Vaardal B, Lossius H M, Steen P A, Johnsen R
Regional Centre for Emergency Medical Research and Development, Rogaland Central and University Hospital, 4068 Stavanger, Norway.
Emerg Med J. 2005 Mar;22(3):216-9. doi: 10.1136/emj.2004.015255.
Emergency medical service systems in Norway are based on equity and equality. A toll free number (113) and criteria based dispatch are crucial components. The establishment of an emergency medical system (EMS) manned by an air and ground emergency physician (EP) has challenged the role of the general practitioner (GP) in emergency medical care. We investigated whether there were any geographical differences in the use of 113, alerts to GPs by the emergency medical dispatch centres (EMDCs), and of the presence of GPs on scene in medical emergencies leading to a turnout of the EP manned EMS.
This was a prospective, observational cohort study of 385,000 inhabitants covered by the two EMDCs of Rogaland county, Norway, including 1035 on scene missions of the EP manned EMS during the period 1998-99.
The proportion of emergency calls routed through 113 was significantly lower, the proportion of alerts to GPs significantly higher, and the proportions of GPs on scene significantly higher in rural than urban areas.
We found geographical differences in the involvement of GPs in pre-hospital emergency medical situations, probably caused by a specialised emergency medical service system including an EMDC and an air and ground EP manned EMS. There were geographical differences in public use of the toll free 113, and alerts to GPs by the EMDCs, which is likely to result from geographical conditions and proximity to medical resources. Future organisation of the EMS has to reflect this to prevent unplanned and unwanted autonomously emerging EMS systems.
挪威的紧急医疗服务系统基于公平和平等原则。免费电话（113）及基于标准的调度是关键组成部分。由空中和地面急救医生（EP）配备的紧急医疗系统（EMS）的建立，对全科医生（GP）在紧急医疗护理中的作用提出了挑战。我们调查了在使用113、紧急医疗调度中心（EMDC）向全科医生发出警报以及在导致配备急救医生的EMS出动的医疗紧急情况现场全科医生到场情况方面是否存在地理差异。
这是一项对挪威罗加兰郡两个EMDC所覆盖的385,000名居民进行的前瞻性观察队列研究，包括1998 - 1999年期间配备急救医生的EMS的1035次现场任务。
通过113转接的紧急呼叫比例在农村地区显著低于城市地区，向全科医生发出警报的比例在农村地区显著高于城市地区，且全科医生在现场的比例在农村地区也显著高于城市地区。
我们发现全科医生参与院前紧急医疗情况存在地理差异，这可能是由包括EMDC以及空中和地面配备急救医生的EMS在内的专门紧急医疗服务系统导致的。在免费电话113的公众使用以及EMDC向全科医生发出警报方面存在地理差异，这可能是由地理条件和与医疗资源的距离导致的。未来的EMS组织必须考虑到这一点，以防止出现未经计划和不必要的自主形成的EMS系统。
