Spaite D W, Karriker K J, Conroy C, Seng M, Battaglia N, Salik R M
Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson 85721-0468, USA.
Prehosp Disaster Med. 2001 Apr-Jun;16(2):96-101. doi: 10.1017/s1049023x00025760.
This study evaluates whether a continuing education program for paramedics, focusing on Children with Special Health Care Needs, improved paramedics' assessment and management.
Emergency Medical Services responses for children, 21 years of age or younger, with a congenital or acquired condition or a chronic physical or mental illness, were identified. The responses before and after the specialized education program were reviewed by a multidisciplinary team to evaluate assessment and management of the children. Interreviewer agreement between the nurses on the team and between the physicians on the team was assessed. We also evaluated whether there was an improvement in assessment and care by paramedics completing our education program.
Significant improvement was seen in appropriate assessment and overall care by paramedics who completed our specialized education program. Reviewers also noted an appropriate rating for the initial assessment category more often for responses involving paramedics who had the training. Agreement on whether assessment and treatment was appropriate for all five reviewers varied considerably, ranging from 32% to 93%. Overall there was a high percentage of agreement (>70%) between the nurses and between the physicians on most items. However, kappa statistics did not generally reflect good agreement except for most of the focused assessment items and some treatment and procedure items.
Most of the documentation on the EMS records indicated appropriate assessment and treatment during all responses for Children with Special Health Care Needs. Nevertheless, the results indicate that paramedics may improve their assessment and management of these children after specialized continuing education.
本研究评估了一项针对护理人员的继续教育项目，该项目聚焦于有特殊医疗需求的儿童，是否改善了护理人员的评估和管理能力。
确定了针对21岁及以下患有先天性或后天性疾病、慢性身体或精神疾病的儿童的紧急医疗服务响应情况。一个多学科团队对专业教育项目前后的响应情况进行了审查，以评估对儿童的评估和管理。评估了团队中的护士之间以及医生之间的评审者间一致性。我们还评估了完成我们教育项目的护理人员在评估和护理方面是否有改进。
完成我们专业教育项目的护理人员在适当评估和整体护理方面有显著改善。评审者还指出，对于涉及接受过培训的护理人员的响应，初始评估类别的评级更合适。对于所有五位评审者而言，评估和治疗是否合适的一致性差异很大，范围从32%到93%。总体而言，护士之间以及医生之间在大多数项目上的一致性百分比很高（>70%）。然而，除了大多数重点评估项目以及一些治疗和操作项目外，kappa统计量一般并未反映出良好的一致性。
紧急医疗服务记录中的大多数文件表明，在对有特殊医疗需求的儿童的所有响应过程中，评估和治疗都是适当的。尽管如此，结果表明，护理人员在接受专门的继续教育后，可能会改善对这些儿童的评估和管理。
