Emergency Medicine Residency Program, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas, Austin, TX.
Emergency Medicine Residency Program, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas, Austin, TX.
Ann Emerg Med. 2019 Jul;74(1):101-109. doi: 10.1016/j.annemergmed.2018.09.032. Epub 2019 Jan 12.
We compare reported crash rates for US ambulances responding to or transporting patients from a 911 emergency scene with or without lights and sirens. Our null hypothesis is that there will be no difference in the rate of ambulance crashes whether lights and sirens are used.
For this retrospective cohort study, we used the 2016 National EMS Information System data set to identify 911 scene responses and subsequent patient transports by transport-capable emergency medical services (EMS) units. We used the system's "response mode to scene" and "transport mode from scene" fields to determine lights and sirens use. We used the "type of response delay" and "type of transport delay" fields to identify responses and transports that were delayed because of a crash involving the ambulance. We calculated the rate of crash-related delays per 100,000 responses or transports and used multivariable logistic regression with clustered (by agency) standard errors to calculate adjusted odds ratios (AORs) (with 95% confidence intervals [CIs]) for the association between crash-related delays and lights and sirens use for responses and transports separately.
Among 19 million included 911 scene responses, the response phase crash rate was 4.6 of 100,000 without lights and sirens and 5.4 of 100,000 with lights and sirens (AOR 1.5; 95% CI 1.2 to 1.9). For the transport phase, the crash rate was 7.0 of 100,000 without lights and sirens and 17.1 of 100,000 with lights and sirens (AOR 2.9; 95% CI 2.2 to 3.9). Excluding responses and transports with only partial lights and sirens use did not meaningfully alter the results (response AOR 1.5, 95% CI 1.2 to 1.9; transport AOR 2.8, 95% CI 2.1 to 3.8).
Ambulance use of lights and sirens is associated with increased risk of ambulance crashes. The association is greatest during the transport phase. EMS providers should weigh these risks against any potential time savings associated with lights and sirens use.
我们比较了美国救护车在有无警灯警笛的情况下，从 911 紧急现场响应或转运患者的报告事故率。我们的零假设是，无论是否使用警灯警笛，救护车事故率都不会有差异。
这项回顾性队列研究使用 2016 年国家急救医疗服务信息系统数据集，确定了由具备转运能力的紧急医疗服务（EMS）单位响应的 911 现场和随后的患者转运。我们使用系统的“对现场的响应模式”和“从现场的转运模式”字段来确定警灯警笛的使用情况。我们使用“响应延迟类型”和“转运延迟类型”字段来确定因救护车事故而延迟的响应和转运。我们计算了每 10 万次响应或转运中与事故相关的延迟率，并使用带有聚类（按机构）标准误差的多变量逻辑回归，分别计算了与响应和转运中与事故相关的延迟与警灯警笛使用之间关联的调整比值比（AOR）（95%置信区间[CI]）。
在纳入的 1900 万次 911 现场响应中，响应阶段的事故率为无警灯警笛时每 10 万次 4.6 次，有警灯警笛时每 10 万次 5.4 次（AOR 1.5；95%CI 1.2 至 1.9）。在转运阶段，事故率为无警灯警笛时每 10 万次 7.0 次，有警灯警笛时每 10 万次 17.1 次（AOR 2.9；95%CI 2.2 至 3.9）。排除仅部分使用警灯警笛的响应和转运，结果并无明显改变（响应 AOR 1.5，95%CI 1.2 至 1.9；转运 AOR 2.8，95%CI 2.1 至 3.8）。
救护车使用警灯警笛与增加救护车事故风险相关。这种关联在转运阶段最大。EMS 提供者应权衡这些风险与警灯警笛使用相关的任何潜在时间节省。
