肌萎缩侧索硬化症（ALS）救护车的调派：一个大型城市系统中的特征、原因及影响

Silka P A, Geiderman J M, Kim J Y

Emergency Department, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.

Prehosp Emerg Care. 2001 Jan-Mar;5(1):23-8. doi: 10.1080/10903120190940272.

OBJECTIVE

To characterize the reasons for and effects of diversions of advanced life support (ALS) ambulances in a large urban area with a high concentration of receiving hospitals.

METHODS

A retrospective study was performed in a large urban region during a consecutive three-month period. Diversion was defined as the ALS transport of a patient to an emergency department (ED) other than the designated primary receiving facility. Case-matched concurrent cohorts of patients who were and were not diverted were studied to establish emergency medical services (EMS) time intervals, including total prehospital interval (TPI), on-scene interval (OSI), and patient transfer interval (PTI); age; gender; Glasgow Coma Score (GCS); ALS interventions; and insurance status. The reasons for diversion and the chief complaints of diverted patients were also studied.

RESULTS

During the study period, 2,534 ALS runs occurred, of which 147 (5.8%) were diverted. Twenty-four (16.3%) diversions had incomplete run times, leaving 123 (83.7%) for analysis. The most common chief complaints of diverted patients were shortness of breath (SOB), chest pain (CP), and altered mental status (AMS). The most common reason for diversion was special consideration (SC), defined as a diversion requested by a patient, family member, law enforcement officer, or private medical doctor. Diverted ambulances had significant increases in TPI, 36.4 [95% confidence interval (95% CI) 35.1-37.7] vs. 33.4 [95% CI 32.13-34.7], and PTI, 10.3 [95% CI 9.4-11.2] vs. 7.9 [95% CI 7.2-8.6], compared with nondiverted ambulances. Further analysis demonstrated that SC diversions accounted for all of the increases in TPI (p<0.001) and PTI (p<0.001) when compared with other types of diversions and nondiverted transports.

CONCLUSION

"Special consideration" was the most common reason for diversion in this study. Special consideration diversions increased TPI and PTI, causing delays in arrival to the ED and decreased ALS ambulance availability.

目的

明确在接收医院高度集中的大城市地区，高级生命支持（ALS）救护车转向的原因及影响。

方法

在一个大城市地区进行了一项为期连续三个月的回顾性研究。转向定义为将患者通过ALS转运至指定的主要接收机构以外的急诊科（ED）。对转向和未转向的患者进行病例匹配的同期队列研究，以确定紧急医疗服务（EMS）时间间隔，包括总院前间隔（TPI）、现场间隔（OSI）和患者转运间隔（PTI）；年龄；性别；格拉斯哥昏迷评分（GCS）；ALS干预措施；以及保险状况。还研究了转向的原因和转向患者的主要症状。

结果

在研究期间，共发生了2534次ALS出诊，其中147次（5.8%）出现转向。24次（16.3%）转向的出诊时间不完整，剩余123次（83.7%）用于分析。转向患者最常见的主要症状是呼吸急促（SOB）、胸痛（CP）和精神状态改变（AMS）。转向最常见的原因是特殊考虑（SC），定义为由患者、家庭成员、执法人员或私人医生提出的转向请求。与未转向的救护车相比，转向的救护车在TPI方面显著增加，分别为36.4[95%置信区间（95%CI）35.1 - 37.7]和33.4[95%CI 32.13 - 34.7]，在PTI方面也显著增加，分别为10.3[95%CI 9.4 - 11.2]和7.9[95%CI 7.2 - 8.6]。进一步分析表明，与其他类型的转向和未转向的转运相比，SC转向导致了TPI（p<0.001）和PTI（p<0.001）的所有增加。