Triage of road injury casualties - the role of bystanders: a scoping review

Background: Bystanders have the potential to be a critical component of the Road Injury Chain of Survival, particularly in the early phases of injury recognition, scene assessment, and emergency service activation. Their potential role in trauma triage remains underexplored. This scoping review aims to examine the existing evidence of the use of bystanders in triage—both laypersons and non-clinical professionals—during the prehospital phase of road injury and other trauma scenarios. Methods: A systematic search was undertaken across MEDLINE, CINAHL, and the Psychology & Behavioural Sciences Collection using the EBSCO Host platform, with supplementary hand searches via Google Scholar and reference screening. Articles were included if they addressed triage by lay or professional bystanders (e.g. police, fire and rescue) in prehospital trauma settings. Data were extracted and synthesised using a descriptive analytical approach. Results: Twenty-three studies were included. Bystanders demonstrated the ability to apply basic triage tools with moderate accuracy, although over-triage was common and under-triage rates often exceeded accepted thresholds. Several trauma training programmes in low-resource settings included triage components, leading to improvements in knowledge and confidence. Long-term retention and real-world clinical utility remain uncertain. Only one study directly evaluated bystander assessment of crash parameters; lay performance approached that of health professionals in some domains. Technological innovations such as video live-streaming from bystanders to emergency call handlers showed potential to enhance triage and situational awareness, though operational and ethical barriers remain. Conclusions: Bystanders may have an expanded role in the triage and early assessment of trauma casualties, particularly in settings where formal EMS is limited or delayed. Within the Road Injury Chain of Survival, empowering bystanders through structured training and technology-enabled support could strengthen early links in the chain. Future research should focus on validating simplified triage approaches, evaluating training impact, and assessing outcomes related to both patient care and system efficiency.