Background Evidence suggests that patients with traumatic brain injury (TBI) benefit from treatment at specialised neurotrauma centres, emphasising the importance of accurate identification in prehospital care. A practical need exists to evaluate prehospital providers’ perspectives in order to introduce new measures to enhance triage decisions, such as brain biomarkers, near-infrared spectroscopy and decision aids. This study explored the current challenges ambulance personnel face when triaging patients with suspected TBI and their perceptions of the facilitators and barriers to adopting new decision aids to enhance TBI diagnosis in the prehospital environment.

Methods Twenty semi-structured interviews were conducted remotely between June 2022 and December 2022 with prehospital clinicians of varying levels of experience across the UK. Participants were recruited in collaboration with the research lead of each UK NHS ambulance trust. The interview topic guide was developed a priori and piloted. Interviews were audio recorded, transcribed verbatim, and analysed using a hybrid process of deductive and inductive thematic analysis.

Results Four themes and fifteen subthemes emerged, as follows. The first theme related to specific triage challenges: elderly patients; differentiating TBI from other conditions; identifying mild to moderate TBI; and using the current triage tools. The second theme related to potential areas for improvement: education and training; specific TBI triage criteria; elderly triage criteria and new diagnostic tools. Third, there were barriers to using new innovations: training and financial aspects; on-scene time; and application and distribution concerns. The fourth theme was facilitators: effective implementation strategies; in-depth and practical training to instil confidence in paramedics; evidence of accuracy, cost-effectiveness and feasibility of implementation; and guidelines for selecting patients for testing and guiding care.

Conclusion Enhancing personal training and education, assessing the feasibility of introducing new diagnostic tools, and developing evidence-based triage tools may improve prehospital triage for patients with suspected TBI.