Department of Anaesthesia and Intensive Care, Klinik am Eichert, Eichertstraße 3, 73035 Goeppingen, Germany.
Resuscitation. 2011 Mar;82(3):285-93. doi: 10.1016/j.resuscitation.2010.11.001. Epub 2010 Dec 14.
The aim of this prospective study was the comparison of four emergency medical service (EMS) systems-emergency physician (EP) and paramedic (PM) based-and the impact of advanced live support (ALS) on patients status in preclinical care.
The EMS systems of Bonn (GER, EP), Cantabria (ESP, EP), Coventry (UK, PM) and Richmond (US, PM) were analysed in relation to quality of structure, process and performance when first diagnosis on scene was cardiac arrest (OHCA), chest pain or dyspnoea. Data were collected prospectively between 01.01.2001 and 31.12.2004 for at least 12 month.
Over all 6277 patients were included in this study. The rate of drug therapy was highest in the EP-based systems Bonn and Cantabria. Pain relief was more effective in Bonn in patients with severe chest pain. In the group of patients with chest pain and tachycardia ≥ 120 beats/min, the heart rate was reduced most effective by the EP-systems. In patients with dyspnoea and S(p)O(2) <90% the improvement of oxygen saturation was most effective in Bonn and Richmond. After OHCA significant more patients reached the hospital alive in EMS systems with EPs than in the paramedic staffed (Bonn = 35.6%, Cantabria = 30.1%; Coventry = 11.9%, Richmond = 9.2%). The introduction of a Load Distributing Band chest compression device in Richmond improved admittance rate after OHCA (21.7%) but did not reach the survival rate of the Bonn EMS system.
Higher qualification and greater training and experience of ALS unit personnel increased survival after OHCA and improved patient's status with cardiac chest pain and respiratory failure.
本前瞻性研究的目的是比较四种急救医疗服务（EMS）系统-急诊医师（EP）和护理人员（PM）为基础的系统-以及高级生命支持（ALS）对临床前护理中患者状况的影响。
本研究分析了波恩（德国，EP）、坎塔布里亚（西班牙，EP）、考文垂（英国，PM）和里士满（美国，PM）的 EMS 系统，以评估其在首次现场诊断为心搏骤停（OHCA）、胸痛或呼吸困难时的结构、过程和绩效质量。数据于 2001 年 1 月 1 日至 2004 年 12 月 31 日期间进行前瞻性收集，至少持续 12 个月。
本研究共纳入 6277 例患者。在基于 EP 的波恩和坎塔布里亚系统中，药物治疗率最高。在严重胸痛患者中，波恩的止痛效果更有效。在胸痛和心率≥120 次/分的患者中，EP 系统最有效地降低心率。在呼吸困难和 S(p)O(2)<90%的患者中，波恩和里士满的血氧饱和度改善最有效。在 OHCA 后，有 EP 的 EMS 系统中存活到达医院的患者明显多于护理人员配备的系统（波恩=35.6%，坎塔布里亚=30.1%；考文垂=11.9%，里士满=9.2%）。里士满引入负荷分配带胸部按压装置后，OHCA 后的入院率提高（21.7%），但未达到波恩 EMS 系统的生存率。
ALS 单位人员更高的资质和更多的培训和经验增加了 OHCA 后的存活率，并改善了有心脏胸痛和呼吸衰竭的患者状况。
