6927例院前急救的流行病学分析对院前急救管理的启示

总结了2006年1月～2008年12月院前急救的流行病学特点,包括急救出车次数、呼救原因、院前死亡、日均院前急救次数、急救反应时间,以及空诊率等。认为为了提高院前急救水平,应从院前急救的流行病学特征出发,根据出车呼叫的高峰时段,合理配置人力资源;有针对性地加强院前急救人员的急救知识和技能培训,提高院前急救成功率,减少院前死亡率。     

广州市番禺区120院前急救救护车空返现状分析及对策

目的:对广州市番禺区院前急救空返现状的调查,探讨降低空返率措施,提高院前急救效率。方法:从番禺120急救系统派车数据库中导出2016年1月至2017年12月所有120急救网络医院的院前急救数据,包括调度出车次数、空返次数、空返原因、空返病种,计算空返率并进行分析。结果:2016-2017年我区空返率分别为16.38%、20.45%。2016年空返原因前三位是来电取消、病人自送、无人接应,2017年空返原因前三位是病人不去、来电取消、车到人走。我区空返病种2016年及2017年前三位均是车祸、晕厥、外伤。结论:我区院前急救空返率较高,造成了急救资源的浪费,影响急救医疗质量。可通过通过政府部门、卫生医疗机构不断完善急救网络体系,加强社会广大群众的急救知识普及等措施来降低空返率。     

院前急救1241次分析

目的:探讨综合性医院院前急救面临的问题和对策。方法:统计分析本科2006年7月1日至2007年6月30日院前急救次数以及空车率、呼救原因、现场施救措施以及复苏成功率、备车时间、路程耗时、呼叫-施救间期、院前急救收入和欠费情况。结果:院前急救出诊任务1241次,实际急救1023人,空车返回125次,空车率为10.07%;呼救原因前三位是创伤、心脑血管急症、急性中毒,占实际的71.85%;其中仅需转运服务占22.09%(226例);现场心肺复苏61例,成功5例,成功率仅为8.20%;平均呼叫-施救间期11.2±4.3min;有12.65%的院前急救任务无法收到应得费用约占应得收入的5%。结论:区分一般帮助和紧急医疗救护有利于合理使用现有急诊医疗资源,大力普及急救知识和技能是提高心肺复苏效果和抢救成功率的根本途径,进一步探索和完善急诊医疗补偿机制对提高院前急救质量和促进急诊医学发展有重要意义。     

失效模式和效应分析在缩短院前急救出车时间中的应用

目的:运用失效模式与效应分析(FMEA)对院前急救出车流程进行改进,以缩短院前急救出车时间。方法:根据FMEA方法,成立科室失效模式和效应分析小组,绘制院前急救出车流程,进行失效模式与潜在风险原因分析,计算优先风险指数(RPN),找出失效模式及相关原因,对需要优先解决的问题制订改进措施。结果:院前急救出车时间(指接受呼叫至救护车出诊时间)超过3 min的比例由实施FMEA模式管理前的33.2%下降到实施后的6.2%(P<0.05),院前急救出车时间潜在失效因素的风险优先指数(RPN值)由696.7降至49.4(P<0.05)。结论:将FMEA模式应用于院前急救出车流程管理,可缩短院前急救出车时间,提高院前急救出车效率。     

院前急救的临床特点与对策

目的:分析院前急救的时间、病种及院前处理情况,为进一步提高院前急救水平提供依据。方法:回顾性分析2004年6月～2005年5月间5016例出诊及院前急救病例的院前急救时间、呼叫病种构成及院前急救结果。结果:出诊记录共5121例,有效出车共5016例。其中男3326例,女1690例;院前急救时间集中在10～20min内(2048例占40.8%);呼叫原因主要为“车祸”(1284例占40.2%)及“昏厥”442例占24.5%);院前急救结果接回医院3677例(占73.3%),空车781例(占15.6%),现场处理356例(占4.0%)。结论:院前急救的主要病种是创伤,特别是交通伤,应缩短院前急救时间,加强院前创伤抢救的技术和完善急救设备,加强院前急救医护的全科医学知识的培训,从而提高院前急救抢救成功率。     

不同中心城区院前急救需求的分析

目的:识别院前急救不同行政区域人群的需求,为进一步提升院前急救服务质量提供依据.方法:采用回顾性横断面研究,收集2002年1月至2006年12月广州市中心城区呼叫120呼叫资料及数据进行分析.结果:广州市白云区的出车量显著性地多于其他中心城市区域(P<0.05);从2002年到2004年出车量和人口大小具有正性相关关系,其相关系数分别为0.92,0.98及0.87(P<0.01).结论:影响院前急救出车量的主要因素是人口因素和城市化扩展,政策制定者及护理服务提供者应更合理地分配资源以更好地满足人们的需要.     

