Use of the emergency ambulance service to an inner city accident and emergency department--a comparison of general practitioner and ''999'' calls.

Over a 2-week period a prospective study was undertaken of patients brought to an inner city accident and emergency department by the emergency ambulance service. Criteria for assessing the appropriateness of use of the emergency ambulance service are not well defined and at worst entirely subjective. The author's finding that, of patients attending after a '999' call, 49.8% were discharged with no follow-up suggests that many of these journeys represented inappropriate use of the emergency ambulance service. Close liaison between senior medical staff and the emergency ambulance service may allow more appropriate and effective use of the service, improving patient care in the pre-hospital setting.     

院前急救医师配置缺口的测算方法和结果——以上海为例

本文研制院前急救医师配置缺口的测算方法并对上海市的急救医师配置缺口进行测算。以减少迟缓派车现象为目标,通过分析上海市市区近两年的迟缓派车数据来获得上海市市区急救医师缺口的数量,并推广至整个上海市。课题组研制出了峰值法,该方法建立了急救医师增量与减少迟缓派车次数的数量关联。峰值法采用描述统计方法,运用SAS软件编程对原始数据进行分析,具有良好的信度和效度。课题组使用峰值法对上海市2013年、2014年的迟缓派车数据进行分析,结果发现增加40辆值班车次(381名急救医师)可将迟缓派车率从25.61%降至0.22%。建立了增加急救医师与减少迟缓派车次数的数量关联,为决策提供了科学依据。     

加强急诊"三环理论"的实践体会

目的 探讨急诊"三环理论"在急危重症的抢救、突发公共卫生事件的处置及人才培养等方面的优势.方法回顾分析我院急诊科自2005以来的院前急救、急诊抢救、急诊ICU等环节的临床资料及急诊医生培养情况.结果 急诊科布局合理,急诊绿色通道通畅快捷.120出诊平均在接诊后5～10分钟内到达现场,抢救成功率87.34%,抢救后的危重患者在转运途中无死亡;院内急诊抢救成功率95.25%,急诊ICU救治成功率95.69%,无手术死亡.结论 按照急诊三环理论建设急诊医疗服务体系,可以实现院前急救体系、院内急诊体系和重症监护治疗体系无缝衔接,有利于提高危重病抢救成功率和处置公共卫生事件的能力,有利于培养急诊医学队伍.有针对性的人员排班和与其他科室的良好协调能进一步保障危重病患者的抢救.     

“120”出诊救护车资源使用合理性分析

  目的  分析救护车急救患者的非必须救治和必须救治情况以及急救车资源使用的合理性，以期为救护资源的合理使用提供科学依据。
  方法  救护车到达现场后，急救医生和护士根据现场情况，将2019年11月沈阳市内五个行政区的"120"急救车接诊的10 617名患者分为两组，即非必须救治组患者和必须救治组患者，并对两组人员的各类特征进行比较。
  结果  患者男性5 134例（占48.3%），女性5 483例（占51.6%），36.8%的患者（3 902名）为非必须救治患者，沈河区的"非必须救治"患者比例最高（46.7%）。非必须救治组男性患者比例高于必须救治组（P < 0.01）。在时间分组上，08:01-17:00接听到"120"电话的量最多，08:01-17:00非必须救治患者占比最多，00:01-08:00非必须救治患者占比最少（P < 0.01）。必须救治和非必须救治组在各个年龄段中的分布差异有统计学意义（P < 0.01），18岁以下非必须救治患者占比最高，41~65岁占比最少。在院患者由其医护人员拨打"120"电话者中，只有64%被急救人员评估为"必须救治"，患者本人和家庭成员拨打电话送来的非必须救治患者占比最多，接近50.0%，而警察或路人打电话送来的非必须救治患者占比最少（P < 0.01）。主诉的患者中，有35.9%（1 718/4 780）不需要急救帮助。3 902例非必须救治患者中:只有一小部分（4.1%）被认为处于紧急状态但没有生命危险；既不威胁生命也不紧急的患者最多（占85.0%）。不需要紧急医疗帮助的患者中，55.0%的患者能够自行驾车或乘坐出租车到达医院就诊，由医务人员拨打"120"急救电话但并不需要急救车服务的患者中，有90.0%也仅仅需要一辆能够平躺下的车即可。
  结论  沈阳市内院前急救接诊患者中有很大比例的患者并不需要用救护车接诊。医护人员在院前缺乏针对患者的有效评估，影响了急救资源使用的合理性。建议院前急救管理部门为使用救护车服务制定明确的标准，以保证患者的安全，更加合理地利用急救资源。
     

