Centrale Operativa Provinciale Rovigo Emergenza, Ospedale S. Maria della Misericordia, Rovigo, Italy.
Prehosp Disaster Med. 2013 Oct;28(5):523-8. doi: 10.1017/S1049023X13008790. Epub 2013 Aug 15.
In Italy, administration of medications or advanced procedures dictates the prehospital presence of a physician to initiate treatment. Nursing staff is often used as dispatchers in Italian emergency medical ambulance services. There is little data about nursing dispatch performance in detecting high-acuity patients who need prehospital medications and procedures.
To determine the ability of a dispatch center staffed by emergency ambulance nurses to detect prehospital need for physician interventions in the context of a semi-rural area Emergency Medical Services system.
A retrospective analysis of 53,606 calls from the Rovigo Emergency Ambulance Services' database was undertaken. Physician prehospital interventions were defined as the administration of medications or procedures (advanced airway management and ventilation, pneumothorax decompression, fluid replacement therapy, external defibrillation, cardioversion and pacing). The dispatch codes (assigned by a subjective decision-making process as Red, Yellow, or Green) of all transported prehospital patient calls were matched with an out-of-hospital triage system staffed by clinicians to determine the number of correctly identified prehospital need of physician interventions. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated.
The sensitivity of subjective experience-based nursing dispatch in detecting the need for physician interventions was 78.0% (95% CI, 76.9%-79.1%), with a PPV of 36.6% (95% CI, 35.8%-37.5%). Specificity was 83.8% (95% CI: 83.4%-84.1%), with an NPV of 96.9% (95% CI, 96.8%-97.1%).
A dispatch center staffed by nurses with six years of experience and three months of training correctly identified when not to send a doctor to the scene in the absence of need for physician interventions, using a subjective decision-making process. The nurses staffing the dispatch center also worked in the field. Dispatch center staff were not able to predict when there was no need for physician interventions in high-acuity dispatch code patients, resulting in an over-triage and use of emergency physicians on scene.
在意大利，给予药物或进行高级治疗程序需要医生在场以启动治疗。在意大利的紧急医疗救护车上，护理人员通常作为调度员。关于护理调度员在检测需要院前药物和程序的高紧急程度患者方面的表现，相关数据很少。
确定由急诊救护护士组成的调度中心在半农村地区紧急医疗服务系统中检测院前需要医生干预的能力。
对罗维戈紧急救护服务数据库中的 53606 个电话进行回顾性分析。院前医生干预定义为给予药物或程序（高级气道管理和通气、气胸减压、液体替代疗法、体外除颤、电复律和起搏）。将所有转运的院前患者电话的调度代码（通过主观决策过程分配为红色、黄色或绿色）与由临床医生组成的院外分诊系统相匹配，以确定正确识别需要医生干预的院前人数。计算了灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
基于主观经验的护理调度识别医生干预需求的灵敏度为 78.0%（95%CI，76.9%-79.1%），阳性预测值为 36.6%（95%CI，35.8%-37.5%）。特异性为 83.8%（95%CI：83.4%-84.1%），阴性预测值为 96.9%（95%CI，96.8%-97.1%）。
在没有医生干预需求的情况下，由具有六年经验和三个月培训的护士组成的调度中心使用主观决策过程正确地确定了是否派遣医生到现场。在现场工作的护理人员也在调度中心工作。调度中心工作人员无法预测高紧急程度调度代码患者何时不需要医生干预，导致过度分诊和现场使用急诊医生。
