Buswell Marina, Lumbard Philip, Prothero Larissa, Lee Caroline, Martin Steven, Fleming Jane, Goodman Claire
NIHR CLAHRC-EoE, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK.
East of England Ambulance Service (EEAS), Cambridge, UK.
Emerg Med J. 2016 Jan;33(1):61-70. doi: 10.1136/emermed-2014-203941. Epub 2014 Dec 2.
To synthesise the existing literature on the roles that emergency medical services (EMS) play in unplanned, urgent and emergency care for older people with dementia (OPWD), to define these roles, understand the strength of current research and to identify where the focus of future research should lie.
An integrative review of the synthesised reports, briefings, professional recommendations and evidence. English-language articles were included if they made any reference to the role of EMS in the urgent or emergency care of OPWD. Preparatory scoping and qualitative work with frontline ambulance and primary care staff and carers of OPWD informed our review question and subsequent synthesis.
Seventeen literature sources were included. Over half were from the grey literature. There was no research that directly addressed the review question. There was evidence in reports, briefings and professional recommendations of EMS addressing some of the issues they face in caring for OPWD. Three roles of EMS could be drawn out of the literature: emergency transport, assess and manage and a 'last resort' or safety net role.
The use of EMS by OPWD is not well understood, although the literature reviewed demonstrated a concern for this group and awareness that services are not optimum. Research in dementia care should consider the role that EMS plays, particularly if considering crises, urgent care responses and transitions between care settings. EMS research into new ways of working, training or extended paramedical roles should consider specific needs and challenges of responding to people with dementia.
综合现有关于紧急医疗服务（EMS）在为患有痴呆症的老年人（OPWD）提供非计划性、紧急和急诊护理中所起作用的文献，明确这些作用，了解当前研究的优势，并确定未来研究的重点所在。
对综合报告、简报、专业建议和证据进行综合综述。如果英文文章提及了EMS在OPWD紧急或急诊护理中的作用，则将其纳入。与一线救护车工作人员、初级护理人员以及OPWD的护理人员开展的预备性范围界定和定性工作为我们的综述问题及后续综合分析提供了参考。
纳入了17篇文献来源。超过半数来自灰色文献。没有直接针对综述问题的研究。在报告、简报和专业建议中，有证据表明EMS在应对护理OPWD时面临的一些问题。从文献中可以提炼出EMS的三个作用：紧急转运、评估与管理以及“最后手段”或安全网作用。
尽管所综述的文献表明对这一群体的关注以及意识到服务并非最优，但OPWD对EMS的使用情况仍未得到充分了解。痴呆症护理研究应考虑EMS所起的作用，特别是在考虑危机、紧急护理应对以及护理环境之间的过渡时。EMS对新工作方式、培训或扩展辅助医疗角色的研究应考虑应对痴呆症患者的特定需求和挑战。
