Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland.
Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Chemin du Petit-Bel-Air 2, CH 1226, Geneva, Thônex, Switzerland.
Scand J Trauma Resusc Emerg Med. 2021 Feb 9;29(1):31. doi: 10.1186/s13049-021-00844-y.
Some emergency medical systems (EMS) use a dispatch centre where nurses or paramedics assess emergency calls and dispatch ambulances. Paramedics may also provide the first tier of care "in the field", with the second tier being an Emergency Physician (EP). In these systems, the appropriateness of the decision to dispatch an EP to the first line at the same time as the ambulance has not often been measured. The main objective of this study was to compare dispatching an EP as part of the first line emergency service with the severity of the patient's condition. The secondary objective was to highlight the need for a recognized reference standard to compare performance analyses across EMS.
This prospective observational study included all emergency calls received in Geneva's dispatch centre between January 1st, 2016 and June 30th, 2019. Emergency medical dispatchers (EMD) assigned a level of risk to patients at the time of the initial call. Only the highest level of risk led to the dispatch of an EP. The severity of the patient's condition observed in the field was measured using the National Advisory Committee for Aeronautics (NACA) scale. Two reference standards were proposed by dichotomizing the NACA scale. The first compared NACA≥4 with other conditions and the second compared NACA≥5 with other conditions. The level of risk identified during the initial call was then compared to the dichotomized NACA scales.
97'861 assessments were included. Overall prevalence of sending an EP as first line was 13.11, 95% CI [12.90-13.32], and second line was 2.94, 95% CI [2.84-3.05]. Including NACA≥4, prevalence was 21.41, 95% CI [21.15-21.67], sensitivity was 36.2, 95% CI [35.5-36.9] and specificity 93.2 95% CI [93-93.4]. The Area Under the Receiver-Operating Characteristics curve (AUROC) of 0.7507, 95% CI [0.74734-0.75397] was acceptable. Looking NACA≥5, prevalence was 3.09, 95% CI [2.98-3.20], sensitivity was 64.4, 95% CI [62.7-66.1] and specificity 88.5, 95% CI [88.3-88.7]. We found an excellent AUROC of 0.8229, 95% CI [0.81623-0.82950].
The assessment by Geneva's EMD has good specificity but low sensitivity for sending EPs. The dichotomy between immediate life-threatening and other emergencies could be a valid reference standard for future studies to measure the EP's dispatching performance.
一些紧急医疗系统（EMS）使用调度中心，护士或护理人员在调度中心评估紧急电话并派遣救护车。护理人员也可能在现场提供第一级护理，第二级护理由急诊医师（EP）提供。在这些系统中，同时派遣 EP 到第一线与救护车的合理性通常没有得到衡量。本研究的主要目的是比较派遣 EP 作为一线急救服务的一部分与患者病情的严重程度。次要目的是强调需要一个公认的参考标准来比较 EMS 之间的绩效分析。
本前瞻性观察研究包括 2016 年 1 月 1 日至 2019 年 6 月 30 日期间日内瓦调度中心收到的所有紧急电话。紧急医疗调度员（EMD）在初始呼叫时为患者分配风险级别。只有最高风险级别才会导致派遣 EP。在现场观察到的患者病情严重程度使用国家航空咨询委员会（NACA）量表进行测量。通过将 NACA 量表二分法提出了两种参考标准。第一种将 NACA≥4 与其他情况进行比较，第二种将 NACA≥5 与其他情况进行比较。然后将初始呼叫期间确定的风险级别与二分法的 NACA 量表进行比较。
共纳入 97'861 次评估。派遣 EP 作为一线治疗的总体流行率为 13.11%，95%CI[12.90-13.32]，二线治疗的流行率为 2.94%，95%CI[2.84-3.05]。包括 NACA≥4，流行率为 21.41%，95%CI[21.15-21.67]，灵敏度为 36.2%，95%CI[35.5-36.9]，特异性为 93.2%，95%CI[93-93.4]。0.7507，95%CI[0.74734-0.75397]的接受者操作特征曲线（AUROC）曲线下面积（AUROC）可接受。观察 NACA≥5，流行率为 3.09%，95%CI[2.98-3.20]，灵敏度为 64.4%，95%CI[62.7-66.1]，特异性为 88.5%，95%CI[88.3-88.7]。我们发现 0.8229 的优秀 AUROC，95%CI[0.81623-0.82950]。
日内瓦 EMD 的评估对于派遣 EP 具有良好的特异性，但敏感性较低。将危及生命的紧急情况与其他紧急情况之间的二分法可能是衡量 EP 派遣绩效的未来研究的有效参考标准。
