Nambiar Dhanya, Pearce James W, Bray Janet, Stephenson Michael, Nehme Ziad, Masters Stacey, Brink Deon, Smith Karen, Arendts Glenn, Fatovich Daniel, Bernard Stephen, Haskins Brian, Grantham Hugh, Cameron Peter
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
South Australian Ambulance Service, Adelaide, South Australia, Australia.
Emerg Med Australas. 2020 Jun;32(3):438-445. doi: 10.1111/1742-6723.13431. Epub 2019 Dec 15.
The objective of the present study is to examine variations in paramedic care of the agitated patient, including verbal de-escalation, physical restraint and sedation, provided by ambulance services in Australia and New Zealand.
To examine the care of agitated patients, we first identified and reviewed all clinical practice guidelines for the management of agitated patients in Australian and New Zealand ambulance services between September and November 2018. We then conducted a structured questionnaire to obtain further information on the training, assessment and care of agitated patients by the ambulance services. Two authors extracted the data independently, and all interpretations and results were reviewed and confirmed by relevant ambulance services.
There were 10 independent clinical practice guidelines for the care of agitated patients in the 10 ambulance services. All services reported training in the management of agitated patients, and two services used a validated tool to assess the level of agitation. All services used physical restraint, although six services required police presence to restrain the patient. All ambulance services used some form of sedation, typically divided into the management of mild to moderate, and severe agitation. The most common agent for sedation was midazolam, while ketamine was the most common agent for sedating severely agitated patients. The maximum dose was varied, and contraindications for sedating agents varied between services.
There were wide variations across the ambulance services in terms of the assessment of agitation, as well as the use of physical restraint and sedation.
本研究的目的是调查澳大利亚和新西兰救护车服务机构对躁动患者的护理差异，包括言语缓和、身体约束和镇静。
为了调查对躁动患者的护理情况，我们首先识别并回顾了2018年9月至11月期间澳大利亚和新西兰救护车服务机构中所有关于躁动患者管理的临床实践指南。然后我们进行了一项结构化问卷调查，以获取关于救护车服务机构对躁动患者的培训、评估和护理的更多信息。两位作者独立提取数据，所有的解读和结果都由相关救护车服务机构进行了审核和确认。
10家救护车服务机构中有10项关于躁动患者护理的独立临床实践指南。所有服务机构都报告了对躁动患者管理的培训，有两家服务机构使用了经过验证的工具来评估躁动程度。所有服务机构都使用身体约束，尽管有6家服务机构需要警察在场才能约束患者。所有救护车服务机构都使用了某种形式的镇静，通常分为轻度至中度和重度躁动的管理。最常用的镇静剂是咪达唑仑，而氯胺酮是镇静重度躁动患者最常用的药物。最大剂量各不相同，各服务机构之间镇静剂的禁忌症也有所不同。
各救护车服务机构在躁动评估以及身体约束和镇静的使用方面存在很大差异。
