Designing a Guideline for Emergency Medical Communication Center Staff to Help Road Traffic Crash Patients: A Delphi Study

Document Type : Original Article


1 Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Health in Emergencies and Disasters, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Epidemiologist at Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Professor, Departments of Emergency Medicine and of Epidemiology and Public Health, University of Maryland School of Medicine, USA

5 Evidence-Based Caring Research Center, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

6 Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran


Background: Injuries and deaths from RTC are critical health problems of societies and one of the main causes of death especially among the young.
Objective: This study aimed to design and compile a guideline for emergency medical communication centers (EMCC) staff to provide direct assistance offered by road traffic crash (RTC) bystanders.
Methods: Based on prior literature, the RTC bystanders' initial draft guideline contained 20 domains and 28 items. As a validation step, the draft guideline was reviewed by content experts (one emergency medicine and two disaster specialists) and modified based on their recommendations. The subsequent draft guideline was then reviewed in three Delphi rounds by 67 participants, including health professionals in emergencies and disasters, emergency medicine, nurses, emergency medical experts, and EMCC staff. The accepted agreement coefficient was set at ≥70%. As the final step, an expert consensus meeting was held to review the guideline.
Results: The participants agreed on 56 items regarding 20 domains, including scene safety, hand precautions, and personal protection, alertness assessment, respiration, cardiopulmonary resuscitation (CPR), bleeding control, recovery position, splinting, rapid evacuation, scene management, patient transfer, triage, spinal cord injury prevention and immobilization, injured transportation, psychological support, hypothermia prevention, water and food, amputated limb protection, and support of deceased people. Two items in relation to airway opening maneuvers were added to the guideline during the expert consensus meeting.
Conclusion: Compared to other RTC bystander guidelines for EMCC staff, more comprehensive guidelines can be served as a basis for directing RTC bystanders to provide assistance. Important areas of hand care and personal protection, breathing, airway, splinting, scene management, mental and psychological support, and support of deceased people were included in this guideline. EMCC staff can provide guidance to be performed by RTC bystanders. RTC bystanders can play important roles at crash scenes, including preventing secondary injury, supporting scene management, and providing first aid for the injured people. This guideline can be used to help direct appropriate care and behavior by RTC bystanders.


Volume 26, Issue 1
January and February 2021
Pages 41-51
  • Receive Date: 28 September 2020
  • Revise Date: 01 January 2021
  • Accept Date: 18 February 2021