Department of Anaesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Prague, Czech Republic.
Emergency Medical Service of Karlovy Vary Region, Karlovy Vary, Czech Republic.
Prehosp Disaster Med. 2020 Dec;35(6):656-662. doi: 10.1017/S1049023X2000117X. Epub 2020 Sep 28.
The effect and subjective perception of audiovisual consults (AVCs) by paramedics with a distant physician in prehospital emergency care (PHEC) remain unexplained, especially in low-urgency calls.
The primary objective of the study was to evaluate the effect of AVCs by paramedics with a base physician on the rate of patients treated on site without the need of hospital transfer. The co-primary safety outcome was the frequency of repeated ambulance trips within 48 hours to the same patient. Secondary objective was the qualitative analysis of perception of the AVCs.
During a six-week period, the dispatching center of Karlovy Vary Emergency Medical Service (EMS) randomized low-urgency events from a rural area (n = 791) to receive either a mandatory phone-call consult (PHONE), AVC (VIDEO), or performed by the paramedic crew in a routine manner, when phone-call consultation is for paramedic crew optional (CONTROL). Secondarily, the qualitative analysis of subjective perception of AVCs compared to consultation over the phone by the paramedic and consulting physician was performed.
Per-protocol analysis (PPA) was performed (CONTROL, n = 258; PHONE, n = 193; and VIDEO, n = 192) in addition to the intention-to-treat (ITT) analysis. Patients (PPA) in both mandatory consulted groups were twice as likely to be treated and left on site compared to the CONTROL (PHONE: OR = 2.07; 95% CI, 1.19 to 3.58; P = 0.01 or VIDEO: OR = 2.01; 95% CI, 1.15 to 3.49; P = .01). Repeated trips to patients treated and left on site in 48 hours occurred in three (8.6%) of 35 cases in the PHONE group and in eight (23.5%) of 34 cases in the VIDEO group.
The AVCs of the emergency physician by paramedics was not superior to the mandatory conventional phone call in increasing the proportion of patients treated and left at home after a low-urgency call. The AVC improved the subjective feelings of safety by physicians, but not the satisfaction of patients or paramedics, and may lead to an increased need of repeated trips.
在院前急救中，护理人员与远程医生进行视听咨询（AVC）的效果和主观感知仍未得到解释，尤其是在低紧急呼叫中。
该研究的主要目的是评估护理人员与基地医生进行 AVC 对现场治疗无需转院的患者比例的影响。主要安全性结果是在 48 小时内同一患者重复呼叫救护车的频率。次要目标是对 AVC 感知进行定性分析。
在六周的时间里，卡罗维发利紧急医疗服务（EMS）的调度中心将农村地区的低紧急事件（n = 791）随机分为接受强制性电话咨询（PHONE）、AVC（VIDEO）或由护理人员常规进行，当电话咨询是护理人员可选时（CONTROL）。其次，对 AVC 与护理人员和咨询医生的电话咨询的主观感知进行了定性分析。
进行了符合方案分析（PPA）（CONTROL，n = 258；PHONE，n = 193；VIDEO，n = 192），此外还进行了意向治疗（ITT）分析。与 CONTROL 相比，接受强制性咨询的两组患者（PPA）接受治疗并留在现场的可能性是两倍（PHONE：OR = 2.07；95%CI，1.19 至 3.58；P = 0.01 或 VIDEO：OR = 2.01；95%CI，1.15 至 3.49；P = 0.01）。在 48 小时内对接受治疗并留在现场的患者进行了三次（8.6%）PHONE 组和八次（23.5%）VIDEO 组的重复治疗。
在增加低紧急呼叫后在家中接受治疗和留治的患者比例方面，护理人员与紧急医生的 AVC 并不优于强制性常规电话呼叫。AVC 改善了医生的安全感，但没有提高患者或护理人员的满意度，并可能导致重复呼叫的需求增加。
