Defining Research Criteria to Characterize Medical Necessity in Emergency Medical Services: A Consensus among Experts at the Neely Conference

N. Clay Mann, Terri A. Schmidt, David C. Cone

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Objective. Researchers interested in ensuring appropriate use of emergency medical services (EMS) resources have attempted to define safe and effective protocols for triage either at the time of dispatch or after on-scene evaluation. Published work in this area is difficult to evaluate because protocols and outcome criteria vary from study to study. The goal of the Neely Conference was to bring together EMS experts to define a set of criteria to be used in research studies evaluating dispatch triage and field triage systems. Methods. Thirty-one experts in EMS systems and research attended a day-long workshop to assess the current literature regarding dispatch triage and field triage, and make recommendations to standardize methods used to evaluate future triage protocols. Participants were surveyed during the workshop; consensus analysis techniques were used to determine if a formal consensus was reached. A Bayesian posterior probability of 0.99 was required to consider responses a "consensus." Results. Participants considered current evidence regarding the usefulness of EMS triage criteria to be "weak." However, respondents agreed on a set of research criteria that could define the need for an EMS response and/or EMS transport. Field triage criteria were considered more plausible than dispatch criteria. Valid outcome criteria for assessing the effectiveness of triage protocols included ED assessment and the need for immediate surgery. Hospital admission, final diagnosis, and expert opinion were not considered adequate outcome measures. Conclusion. EMS experts agreed on a standard set of triage criteria and outcome measures for evaluating triage protocols supporting alternative forms of transport and care.

Original languageEnglish (US)
Pages (from-to)138-153
Number of pages16
JournalPrehospital Emergency Care
Issue number2
StatePublished - 2004


  • Consensus
  • Emergency medical services
  • Expert opinion
  • Medical necessity

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency


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