紧急医疗服务提供者对中风管理的知识、实践及障碍
Emergency Medical Services Providers' Knowledge, Practices, And Barriers To Stroke Management.
作者信息
Li Timmy, Munder Sneh Preet, Chaudhry Anisha, Madan Rima, Gribko Michele, Arora Rohan
机构信息
Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, USA.
Department of Neurology, North Shore University Hospital, Manhasset, NY 11030, USA.
出版信息
Open Access Emerg Med. 2019 Nov 15;11:297-303. doi: 10.2147/OAEM.S228240. eCollection 2019.
PURPOSE
Many strokes are not recognized by emergency medical services (EMS) providers and many providers do not prenotify emergency departments (EDs) of incoming stroke patients. The objectives of this project were to survey EMS providers to (1) assess knowledge of prehospital care related to stroke identification, time window for intravenous tissue plasminogen activator (IV tPA) administration, and comprehensive stroke centers in our health system, (2) gain insight from EMS providers regarding barriers to providing prenotification, information they provide for a prenotification, and optimal methods of providing feedback, and (3) provide EMS providers with stroke care and management information.
METHODS
A survey was administered to EMS providers at four hospital EDs. The survey included questions related to knowledge of prehospital stroke care and barriers to providing prenotification. EMS providers were also provided a one-page flyer with information related to prehospital stroke care. Descriptive statistics were used to describe results.
RESULTS
Of 301 EMS providers surveyed, 96.0% report that they use the Cincinnati Prehospital Stroke Scale to identify stroke, and 11.0% correctly identified the time window for IV tPA administration for acute ischemic stroke as within 4.5 hrs from the last known well time. The majority (82.7%) correctly identified the comprehensive stroke center in our health system. Barriers to providing prenotification included short transport time (40.5%), information being lost in dispatch (39.5%), and not having direct communication with ED staff (30.2%). Most reported wanting to receive feedback on the stroke patients they transported (93.7%), and 49.5% reported that the optimal method of providing feedback is via a mobile application.
CONCLUSION
Deficits in stroke care knowledge among EMS providers were identified. Short transport time, inability to communicate with ED staff, and information lost in dispatch were cited as barriers to providing prenotification. Most EMS providers desire real-time feedback regarding patients via a mobile application.
目的
许多中风患者未被紧急医疗服务（EMS）人员识别，且许多EMS人员未提前通知急诊科（ED）有中风患者即将送达。本项目的目标是对EMS人员进行调查，以（1）评估其对与中风识别、静脉注射组织型纤溶酶原激活剂（IV tPA）给药时间窗以及我们医疗系统中的综合中风中心相关的院前护理知识，（2）了解EMS人员在提供提前通知方面面临的障碍、他们为提前通知提供的信息以及提供反馈的最佳方法，（3）为EMS人员提供中风护理和管理信息。
方法
对四家医院急诊科的EMS人员进行了一项调查。该调查包括与院前中风护理知识和提供提前通知的障碍相关的问题。还向EMS人员提供了一份关于院前中风护理的单页传单。使用描述性统计来描述结果。
结果
在接受调查的301名EMS人员中，96.0%报告他们使用辛辛那提院前中风量表来识别中风，11.0%正确识别急性缺血性中风IV tPA给药的时间窗为距最后一次已知健康时间4.5小时内。大多数人（82.7%）正确识别了我们医疗系统中的综合中风中心。提供提前通知的障碍包括运输时间短（40.5%）、信息在调度过程中丢失（39.5%）以及与急诊科工作人员没有直接沟通（30.2%）。大多数人报告希望收到关于他们运送的中风患者的反馈（93.7%），49.5%报告提供反馈的最佳方法是通过移动应用程序。
结论
确定了EMS人员在中风护理知识方面存在不足。运输时间短、无法与急诊科工作人员沟通以及信息在调度中丢失被认为是提供提前通知的障碍。大多数EMS人员希望通过移动应用程序获得关于患者的实时反馈。
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