Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway.
Health Services Research Group, Department of Global Public Health and Primary Care, University of Bergen, PBox 7810, 5020, Bergen, Norway.
BMC Emerg Med. 2020 Nov 2;20(1):88. doi: 10.1186/s12873-020-00377-0.
Organizational changes in out-of-hour (OOH) services may have unintended consequences for other prehospital services. Reports indicate an increased use of helicopter emergency medical services (HEMS) after changes in OOH services in Norway due to greater geographical distances for the on-call doctors. We investigated whether HEMS dispatches increased when nine municipalities in Sogn og Fjordane County merged into one large inter-municipal OOH district.
All primary dispatches of the HEMS in the county between 2004 and 2013 were included. We applied interrupted time series regression to monthly aggregated data to evaluate the impact of the organizational change 1 April 2009. The nine target municipalities were compared to the rest of the municipalities in the county, which served as a control group. A quasipoisson model adjusted for seasonality was found to be most applicable.
We included 8,751 dispatches, 5,009 (57.2%) of which were completed with a patient encounter. Overall, we found no alteration in requests for HEMS after 2009 (p = 0.251). Separate analyses of the target municipalities and control group revealed no significant increase after 2009 (p = 0.400 and p = 0.056, respectively). When categorizing the municipalities into urban or rural, we found a general increase in HEMS dispatches for the rural group over the 10-year span (p = 0.045) but no added increase after 2009 (p = 0.502). The urban subgroup showed no change. Distance from the OOH service in regards to travel increased within the nine municipalities after 2009, median [quartiles] (5.0[3.0, 6.2] km vs 26.5[5.0, 62.2] km, p < 0.001).
After relocating nine local OOH services into one large inter-municipal OOH district, we found no increase in requests for HEMS.
在非工作时间（OOH）服务中进行组织变革可能会对其他院前服务产生意想不到的后果。有报道称，由于值班医生的地理距离较远，挪威在 OOH 服务发生变化后，直升机紧急医疗服务（HEMS）的使用增加了。我们调查了当松恩-菲尤拉讷郡的 9 个市合并为一个大型市际 OOH 区后，HEMS 派遣是否增加。
包括该县 2004 年至 2013 年期间所有 HEMS 的初步派遣。我们应用中断时间序列回归对每月汇总数据进行评估，以评估 2009 年 4 月 1 日组织变革的影响。九个目标市与该县其他作为对照组的市进行了比较。发现季节性调整的拟泊松模型最适用。
我们纳入了 8751 次派遣，其中 5009 次（57.2%）完成了患者就诊。总体而言，我们发现 2009 年后 HEMS 的请求没有改变（p=0.251）。对目标市和对照组分别进行分析后，发现 2009 年后没有显著增加（p=0.400 和 p=0.056）。当将这些市分类为城市或农村时，我们发现 10 年间农村组的 HEMS 派遣量普遍增加（p=0.045），但 2009 年后没有增加（p=0.502）。城市子组没有变化。2009 年后，九个市内部的 OOH 服务的旅行距离增加，中位数[四分位数]（5.0[3.0, 6.2]公里与 26.5[5.0, 62.2]公里，p<0.001）。
在将 9 个当地 OOH 服务转移到一个大型市际 OOH 区后，我们没有发现 HEMS 请求增加。