加强院前急救护理管理对提高院前救护效果的影响

目的探讨加强院前急救护理管理对提高院前救护的效果。方法加强院前急救护理管理的内容包括加强护士院前急救专业培训,保证院前急救药品、设备的齐全及完好,规范现场急救和运送途中的急救制度等,比较加强院前急救护理管理前后院前救护效果。结果加强院前急救护理管理后院前急救呼叫出车反应时间和途中时间均较前缩短,急救成功率从90.2%上升到96.3%,加强管理前后比较,经统计学分析,均P0.05,差异具有统计学意义。结论加强院前急救护理管理能缩短院前急救时间,提高急救成功率。     

上海嘉定南翔地区839例院前急救与转运患者的疾病谱分析

目的了解上海嘉定南翔地区院前急救与转运患者的疾病谱。方法对839例院前急救与转运患者的性别、年龄、呼叫时间、急诊诊断或主诉、不同病种求治人数、院前死亡病种、出车情况等进行分析。结果院前急救与转运患者839例中,男女比为1.66∶1,平均年龄49.6岁;每天9∶00~12∶00和15∶00~18∶00为出诊高峰时间;院前急救疾病谱排序的前5位依次是:颅脑损伤、下肢外伤、脑血管意外、新生儿窒息、早产儿;院前死亡疾病谱排序依次是:交通伤、中毒、溺水等。结论提高院前急救水平对人类健康和学科建设有重大意义,可根据院前急救的疾病谱排序特征制定急救工作重点,急诊诊断或主诉,对指导急诊专业人员培训有意义。     

南昌急救中心急救待命点的空间设置及优化设想

<正>院前急救是急救医疗服务前沿阵地,随着城市的日益发展,急救待命点合理的空间设置是开展快速、及时、有效的抢救、转运工作和极大程度地减少伤亡的前提和基础~(〔1〕)。1国内外急救网络概况目前,国内外学者分别尝试以距离定半径、以时间定半径和以社区定半径布局急救网络,或实行区域急救建设区域性急救网络,并进行了相关研究。国外发达国家要求城市内接到急救呼叫后3min内出车,7min内到达出事地点。英国的急救     

中山市博爱医院老年患者院前急救流行病学分析

目的:通过分析我院老年患者院前急救的流行病学特点,为急诊科制定符合实际需求的急救医疗服务提供依据,以及提高老年人群患者院前急救的效率。方法:采用回顾性分析研究方法,对中山市博爱医院急诊科2015年7月至2018年7月院前急救共1354例老年患者的年龄、性别、疾病谱等指标进行描述性分析,对相对应的出车时间进行统计分析,从而得出相对应的自身特点。结果:本中心1354例老年患者中男女比例0.85∶1.0,平均年龄(72.0±8.5)岁。疾病谱排名前3位疾病依次为创伤、呼吸系统疾病与心脑血管疾病。出车时间统计结果显示5月至次7月,12月至次年2月为老年患者院前急救高峰期;一天中的急救高峰时段为12点至18点与0点至6点。结论:我院院前急救老年患者的情况具有自身特点,急诊科可据此合理配置急救资源,组织相关培训,重点提高创伤、呼吸系统与心血管疾病急症的现场救治能力。     

Prehospital response to respiratory distress by the public ambulance system in a Ukrainian city

BACKGROUND: The capability of the public ambulance system in Ukraine to address urgent medical complaints in a prehospital environment is unknown. Evaluation using reliable sources of patient data is needed to provide insight into current treatments and outcomes. METHODS: We obtained access to de-identified computer records from the emergency medical services (EMS) dispatch center in Poltava, a medium-sized city in central Ukraine. Covering a five-month period, we retrieved data for urgent calls with a patient complaint of respiratory distress. We evaluated ambulance response and treatment times, field diagnoses, and patient disposition, and analyzed factors related to fatal outcomes. RESULTS: Over the five-month period of the study, 2,029 urgent calls for respiratory distress were made to the Poltava EMS dispatch center. A physician-led ambulance typically responded within 10 minutes. Seventy-seven percent of patients were treated and released, twenty percent were taken to hospital, and three percent died in the prehospital phase. On univariate analysis, age over 60 and altered mental status at the time of the call were strongly associated with a fatal outcome. CONCLUSION: The EMS dispatch center in a medium-sized city in Ukraine has adequate organizational infrastructure to ensure that a physician-led public ambulance responds rapidly to complaints of respiratory distress. That EMS system was able to manage most patients without requiring hospital admission. However, a prehospital fatality rate of three percent suggests that further research is warranted to determine training, equipment, or procedural needs of the public ambulance system to manage urgent medical conditions.     

