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Objectives
Reconfiguration of emergency services could lead to patients with life‐threatening conditions travelling longer distances to hospital. Concerns have been raised that this could increase the risk of death. We aimed to determine whether distance to hospital was associated with mortality in patients with life‐threatening emergencies.Methods
We undertook an observational cohort study of 10 315 cases transported with a potentially life‐threatening condition (excluding cardiac arrests) by four English ambulance services to associated acute hospitals, to determine whether distance to hospital was associated with mortality, after adjustment for age, sex, clinical category and illness severity.Results
Straight‐line ambulance journey distances ranged from 0 to 58 km with a median of 5 km, and 644 patients died (6.2%). Increased distance was associated with increased risk of death (odds ratio 1.02 per kilometre; 95% CI 1.01 to 1.03; p<0.001). This association was not changed by adjustment for confounding by age, sex, clinical category or illness severity. Patients with respiratory emergencies showed the greatest association between distance and mortality.Conclusion
Increased journey distance to hospital appears to be associated with increased risk of mortality. Our data suggest that a 10‐km increase in straight‐line distance is associated with around a 1% absolute increase in mortality. 相似文献Methods: We simulated an MCI, including 15 patients plus 4 hazards, on a college campus. A UAV surveyed the scene, capturing video of all patients, hazards, surrounding buildings and streets. We invited attendees of a provincial paramedic meeting to participate. Participants received a lecture on Sort-Assess-Lifesaving Interventions-Treatment/Transport (SALT) Triage and MCI scene management principles. Next, they watched the UAV video footage. We directed participants to sort patients according to SALT Triage Step One, identify injuries, and to localize the patients within the campus. Additionally, we asked them to select a start point for SALT Triage Step Two, identify and locate hazards, and designate locations for an Incident Command Post, Treatment Area, Transport Area and Access/Egress routes. The primary outcome was the number of correctly allocated triage scores.
Results: Ninety-six individuals participated. Mean age was 35 years (SD 11); 46% (44) were female and 49% (47) were Primary Care Paramedics. Most participants (79; 82%) correctly sorted at least 12 of 15 patients. Increased age was associated with decreased triage accuracy [?0.04(?0.07, ?0.01); p?=?0.031]. Fifty-two (54%) correctly localized 12 or more patients to a 27?×?20m grid area. Advanced paramedic certification, and local residency were associated with improved patient localization [2.47(0.23,4.72); p?=?0.031], [3.36(1.10,5.61); p?=?0.004]. The majority of participants (70; 81%) chose an acceptable location to start SALT Triage Step Two and 75 (78%) identified at least 3 of 4 hazards. Approximately half (53; 56%) of participants appropriately designated 4 or more of 5 key operational areas.
Conclusion: This study demonstrates the ability of UAV technology to remotely facilitate the scene size-up in an MCI. Additional research is required to further investigate optimal strategies to deploy UAVs in this context. 相似文献
Methods: Retrospective, cohort analysis comparing rates of hospital complications (ventricular fibrillation or tachycardia, shock, atrial arrhythmia or bradyarrhythmia with systolic blood pressure 90 mm Hg, pulmonary edema) or interventions among patients with a final hospital diagnosis of AMI and an initially negative vs positive ECG. A negative ECG was normal or had nonspecific ST–segment and/or T–wave abnormalities (upright, flattened T waves; an isolated inverted T wave; ST depression <0.1 mV; tall T waves with J–point elevation) or minor nonischemic abnormalities. Sample size was adequate to detect a 30% between–group difference in complication rates [α = 0.05, 1 —- β (power) = 0.80].
Results: The 27 negative–ECG AMI patients differed from the 38 control patients in (mean X SD) age [57 X 12 vs 66 X 12 years, p < 0.01] but not in gender or history of AMI. The negative– and positive–ECG groups had similar rates of hospital complications [30% (95% CI: 13–47%) vs 42% (95% CI: 26–58%), p = 0.44] and intensive procedures [19% (95% CI: 4–34%) vs 29% (95% CI: 15–43%), p = 0.50], respectively. The negative–ECG patients with hospital complications had ECG evolution precede the event in 83% (95% CI: 69–97%) of cases; persistently negative–ECG patients had no complication [(95% CI: 0–33%), p = 0.06].
Conclusions: Negative– and positive–ECG AMI patients do not have moderate or large differences in the rates of in–hospital complications. Most negative–ECG patients who suffer complications evolve ECG changes prior to the event and such changes indicate the potential need for a higher level of care. 相似文献