Emergency Department, Mayo General Hospital, Castlebar, Mayo, UK.
Emerg Med J. 2010 Feb;27(2):151-5. doi: 10.1136/emj.2008.064816.
Acute coronary syndromes remain a leading cause of preventable early deaths. However, previous studies have indicated that paramedics' compliance with chest pain protocols is suboptimal and that many patients do not receive the benefits of appropriate prehospital treatment.
To evaluate paramedics' level of compliance with national clinical practice guidelines and to investigate why, in certain circumstances, they may deviate from the clinical guidelines.
The Health Service Executive Mid-Western Regional Ambulance Service which serves a mixed urban and rural population across three counties in the west of Ireland.
A retrospective review of completed ambulance Patient Care Report Forms was conducted for all adult patients with non-traumatic chest pain treated between 1 December 2007 and 31 March 2008. During the same study period, paramedics were asked to complete a prospective questionnaire survey investigating the rationale behind their treatment decisions, their estimation of patient risk and their attitudes towards the clinical practice guidelines and training.
382 completed Patient Care Report Forms were identified for patients with chest pain, of whom 84.8% received ECG monitoring, 75.9% were given oxygen, 44.8% were treated with sublingual glyceryl trinitrate (GTN) and 50.8% were treated with aspirin. Only 20.4% of patients had a prehospital 12-lead ECG recorded. 58 completed questionnaires were returned (response rate 15%); 64% of respondents said they had received insufficient training to identify ECG abnormalities.
Prehospital treatment with oxygen, aspirin, sublingual GTN and ECG monitoring remains underused by paramedics, even though only a small number of patients had documented contraindications to their use. The small number of patients who received a prehospital 12-lead ECG is a cause of particular concern and suggests that incomplete patient assessment may contribute to undertreatment. Further provision of training and equipment is necessary to enable paramedics to more accurately assess and treat patients with acute coronary syndromes.
急性冠状动脉综合征仍然是可预防的早期死亡的主要原因。然而，先前的研究表明，护理人员对胸痛方案的遵守情况并不理想，许多患者没有得到适当的院前治疗的益处。
评估护理人员对国家临床实践指南的遵守程度，并研究为什么在某些情况下他们可能会偏离临床指南。
服务于爱尔兰西部三个县的混合城市和农村人口的健康服务执行中西部地区救护车服务。
对 2007 年 12 月 1 日至 2008 年 3 月 31 日期间治疗的所有非创伤性胸痛的成年患者的完成的救护车患者护理报告表进行回顾性审查。在同一研究期间，护理人员被要求完成一项前瞻性问卷调查，调查他们治疗决策背后的基本原理、对患者风险的估计以及他们对临床实践指南和培训的态度。
确定了 382 份胸痛患者的完成的患者护理报告表，其中 84.8%接受了心电图监测，75.9%给予了氧气，44.8%接受了舌下硝酸甘油（GTN）治疗，50.8%接受了阿司匹林治疗。只有 20.4%的患者在院前记录了 12 导联心电图。共收回 58 份完成的问卷（回应率为 15%）；64%的受访者表示他们接受的培训不足，无法识别心电图异常。
即使只有少数患者有其使用的明确禁忌症，护理人员仍未充分使用氧气、阿司匹林、舌下 GTN 和心电图监测进行院前治疗。接受院前 12 导联心电图的患者人数较少尤其令人担忧，这表明不完整的患者评估可能导致治疗不足。需要进一步提供培训和设备，使护理人员能够更准确地评估和治疗急性冠状动脉综合征患者。
