Bertholet Olivier, Pasquier Mathieu, Christes Elina, Wirths Damien, Carron Pierre-Nicolas, Hugli Olivier, Dami Fabrice
Emergency Department, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland.
Faculty of Medicine, University of Lausanne, Lausanne, Switzerland.
Emerg Med Int. 2020 Mar 16;2020:2651624. doi: 10.1155/2020/2651624. eCollection 2020.
The use of lights and siren transport (LST) has been a matter of debate because of the short time savings and well-established increased risks for Emergency Medical Services (EMS) and bystanders. Time-critical hospital intervention (TCHI) denotes urgently needed procedures that cannot be performed properly in an out-of-hospital setting. Since 2013, rapid transportation from the field, , is currently used for patients with acute ST-elevation myocardial infarction, suspicion of acute stroke and out-of-hospital cardiac arrest. The aim of this study was to determine whether the use of LST was associated with the realization of TCHI for nontrauma cases within 15 minutes of hospital arrival, to quantify overtriage (LST without TCHI) and to identify the predictors of TCHI.
This is a monocentric prospective observational study of nontrauma patients transported by ambulance. Based on Ross et al.'s work in 2016 on trauma patients, TCHI procedures were developed by the study team. Descriptive statistics were used to determine whether the use of LST was associated with the realization of TCHI. Multivariable analyses determined the predictors of TCHI and compared clinical outcomes.
On the 324 patients included, 67 (20.7%) benefitted from LST, with 40 (59.7%) receiving TCHI ( < 0.001). The overtriage rate was 40.3%. The most common medical TCHI was the (65.2% of all TCHI). LST was predictive of the need for TCHI ( < 0.001), as was the clinical condition of the patient and also when EMS providers expected TCHI.
A majority of the LST benefitted from TCHI with an overtriage rate of 40%. To reduce the rate of overtriage (LST without TCHI), LST should mainly be used for and when TCHI is expected by the EMS providers.
由于节省时间有限且已明确会增加紧急医疗服务（EMS）人员及旁观者的风险，使用灯光和警报器护送转运（LST）一直存在争议。时间紧迫的医院干预（TCHI）指的是那些在院外环境无法妥善进行的急需操作。自2013年以来，从现场快速转运目前用于急性ST段抬高型心肌梗死、疑似急性中风及院外心脏骤停的患者。本研究的目的是确定LST的使用是否与非创伤性病例在入院后15分钟内实现TCHI相关，量化过度分诊（LST但无TCHI）情况，并确定TCHI的预测因素。
这是一项对由救护车转运的非创伤性患者进行的单中心前瞻性观察研究。基于罗斯等人2016年对创伤患者的研究工作，研究团队制定了TCHI操作流程。采用描述性统计来确定LST的使用是否与TCHI的实现相关。多变量分析确定了TCHI的预测因素并比较了临床结果。
纳入的324例患者中，67例（20.7%）受益于LST，其中40例（59.7%）接受了TCHI（P<0.001）。过度分诊率为40.3%。最常见的医疗TCHI是[此处原文缺失具体内容]（占所有TCHI的65.2%）。LST可预测TCHI的需求（P<0.001），患者的临床状况以及EMS人员预期有TCHI时也是如此。
大多数LST患者受益于TCHI，过度分诊率为40%。为降低过度分诊率（LST但无TCHI），LST应主要用于[此处原文缺失具体内容]以及EMS人员预期有TCHI的情况。
