Summary Precise prehospital trauma triage criteria are critical for ensuring patients with severe injuries are transported to trauma centres. Most prehospital trauma triage criteria adopt a combination of physiological, anatomic and mechanism of injury components, but this approach still fails to identify a number of patients with severe injuries and often burdens trauma centres with patients suffering minor injuries. Paramedic judgement has been identified as an alternative method for the triage of trauma patients. This study critically reviewed the literature regarding the ability of paramedics to predict injury severity, and found there is no clear evidence supporting paramedic judgement as an accurate triage method. However, the studies were limited due to significant data losses, variable definitions of major trauma, differences across EMS and trauma care systems, variable paramedic experience levels and incomparable methods of data collection. The role of paramedic judgement in identifying patients with severe blunt anatomic injuries requires further investigation.

To determine whether exercise modality affects arterial hypoxemia (EIAH) during training-intensity exercise, 13 triathletes performed 20 min of cycling (C) followed by 20 min of running (R): C-R, and two weeks later, 20 min of R followed by 20 min of C: R-C. Each trial was performed at an intensity slightly above the ventilatory threshold and close to the daily training intensity (75 % of V·O2max). Ventilatory data were collected continuously using an automated breath-by-breath system. Partial pressure of oxygen in arterial blood (PaO2) was measured after each C and R segment and arterial oxyhemoglobin saturation (SpO2) was monitored continuously via pulse oximetry. The metabolic rate was similar across modalities and trials, i.e., C-R (53.8 ± 3.8 vs. 51.1 ± 5.3 ml · min-1 · kg-1) and R-C (52.2 ± 4.5 vs. 53.2 ± 4.6 ml · min-1 · kg-1). EIAH showed significantly greater severity for R compared to C irrespective of the order (p < 0.05 for both trials). R values of PaO2 (and SpO2) for C-R and R-C were 88.7 ± 6.0 mm Hg (93.0 ± 0.6 % SpO2) and 86.6 ± 7.3 mm Hg (93.5 ± 0.6 % SpO2) and C values were 93.7 ± 8.4 mm Hg (95.4 ± 0.4 % SpO2) and 91.4 ± 5.4 mm Hg (94.8 ± 0.3 % SpO2). R ventilatory data described a significantly different breathing pattern than C, with higher respiratory rate (35.9 b · min-1 vs. 51.1 b · min-1 for C-R, p < 0.01; and 50.0 b · min-1 vs. 41.5 b · min-1 for R-C, p < 0.01) and lower tidal volume (2636 ml vs. 2282 ml for C-R, p < 0.02 and 2272 ml vs. 2472 ml for R-C, p < 0.05). We concluded that EIAH was greater during running than cycling for a similar metabolic rate corresponding to training intensity and that EIAH could thus be considered dependent on exercise modality.