Field triage in trauma – do the data really justify the conclusions?

First, the authors compared undertriage and overtriage of the traumatized patients and found 2% and 17% undertriage and 35% and 66% overtriage for anaesthetists and paramedics, respectively. They conclude that "anaesthetists perform precise trauma triage, whereas paramedics have potential for improvement" although the authors themselves state that "skewed mission profiles make comparison of differences in triage precision difficult" [1]. The ground ambulances staffed with paramedics are used locally while the helicopters staffed with anaesthetists are a regional resource. The helicopters are dispatched when major trauma is suspected while ground ambulances are dispatched to any sort of incidence. In Oslo, an anaesthetist-staffed ground ambulance operates alongside ordinary ambulances and the patients transported with this service are a subgroup of the patients transported by anaesthetists. If the triage precision between paramedics and anaesthetists is to be compared, data from ground ambulances in Oslo (with or without anaesthetist) should be used and the data from patients brought to the hospital by helicopter or other services should be excluded. Such a comparison would give a good indication about the real difference in triage precision between the two groups of prehospital care providers. Unfortunately, that subgroup analysis has not been performed. That is sad, because the numbers that is provided in the article is of little interest since the services that are compared are too different.