Table 4.

Triage, Prehospital Life Support and Damage Control, and Prehospital Process Statements that Did Not Achieve Consensus with SD >1.0 after Three Delphi Expert Rounds

Theme	Statements	Mean Score
Triage	1. Patients should be assigned a triage category, as defined by the first response agency, according to their condition after any life-saving interventions.	5.2
	2. Each first response agency should develop specific education, training, and competencies for their specific jurisdiction triage system.	5.8
	3. Each triage system should be based on the jurisdiction hazard vulnerability and risk analysis.	4.7
	4. The shock index may be used to guide life-saving and damage control interventions.	4.2
	5. The pulse pressure may be used to guide life-saving and damage control interventions.	3.9
	6. The heart rate variability may be used to guide life-saving and damage control interventions.	4.0
Prehospital Life Support and Damage Control	1. Each first response agency should develop crush injury incident recognition guidelines, education, and training to achieve and maintain competencies.	5.6
	2. Materials for crush injury resuscitation should be included on every medical first response vehicle.	5.2
	3. Each first response agency should develop life-threatening hemorrhage control guidelines, education, and training to achieve and maintain competencies.	6.6
	4. Each first response agency should develop life-threatening hemorrhage first provider/bystander training and education programs that interface with the first response agency.	5.7
	5. Each first response agency should develop CBRNE incident recognition, education, and training to achieve and maintain competencies.	5.7
	6. Each first response agency should develop CBRNE incident clinical guidelines, education, and training to achieve and maintain competencies.	5.1
	7. Each first response agency should develop an awareness of the need for specific CBRNE antidotes and to deliver these to the scene.	4.6
	8. When feasible, the medical first response agency should develop blood product use clinical guidelines, education, and training to achieve and maintain competencies and to deliver these to the scene.	4.9
	9. Each medical first agency should develop tranexamic acid (TXA) clinical guidelines, education, and training to achieve and maintain competencies.	5.8
	10. Each first response agency should develop mass hypothermia monitoring and treatment guidelines.	5.5
	11. First responders should only perform interventions within their scope of practice.	6.0
	12. Each first response agency should develop smoke inhalation education and training to achieve and maintain competencies.	5.7
	13. Each medical first response agency should develop clinical guidelines, education, and training to achieve and maintain competencies to treat the specific patient with hypotension due to hemorrhage and a declining level of consciousness without clear evidence of a head injury.	6.5
	14. Each medical first response agency should develop blunt and penetrating chest trauma education and training to achieve and maintain competencies.	6.3
	15. Deployable technology should employ evidence-based physiologic parameters and undergo clinical evaluation before utilization.	5.8
	16. Each medical first response agency should evaluate the use of the motor Glasgow Coma Score (mGCS) in certain clinical scenarios in preference to the total Glasgow Coma Score (tGCS).	4.1
	17. Each jurisdiction should utilize a patient consent process for interventions.	4.3
Prehospital Processes	1. Each jurisdiction should develop mass-casualty incident CBRNE decontamination guidelines.	6.0
	2. Each jurisdiction should define futility of care.	5.0
	3. Each jurisdiction should develop community response education and training to active shooter.	5.2
	4. Each jurisdiction should develop first responder plans, education training, and competencies for active shooter events.	5.4
	5. Where possible, a jurisdiction should apply telemedicine technology and processes to support the mass-casualty incident event response.	5.6

Abbreviation: CBRNE, Chemical, Biological, Radiological, Nuclear, and Explosives