Lu Tsung-Chien, Chen Ying-Ta, Ko Patrick Chow-In, Lin Chih-Hao, Shih Fuh-Yuan, Yen Zui-Shen, Ma Matthew Huei-Ming, Chen Shyr-Chyr, Chen Wen-Jone, Lin Fang-Yue
Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Resuscitation. 2006 Nov;71(2):171-9. doi: 10.1016/j.resuscitation.2006.03.016. Epub 2006 Sep 20.
Implementing prehospital advanced life support (ALS) services requires more medical and societal resources in training and equipment. The actual demand for ALS services in our communities was not clear. To ensure good use of expensive resources, it is important to evaluate the demand and appropriateness of ALS services before full-scale implementation takes place.
To evaluate the rate and characteristics of demand for ALS, and the appropriateness of ALS dispatch of the emergency medical service (EMS) system in metropolitan Taipei City.
A retrospective, cross-sectional analysis of the EMS records of Taipei City Fire Department from April 1999 to December 2000 was conducted. Stratified random sampling of all EMS records in the second week of January, April, July and October of 2000 were obtained, along with the corresponding ALS dispatch records. Retrospective ALS demand criteria, including the chief complaints, mechanisms of injury/illness, initial vital signs and types of care rendered, were developed to estimate the rate of ALS demand. ALS demand is expressed as the percentage of cases fulfilling ALS criteria over the total number of EMS cases. Appropriate ALS dispatches were those ALS dispatches determined as fulfilling the ALS demand criteria.
Among the sampled 5433 EMS cases, 490 (9.02%) were determined as a demand for ALS care. ALS demands varied from region to region, and were higher during winter months and afternoon rush hours. There were 175 actual ALS dispatches, accounting for 3.22% of the sampled EMS services. The triage performance was suboptimal: the appropriateness of ALS dispatch was 37.14%; the overtriage rate was 72.86%.
Around nine percent of EMS calls demand ALS services. The current triage performance for proper ALS dispatch was suboptimal. A correct ALS dispatch protocol and more dispatcher training programmes should be established in the communities to ensure best use of valuable ALS resources.
实施院前高级生命支持（ALS）服务在培训和设备方面需要更多的医疗和社会资源。我们社区对ALS服务的实际需求尚不清楚。为确保昂贵资源的合理使用，在全面实施之前评估ALS服务的需求和适用性非常重要。
评估台北市都会区ALS的需求率和特征，以及紧急医疗服务（EMS）系统的ALS调度的适用性。
对台北市消防局1999年4月至2000年12月的EMS记录进行回顾性横断面分析。获取2000年1月、4月、7月和10月第二周所有EMS记录的分层随机样本，以及相应的ALS调度记录。制定回顾性ALS需求标准，包括主要投诉、受伤/疾病机制、初始生命体征和提供的护理类型，以估计ALS需求率。ALS需求表示为符合ALS标准的病例数占EMS病例总数的百分比。适当的ALS调度是指确定符合ALS需求标准的那些ALS调度。
在抽样的5433例EMS病例中，490例（9.02%）被确定需要ALS护理。ALS需求因地区而异，在冬季和下午高峰时段较高。实际有175次ALS调度，占抽样EMS服务的3.22%。分诊表现欠佳：ALS调度的适用性为37.14%；过度分诊率为72.86%。
约9%的EMS呼叫需要ALS服务。目前用于正确ALS调度的分诊表现欠佳。应在社区中建立正确的ALS调度协议和更多调度员培训计划，以确保宝贵的ALS资源得到最佳利用。