院前急救护理中潜在的安全隐患及应对措施

目的本研究主要就院前急救护理中潜在的安全隐患以及应对措施展开分析讨论。方法选择该院2010年1月—2012年1月所接到的急救电话资料作为研究对象,对其急救护理的相关资料进行回顾性分析。结果 2011年,该院护士在综合水平的提升方面明显优于2010年,患者的满意度有了明显的提升,救护车的出车时间也明显缩短,它们之间的差异具有统计学意义,P<0.01。结论为了提高院前急救护理的质量,医院就必提高120的接听应急能力,须强化人员配备、加强急救护理人员的专业技能培训,在急救前做好充分的准备工作,这样不仅可以缩短救护车的出车时间,而且还可以提高院前抢救的成功率。     

ECHO: the Western Australian Emergency Care Hospitalisation and Outcome linked data project

OBJECTIVE: To describe and assess the quality of the data resources linked for the Western Australian Emergency Care Hospitalisation and Outcome (ECHO) project. METHODS: The ECHO project links electronic records from the WA Emergency Department Information System to the St John Ambulance Service Pre-Hospital Care Database, the WA Hospital Morbidity Data System and the WA Mortality Database. Linkages are created using standard probabilistic matching techniques with extensive clerical review. Commencing with all metropolitan Perth public emergency departments from July 2000, these linkages will be updated annually for at least five successive years. The proportion of actual linkages between emergency department records and ambulance, admission and death records was assessed in comparison to expected linkage rates. RESULTS: Of 578,200 total emergency department records, there were 144,897 emergency presentations recorded as arriving by ambulance, of which 135,332 (93.4%) were linked to an ambulance record pertaining to the same episode. Of the 165,650 presentations recorded as admitted, 162,216 (97.9%) were linked to a hospital morbidity record relating to the same episode. Furthermore, 96.2% of the 2,084 cases recorded as 'dead on arrival' and 98.9% of the 624 cases recorded as 'died in emergency' were linked to a corresponding death record. CONCLUSIONS: Linkage quality consistent with international standards has been achieved, resulting in an information infrastructure capable of supporting an extensive research agenda focusing on the interaction and outcomes of both pre-hospital and within-hospital emergency medical care services.     

创伤失血性休克病人196例院前和院内的急救护理

目的探讨创伤失血性休克病人院前和院内的急救护理。方法回顾性分析广州市第十二人民医院2002年1月-2007年12月由120送来的196例病人院前和院内急救护理情况。结果经急诊抢救后52例送ICU进一步治疗,68例病情稳定后送手术室实施必要的手术,74例抢救稳定后送普外科进一步保守治疗,2例院前死亡,8例因重度休克时间过长,ICU抢救无效死亡。结论正确、及时、有效的救护是抢救成功的重要保证。     

Variations in the provision of extended-trained ambulance personnel within the Welsh ambulance services

This paper describes the distribution of extended-trained ambulance personnel within the nine Welsh Ambulance Services. While over a quarter of all emergency ambulance crews possess some extended skills, there is a wide variation in their distribution and protocols of treatment. Increasing numbers of ambulance personnel will receive such training in the future, leading to improved standards of pre-hospital care. To justify the use of such skills in terms of clinical outcome and expenditure, the ambulance services must provide accurate data to allow subsequent audit of pre-hospital clinical practice. It is therefore essential that the medical profession becomes aware of these developments and participates in advising, assessing and training extended-trained ambulance personnel.     

综合性医院急诊收住院患者流行病学研究

目的研究综合性医院急诊收住院患者流行病学特点.方法采用前瞻性资料收集的方法,对2003年1月1日至2003年12月31日间我院急诊并收住院患者的性别、年龄、收住院时间、就诊方式、住院科别或系统、急诊诊断或主诉等项目进行调查统计分析.结果全年有10 221例急诊收住院患者,占全年急诊科实际来诊患者的17.39%.收入院患者中男女比例为1.63:1.高发年龄组为20～29岁、30～39岁2个组.每天11:00～14:00、19:00～23:00两个时间段出现急诊收住院高峰,分别占全天急诊收住院病人的20.65%、23.38%.利用出租车或小车来诊者占49.61%,利用市"120'"急救中心或医院救护车来诊者占38.83%.收住院者以外科系统最多,其次为内科系统,第三为儿科.创伤、消化系统疾病、心血管系统疾病、神经系统疾病是急诊收住院病人的前4位系统或大类疾病.前5位具体疾病谱为四肢或身体未特指部位损伤、颅脑损伤、冠心病心绞痛或心梗、脑梗塞、高血压病或高血压急症.创伤占外科急诊收住院病人的81.13%.由其他医院转诊的占29.27%.结论急诊病人是医院住院病人的主要来源;要加强对男性的健康宣教和医疗保健工作,提高医疗质量;要根据急诊收住院病人高峰时间科学合理安排病房和急诊科工作;要重视院前急救与转运工作;系统大类疾病和疾病谱的排序对医院各学科建设有重要参考价值.     

