系统护理人员的数量会影响临床基准阈值吗？

Vrotsos Kristin M, Pirrallo Ronald G, Guse Clare E, Aufderheide Tom P

Department of Emergency Medcine, Injury Research Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA.

Prehosp Emerg Care. 2008 Jul-Sep;12(3):302-6. doi: 10.1080/10903120802101355.

OBJECTIVE

Competency is affected by skill exposure, skill complexity, and training program quality. The purpose of this study was to reevaluate the biennial (24-month) critical care skill and experience benchmark thresholds established by the Milwaukee County Emergency Medical Services (MCEMS) system in 1997.

METHODS

This was a retrospective review of annual experience profiles for paramedics working during 2001-2005 using the MCEMS patient care record (PCR) database. The number of patient contacts, role as team leader/report writer, adult and pediatric endotracheal intubations, adult and pediatric intravenous (IV) access initiations, medication administration, and 12-lead electrocardiogram (ECG) acquisitions were analyzed. t-tests and descriptive statistics were performed for comparison with the 1997 study.

RESULTS

Over the five-year study period, 1,215 paramedic profiles gleaned from 107,524 PCRs documented a total of 297,900 patient contacts. Annual means+/-standard deviations [ranges] were as follows: patient contacts 245+/-133 [12-788]; team leader: 106+/-119 [0-739]; intubations: adult 2.57+/-2.54 [0-20], pediatric 0.1+/-0.3 [0-3]; IV starts: adult 44+/-37 [0-267], pediatric 0.34+/-0.77 [0-5]; treated cardiac arrests: adult 8+/-6 [0-34], pediatric 0.26+/-0.61 [0-4]; treated hypotensive trauma: 5+/-6 [0-42]; and ECGs acquired: 31+/-19 [0-144]. The 1997 analysis (1987-1996 data) included 1,450 paramedic profiles representing 467,559 patient contacts generated from 172,131 filed PCRs. All comparable experiences decreased significantly between the 1997 analysis and the current study, except medication administration, which increased 25%.

CONCLUSION

These data show a decreased opportunity and a wide variability in the frequency of successfully completed paramedic technical skills and experiences in this EMS system. Limited exposure to critically ill adult and pediatric patients reaffirms that high-risk skills are performed infrequently. A multifaceted approach should be considered for maintaining provider competency.

目的

能力受到技能接触、技能复杂性和培训项目质量的影响。本研究的目的是重新评估密尔沃基县紧急医疗服务（MCEMS）系统于1997年制定的每两年（24个月）的重症护理技能和经验基准阈值。

方法

这是一项回顾性研究，使用MCEMS患者护理记录（PCR）数据库对2001年至2005年工作的护理人员的年度经验概况进行分析。分析了患者接触次数、团队领导/报告撰写者角色、成人和儿童气管插管、成人和儿童静脉（IV）通路建立、药物给药以及12导联心电图（ECG）采集情况。进行t检验和描述性统计以与1997年的研究进行比较。

结果

在为期五年的研究期间，从107,524份PCR中收集的1,215份护理人员概况记录了总共297,900次患者接触。年度均值±标准差[范围]如下：患者接触245±133[12 - 788]；团队领导：106±119[0 - 739]；插管：成人2.57±2.54[0 - 20]，儿童0.1±0.3[0 - 3]；静脉通路建立：成人44±37[0 - 267]，儿童0.34±0.77[0 - 5]；治疗的心脏骤停：成人8±6[0 - 34]，儿童0.26±0.61[0 - 4]；治疗的低血压创伤：5±6[0 - 42]；以及采集的ECG：31±19[0 - 144]。1997年的分析（1987 - 1996年数据）包括1,450份护理人员概况，代表了从172,131份存档的PCR中产生的467,559次患者接触。在1997年的分析和当前研究之间，除药物给药增加了25%外，所有可比经验均显著下降。