Hauswald Mark
Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque 87131-5121, USA.
Prehosp Emerg Care. 2002 Oct-Dec;6(4):383-6. doi: 10.1080/10903120290937978.
To determine whether paramedics can safely decide which patients do not require ambulance transport or emergency department (ED) care.
This was a prospective survey and linked medical record review. Paramedics completed a brief questionnaire for each patient they transported to a university hospital ED during a one-month period. A faculty emergency physician masked to the survey results reviewed hospital records. Ambulance transport was defined as "needed" if the charted differential diagnosis included diagnoses that could necessitate treatment in an ambulance. ED care was defined as "needed" if treatment of these diagnoses would necessitate resources not available in local urgent care centers (UCCs).
Two hundred thirty-six patients were transported; 183 corresponding ED charts were found. Agreement between paramedics and need determined by ED chart review was low for both transport method [kappa (kappa) = 0.47, 95% confidence interval (95% CI) = 0.34-0.60] and ED care (kappa = 0.32, 95% CI = 0.17-0.46). Paramedics recommended alternative transport for 97 patients, 23 of whom needed ambulance transport. Paramedics recommended non-ED care for 71 patients, 32 of whom needed ED care.
Paramedics cannot safely determine which patients do not need ambulance transport or ED care.
确定护理人员是否能够安全地判定哪些患者不需要救护车转运或急诊科（ED）护理。
这是一项前瞻性调查并关联病历审查。护理人员为他们在一个月期间转运至大学医院急诊科的每位患者填写一份简短问卷。一位对调查结果不知情的急诊科医生审查医院病历。如果记录的鉴别诊断包括可能需要在救护车上进行治疗的诊断，则将救护车转运定义为“需要”。如果对这些诊断的治疗需要当地紧急护理中心（UCC）无法提供的资源，则将急诊科护理定义为“需要”。
共转运了236名患者；找到183份相应的急诊科病历。护理人员与通过急诊科病历审查确定的需求之间，在转运方式方面一致性较低[卡方（kappa）= 0.47，95%置信区间（95%CI）= 0.34 - 0.60]，在急诊科护理方面也是如此（kappa = 0.32，95%CI = 0.17 - 0.46）。护理人员为97名患者推荐了其他转运方式，其中23名患者需要救护车转运。护理人员为71名患者推荐了非急诊科护理，其中32名患者需要急诊科护理。
护理人员无法安全地判定哪些患者不需要救护车转运或急诊科护理。
