Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama city, Okayama 700-8558, Japan; Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaigandori, chuo-ku, Kobe, Hyogo 651-0073, Japan.
Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama city, Okayama 700-8558, Japan.
Am J Emerg Med. 2022 Jun;56:218-222. doi: 10.1016/j.ajem.2022.04.004. Epub 2022 Apr 11.
Appropriate decisions by medical technicians at a trauma scene may influence a patient's prognosis. Emergency life-saving technicians (ELSTs) are certified specialists trained with the knowledge to provide advanced techniques for prehospital emergency care in Japan. However, the benefit of treatment by ELSTs compared to basic emergency medical technicians (BEMTs) remains unclear. The aim of this study is to determine whether treatment by ELSTs improves outcomes for trauma patients.
We retrospectively reviewed the Japan Trauma Data Bank for the years 2004 to 2017. Patients transferred to the hospital directly from the trauma scene and at least 16 years old were included in this study. The following criteria were used to exclude patients; presence of burns, untreatable severe traumas, unknown ELST attendance, and missing prognosis. We compared two groups (ELST group: patients transported by emergency medical services (EMS) with the presence of at least one ELST; BEMT group: patients transported only by BEMTs). Primary outcome was survival to discharge. Secondary outcomes were the need of definitive treatments defined by surgical intervention, intravascular radiology and blood transfusion at the receiving hospital within 24 h. A multivariable logistic regression model was used to calculate odds ratio (OR) and confidence intervals (CI) adjusted by age, sex, revised trauma score, and Injury severity score (ISS).
Overall survival to discharge did not improve significantly (adjusted OR 1.13, 95% CI 0.99-1.30) with ELST intervention. In-hospital blood transfusion was more frequently required in the ELST group (adjusted OR 1.10, 95% CI 1.01-1.20). Emergency interventions (adjusted OR 1.03, 95% CI 0.97-1.09) were not different between the groups. In stratified analysis, the benefit of ELST attendance for survival was observed among patients with ISS <16 (adjusted OR 1.53, 95% CI 1.10-2.15), aged 65 years or older (adjusted OR 1.27, 95% CI 1.07-1.52), during the earlier study period (2004-2008, adjusted OR 1.50, 95% CI 1.14-1.97), and shorter transportation time (adjusted OR 1.21, 95% CI 1.03-1.41).
Dispatch systems with ELST should be considered for trauma transports, which may benefit elderly or moderate severity trauma groups, with shorter transportation time conditions.
创伤现场医务人员的正确决策可能会影响患者的预后。急救生命支持技术员（ELST）是经过认证的专家，他们接受过培训，具备在日本提供院前急救高级技术的知识。然而，ELST 治疗与基本急救医疗技术员（BEMT）相比的治疗效果尚不清楚。本研究旨在确定 ELST 治疗是否能改善创伤患者的预后。
我们回顾性分析了 2004 年至 2017 年的日本创伤数据库。纳入本研究的患者为直接从创伤现场转入医院且年龄至少 16 岁的患者。排除标准为：烧伤、无法治疗的严重创伤、无法确定 ELST 参与情况以及预后不详。我们比较了两组患者（ELST 组：由至少一名 ELST 参与转运的患者；BEMT 组：仅由 BEMT 转运的患者）。主要结局为出院时的存活率。次要结局为在 24 小时内于接收医院接受确定性治疗（定义为手术干预、血管内放射学和输血）的需要。采用多变量逻辑回归模型计算调整年龄、性别、修订创伤评分和损伤严重程度评分（ISS）后的优势比（OR）和置信区间（CI）。
ELST 干预并未显著提高总体出院存活率（调整后的 OR 为 1.13，95%CI 为 0.99-1.30）。ELST 组患者在医院内输血更频繁（调整后的 OR 为 1.10，95%CI 为 1.01-1.20）。两组之间的急诊干预（调整后的 OR 为 1.03，95%CI 为 0.97-1.09）无差异。在分层分析中，ISS<16（调整后的 OR 为 1.53，95%CI 为 1.10-2.15）、年龄≥65 岁（调整后的 OR 为 1.27，95%CI 为 1.07-1.52）、研究早期（2004-2008 年，调整后的 OR 为 1.50，95%CI 为 1.14-1.97）和较短的转运时间（调整后的 OR 为 1.21，95%CI 为 1.03-1.41）的患者中，ELST 治疗的生存获益更为明显。
对于创伤转运，应考虑配备 ELST 的调度系统，这可能对老年或中度严重创伤患者以及转运时间较短的患者有益。
