Cortez Eric J, Panchal Ashish R, Davis James E, Keseg David P
1City of Columbus,Division of Fire,Columbus,OhioUSA.
3Center for EMS,Department of Emergency Medicine,The Ohio State University Wexner Medical Center,Columbus,OhioUSA.
Prehosp Disaster Med. 2017 Apr;32(2):175-179. doi: 10.1017/S1049023X16001539. Epub 2017 Jan 18.
Introduction The staffing of ambulances with different levels of Emergency Medical Service (EMS) providers is a difficult decision with evidence being mixed on the benefit of each model. Hypothesis/Problem The objective of this study was to describe a pilot program evaluating alternative staffing on two ambulances utilizing the paramedic-basic (PB) model (staffed with one paramedic and one emergency medical technician[EMT]).
This was a retrospective study conducted from September 17, 2013 through December 31, 2013. The PB ambulances were compared to geographically matched ambulances staffed with paramedic-paramedic (PP ambulances). One PP and one PB ambulance were based at Station A; one PP and one PB ambulance were based at Station B. The primary outcome was total on-scene time. Secondary outcomes included time-to-electrocardiogram (EKG), time-to-intravenous (IV) line insertion, IV-line success rate, and percentage of protocol violations. Inclusion criteria were all patients requesting prehospital services that were attended to by these teams. Patients were excluded if they were not attended to by the study ambulance vehicles. Descriptive statistics were reported as medians and interquartile ranges (IQR). Proportions were reported with 95% confidence intervals (CI). The Mann-Whitley U test was used for significance testing (P<.05).
Median on-scene times at Station A for the PP ambulance were shorter than the PB ambulance team (PP: 10.1 minutes, IQR 6.0-15; PB: 13.0 minutes, IQR 8.1-18; P=.01). This finding also was noted at Station B (PP: 13.5 minutes, IQR 8.5-19; PB: 14.3 minutes, IQR 9.9-20; P=.01). There were no differences between PP and PB ambulance teams at Station A or Station B in time-to-EKG, time-to-IV insertion, IV success rate, and protocol violation rates.
In the setting of a well-developed EMS system utilizing an all-Advanced Life Support (ALS) response, this study suggests that PB ambulance teams may function well when compared to PP ambulances. Though longer scene times were observed, differences in time to ALS interventions and protocol violation rates were not different. Hybrid ambulance teams may be an effective staffing alternative, but decisions to use this model must address clinical and operational concerns. Cortez EJ , Panchal AR , Davis JE , Keseg DP . The effect of ambulance staffing models in a metropolitan, fire-based EMS system. Prehosp Disaster Med. 2017;32(2):175-179.
引言 为救护车配备不同级别的紧急医疗服务（EMS）人员是一个艰难的决策，关于每种模式的益处的证据并不一致。假设/问题 本研究的目的是描述一个试点项目，该项目评估了在两辆救护车上采用护理人员-急救员（PB）模式（配备一名护理人员和一名急救医疗技术员[EMT]）的替代人员配置情况。
这是一项回顾性研究，时间跨度为2013年9月17日至2013年12月31日。将PB救护车与地理位置匹配的配备护理人员-护理人员（PP救护车）的救护车进行比较。一辆PP救护车和一辆PB救护车驻扎在A站；一辆PP救护车和一辆PB救护车驻扎在B站。主要结局是总现场时间。次要结局包括心电图（EKG）检查时间、静脉输液（IV）管路插入时间、IV管路成功率和违反方案的百分比。纳入标准是所有由这些团队提供院前服务的患者。如果患者未由研究救护车接诊，则将其排除。描述性统计数据以中位数和四分位数间距（IQR）报告。比例以95%置信区间（CI）报告。使用曼-惠特尼U检验进行显著性检验（P<0.05）。
在A站，PP救护车的中位现场时间短于PB救护车团队（PP：10.1分钟，IQR 6.0 - 15；PB：13.0分钟，IQR 8.1 - 18；P = 0.01）。在B站也观察到了这一结果（PP：13.5分钟，IQR 8.5 - 19；PB：14.3分钟，IQR 9.9 - 20；P = 0.01）。在A站或B站，PP和PB救护车团队在EKG检查时间、IV插入时间、IV成功率和违反方案率方面没有差异。
在一个利用全高级生命支持（ALS）响应的成熟EMS系统中，本研究表明，与PP救护车相比，PB救护车团队可能运行良好。尽管观察到现场时间更长，但在ALS干预时间和违反方案率方面没有差异。混合救护车团队可能是一种有效的人员配置替代方案，但采用这种模式的决策必须考虑临床和操作方面的问题。科尔特斯EJ、潘查尔AR、戴维斯JE、凯塞格DP。大城市基于消防的EMS系统中救护车人员配置模式的影响。院前灾难医学。2017；32(2)：175 - 179。
