Lossius H M, Søreide E, Hotvedt R, Hapnes S A, Eielsen O V, Førde O H, Steen P A
Department of Anesthesia and Intensive Care, Rogaland Central Hospital, Stavanger, Norwegian Air Ambulance, Oslo, Norway.
Acta Anaesthesiol Scand. 2002 Aug;46(7):771-8. doi: 10.1034/j.1399-6576.2002.460703.x.
The benefit of prehospital advanced life support (ALS) is disputed, as is the prehospital use of specially trained, hospital-based physicians. The purpose of the study was to assess the health benefit from an anesthesiologist-manned prehospital emergency medical service (EMS), and to separate the benefit of the anesthesiologist from that of rapid transport.
The anesthesiologist-manned helicopter and rapid response car service at Rogaland Central Hospital assisted 1106 patients at the scene during the 18-month study period. Two expert panels assessed patients with a potential health benefit for life years gained (LYG) using a modified Delphi technique. The probability of survival as a result of the studied EMS was multiplied by the life expectancy of each patient. The benefit was attributed either to the anesthesiologist, the rapid transport or a combination of both.
The expert panels estimated a benefit of 504 LYG in 74 patients (7% of the total study population), with a median age of 54 years (range 0-88). The cause of the emergency was cardiac diseases (including cardiac arrest) in 61% of the 74 patients, trauma in 19%, and cardio-respiratory failure as a result of other conditions in 20%. The LYG were equally divided between air and ground missions, and the majority (88%) were attributed solely to ALS by the anesthesiologist.
The expert panels found LYG in every 14th patient assisted by this anesthesiologist-manned prehospital EMS. There was no difference in LYG between the helicopter and the rapid response car missions. The role of the anesthesiologist was crucial for health benefits.
院前高级生命支持（ALS）的益处存在争议，同样存在争议的是在院前使用经过专门培训的医院医生。本研究的目的是评估由麻醉医生提供的院前紧急医疗服务（EMS）对健康的益处，并区分麻醉医生的作用与快速转运的作用。
在为期18个月的研究期间，罗加兰中央医院由麻醉医生配备的直升机和快速反应车服务在现场协助了1106名患者。两个专家小组使用改良的德尔菲技术评估了对潜在健康有益的患者的生命年增益（LYG）。将所研究的EMS导致的生存概率乘以每个患者的预期寿命。益处要么归因于麻醉医生，要么归因于快速转运，或者两者兼而有之。
专家小组估计，74名患者（占研究总人群的7%）的生命年增益为504，中位年龄为54岁（范围0 - 88岁）。在这74名患者中，61%的紧急情况原因是心脏疾病（包括心脏骤停），19%是创伤，20%是其他情况导致的心肺衰竭。生命年增益在空运和陆运任务中平均分配，并且大多数（88%）仅归因于麻醉医生的ALS。
专家小组发现，在由这名麻醉医生提供的院前EMS协助的每14名患者中就有一名获得生命年增益。直升机和快速反应车任务的生命年增益没有差异。麻醉医生的作用对健康益处至关重要。