Prehospital Emergency Care in Shanghai: Present and Future

Background

In Shanghai, prehospital emergency medical services are provided by the public Ambulance Services. The 60th anniversary of the local Ambulance Services is a good opportunity to provide an overview of the current trends in prehospital emergency medical care in Shanghai.

Objectives

In this report, the features of Shanghai prehospital emergency medical care are described, as well as the Shanghai model of purely prehospital emergency medical care, including the communications and dispatch system, ambulance depots and ambulances, and prehospital rescue teams. Responses to major incidents including public health emergencies and natural disasters are also discussed, with the intention of highlighting future directions in emergency medical services, as well as the influence of international trends in emergency patient care.

Discussion

Although Shanghai has the most advanced dispatch system in China (equipped with a Global Positioning System, Global Information System, and more) and can be expanded quickly in case of mass casualty incidents, there is, as yet, no uniform Emergency Medical Service (EMS) dispatching for the entire city. Nor are there certifications, degrees, or special continuing education programs available for EMS dispatchers. Although there are more and more ambulance depots spread all over Shanghai, the city struggles with inadequate prehospital emergency caregivers, because every ambulance has to be staffed with a qualified Emergency Physician, and there are also recruitment problems for ambulance physicians.

Conclusions

Although faced with many challenges, substantial progress is expected in Shanghai prehospital emergency care.     

Vital signs records omissions on prehospital patient encounter forms

INTRODUCTION: A reported in-field, prospective evaluation of 227 prehospital patient assessments by advanced life support (ALS) emergency medical technicians (EMTs) found a frequent failure to measure vital signs. The objective of this retrospective review was to report the omission frequency of vital signs found in a centralized emergency medical services (EMS) data collection system. METHODS: The EMS database contained information from 90,480 optically scanned, prehospital patient encounter forms. Each record identified EMT skill levels, response times, dispatch type, vital signs, medical and trauma information, treatment, and patient disposition. Records for 1989 and 1990 were collected from 92 rural EMS providers who responded to emergency medical and trauma events. RESULTS: Of 90,480 emergency responses, 14,129 (15.6%) were false alarms, deceased, or canceled without vital patient contact. Valid encounters were documented for 76,351 (84.4%) patient contacts. Systolic blood pressure measurements were not recorded for 13,262 (17.4%) patients. Diastolic blood pressure was not recorded for 14,272 (18.7%) patients. A pulse record was not recorded for 12,125 (15.9%) patients. A ventilatory rate was absent in 12,958 (17.0%) patient records. CONCLUSION: This study found a frequent failure by non-metropolitan basic life support (BLS) and advanced life support (ALS) EMTs to record vital signs on prehospital emergency patient encounter forms. It supports a previous report of direct in-field observations of ALS EMTs failing to measure vital signs during patient assessment. The impact of vital sign omissions upon individual patient care can be assessed only by receiving medical control physicians. In the absence of effective emergency physician networking, the statewide magnitude of the problem among BLS and ALS EMTs has not been recognized as a system issue.     

Time Is Brain: Prehospital Emergency Medical Services Response Times for Suspected Stroke and Effects of Prehospital Interventions

ObjectivesTo compare prehospital time for patients with suspected stroke in Florida with the American Stroke Association (ASA) time benchmarks, and to investigate the effects of dispatch notification and stroke assessment scales on prehospital time.Patients and MethodsA retrospective analysis was performed using data from Florida’s Emergency Medical Services Tracking and Reporting System database. All patients with suspected stroke transported to a treatment center from January 1, 2018, through December 31, 2018, were analyzed. Time intervals from 911 call to hospital arrival were evaluated and compared with ASA benchmarks.ResultsIn 2018, 11,577 patients with suspected stroke were transported to a hospital (mean age, 71.5±15.7 years; 51.5% women). The median alarm-to-hospital time was 33.98 minutes (27.8 to 41.4), with a total emergency medical services (EMS) time of 32.30 minutes (26.5 to 39.478). The on-scene time was the largest time interval with a median of 13.28 minutes (10.0 to 17.4). Emergency medical services encounters met the ASA benchmarks for time in 58% to 62% of the EMS encounters in Florida (recommended 90%; P<.001). The total EMS time was reduced when a stroke notification was reported by the dispatch center (32.00 minutes vs 32.62 minutes; P=.006) or when a stroke assessment scale was used by the EMS personnel (31.88 minutes vs 32.96 minutes; P=.005).ConclusionThis study reveals a substantial opportunity for improvement in stroke care in Florida. Two prehospital EMS stroke interventions seem to reduce prehospital time for patients with suspected stroke. Adoption of these interventions might improve the stroke systems of care.     

