Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Emergency Medical Services and Prehospital Care Program, American University of Beirut Medical Center, Beirut, Lebanon.
Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Am J Emerg Med. 2018 May;36(5):763-768. doi: 10.1016/j.ajem.2017.10.008. Epub 2017 Oct 6.
Emergency and transport ventilators use in the prehospital field is not well described. This study examines trends of ventilator use by EMS agencies during 911 calls in the United States and identifies factors associated with this use.
This retrospective study used four consecutive releases of the US National Emergency Medical Services Information System (NEMSIS) public research dataset (2011-2014) to describe scene EMS activations (911 calls) with and without reported ventilator use.
Ventilator use was reported in 260,663 out of 28,221,321 EMS 911 scene activations (0.9%). Patients with ventilator use were older (mean age 67±18years), nearly half were males (49.2%), mostly in urban areas (80.2%) and cared for by advanced life support (ALS) EMS services (89.5%). CPAP mode of ventilation was most common (71.6%). "Breathing problem" was the most common dispatch complaint for EMS activations with ventilator use (63.9%). Common provider impression categories included "respiratory distress" (72.5%), "cardiac rhythm disturbance" (4.6%), "altered level of consciousness" (4.3%) and "cardiac arrest"(4.0%). Ventilator use was consistently higher at the Specialty Care Transport (SCT) and Air Medical Transport (AMT) service levels and increased over the study period for both suburban and rural EMS activations. Significant factors for ventilator use included demographic characteristics, EMS agency type, specific complaints, provider's primary impressions and condition codes.
Providers at different EMS levels use ventilators during 911 scene calls in the US. Training of prehospital providers on ventilation technology is needed. The benefit and effectiveness of this intervention remain to be assessed.
在院前领域，急救和转运呼吸机的使用情况描述得并不充分。本研究考察了美国 911 呼叫中 EMS 机构使用呼吸机的趋势，并确定了与这种使用相关的因素。
本回顾性研究使用了美国国家紧急医疗服务信息系统（NEMSIS）公共研究数据集的四个连续版本（2011-2014 年），描述了有和没有报告使用呼吸机的场景 EMS 激活（911 呼叫）。
在 28221321 次 EMS 911 场景激活中，有 260663 次报告使用了呼吸机（0.9%）。使用呼吸机的患者年龄较大（平均年龄 67±18 岁），近一半为男性（49.2%），大多在城市地区（80.2%），并由高级生命支持（ALS）EMS 服务（89.5%）提供治疗。CPAP 通气模式最为常见（71.6%）。“呼吸问题”是最常见的与呼吸机使用相关的 EMS 激活调度投诉（63.9%）。常见的提供者印象类别包括“呼吸窘迫”（72.5%）、“心律失常”（4.6%）、“意识水平改变”（4.3%）和“心搏骤停”（4.0%）。在特种护理转运（SCT）和空中医疗转运（AMT）服务水平上，呼吸机的使用始终较高，并且在研究期间，无论是在郊区还是农村的 EMS 激活中，呼吸机的使用都有所增加。呼吸机使用的显著因素包括人口统计学特征、EMS 机构类型、具体投诉、提供者的主要印象和病情代码。
美国不同 EMS 级别的提供者在 911 场景呼叫中使用呼吸机。需要对院前提供者进行通气技术培训。这种干预的益处和效果仍有待评估。
