Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
Prehosp Emerg Care. 2013 Jan-Mar;17(1):38-45. doi: 10.3109/10903127.2012.710718. Epub 2012 Aug 22.
The purpose of this analysis was to determine whether there is an association between type of emergency medical services (EMS) medical direction and local EMS agency practices and characteristics specifically related to emergency response for acute cardiovascular events.
We surveyed 1,292 EMS agencies in nine states. For each cardiovascular prehospital procedure or practice, we compared the proportion of agencies that employed paid (full- or part-time) medical directors with the proportion of agencies that employed volunteer medical directors. We also compared the proportion of EMS agencies who reported direct interaction between emergency medical technicians (EMTs) and their medical director within the previous four weeks with the proportion of agencies who reported no direct interaction. Chi-square tests were used to assess statistical differences in proportion of agencies with a specific procedure by medical director employment status and medical director interaction. We repeated these comparisons using t-tests to evaluate mean differences in call volume.
The EMS agencies with prehospital cardiovascular response policies were more likely to report employment of a paid medical director and less likely to report employment of a volunteer medical director. Similarly, agencies with prehospital cardiovascular response practices were more likely to report recent medical director interaction and less likely to report absence of recent medical director interaction. Mean call volumes for chest pain, cardiac arrest, and stroke were higher among agencies having paid medical directors (compared with agencies having volunteer medical directors) and agencies having recent medical director interaction (compared with agencies not having recent medical director interaction).
Our study demonstrated that EMS agencies with a paid medical director and agencies with medical director interaction with EMTs in the previous four weeks were more likely to have prehospital cardiovascular procedures in place. Given the strong relationship that both employment status and direct interaction have with the presence of these practices, agencies with limited resources to provide a paid medical director or a medical director that can be actively involved with EMTs should be supported through partnerships and other interventions to ensure that they receive the necessary levels of medical director oversight.
本分析旨在确定紧急医疗服务（EMS）医疗指导的类型与当地 EMS 机构的实践和具体与急性心血管事件的紧急响应相关的特征之间是否存在关联。
我们调查了 9 个州的 1292 个 EMS 机构。对于每个心血管院前程序或实践，我们比较了雇佣有薪（全职或兼职）医疗主任的机构比例与雇佣志愿者医疗主任的机构比例。我们还比较了报告 EMT 与医疗主任在过去四周内有直接互动的 EMS 机构比例与报告无直接互动的机构比例。使用卡方检验评估特定程序的机构比例在医疗主任就业状况和医疗主任互动方面的统计学差异。我们使用 t 检验重复这些比较，以评估呼叫量的平均值差异。
具有院前心血管反应政策的 EMS 机构更有可能报告雇佣有薪医疗主任，而不太可能报告雇佣志愿者医疗主任。同样，具有院前心血管反应实践的机构更有可能报告最近有医疗主任互动，而不太可能报告最近没有医疗主任互动。胸痛、心脏骤停和中风的机构平均呼叫量在有薪医疗主任的机构（与有志愿者医疗主任的机构相比）和有最近医疗主任互动的机构（与没有最近医疗主任互动的机构相比）中较高。
我们的研究表明，有薪医疗主任的 EMS 机构和在过去四周内与 EMT 有医疗主任互动的机构更有可能实施院前心血管程序。鉴于就业状况和直接互动与这些实践的存在之间存在很强的关系，对于那些资源有限，无法提供有薪医疗主任或能够积极参与 EMT 的医疗主任的机构，应通过伙伴关系和其他干预措施提供支持，以确保他们获得必要的医疗主任监督水平。