Physician at the scene of an emergency

Growth and maturation in the delivery of prehospital emergency medical care has been dramatic in the past 15 years. The increased availability and use of emergency medical services (EMS) has led to more frequent interactions between providers of prehospital care and the medical practitioner. This paper reviews the training and capabilities of emergency medical personnel and introduces the issue of medical control at the scene of an emergency. Also presented are the basics of emergency scene and victim stabilization. Physicians can help improve prehospital care by becoming familiar with local EMS capabilities and personnel.     

Into the fray: integration of emergency medical services and special weapons and tactics (SWAT) teams

INTRODUCTION: The purpose of this study was to determine current experience and training of emergency medical support personnel for special weapons and tactics (SWAT) teams in North America. METHODS: This cross-sectional, epidemiologic survey was sent to SWAT unit commanders from the 200 largest metropolitan areas. Questions included basic demographics, specialized training of emergency medical services (EMS) personnel, and where such personnel are deployed during tactical operations. Unit commanders also were asked to estimate the number and type of injuries sustained during tactical operations and to list any recommendations to improve the EMS response. RESULTS: A total of 150 surveys was completed, for a response rate of 75%. The most common medical support (69%) was a civilian ambulance on standby at a predesignated location. Ninety-four percent of these prehospital care providers had no specialized training, and could not enter an area that was not secured tactically. Police officers with first aid or EMT training comprised the next largest group of medical support. Overall, 31% of SWAT commanders depended on remote EMS dispatch by radio to the scene when injuries occurred. Thirty-eight percent of respondents reported a significant injury had occurred during their tactical operations within the past 24 months. Common injuries included gunshot wounds, chemical exposure, and fractures. However, 78% (117/150) of respondents did not have a medical director, and 23% (35/150) of teams did not have an EMS preplan or protocol. CONCLUSION: The results suggest a need for established EMS protocols, medical direction, and specialized tactical medical training, especially in large metropolitan areas.     

Terrorism in France

France has experienced two waves of major terrorist bombings since 1980. In the first wave (1985-1986), eight bombings occurred in Paris, killing 13 and injuring 281. In the second wave (1995-1996), six bombings occurred in Paris and Lyon, killing 10 and injuring 262. Based on lessons learned during these events, France has developed and improved a sophisticated national system for prehospital emergency response to conventional terrorist attacks based on its national emergency medical services (EMS) system, Service d'Aide Medicale Urgente (SAMU). According to the national plan for the emergency medical response to mass-casualty events (White Plan), the major phases of EMS response are: (1) alert; (2) search and rescue; (3) triage of victims and provision of critical care to first priority victims; (4) regulated dispatch of victims to hospitals; and (5) psychological assistance. Following the 1995 Tokyo subway sarin attack, a national plan for the emergency response to chemical and biological events (PIRATOX) was implemented. In 2002, the Ministries of Health and the Interior collaborated to produce a comprehensive national plan (BIOTOX) for the emergency response to chemical, biological, radiological, and nuclear events. Key aspects of BIOTOX are the prehospital provision of specialized advance life support for toxic injuries and the protection of responders in contaminated environments. BIOTOX was successfully used during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak in France.     

The demand for prehospital advanced life support and the appropriateness of dispatch in Taipei

