Waldron Rachel, Finalle Cheri, Tsang James, Lesser Martin, Mogelof Deborah
Department of Emergency Medicine, New York Hospital Queens, Flushing, New York 11355, USA.
J Emerg Med. 2012 Aug;43(2):283-90. doi: 10.1016/j.jemermed.2011.06.136. Epub 2012 Feb 10.
"Refusal of medical aid" (RMA) is the term commonly used by emergency medical technicians (EMTs) when someone calls 911 for care (usually the patient or a family member) but, after the initial encounter with the EMTs, the patient refuses emergency medical services transport to the hospital. Some intervention may have been performed, such as taking vital signs or an electrocardiogram, before the RMA. Although there have been multiple studies of the characteristics and outcomes of patients who RMA, little analysis has been done of the role of EMTs in these cases.
To analyze the association between EMT gender and the patient's decision to refuse medical aid in the prehospital setting.
The study was performed using data from one hospital-based ambulance service in an urban setting that participates in the 911 system. This was a case control study that examined the data from consecutive patients who refused medical aid for a 1-year period compared to a control group of non-RMA patients.
There was a significantly higher representation of all-male EMT teams in the RMA group (p<0.0001). Using propensity score-matching methodology to control for other factors, all-male EMT teams were 4.75 times more likely to generate an RMA as compared to all-female and mixed-gender EMT teams (95% confidence interval 1.63-13.96, p=0.0046).
We found that the gender of the EMTs was one of the most important factors associated with RMA, with a much higher frequency of RMAs occurring when both members of the team were male.
“拒绝医疗救助”（RMA）是紧急医疗技术人员（EMT）在有人拨打911寻求医疗护理（通常是患者或其家庭成员），但在初次接触EMT后，患者拒绝前往医院接受紧急医疗服务转运时常用的术语。在发生RMA之前，可能已经进行了一些干预措施，如测量生命体征或进行心电图检查。尽管已经对拒绝医疗救助的患者的特征和结局进行了多项研究，但对于EMT在这些案例中的作用分析甚少。
分析院前环境中EMT的性别与患者拒绝医疗救助决定之间的关联。
本研究使用了来自一个参与911系统的城市地区一家医院救护车服务机构的数据。这是一项病例对照研究，将连续1年拒绝医疗救助的患者数据与非RMA患者对照组进行了对比。
RMA组中全男性EMT团队的比例显著更高（p<0.0001）。使用倾向得分匹配方法控制其他因素后，与全女性和混合性别的EMT团队相比，全男性EMT团队导致RMA的可能性高4.75倍（95%置信区间1.63 - 13.96，p = 0.0046）。
我们发现EMT的性别是与RMA相关的最重要因素之一，当团队的两名成员均为男性时，RMA发生的频率要高得多。
