Akın Paker Sehnaz, Dagar Seda, Gunay Erkan, Temizyurek Cebeci Zeynep, Aksay Ersin
Emergency Department, Canakkale State Hospital, Canakkale, Turkey.
Emergency Department, Kars State Hospital, Kars, Turkey.
Turk J Emerg Med. 2015 Nov 17;15(3):122-5. doi: 10.1016/j.tjem.2015.11.005. eCollection 2015 Sep.
In our study we aimed to investigate the quality and quantity of medical management inside ambulances for 14 and over 14 years old patients transported to a level three emergency department (ED).
Our study was conducted prospectively at a level three ED. 14 and over 14 years old patients who were transported to the ED by ambulance were included in the study consecutively. "Lack of vital rate" was described as missing of one or more of five vital rates during ambulance transportation. Both of two attending emergency physicians evaluated the medical procedures and management of patients at the ambulance simultaneously and this was recorded on the study forms.
Four hundred and fifty six patients were included in the study. Missing vital signs were identified for 90.1% (n = 322) of the patients that were transported by physicians and 92.4% (n = 73) of the patients that were transported by paramedics. For five patients with cardiac arrest two (33.3%) had cardiopulmonary resuscitation (CPR), one (20%) was intubated, one (20%) received adrenaline. Out of 120 patients, needed spinal immobilization, 69 (57.5%) had spinal board. Cervical collar usage was 65.1% (n = 69) We have revealed that 316 (69.3%) patients did not receive at least one of the necessary medical intervention or treatment.
During ambulance transportation, life-saving procedures like cardiopulmonary resuscitation, vital sign measurement, crucial treatment administration, endotracheal intubation, defibrillation, fracture immobilization were not performed adequately. Increasing the training on the deficient interventions and performing administrative inspections may improve quality of patient care.
在我们的研究中，我们旨在调查被转运至三级急诊科（ED）的14岁及以上患者在救护车内部的医疗管理质量和数量。
我们的研究在一家三级急诊科前瞻性开展。连续纳入通过救护车转运至该急诊科的14岁及以上患者。“生命体征缺失”被定义为在救护车转运过程中五项生命体征中的一项或多项缺失。两名主治急诊医生同时评估患者在救护车上的医疗程序和管理情况，并记录在研究表格上。
456名患者纳入研究。由医生转运的患者中有90.1%（n = 322）存在生命体征缺失，由护理人员转运的患者中有92.4%（n = 73）存在生命体征缺失。对于5名心脏骤停患者，2名（33.3%）接受了心肺复苏（CPR），1名（20%）进行了气管插管，1名（20%）接受了肾上腺素治疗。在120名需要脊柱固定的患者中，69名（57.5%）使用了脊柱板。颈托使用率为65.1%（n = 69）。我们发现316名（69.3%）患者至少未接受一项必要的医疗干预或治疗。
在救护车转运过程中，诸如心肺复苏、生命体征测量、关键治疗给药、气管插管、除颤、骨折固定等救生程序未得到充分执行。增加对不足干预措施的培训并进行行政检查可能会提高患者护理质量。
