The influence of successfully completed triage courses and work experience of advanced emergency medical technicians on their perception of patient disposition


Advanced Emergency Medical Technician

How to Cite

Mozafari J, Afzalimoghaddam M, Talebian MT, Bahreini M, Mohammadnejad E. The influence of successfully completed triage courses and work experience of advanced emergency medical technicians on their perception of patient disposition. Australasian Journal of Paramedicine [Internet]. 2020Nov.12 [cited 2021Nov.28];17. Available from:



This study assessed the impact of various one-day workshops and the work experience of advanced emergency medical technicians (AEMTs) on their prediction of patient disposition.


We conducted a prospective study on 267 patient transport missions to the emergency department. During the study, convenience sampling was used in all the clinical shifts of the lead author. The AEMTs completed the questionnaires, which comprised of the number of successfully completed workshops; other training courses; work experience and their perception of the patient’s disposition. The latter was compared to the ultimate disposition of patients determined by emergency medicine specialists.


The respective figures for sensitivity, specificity, positive predictive value and negative predictive value were 86%, 80%, 33% and 66% on predicting patient disposition for AEMTs who passed fewer workshops; and 79%, 76%, 34% and 96% for the participants with less than 4 years’ work experience. The Kappa coefficient for the agreement between AEMTs’ prediction and ultimate patient disposition was 0.387.


The number of triage courses was not positively effective in the prediction of patient disposition by AEMTs; the number of years of work experience did not make a difference either. The AEMTs were fair in their prediction of patient disposition in comparison with the emergency medicine specialists.


Bermnnan J KJ. Principle of EMS Systems. 3rd edn. USA: Jones and Bartlett Publishers; 2005.

Levine SD, Colwell CB, Pons PT, et al. How well do paramedics predict admission to the hospital? A prospective study. J Emerg Med 2006;31:1-5.

Clesham K, Mason S, Gray J, Walters S, Cooke V. Can emergency medical service staff predict the disposition of patients they are transporting? Emerg Med J 2008;25:691-4.

Price TG, Hooker EA, Neubauer J. Prehospital provider prediction of emergency department disposition: implications for selective diversion. Prehosp Emerg Care 2005;9:322-5.

Millin MG, Brown LH, Schwartz B. EMS provider determinations of necessity for transport and reimbursement for EMS response, medical care, and transport: combined resource document for the National Association of EMS Physicians Position Statements. ibid. 2011;15:562-9.

Ebrahimian A, Khalesi N, Tourdeh M, Dargahi H. Attention and related factors in Tehran night shift prehospital emergency personnel. Health in Emergencies and Disasters Quarterly 2015;1:25-32.

Saberian P, Hasani Sharamin P, Dadashi F. Emergency medical service concepts in Tehran, Iran. J Orthop Spine Trauma 2017;3(3).

McHugh M, Tanabe P, McClelland M, Khare RK. More patients are triaged using the Emergency Severity Index than any other triage acuity system in the United States. Acad Emerg Med 2012;19:106-9.

Elshove-Bolk J, Mencl F, van Rijswijck BTF, Simons MP, van Vugt AB. Validation of the Emergency Severity Index (ESI) in self-referred patients in a European emergency department. Emerg Med J 2007;24:170-4.

Handel D, Epstein S, Khare R, et al. Interventions to improve the timeliness of emergency care. Acad Emerg Med 2011;18:1295-302.

Patterson PD, Huang DT, Fairbanks RJ, et al. Variation in emergency medical services workplace safety culture. Prehosp Emerg Care 2010;14:448-60.

Ebben RHA, Vloet LCM, Speijers RF, et al. A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review. Scand J Trauma Resusc Emerg Med 2017;25:71.

Cushman JT, Fairbanks RJ, O'Gara KG, et al. Ambulance personnel perceptions of near misses and adverse events in pediatric patients. Prehosp Emerg Care 2010;14:477-84.

Polk JD, Merlino JI, Kovach BL, Mancuso C, Fallon WF, Jr. Fetal evaluation for transport by ultrasound performed by air medical teams: a case series. Air Med J 2004;23:32-4.

Qazi K, Kempf JA, Christopher NC, Gerson LW. Paramedic judgment of the need for trauma team activation for pediatric patients. Acad Emerg Med 1998;5:1002-7.

Brown LH, Hubble MW, Cone DC, et al. Paramedic determinations of medical necessity: a meta-analysis. Prehosp Emerg Care 2009;13:516-27.

Hauswald M. Can paramedics safely decide which patients do not need ambulance transport or emergency department care? ibid 2002;6:383-6.

Richards JR, Ferrall SJ. Triage ability of emergency medical services providers and patient disposition: a prospective study. Prehosp Disaster Med 1999;14:174-9.

Meisel ZF, Mathew R, Wydro GC, et al. Multicenter validation of the Philadelphia EMS admission rule (PEAR) to predict hospital admission in adult patients using out-of-hospital data. Acad Emerg Med 2009;16:519-25.

Lang ES, Spaite DW, Oliver ZJ, et al. A national model for developing, implementing, and evaluating evidence-based guidelines for prehospital care. ibid 2012;19:201-9.