Univ. Lyon, University Claude Bernard Lyon 1, HESPER EA 7425, 69008, Lyon, France.
Emergency Department and RESCUe Network, Lucien Hussel Hospital, Vienne, 38200, France.
Int J Health Geogr. 2018 Jan 12;17(1):1. doi: 10.1186/s12942-018-0121-4.
The World Health Organization refers to stroke, the second most frequent cause of death in the world, in terms of pandemic. Present treatments are only effective within precise time windows. Only 10% of thrombolysis patients are eligible. Late assessment of the patient resulting from admission and lack of knowledge of the symptoms is the main explanation of lack of eligibility.
The aim is the measurement of the time of access to treatment facilities for stroke victims, using ambulances (firemen ambulances or EMS ambulances) and private car. The method proposed analyses the potential geographic accessibility of stroke care infrastructure in different scenarios. The study allows better considering of the issues inherent to an area: difficult weather conditions, traffic congestion and failure to respect the distance limits of emergency transport.
Depending on the scenario, access times vary considerably within the same commune. For example, between the first and the second scenario for cities in the north of Rhône county, there is a 10 min difference to the nearest Primary Stroke Center (PSC). For the first scenario, 90% of the population is 20 min away of the PSC and 96% for the second scenario. Likewise, depending on the modal vector (fire brigade or emergency medical service), overall accessibility from the emergency call to admission to a Comprehensive Stroke Center (CSC) can vary by as much as 15 min.
The setting up of the various scenarios and modal comparison based on the calculation of overall accessibility makes this a new method for calculating potential access to care facilities. It is important to take into account the specific pathological features and the availability of care facilities for modelling. This method is innovative and recommendable for measuring accessibility in the field of health care. This study makes possible to highlight the patients' extension of care delays. Thus, this can impact the improvement of patient care and rethink the healthcare organization. Stroke is addressed here but it is applicable to other pathologies.
世界卫生组织将中风定义为全球第二大致死原因。目前的治疗方法仅在特定的时间窗口内有效。只有 10%的溶栓患者符合条件。由于入院后对患者的评估延迟以及对症状的了解不足，是导致不符合溶栓条件的主要原因。
本研究旨在通过救护车（消防员救护车或 EMS 救护车）和私家车评估中风患者到达治疗设施的时间。所提出的方法分析了在不同场景下中风护理基础设施的潜在地理可达性。该研究更好地考虑了特定区域的固有问题：恶劣的天气条件、交通拥堵和对紧急运输距离限制的不遵守。
根据场景的不同，同一市镇内的到达时间差异很大。例如，在罗纳北部城市的第一和第二场景之间，到达最近的初级中风中心（PSC）的时间相差 10 分钟。对于第一场景，90%的人口距离 PSC 有 20 分钟的路程，对于第二场景，这一比例为 96%。同样，根据模态向量（消防队或紧急医疗服务）的不同，从紧急呼叫到进入综合中风中心（CSC）的整体可达性可能相差多达 15 分钟。
基于整体可达性的计算，设置各种场景和模态比较是一种新的计算潜在医疗设施可达性的方法。在建模时，考虑特定的病理特征和护理设施的可用性非常重要。该方法具有创新性，推荐用于医疗保健领域的可达性测量。本研究能够突出患者护理延迟的扩展。因此，这可能会影响患者护理的改善和重新思考医疗保健组织。这里讨论的是中风，但它也适用于其他疾病。
