Laatz Diane, Welzel Tyson, Stassen Willem
Division of Emergency Medicine, University of Cape Town, South Africa.
Afr J Emerg Med. 2019 Mar;9(1):1-7. doi: 10.1016/j.afjem.2018.09.001. Epub 2018 Oct 13.
Helicopter Emergency Medical Services (HEMS) are an expensive resource that should be utilised efficiently to optimise the cost-benefit ratio. This is especially true in resource-limited settings, such as South Africa. This may be achieved by implementing call-out criteria that are most appropriate to the healthcare system in which HEMS operate. Currently, there are no published evidence-based HEMS call-out criteria developed for South Africa. By identifying patients that are most likely to benefit from HEMS, their utilisation can be enhanced and adjusted to ensure optimal patient outcome. We aimed to systematically utilise expert opinions to reach consensus on HEMS call-out criteria that are contextual to the South African setting.
A modified Delphi technique was used to develop call-out criteria, using current literature as the basis of the study. Purposive, snowball sampling was employed to identify a sample of 118 participants locally and internationally, of which 42 participated for all three rounds. Using an online survey platform, binary agreement/disagreement with each criterion was sought. Acceptable consensus was set at 75%. Statements were sent out in the third round ascertaining whether participants agreed with the analysis of the first two rounds.
After two rounds, consensus was obtained for 63% (36/57) of criteria, while 64% of generated statements received consensus in the third round. Results emphasised the opinion that HEMS dispatch criteria relating to patient condition and incident locations were preferential to a comprehensive list. Through collation of these results and international literature, we present an initial concept for a South African HEMS Activation Screen (SAHAS), favouring inquiry on a case-by-case basis.
The combination of existing literature and participant opinions, established that call-out criteria are most efficient when based on clinical parameters and geographic considerations, as opposed to a specified list of criteria. The initial concept of our SAHAS should be investigated further.
直升机紧急医疗服务（HEMS）是一种昂贵的资源，应有效利用以优化成本效益比。在资源有限的地区，如南非，情况尤其如此。这可以通过实施最适合HEMS运行的医疗系统的出诊标准来实现。目前，尚未有针对南非制定的基于证据的HEMS出诊标准发表。通过识别最有可能从HEMS中受益的患者，可以提高其利用率并进行调整，以确保患者获得最佳治疗效果。我们旨在系统地利用专家意见，就适用于南非情况的HEMS出诊标准达成共识。
采用改良的德尔菲技术制定出诊标准，以当前文献作为研究基础。采用目的抽样和滚雪球抽样方法，在本地和国际范围内确定了118名参与者的样本，其中42人参与了所有三轮调查。通过在线调查平台，征求对每个标准的二元同意/不同意意见。可接受的共识设定为75%。在第三轮中发出声明，确定参与者是否同意前两轮的分析。
两轮后，63%（36/57）的标准达成了共识，而在第三轮中，64%的生成声明获得了共识。结果强调，与患者病情和事件地点相关的HEMS派遣标准比综合列表更具优先性。通过整理这些结果和国际文献，我们提出了南非HEMS激活筛查（SAHAS）的初步概念，主张逐案进行询问。
现有文献和参与者意见的结合表明，出诊标准基于临床参数和地理因素时最为有效，而不是特定的标准列表。我们的SAHAS的初步概念应进一步研究。
