Chan Theodore C, Griswold William G, Buono Colleen, Kirsh David, Lyon Joachim, Killeen James P, Castillo Edward M, Lenert Leslie
Department of Emergency Medicine, University of California, San Diego, San Diego, California USA.
Prehosp Disaster Med. 2011 Aug;26(4):268-75. doi: 10.1017/S1049023X11006480. Epub 2011 Oct 13.
The use of wireless, electronic, medical records and communications in the prehospital and disaster field is increasing.
This study examines the role of wireless, electronic, medical records and communications technologies on the quality of patient documentation by emergency field responders during a mass-casualty exercise.
A controlled, side-to-side comparison of the quality of the field responder patient documentation between responders utilizing National Institutes of Health-funded, wireless, electronic, field, medical record system prototype ("Wireless Internet Information System for medicAl Response to Disasters" or WIISARD) versus those utilizing conventional, paper-based methods during a mass-casualty field exercise. Medical data, including basic victim identification information, acuity status, triage information using Simple Triage and Rapid Treatment (START), decontamination status, and disposition, were collected for simulated patients from all paper and electronic logs used during the exercise. The data were compared for quality of documentation and record completeness comparing WIISARD-enabled field responders and those using conventional paper methods. Statistical analysis was performed with Fisher's Exact Testing of Proportions with differences and 95% confidence intervals reported.
One hundred simulated disaster victim volunteers participated in the exercise, 50 assigned to WIISARD and 50 to the conventional pathway. Of those victims who completed the exercise and were transported to area hospitals, medical documentation of victim START components and triage acuity were significantly better for WIISARD compared to controls (overall acuity was documented for 100% vs 89.5%, respectively, difference = 10.5% [95%CI = 0.5-24.1%]). Similarly, tracking of decontamination status also was higher for the WIISARD group (decontamination status documented for 59.0% vs 0%, respectively, difference = 9.0% [95%CI = 40.9-72.0%]). Documentation of disposition and destination of victims was not different statistically (92.3% vs. 89.5%, respectively, difference = 2.8% [95%CI = -11.3-17.3%]).
In a simulated, mass-casualty field exercise, documentation and tracking of victim status including acuity was significantly improved when using a wireless, field electronic medical record system compared to the use of conventional paper methods.
无线、电子病历及通信技术在院前及灾害领域的应用日益广泛。
本研究旨在探讨无线、电子病历及通信技术在大规模伤亡演习中对急救现场救援人员患者文件记录质量的作用。
在一次大规模伤亡现场演习中，对使用美国国立卫生研究院资助的无线电子现场病历系统原型（“用于灾害医疗响应的无线互联网信息系统”或WIISARD）的救援人员与使用传统纸质方法的救援人员在现场救援人员患者文件记录质量方面进行了对照、横向比较。从演习期间使用的所有纸质和电子日志中收集模拟患者的医疗数据，包括基本受害者识别信息、病情严重程度、使用简单分类和快速治疗（START）的分诊信息、去污状态和处置情况。比较了启用WIISARD的现场救援人员和使用传统纸质方法的救援人员在文件记录质量和记录完整性方面的数据。采用Fisher精确比例检验进行统计分析，并报告差异和95%置信区间。
100名模拟灾难受害者志愿者参加了演习，50人被分配到WIISARD组，50人被分配到传统路径组。在完成演习并被送往地区医院的受害者中，与对照组相比，WIISARD组对受害者START组件和分诊严重程度的医疗记录明显更好（总体严重程度记录分别为100%和89.5%，差异=10.5%[95%CI=0.5-24.1%]）。同样，WIISARD组对去污状态的跟踪也更高（去污状态记录分别为59.0%和0%，差异=9.0%[95%CI=40.9-72.0%]）。受害者处置和目的地的记录在统计学上没有差异（分别为92.3%和89.5%，差异=2.8%[95%CI=-11.3-17.3%]）。
在模拟的大规模伤亡现场演习中，与使用传统纸质方法相比，使用无线现场电子病历系统时，包括严重程度在内的受害者状态的记录和跟踪有显著改善。
