Objective: The Florida Adult Trauma Triage Criteria (FATTC) define specific parameters concerning injury mechanism and physiologic data that prompt paramedics to initiate a trauma alert and necessitate transport to a trauma center. In the state of Florida, paramedics are also given discretion to bring patients to the trauma center who do not meet those criteria. Our aim was to compare the injury characteristics and outcomes of adult patients who were evaluated in our trauma center after activation due to FATTC criteria vs. paramedic discretion (PD) and to identify predictors of PD. Methods: This retrospective study included all patients 18 years and older evaluated in our trauma center from January 1, 2007, to December 31, 2014. Descriptive statistics were computed for all variables. Bivariate and multivariate analyses were performed to compare demographic, injury severity, and outcome differences between groups. Results: A total of 13,963 patients met FATTC during the study period, and 1,811 were brought in by PD. PD patients had lower injury severity and crude mortality. Regression modeling of demographic and injury variables found that only the combination of older age and higher heart rate predicted PD when both were lower than FATTC alone. Conclusions: While PD patients were less seriously injured and had lower mortality, they experienced similar lengths of stay and resource utilization after presentation. Paramedics may be able to identify patients at risk for poor outcomes who would otherwise not be captured by FATTC.

Bakgrund: Trauma är den vanligaste primära dödsorsaken bland individer upp till 44 års ålder i Sverige, vilket påvisar betydelsen av en utvecklad traumavård. Inom kontexten av traumalarm på sjukhus är anestesisjuksköterskans roll avgörande. När traumapatienter anländer till sjukhus, larmas dedikerade traumateam enligt förutbestämda protokoll för att möta patienten och dennes behov. Specifikt för traumalarm nivå 1, vilket indikerar en högre grad allvar, är att anestesisjuksköterskan tillsammans med en anestesiläkare mobiliseras. I dessa situationer lämnar anestesisjuksköterskan den vanliga arbetsmiljön på operationsavdelningen för att arbeta under akuta och oförutsedda förhållanden på akutmottagningen. Syfte: Att undersöka anestesisjuksköterskors upplevelse av traumalarm nivå 1. Metod: Datamaterialet samlades in genom kvalitativa semistrukturerade intervjuer med tio deltagare från samma sjukhus. Datamaterialet analyserades genom en kvalitativ innehållsanalys. Resultat: Utifrån datamaterialet utformades nio underkategorier med tre tillhörande kategorier; förutsättningar för säkert traumaomhändertagande, stress vid traumalarm och känslomässiga aspekter vid traumalarm. Utifrån dessa kategorier framkom ett tema; kan det oförberedda förberedas. Konklusion: Anestesisjuksköterskor upplever att god och tydlig kommunikation under traumalarm är centralt och att framgång i arbetet underlättas mycket av en stark traumaledare. Anestesisjuksköterskorna upplever känslomässiga reaktioner både före, under och efter traumalarm. Mest framträdande i de emotionella aspekterna är den eftervarande responsen då larmet och situationen är hanterad. / Background: Trauma is the leading primary cause of death for individuals up to 44 years old in Sweden, underscoring the need for advanced trauma care. Nurse anaesthetists play a crucial role in hospital trauma alerts. When trauma patients arrive, specialized teams are mobilized following specific protocols. For level 1 trauma alerts, indicating severe cases, nurse anaesthetists work with anaesthesiologists, leaving their regular operating room duties for emergency department conditions. Purpose: This study investigates nurse anaesthetists’ experiences with level 1 trauma alerts. Method: Data were gathered from qualitative semi-structured interviews with ten hospital staff members working at the same hospital. A qualitative content analysis was conducted. Results: The analysis yielded nine subcategories and three main categories: prerequisites for safe trauma care, stress during trauma alerts, and emotional aspects of trauma alerts. From these categories a theme emerged: can the unprepared be prepared? Conclusion: Effective communication is vital during trauma alerts, and successful outcomes are often aided by strong leadership. Nurse anaesthetists experience emotional responses before, during, and after trauma alerts, with notable emotional impacts following the resolution of the situation.