Shrestha S K, Koirala K, Amatya B
Department of Emergency, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.
Kathmandu Univ Med J (KUMJ). 2018;16(61):39-42.
Background In many developing countries, emergency medical services, especially pre-hospital emergency care, has long been neglected. It is the major obstacle for provision of timely care. Patients are regularly brought to emergency department by the relatives in taxis, bus or other readily available mode of transportation that lacks emergency medical services. Development the Nepal Ambulance Service established its first proper ambulance service in Nepal in 2011 and Dhulikhel Emergency Medical Services in 2013 at Dhulikhel Hospital, Kathmandu University Hospital. Proper prehospital emergence medical service can improve survival rates. Objective To determine the mode of transportation used by patients to arrive at the emergency department and effectiveness of medical services specific to Dhulikhel Hospital, Kavre, Nepal. Method In this study, 160 patients who arrived to emergency department during one-month period were included. The emergency physicians and paramedics collected data on a predesigned questionnaire regarding demographic details, mode of transport used by the patients to arrive emergency department, reason for not using ambulance, knowledge on emergency medical services at Dhulikhel Hospital and their acceptability for those services. Result Mean age of the patients was 46±18 years and (52%) were men. Out of them, only 31% arrived to the emergency department by ambulance while the rest other patients used other forms of transport such as private vehicles (21%), bus (16%), taxi (13%), motorbike (11%) and van (7%). Among 50 patients who used ambulance, 24% of the patients who used Dhulikhel Hospital ambulance received medical care and trained medical staff services; all patients were satisfied with the services. 155 out of 160 patients mentioned the need of a trained medical personal in ambulance. The mean duration for waiting time for ambulance was 33.78 minutes. The main reasons to not using ambulance were they did not know the ambulance number, ability to find other vehicles easily and having own private vehicle. Conclusion A prominent proportion of patients did not arrive by ambulance to the emergency department and the main reason was that they didn't know the number of ambulance service. Developing three-digit phone number for ambulance service at the local level will make people easier to remember and contact. Similarly, education and training must be developed to improve emergency medical services. These strategies along with team management of patients could significantly improve patient care in Nepal.
在许多发展中国家，紧急医疗服务，尤其是院前急救，长期以来一直被忽视。这是提供及时医疗护理的主要障碍。患者通常由亲属乘坐出租车、公交车或其他缺乏紧急医疗服务的便捷交通工具送往急诊科。尼泊尔发展救护车服务组织于2011年在尼泊尔建立了首个正规救护车服务，并于2013年在加德满都大学医院杜利凯尔医院设立了杜利凯尔紧急医疗服务。适当的院前紧急医疗服务可以提高生存率。目的：确定患者到达急诊科所使用的交通方式以及尼泊尔卡夫雷杜利凯尔医院特定医疗服务的有效性。方法：本研究纳入了在一个月期间到达急诊科的160名患者。急诊医生和护理人员根据预先设计的问卷收集数据，内容包括人口统计学细节、患者到达急诊科所使用的交通方式、不使用救护车的原因、对杜利凯尔医院紧急医疗服务的了解以及他们对这些服务的接受程度。结果：患者的平均年龄为46±18岁，男性占52%。其中，只有31%的患者乘坐救护车到达急诊科，其余患者使用其他交通方式，如私家车（21%）、公交车（16%）、出租车（13%）、摩托车（11%）和面包车（7%）。在50名使用救护车的患者中，24%使用杜利凯尔医院救护车的患者接受了医疗护理和专业医护人员服务；所有患者对服务都很满意。160名患者中有155名提到需要在救护车上配备经过培训的医护人员。救护车的平均等待时间为33.78分钟。不使用救护车的主要原因是他们不知道救护车号码、能够轻松找到其他车辆以及拥有私家车。结论：相当一部分患者不是乘坐救护车到达急诊科，主要原因是他们不知道救护车服务号码。在地方层面为救护车服务制定三位数电话号码将使人们更容易记住和联系。同样，必须开展教育和培训以改善紧急医疗服务。这些策略以及对患者的团队管理可以显著改善尼泊尔的患者护理。