基于无线3G网络的120院前急救系统研究

目的:针对国内院前急救的发展现状和不足,提出一种基于无线3G网络的120院前急救系统的解决方法.方法:利用无线3G网络通信技术,建立救护车、接诊医院与远端专家之间的信息通路,实现实时音视频和生命体征信息的传输.结果:该系统实现了远程救护指导、抢救方案的提前制订及接诊的准备,从而缩短了患者的救治时延,提高了患者的救治率,减少了医疗纠纷.结论:基于无线3G网络的120院前急救系统是可行的,并将在提高院前急救和转运水平、提高患者的救治率、节约急救资源、减少医疗纠纷等方面发挥更积极的作用.     

Study to examine the timeliness of care received by patients with open fractures of the lower limb.

The aim of this study was to identify deficiencies in the timeliness of emergency care received by patients with open fracture of the lower limb treated in the Accident and Emergency department at the City Hospital Truro, to help decide whether further investments in emergency ambulance services are warranted and, if so, where specific investments should be made. The ambulance service 'response time', 'on-scene times' and 'mission times', and the 'time to operation after attendance in casualty' were considered. The major deficiency in care identified was the long in-hospital delay before operation, probably resulting from unavailability of operating theatre staff. A lesser deficiency was that ambulance crew seemed to be spending too long on-scene. Suggestions are made on how to identify weaknesses in emergency service, and thus prevent costly and inappropriate investments.     

医院急诊临床信息系统建设方案设计与研究

目的:设计并构建急诊临床信息系统,实现对医疗服务和医疗设备的精细化管理.方法:采用浏览器和服务器(B/S)架构,以Java语言为开发工具设计急诊临床信息系统.系统支持主流数据库系统Oracle 10g或以上版本,连接有输出协议及接口的监护仪、臂式血压计设备,具有完成体征数据自动采集的功能.结果:所构建的急诊临床信息系统...     

北京远郊区县卒中患者院前转运与延误现状调查

目的通过北京卒中登记数据库（BSR）研究,探讨北京远郊区县卒中患者院前延误状况。方法将北京10个远郊区县10家医院作为北京卒中登记数据库研究协作中心。采用专家制订的北京卒中登记数据库,内容包括患者的一般人口学信息、院前卒中急救信息、院前院内关键延误时间、卒中亚型、卒中评价和治疗信息、溶栓信息等。由接受统一培训的神经科医生采用网络直报的形式进行登记。结果共有1095名合格的卒中患者进入登记数据库;卒中登记患者付费方式均以新农合为主,平均为53．6％;出租车仍为首选转运方式,占全部转运方式的38．7％,昌平区高达67．6％。使用EMS的比例前4个区县为：平谷（37．4％）、大兴（36．2％）、顺义（30．6％）、房山（21．7％）,其中,平谷以急救中心转运为主。通过EMS途径到院时间小于2小时的比例为40．7％,显著高于其他途径到院患者（X2=54．746,P〈0．001）。结论自行转运卒中患者仍为北京卒中患者院前主要的转运方式;使用EMS方式转运患者的就诊延误小于其他方式;应加强公众教育,提高EMS转运比例。     

