挪威值班初级保健医生参与紧急情况的情况-一项基于人群的前瞻性观察研究。
Involvement in emergency situations by primary care doctors on-call in Norway--a prospective population-based observational study.
机构信息
Department of Research, Norwegian Air Ambulance Foundation, Box 94, Drøbak, Norway.
出版信息
BMC Emerg Med. 2010 Mar 6;10:5. doi: 10.1186/1471-227X-10-5.
BACKGROUND
Primary care doctors on-call in the emergency primary health care services in Norway are, together with the ambulances, the primary resources for handling emergencies outside hospitals. There is a lack of reliable data for Norway on how often the primary care doctors are alerted and on their responses in the most urgent emergency cases. The aim of this study was to investigate how doctors on-call are involved in red responses (highest priority), using three different emergency medical communication centres (EMCC) as catchment area for a prospective population-based study.
METHODS
In the period from October to December 2007 three dispatch centres covering approximately 816,000 inhabitants prospectively recorded all acute emergency cases. Ambulance records, air ambulance records and records from the doctors on-call were collected. NACA score was used to define the severity of the emergencies.
RESULTS
5,105 cases were classified as red responses during the period. We have complete basic recordings (AMIS forms) from all and resaved ambulance records, air ambulance records and records from doctors on-call in 89% of the cases. Ambulances were alerted in 96% and doctors on-call in 47% of the cases, but there were large differences between the three EMCCs. Doctors on-call responded with call-out in 42% of the alerted cases. 28% of all patients were taken to a casualty clinic, 46% were admitted to hospital by a doctor and 24% were taken directly to hospital by ambulances. In total, primary care doctors on-call took active part in 42% of all red response cases, and together with GPs' daytime activity the primary health care services were involved in 50% of the cases. 29% of the cases were classified as life-threatening. Call-out by doctors on-call were found to be more frequent in life-threatening situations compared with not life-threatening situations.
CONCLUSION
Doctors on-call and GPs on daytime were involved in half of all red responses. There were large differences between the EMCCs in the frequency of doctors alerted. The inhabitants in the three EMMCs were thus offered different levels of professional competency in emergency situations outside hospitals.
背景
在挪威的急诊初级卫生保健服务中，值班的初级保健医生与救护车一起，是处理医院外紧急情况的主要资源。挪威缺乏关于初级保健医生接到警报的频率以及在最紧急的紧急情况下的反应的可靠数据。本研究的目的是使用三个不同的紧急医疗通讯中心（EMCC）作为前瞻性基于人群的研究的集水区，调查值班医生如何参与红色反应（最高优先级）。
方法
在 2007 年 10 月至 12 月期间，三个覆盖约 816000 名居民的调度中心前瞻性地记录了所有急性紧急情况。收集了救护车记录、空中救护车记录和值班医生的记录。使用 NACA 评分来定义紧急情况的严重程度。
结果
在研究期间，有 5105 例被归类为红色反应。我们在 89%的病例中完成了所有基本记录（AMIS 表格），并重新保存了救护车记录、空中救护车记录和值班医生的记录。救护车被唤醒的比例为 96%，值班医生的比例为 47%，但三个 EMCC 之间存在很大差异。在被唤醒的病例中，有 42%的值班医生进行了出诊。28%的患者被送往急救诊所，46%的患者由医生收治住院，24%的患者直接由救护车送往医院。总的来说，值班的初级保健医生在所有红色反应病例中积极参与了 42%，加上全科医生的白天活动，初级保健服务参与了 50%的病例。29%的病例被归类为危及生命。与非危及生命的情况相比，值班医生的出诊在危及生命的情况下更为频繁。
结论
值班医生和白天的全科医生参与了所有红色反应的一半。在被唤醒的医生数量方面，EMCC 之间存在很大差异。因此，这三个 EMCC 的居民在医院外的紧急情况下获得了不同水平的专业能力。
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