Department of Prehospital Emergency Care, Region Halland, Sweden.
Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, SE-405 30, Gothenburg, Sweden.
Scand J Trauma Resusc Emerg Med. 2020 Jan 29;28(1):7. doi: 10.1186/s13049-020-0706-3.
Prehospital care has changed in recent decades. Advanced assessments and decisions are made early in the care chain. Patient assessments form the basis of a decision relating to prehospital treatment and the level of care. This development imposes heavy demands on the ability of emergency medical service (EMS) clinicians properly to assess the patient. EMS clinicians have a number of assessment instruments and triage systems available to support their decisions. Many of these instruments are based on vital signs and can sometimes miss time-sensitive conditions. With this commentary, we would like to start a discussion to agree on definitions of temporal states in the prehospital setting and ways of recognising patients with time-sensitive conditions in the most optimal way.
There are several articles discussing the identification and management of time-sensitive conditions. In these articles, neither definitions nor terminology have been uniform. There are a number of problems associated with the definition of time-sensitive conditions. For example, intoxication can be minor but also life threatening, depending on the type of poison and dose. Similarly, diseases like stroke and myocardial infarction can differ markedly in terms of severity and the risk of life-threatening complications. Another problem is how to support EMS clinicians in the early recognition of these conditions. It is well known that many of them can present without a deviation from normal in vital signs. It will most probably be impossible to introduce specific decision support tools for every individual time-sensitive condition. However, there may be information in the type and intensity of the symptoms patients present. In future, biochemical markers and machine learning support tools may help to identify patients with time-sensitive conditions and predict mortality at an earlier stage.
It may be of great value for prehospital clinicians to be able to describe time-sensitive conditions. Today, neither definitions nor terminology are uniform. Our hope is that this commentary will initiate a discussion on the issue aiming at definitions of time-sensitive conditions in prehospital care and how they should be recognised in the most optimal fashion.
近几十年来，院前医疗护理发生了变化。在医疗护理链的早期就做出了高级评估和决策。患者评估构成了与院前治疗和护理水平相关的决策的基础。这种发展对紧急医疗服务 (EMS) 临床医生正确评估患者的能力提出了很高的要求。EMS 临床医生有许多评估工具和分诊系统可用于支持他们的决策。其中许多工具基于生命体征，有时可能会错过对时间敏感的病症。在这篇评论中，我们希望发起讨论，就院前环境中时间敏感状态的定义以及以最佳方式识别具有时间敏感条件的患者的方法达成一致意见。
有几篇文章讨论了时间敏感病症的识别和管理。在这些文章中，既没有统一的定义，也没有统一的术语。时间敏感病症的定义存在一些问题。例如，中毒可能是轻微的，但也可能有生命危险，具体取决于中毒的类型和剂量。同样，中风和心肌梗死等疾病在严重程度和危及生命的并发症风险方面可能有很大差异。另一个问题是如何支持 EMS 临床医生早期识别这些病症。众所周知，其中许多病症在生命体征上没有偏离正常的情况下就可能出现。为每一种特定的时间敏感病症引入特定的决策支持工具可能不太现实。然而，患者所表现出的症状的类型和强度可能会有相关信息。在未来，生化标志物和机器学习支持工具可能有助于更早地识别具有时间敏感病症的患者，并预测死亡率。
对于院前临床医生来说，能够描述时间敏感病症可能具有重要价值。目前，定义和术语都不统一。我们希望这篇评论将引发一场关于院前护理中时间敏感病症的定义以及如何以最佳方式识别这些病症的讨论。
