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Table 1 Description of triggers and categories in the trigger tool. For full instrument see Patterson et al. (28)

From: Patient safety and patient assessment in pre-hospital care: a study protocol

Triggers (11)
Documentation triggers
 1. Missing, incomplete, or unclear documentation for the following: chief complaint, physical assessment, vital signs, haemodynamic monitoring, allergies, pertinent history or medications, patient condition at handoff.
Operational & patient movement triggers
 2. Time from initial patient contact to transfer of care exceeds accepted standards.
 3. Injury to patient or team member during patient encounter/transport.
 4. Request for additional resources, personnel, or supervisor due to change in patient condition.
Patient condition triggers
 5. A worsening trend in patient haemodynamic or mental status indicators.
 6. Cardiac arrest during transport.
Intervention & medication triggers
 7. Use of any of the following interventions during patient care: cardioversion, defibrillation, transcutaneous pacing, advanced airway attempt, surgical airway, intraosseous (IO), chest decompression, chest tube.
 8. Failure of any intervention or procedure during patient care.
 9. Use of following medications or fluids: blood products, vasopressors, inotrope, naloxone.
 10. Evidence of deviation from standard of care by performing an intervention or administering a medication that appears to be outside protocol or failure to perform an intervention or provide a medication that is within the standard of care.
 11. Medication error.
Categories (5)
 1. Actions By Patient: The adverse event was the result of action(s) by the patient.
 2. Actions By Provider: The adverse event was the result of action(s) or inaction(s) by the crew.
 3. Medical or Vehicle Equipment: Failure of the equipment, failure to troubleshoot and correct common problems with the equipment, or failure to remove defective equipment from service.
 4. Environmental/Scene Factors: Factors that may result from weather conditions or factors on the ground/scene (or other). This includes temperature, light and scene safety.
 5. Undetermined by Chart Review: The proximal cause of the adverse events (regardless of severity) cannot be determined by the information available in the chart.
Classification (3)
 1. No adverse events
 2. Adverse event present – potential for harm
 3. Adverse event – harm identified