [Internet]. 2010 [cited 2024 Jun 17];38(3):831–7. Available from: http://dx.doi.org/10.1097/CCM.0b013e3181cc4a67
Kahn C, Schultz C, Miller K, Anderson C. Does START triage work? Outcomes after a disaster. Ann Emerg Med [Internet]. 2009 [cited 2024 Jun 17];54(3):424–30. Available from: https://pubmed.ncbi.nlm.nih.gov/19195739/
Sacco WJ, Navin DM, Fiedler KE, Waddell RK II, Long WB, Buckman RF Jr. Precise formulation and evidence-based application of resource-constrained triage. Acad Emerg Med [Internet]. 2005 [cited 2024 Jun 17];12(8):759–70. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1197/j.aem.2005.04.003
Bullard MJ, Unger B, Spence J, Grafstein E. Revisions to the Canadian ED triage and acuity scale (CTAS). CJEM [Internet]. 2008 [cited 2024 Jun 17];10(2): 136–42. Available from: https://pubmed.ncbi.nlm.nih.gov/18371252/
Garner A, Lee A, Harrison K, Schultz CH. Comparative analysis of multiple-casualty incident triage algorithms. Ann Emerg Med [Internet]. 2001 [cited 2024 Jun 17];38(5):541–8. Available from: https://pubmed.ncbi.nlm.nih.gov/11679866/
Ebben RHA, Vloet LCM, Speijers RF, Tönjes NW, Loef J, Pelgrim T, et al. A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review. Scand J Trauma Resusc Emerg Med [Internet]. 2017 [cited 2024 Jun 17];25(1):71. Available from: https://sjtrem.biomedcentral.com/articles/10.1186/s13049-017-0409-6
Lerner EB, Cushman JT, Drendel AL, Badawy M, Shah MN, Guse CE, et al. Effect of the 2011 Field triage guideline revisions on pediatric trauma under- and over-triage. Prehosp Emerg Care [Internet]. 2017 [cit ed 2024 Jun 17];21(4):456–60. Available from: https://doi.org/10.1080/10903127.2017.1300717
Park SSE, Vij R, Wu J, Zarrin B, Moon JY, Oliveira J, et al. Impact of an Ambulatory ophthalmology urgent care clinic. J Acad Ophthalmol [Internet]. 2022 [cited 2024 Jun 17];14(02):e229–37. Available from: https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0041-1741464
Di Somma S, Paladino L, Vaughan L, Lalle I, Magrini L, Magnanti M. Overcrowding in ED: an international issue. Intern Emerg Med [Internet]. 2014 [cited 2024 Jun 17];10(2):171–5. Available from: https://he01.tci-thaijo.org/index.php/bcnpy/article/view/272000
Atiksawedparit P, Rattanasiri S, McEvoy M, Graham CA, Sittichanbuncha Y, Thakkinstian A. Effects of prehospital adrenaline on OHCA outcomes: a systematic review and meta-analysis. Crit Care [Internet]. 2014 [cited 2024 Jun 17];18:463. Available from: https://doi.org/10.1186/s13054-014-0463-7
Doran KM, Ran Z, Castelblanco D, Shelley D, Padgett DK. “It wasn’t just one thing”: a qualitative study of newly homeless ED patients. Acad Emerg Med [Internet]. 2018 [cited 2024 Jun 17];26(9):982–93. Available from: https://doi.org/10.1111/acem.13677
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Journal of Emergency Medical Services of Thailand
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