Prehospital and hospital delays after stroke onset--United States, 2005-2006

Each year approximately 700,000 persons in the United States have a new or recurrent stroke; of these persons, 15%-30% become permanently disabled, and 20% require institutionalization during the first 3 months after the stroke. The severity of stroke-related disability can be reduced if timely and appropriate treatment is received. Patients with ischemic stroke may be eligible for treatment with intravenous thrombolytic (i.e., tissue plasminogen activator [t-PA]) therapy within 3 hours of symptom onset. Receipt of this treatment usually requires patients to recognize stroke symptoms and receive prompt transport to a hospital emergency department (ED), where timely evaluation and brain imaging (i.e., computed tomography or magnetic resonance imaging) can take place. For patients eligible for t-PA, evidence suggests that the earlier patients are treated after the onset of symptoms the greater the likelihood of a more favorable outcome. In 2001, Congress established the Paul Coverdell National Acute Stroke Registry to measure and track the quality of care provided to acute stroke patients. To assess prehospital delays from onset of stroke symptoms to ED arrival and hospital delays from ED arrival to receipt of brain imaging, CDC analyzed data from the four states participating in the national stroke registry. The results of that analysis indicated that fewer than half (48.0%) of stroke patients for whom onset data were available arrived at the ED within 2 hours of symptom onset, and prehospital delays were shorter for persons transported to the ED by ambulance (i.e., emergency medical services) than for persons who did not receive ambulance transport. The interval between ED arrival and brain imaging also was significantly reduced for those arriving by ambulance. More extensive public education is needed regarding early recognition of stroke and the urgency of telephoning 9-1-1 to receive ambulance transport. Shortening prehospital and hospital delays will increase the proportion of ischemic stroke patients who are eligible to receive t-PA therapy and reduce their risk for severe disability from stroke.     

高血压脑出血患者院前急救与护理干预

目的探讨院前急救对成功救治高血压脑出血患者的重要性。方法对2013年1—12月汕头大学医学院第一附属医院收治的93例高血压脑出血患者进行回顾性分析,将其分为院前急救的观察组和未经院前急救的对照组进行对照分析。结果脑出血患者经过院前急救的病死率明显低于未经院前急救的。结论积极有效的院前急救与护理干预能明显缩短转运时间、提高抢救成功率、降低并发症、减少伤残率,已成为急诊医疗体系的重要组成部分。     

自主型模式急诊科的功能与管理

目的探讨自主型模式急诊科的功能和管理.方法回顾性分析我院急救中心2002年1月至2003年12月的临床资料,急诊出车3 284次,急诊门诊接诊48 350例次,急诊抢救660例,收住急诊病房1896例,收住其它专科病房3 998例,急诊病房住院病人手术592例,其中危重病人手术54例.结果距医院5公里以内的出诊,10分钟以内可到达现场,经现场急救后,转运途中无死亡,急诊抢救成功率92%;一般手术无死亡,危重病手术死亡7例,死亡率13%.结论自主型模式急诊科集院前急救、院内急救、确定性急诊手术、重症监护治疗为一体,有利于急救程序的管理,明显提高了危重病抢救成功率,同时也培养和发展了一支急诊医学队伍.     

Integration of telemedicine into emergency medical services

We developed an integrated model of telemedicine services in emergency medical care. The architecture was designed to support pre-hospital management. The experimental work was carried out with the collaboration of the emergency medical services (EMS) in Madrid. Two different study populations were defined: a control population using conventional EMS protocols and a population using the telemedicine system. The telemedicine system was based on a telepresence service; electrocardiograms and images were transmitted from the ambulance to the health emergency coordination centre. The cost of dealing with 100 patients using telemedicine was C6030 less than the cost of conventional care. The response times using telemedicine were significantly lower.     

严重多发创伤患者的院前急救及护理措施

目的：探讨严重多发创伤病人的院前急救及护理体会,以提高其院前抢救成功率。方法：回顾45例多发性创伤患者院前急救的临床资料,进行统计分析并总结出处理对策及护理体会。结果：45例病人均成功转送入院,无1例院前死亡。结论：快速有效的急救和护理措施,可以降低多发性创伤的院前病死率。     

急性颅脑损伤患者院前急救护理的效果观察

目的：探讨急性颅脑损伤患者院前急救护理的效果。方法：选择2008年6月-2010年11月期间,诸暨市中医院收治的急性颅脑损伤患者104例,随机分成干预组和对照组各52例,对照组患者不采用院前急救,直接迅速送往医院进行救治。干预组则采用院前急救护理干预。对两组患者临床疗效及ADL分级进行比较分析。结果：与对照组患者相比,采用院前急救护理的干预组患者的首次救治时间明显降低,生存率明显提高,死亡率明显下降,差异均具有统计学意义（P〈0．05）。与此同时,与对照组患者相比,采用院前急救护理的干预组患者ADL分级为Ⅰ级、Ⅱ级和Ⅲ级的比例明显提高,而Ⅳ级和Ⅴ级的比例明显下降,差异亦具有统计学意义（P〈0．05）。结论：对急性颅脑损伤患者采取及时有效的院前急救护理能够提高患者的生存率,能更有效地提高治疗效果,具有十分重要的临床应用价值。