Bloomer Karl
Northern Ireland Ambulance Service HSC Trust: ORCID iD: https://orcid.org/0000-0002-7822-4528.
Br Paramed J. 2019 Sep 1;4(2):10-21. doi: 10.29045/14784726.2019.09.4.2.10.
Diabetes mellitus has been referred to as an 'epidemic' and the World Health Organization reported 422 million people with the disease in 2014. Hypoglycaemia is common among emergency presentations, yet understanding around the utilisation of emergency medical services (EMS) for this is incomplete.Ambulance service referral pathways for those suitable to be treated in the community have been developed as a means of managing this growing demand. However, there is limited evidence to suggest how they should be constructed or implemented.The aim of this review was to examine patients who re-contacted the health services following EMS non-transport for a hypoglycaemic episode and to determine if risk factors could be identified.
Medline/PubMed and CINAHL online databases were searched for papers published between 1998 and 2018 relating to re-contacts following an interaction with EMS. The Cochrane Library online database was also searched, as well as manual searches from key journals. Relevant clinical manuals, guidelines and specific grey literature were also hand searched.
After duplicates were removed, 260 articles were identified, with 41 selected for full review. These were then reduced by excluding those that did not provide any data on re-contact rates/demographics. The remaining papers were then assessed using the Critical Appraisal Skills Programme (CASP) appraisal tool and those identified as of low quality were removed. This produced 17 papers for final inclusion.
The literature demonstrates that ambulance clinicians can appropriately treat hypoglycaemia in the community and identify those requiring further assessment at emergency departments. However, due to the very nature of diabetes, repeat episodes will and do occur, regardless of community or emergency department management, but these are rarely in the acute phase. Some groups are higher risk, but thorough holistic assessment is vital for identifying those suitable for community management.
糖尿病被称为一种“流行病”，世界卫生组织报告称2014年全球有4.22亿糖尿病患者。低血糖在急诊病例中很常见，但对于利用紧急医疗服务（EMS）处理低血糖的了解并不全面。已制定了针对适合在社区治疗的患者的救护车服务转诊途径，作为应对这一日益增长的需求的一种方式。然而，关于这些途径应如何构建或实施的证据有限。本综述的目的是研究在因低血糖发作被EMS非转运后再次联系医疗服务机构的患者，并确定是否能识别出风险因素。
检索Medline/PubMed和CINAHL在线数据库，查找1998年至2018年期间发表的与EMS接触后再次联系相关的论文。还检索了Cochrane图书馆在线数据库，并对主要期刊进行手工检索。同时也对手工检索相关临床手册、指南和特定灰色文献。
去除重复文章后，共识别出260篇文章，其中41篇被选作全面综述。然后通过排除那些未提供任何关于再次联系率/人口统计学数据的文章进行筛选。其余论文随后使用批判性评估技能计划（CASP）评估工具进行评估，排除那些被确定为低质量的文章。最终纳入17篇论文。
文献表明，救护车临床医生可以在社区中适当治疗低血糖，并识别出那些需要在急诊科进一步评估的患者。然而，由于糖尿病的本质，无论社区或急诊科如何管理，复发情况都会且确实会发生，但这些很少处于急性期。一些群体风险较高，但全面的整体评估对于识别适合社区管理的患者至关重要。
