Heidet Matthieu, Da Cunha Thierry, Brami Elise, Mermet Eric, Dru Michel, Simonnard Béatrice, Lecarpentier Eric, Chollet-Xémard Charlotte, Bergeron Corinne, Khalid Mohamed, Grunau Brian, Marty Jean, Audureau Etienne
Matthieu Heidet (
Thierry Da Cunha is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP.
Health Aff (Millwood). 2020 Jul;39(7):1175-1184. doi: 10.1377/hlthaff.2019.00842.
Increased emergency medical services (EMS) response times and areas of low socioeconomic status are both associated with poorer outcomes for several time-sensitive medical conditions attended to by medical personnel before a patient is hospitalized. We evaluated the association between EMS response times, area deprivation level, and on-scene access constraints encountered by EMS in a large urban area in France. We conducted a multicenter prospective cohort study of EMS dispatches occurring in the forty-seven cities in a region southeast of Paris. We fit multilevel mixed-effects linear regression models for multivariate assessment of the predictors of EMS response times and then used multivariate logistic regression on outcomes among a subgroup of patients presenting with out-of-hospital cardiac arrest. We found evidence that access constraints were more frequently encountered by EMS in the most deprived areas compared to less deprived ones, and were associated with increased EMS response times until patient contact and with poorer outcomes from cardiac arrest. Strategies to anticipate and overcome access constraints should be implemented to improve outcomes for emergent conditions attended to by prehospital medical teams.
急救医疗服务（EMS）响应时间的增加以及社会经济地位较低的地区，都与患者住院前医务人员处理的几种对时间敏感的医疗状况的较差预后相关。我们评估了法国一个大城市地区的急救医疗服务响应时间、地区贫困程度以及急救医疗服务遇到的现场接入限制之间的关联。我们对巴黎东南部一个地区的47个城市发生的急救医疗服务调度进行了一项多中心前瞻性队列研究。我们拟合了多水平混合效应线性回归模型，用于对急救医疗服务响应时间的预测因素进行多变量评估，然后对一组院外心脏骤停患者的结局进行多变量逻辑回归分析。我们发现，与贫困程度较低的地区相比，急救医疗服务在最贫困地区更频繁地遇到接入限制，并且这与患者接触前急救医疗服务响应时间的增加以及心脏骤停的较差预后相关。应实施预测和克服接入限制的策略，以改善院前医疗团队处理的紧急状况的预后。
