Department of Emergency Medicine, Jan Yperman Ieper, Ieper.
Department of Emergency Medicine, Maria Middelares Hospital, Ghent University.
Eur J Emerg Med. 2020 Apr;27(2):105-109. doi: 10.1097/MEJ.0000000000000595.
Early recognition and appropriate bystander response has proven effect on the outcome of many critically ill patients, including those in cardiac arrest. We wanted to audit prehospital bystander response in our region and identify areas for improvement.
We prospectively collected data, including Emergency Medical Services dispatch center audio files, on all patients with a decreased level of consciousness presenting to the Ghent University Hospital prehospital emergency care unit (n = 151). Three trained emergency physicians reviewed the bystander responses, both before and after dispatcher advice was given. Suboptimal actions (SAs) were only withheld if there was 100% consensus.
SAs were recognized in 54 (38%) of the 142 cases, and most often related to delayed (n = 35) or inaccurate (n = 12) alerting of the dispatch center. In seven cases, the aid given was considered suboptimal in itself. Importantly, in 21 (25.9%) of the 81 cases where a clear advice was given by the dispatcher, this advice was ignored. In 12 cases, a general practitioner was present at scene. We recognized SAs in 80% of these cases (8/10; insufficient information, n = 2). Cardiopulmonary resuscitation was started in only 29 (43.3%) of the 67 cases of cardiac arrest where dispatcher-assisted cardiopulmonary resuscitation was indicated at the moment of first Emergency Medical Services call.
We audited bystander response for unconscious patients in our region and found a high degree of suboptimal actions. These results should inform policy makers and healthcare professionals and force them to urgently reflect on how to improve the first parts of the chain of survival.
早期识别和适当的旁观者反应已被证明对许多危重症患者的预后有影响，包括心搏骤停患者。我们希望审查本地区的院前旁观者反应，并确定需要改进的领域。
我们前瞻性地收集了所有在昏迷状态下被送往根特大学医院院前急救单元的患者的数据，包括紧急医疗服务调度中心的音频文件（n=151）。三名经过培训的急诊医生审查了旁观者的反应，包括在调度员提供建议之前和之后。如果没有 100%的共识，则仅保留次优行为（SA）。
在 142 例病例中有 54 例（38%）识别出 SA，最常见的是调度中心的报警延迟（n=35）或不准确（n=12）。在 7 例中，所给予的救助本身被认为是次优的。重要的是，在 81 例调度员明确建议的病例中，有 21 例（25.9%）忽略了建议。在 12 例中，现场有一名全科医生。我们在这些病例中的 80%（8/10）识别出 SA（信息不足，n=2）。在需要调度员协助心肺复苏的 67 例心搏骤停病例中，仅 29 例（43.3%）开始心肺复苏。
我们审查了本地区无意识患者的旁观者反应，发现存在高度的次优行为。这些结果应该为决策者和医疗保健专业人员提供信息，并迫使他们紧急思考如何改进生存链的前几个环节。
