Hjortdahl Magnus, Zakariassen Erik, Wisborg Torben
National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway.
Scand J Trauma Resusc Emerg Med. 2014 Aug 22;22:47. doi: 10.1186/s13049-014-0047-1.
Together with the ambulances staffed with emergency medical technicians (EMTs), general practitioners (GPs) on call are the primary resources for handling emergencies outside hospitals in Norway. The benefit of the GP accompanying the ambulance to pre-hospital calls is a matter of controversy in Norway. The purpose of the present study was to gain better insight into the EMT's experiences with the role of the GPs in the care for critically ill patients in the pre-hospital setting.
We conducted four focus group interviews with EMTs at four different ambulance stations in Norway. Three of the stations were located at least 2 hours driving distance from the nearest hospital. The interviews were transcribed and analyzed using systematic text condensation.
The EMTs described increasing confidence in emergency medicine during the last few years. However, they felt the need for GP participation in the ambulance when responding to a critically ill patient. The presence of GPs made the EMTs feel more confident, especially in unclear and difficult cases that did not fit into EMT guidelines. The main contributions of the GPs were described as diagnosis and decision-making. Bringing the physician to the patient shortened transportation time to the hospital and important medication could be started earlier. Several examples of sub-optimal treatment in the absence of the GP were given. The EMTs described discomfort with GPs not responding to the calls. They also experienced GPs responding to calls that did not function in the pre-hospital emergency setting. The EMTs reported a need for professional requirements for GPs taking part in out-of-hours work and mandatory interdisciplinary training on a regular basis.
EMTs want GPs to be present in challenging pre-hospital emergency settings. The presence of GPs is perceived as improving patient care. However, professional requirements are needed for GPs taking part in out-of-hours work, and the informants suggested a formalized area for training between EMTs and GPs on call.
在挪威，与配备急救医疗技术人员（EMT）的救护车一起，随叫随到的全科医生（GP）是处理医院外紧急情况的主要资源。在挪威，全科医生陪同救护车进行院前呼叫的益处存在争议。本研究的目的是更深入地了解急救医疗技术人员对全科医生在院前环境中护理重症患者角色的体验。
我们在挪威四个不同的救护车站对急救医疗技术人员进行了四次焦点小组访谈。其中三个车站距离最近的医院至少有两小时的车程。访谈内容经转录后采用系统文本浓缩法进行分析。
急救医疗技术人员表示在过去几年中对急诊医学的信心有所增强。然而，他们认为在应对重症患者时需要全科医生参与救护车出诊。全科医生的在场让急救医疗技术人员更有信心，尤其是在不符合急救医疗技术人员指南的不明和困难病例中。全科医生的主要贡献被描述为诊断和决策。将医生带到患者身边缩短了送往医院的时间，重要药物可以更早开始使用。给出了一些在没有全科医生在场时治疗欠佳的例子。急救医疗技术人员表示对全科医生不响应呼叫感到不满。他们还遇到过全科医生响应的呼叫在院前紧急情况下不起作用。急救医疗技术人员报告称，需要对参与非工作时间工作的全科医生提出专业要求，并定期进行强制性跨学科培训。
急救医疗技术人员希望全科医生出现在具有挑战性的院前紧急情况下。全科医生的在场被认为可改善患者护理。然而，参与非工作时间工作的全科医生需要专业要求，并且受访者建议为急救医疗技术人员和随叫随到的全科医生设立一个正式的培训领域。
