Swansea University Medical School, Swansea University, Swansea, UK.
Hillary Rodham Clinton School of Law, Swansea University, Swansea, UK.
Emerg Med J. 2020 Dec;37(12):752-755. doi: 10.1136/emermed-2019-208967. Epub 2020 Sep 3.
Self-harm is among the top five causes of acute hospital admissions and ambulance clinicians are often the first point of contact. However, the Emergency Department (ED) may not be the most appropriate place of care and little is known about the existence or nature of alternative pathways available to UK ambulance services. This survey describes the current management pathways used by ambulance services for patients who have self-harmed.
A structured questionnaire was sent to all UK ambulance services by email and followed up by telephone in 2018. Three independent researchers (two clinical) coded responses which were analysed thematically.
All 13 UK ambulance services responded to the survey: nine by email and four by telephone interview. Two services reported a service-wide protocol for managing people presenting with self-harm, with referral to mental health crisis team available as an alternative to conveyance to ED, following on-scene psychosocial assessment. Four services reported local pathways for managing mental health patients which included care of patients who had self-harmed. Four services reported being in the process of developing pathways for managing mental health patients. Six services reported no service-wide nor local pathways for managing self-harm patients. No robust evaluation of new care models was reported.
Practice in ambulance services in the UK is variable, with a minority having a specific clinical pathway for managing self-harm, with an option to avoid ED. New pathways for patients who have self-harmed must be evaluated in terms of safety, clinical and cost-effectiveness.
自残是导致急性住院和救护车接诊的五大原因之一，而急救临床医生通常是第一个接诊此类患者的人。然而，急诊科（ED）可能不是最合适的治疗场所，对于英国救护车服务机构中是否存在或了解到有哪些可供选择的替代途径，目前还知之甚少。本调查描述了目前救护车服务机构用于治疗自残患者的管理途径。
2018 年，通过电子邮件向所有英国救护车服务机构发送了一份结构化问卷，并通过电话进行了跟进。三位独立的研究人员（两位临床医生）对回复进行了编码，并进行了主题分析。
所有 13 家英国救护车服务机构均回复了调查：9 家通过电子邮件，4 家通过电话访谈。两家服务机构报告说，他们有一个全面的服务协议，用于管理出现自残的患者，可以在现场心理社会评估后，选择将患者转介给心理健康危机小组，而不是送往 ED。四家服务机构报告了管理心理健康患者的当地途径，其中包括管理自残患者。四家服务机构报告说正在制定管理心理健康患者的途径。六家服务机构报告说，他们没有全面或局部的管理自残患者的途径。没有报告对新护理模式进行严格的评估。
英国救护车服务机构的做法各不相同，少数机构有专门的临床途径来管理自残患者，可以选择避免送往 ED。对于自残患者的新途径，必须从安全性、临床效果和成本效益方面进行评估。
