McEachin Christine Clara, McDermott Joseph Thomas, Swor Robert
Department of Emergency Medicine, William Beaumont Hospital,Royal Oak, MI 48073, USA.
Prehosp Emerg Care. 2002 Oct-Dec;6(4):406-10. doi: 10.1080/10903120290938030.
Previous literature has identified prehospital pain management as an important emergency medical services (EMS) function, and few patients transported by EMS with musculoskeletal injuries receive prehospital analgesia (PA).
This was a four-month (April to July 2000) retrospective study of patients with a final hospital diagnosis of hip or lower-extremity fracture who were transported by EMS to a single suburban community hospital. Data including patient demographics, fracture type, EMS response, and treatment characteristics were abstracted from review of EMS and ED records. Patients who had ankle fractures, had multiple traumatic injuries, were under the age of 18 years, or did not have fractures were excluded.
One hundred twenty-four patients met inclusion criteria. A basic life support (BLS)-only response was provided to 20 (16.0%). Another 38 (38.4%) received an advanced life support (ALS) response and were triaged to BLS transport. Of all the patients, 22 (18.3%) received PA. Patients who received PA were younger (64.0 vs. 77.3 years, p < 0.001) and more likely to have a lower-extremity fracture other than a hip fracture (31.8% vs. 10.7%, p < 0.004). Of all patients, 113 (91.1%) received ED analgesia. Patients received analgesia from EMS almost 2.0 hours sooner that in the ED (mean 28.4 +/- 36 min vs. 146 +/- 74 min after EMS scene arrival, p < 0.001).
A minority of the study group received PA. Older patients and patients with hip fracture are less likely to receive PA. It is unclear whether current EMS system design may adversely impact administration of PA. Further work is needed to clarify whether patient need or EMS practice patterns result in low rates of PA.
以往文献已将院前疼痛管理确定为紧急医疗服务（EMS）的一项重要功能，而很少有因肌肉骨骼损伤由EMS转运的患者接受院前镇痛（PA）。
1）描述下肢和髋部骨折的EMS患者接受院前和急诊科（ED）镇痛的频率；2）描述可能影响对这些患者进行PA给药的EMS和患者因素；3）描述EMS与ED用药给药之间的时间间隔。
这是一项为期四个月（2000年4月至7月）的回顾性研究，研究对象为最终医院诊断为髋部或下肢骨折且由EMS转运至一家郊区社区医院的患者。从EMS和ED记录回顾中提取包括患者人口统计学、骨折类型、EMS反应和治疗特征等数据。排除踝关节骨折、有多处创伤性损伤、年龄在18岁以下或无骨折的患者。
124例患者符合纳入标准。仅提供基本生命支持（BLS）反应的有20例（16.0%）。另有38例（38.4%）接受了高级生命支持（ALS）反应并被分诊至BLS转运。在所有患者中，22例（18.3%）接受了PA。接受PA的患者更年轻（64.0岁对77.3岁，p<0.001），且除髋部骨折外更有可能发生下肢骨折（31.8%对10.7%，p<0.004）。在所有患者中，113例（91.1%）接受了ED镇痛。患者从EMS接受镇痛的时间比在ED早近2.0小时（EMS到达现场后平均28.4±36分钟对146±74分钟，p<0.00）。
研究组中少数患者接受了PA。老年患者和髋部骨折患者接受PA的可能性较小。目前的EMS系统设计是否可能对PA给药产生不利影响尚不清楚。需要进一步开展工作以阐明是患者需求还是EMS实践模式导致了PA的低使用率。
