挪威东南部创伤急救中医生配备的紧急医疗服务派遣准确性：一项回顾性观察研究。
Dispatch accuracy of physician-staffed emergency medical services in trauma care in south-east Norway: a retrospective observational study.
机构信息
Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway.
Department of Anaesthesiology and Intensive Care/Air Ambulance Department, Drammen Hospital, Drammen, Norway.
出版信息
Scand J Trauma Resusc Emerg Med. 2021 Dec 7;29(1):169. doi: 10.1186/s13049-021-00982-3.
BACKGROUND
Selection of incidents and accurate identification of patients that require assistance from physician-staffed emergency medical services (P-EMS) remain essential. We aimed to evaluate P-EMS availability, the underlying criteria for dispatch, and the corresponding dispatch accuracy of trauma care in south-east Norway in 2015, to identify areas for improvement.
METHODS
Pre-hospital data from emergency medical coordination centres and P-EMS medical databases were linked with data from the Norwegian Trauma Registry (NTR). Based on a set of conditions (injury severity, interventions performed, level of consciousness, incident category), trauma incidents were defined as complex, warranting P-EMS assistance, or non-complex. Incident complexity and P-EMS involvement were the main determinants when assessing the triage accuracy. Undertriage was adjusted for P-EMS availability and response and transport times.
RESULTS
Among 19,028 trauma incidents, P-EMS were involved in 2506 (13.2%). The range of overtriage was 74-80% and the range of undertriage was 20-32%. P-EMS readiness in the event of complex incidents ranged from 58 to 70%. The most frequent dispatch criterion was "Police/fire brigade request immediate response" recorded in 4321 (22.7%) of the incidents. Criteria from the groups "Accidents" and "Road traffic accidents" were recorded in 10,875 (57.2%) incidents, and criteria from the groups "Transport reservations" and "Unidentified problem" in 6025 (31,7%) incidents. Among 4916 patient pathways in the NTR, 681 (13.9%) could not be matched with pre-hospital data records.
CONCLUSIONS
Both P-EMS availability and dispatch accuracy remain suboptimal in trauma care in south-east Norway. Dispatch criteria are too vague to facilitate accurate P-EMS dispatch, and pre-hospital data is inconsistent and insufficient to provide basic data for scientific research. Future dispatch criteria should focus on the care aspect of P-EMS. Better tools for both dispatch and incident handling for the emergency medical coordination centres are essential. In general, coordination, standardisation, and integration of existing data systems should enhance the quality of trauma care and increase patient safety.
背景
选择事件和准确识别需要医生配备的紧急医疗服务（P-EMS）协助的患者仍然是至关重要的。我们旨在评估 2015 年挪威东南部的 P-EMS 可用性、派遣的基本标准以及创伤护理的相应派遣准确性，以确定需要改进的领域。
方法
将来自紧急医疗协调中心和 P-EMS 医疗数据库的院前数据与挪威创伤登记处（NTR）的数据进行链接。根据一系列条件（伤害严重程度、实施的干预措施、意识水平、事件类别），将创伤事件定义为复杂的、需要 P-EMS 协助的事件或非复杂的事件。在评估分诊准确性时，事件复杂性和 P-EMS 的参与是主要决定因素。分诊不足是根据 P-EMS 的可用性以及反应和运输时间进行调整的。
结果
在 19028 起创伤事件中，有 2506 起（13.2%）涉及 P-EMS。过度分诊的范围为 74-80%，而分诊不足的范围为 20-32%。在复杂事件中，P-EMS 的准备就绪范围从 58%到 70%不等。最常见的派遣标准是“警察/消防队请求立即响应”，在 4321 起（22.7%）事件中记录。“事故”和“道路交通碰撞”组的标准记录在 10875 起（57.2%）事件中，“运输预订”和“未识别问题”组的标准记录在 6025 起（31.7%）事件中。在 NTR 的 4916 个患者路径中，有 681 个（13.9%）无法与院前数据记录相匹配。
结论
在挪威东南部的创伤护理中，P-EMS 的可用性和派遣准确性都不理想。派遣标准过于模糊，无法促进 P-EMS 的准确派遣，而院前数据不一致且不足以为科学研究提供基本数据。未来的派遣标准应侧重于 P-EMS 的护理方面。紧急医疗协调中心需要更好的派遣和事件处理工具。总体而言，协调、标准化和整合现有数据系统应提高创伤护理的质量并提高患者安全性。
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