Gratton M C, Bethke R A, Watson W A, Gaddis G M
Department of Emergency Medicine, School of Medicine, University of Missouri-Kansas City.
Ann Emerg Med. 1991 Dec;20(12):1306-9. doi: 10.1016/s0196-0644(05)81071-6.
To determine if a protocol change that allowed paramedics to perform certain procedures before base station contact (standing orders) would decrease scene time in trauma patients.
Retrospective review of case series.
A single-tiered, all advanced life support emergency medical services system.
Implementation with standing orders for invasive procedures.
All physiologically unstable trauma patients transported to a Level I trauma center by ambulance.
One hundred ninety-seven patients met the inclusion criteria--87 before and 110 after the initiation of standing orders. Mean scene times for the control group (15.3 +/- 8.4 minutes) and for the standing orders group (15.1 +/- 7.6 minutes) were similar (P = .18). The power of the study to detect a two-minute difference in scene time was .92. Scene time was not influenced by mechanism of injury, and the number of procedures performed on patients was similar between the two groups.
Standing orders did not decrease scene time in physiologically unstable trauma patients. Further study is necessary to delineate the factors that actually contribute to on-scene time and the factors that are important in determining whether standing orders or on-line medical contact should be used.
确定一项允许护理人员在与基地站联系之前执行某些程序（预立医嘱）的方案变更是否会减少创伤患者的现场停留时间。
病例系列回顾性研究。
一个单层的、全高级生命支持的紧急医疗服务系统。
实施侵入性程序的预立医嘱。
所有通过救护车转运至一级创伤中心的生理不稳定创伤患者。
197例患者符合纳入标准，预立医嘱启动前87例，启动后110例。对照组（15.3±8.4分钟）和预立医嘱组（15.1±7.6分钟）的平均现场停留时间相似（P = 0.18）。该研究检测出现场停留时间两分钟差异的效能为0.92。现场停留时间不受损伤机制影响，两组患者接受的操作数量相似。
预立医嘱并未减少生理不稳定创伤患者的现场停留时间。有必要进一步研究以明确实际影响现场停留时间的因素，以及在决定应采用预立医嘱还是在线医疗联系时的重要因素。