INTRODUCTION: Implementing prehospital advanced life support (ALS) services requires more medical and societal resources in training and equipment. The actual demand for ALS services in our communities was not clear. To ensure good use of expensive resources, it is important to evaluate the demand and appropriateness of ALS services before full-scale implementation takes place. OBJECTIVE: To evaluate the rate and characteristics of demand for ALS, and the appropriateness of ALS dispatch of the emergency medical service (EMS) system in metropolitan Taipei City. METHODS: A retrospective, cross-sectional analysis of the EMS records of Taipei City Fire Department from April 1999 to December 2000 was conducted. Stratified random sampling of all EMS records in the second week of January, April, July and October of 2000 were obtained, along with the corresponding ALS dispatch records. Retrospective ALS demand criteria, including the chief complaints, mechanisms of injury/illness, initial vital signs and types of care rendered, were developed to estimate the rate of ALS demand. ALS demand is expressed as the percentage of cases fulfilling ALS criteria over the total number of EMS cases. Appropriate ALS dispatches were those ALS dispatches determined as fulfilling the ALS demand criteria. RESULTS: Among the sampled 5433 EMS cases, 490 (9.02%) were determined as a demand for ALS care. ALS demands varied from region to region, and were higher during winter months and afternoon rush hours. There were 175 actual ALS dispatches, accounting for 3.22% of the sampled EMS services. The triage performance was suboptimal: the appropriateness of ALS dispatch was 37.14%; the overtriage rate was 72.86%. CONCLUSION: Around nine percent of EMS calls demand ALS services. The current triage performance for proper ALS dispatch was suboptimal. A correct ALS dispatch protocol and more dispatcher training programmes should be established in the communities to ensure best use of valuable ALS resources.     

Examining emergency medical services' prehospital transport times for trauma patients during COVID-19

IntroductionLonger prehospital times were associated with increased odds for survival in trauma patients. The purpose of this study was to determine how the COVID-19 pandemic affected emergency medical services (EMS) prehospital times for trauma patients.MethodsThis retrospective cohort study compared trauma patients transported via EMS to six US level I trauma centers admitted 1/1/19–12/31/19 (2019) and 3/16/20–6/30/20 (COVID-19). Outcomes included: total EMS pre-hospital time (dispatch to hospital arrival), injury to dispatch time, response time (dispatch to scene arrival), on-scene time (scene arrival to scene departure), and transportation time (scene departure to hospital arrival). Fisher's exact, chi-squared, or Kruskal-Wallis tests were used, alpha = 0.05. All times are presented as median (IQR) minutes.ResultsThere were 9400 trauma patients transported by EMS: 79% in 2019 and 21% during the COVID-19 pandemic. Patients were similar in demographics and transportation mode. Emergency room deaths were also similar between 2019 and COVID-19 [0.6% vs. 0.9%, p = 0.13].There were no differences between 2019 and during COVID-19 for total EMS prehospital time [44 (33, 63) vs. 43 (33, 62), p = 0.12], time from injury to dispatch [16 (6, 55) vs. 16 (7, 77), p = 0.41], response time [7 (5, 12) for both groups, p = 0.27], or on-scene time [16 (12−22) vs. 17 (12,22), p = 0.31]. Compared to 2019, transportation time was significantly shorter during COVID-19 [18 (13, 28) vs. 17 (12, 26), p = 0.01].ConclusionThe median transportation time for trauma patients was marginally significantly shorter during COVID-19; otherwise, EMS prehospital times were not significantly affected by the COVID-19 pandemic.     

Prehospital use of aspirin rarely is associated with adverse events

INTRODUCTION: Aspirin is commonly administered for acute coronary syndromes in the prehospital setting. Few studies have addressed the incidence of adverse effects associated with prehospital administration of aspirin. OBJECTIVE: To determine the incidence of adverse events following the administration of aspirin by prehospital personnel. METHODS: Multi-center, retrospective, case series that involved all patients who received aspirin in the prehospital setting from (01 August 1999-31 January 2000). Patient encounter forms of the emergency medical services (EMS) of a metropolitan fire department were reviewed. All patients who had a potential cardiac syndrome (i.e., chest pain, dyspnea) as documented on the EMS forms were included in the review. Exclusion criteria included failure to meet inclusion criteria, and chest pain secondary to apparent non-cardiac causes (i.e., trauma). Hospital charts were reviewed from a subset of patients at the participating hospitals. The major outcome was an adverse event following prehospital administration of aspirin. This outcome was evaluated during the EMS encounter, at emergency department discharge, or at six and 24-hours post-aspirin ingestion. An adverse event secondary to aspirin ingestion was defined as anaphylaxis or allergic reactions, such as rash or respiratory changes. RESULTS: A total of 25,600 EMS encounter forms were reviewed, yielding 2,399 patients with a potential cardiac syndrome. Prior to EMS arrival, 585 patients had received aspirin, and 893 were administered aspirin by EMS personnel. No patients had an adverse event during the EMS encounter. Of these patients, 229 were transported to participating hospitals and 219 medical records were available for review with no adverse reactions recorded during their hospital course. CONCLUSION: Aspirin is rarely associated with adverse events when administered by prehospital personnel for presumed coronary syndromes.