Ravindra Prithvishree, Bhat Rachana, Karanth Nisarg, Wilson William, Lavanya B N, Umra Simran, Mahesh Shweta
Department of Emergency Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Department of Emergency Medical Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
J Emerg Trauma Shock. 2022 Apr-Jun;15(2):99-104. doi: 10.4103/jets.jets_83_21. Epub 2022 Jun 27.
Establishment of strong emergency medical services (EMS) systems plays a pivotal role in reducing morbidity and mortality, especially in low and middle-income countries. We aimed to study the EMS utilization and resources available in the ambulances to deliver prehospital care among patients presenting to the Emergency Medicine Department in a tertiary care hospital in south India.
Data regarding prehospital transport practices such as mode of arrival, utilization of EMS, resources available in the ambulance, presenting complaints, triage category, and demographic details were collected and analyzed. Subgroup analysis for time-sensitive complaints was done. Variables were subjected to univariate and multivariate analysis to find the predictors of ambulance usage.
The study included 3935 patients. The most common time-sensitive complaints were trauma (17%) and chest pain (11.5%). The most preferred mode of transport was the personal vehicle (45.6%). 29.8% of patients arrived in the ambulance. 97.7% of ambulances were not Advanced Cardiac Life Support equipped and 87.1% did not have an accompanying health care provider. 64.5% inter-hospital patient transfers were through ambulance, 83.8% transfers were unaccompanied. Among patients with time-sensitive complaints, EMS utilization was inadequate (46.8% in acute coronary syndrome, 34% in trauma, and 56.5% in early acute ischemic stroke).
There was underutilization of the EMS services. Majority of the ambulances were not adequately equipped/staffed to deliver prehospital interventions. Policies at national level are required to encourage EMS utilization by the public and urgent measures are needed to improve services provided by them.
建立强大的紧急医疗服务（EMS）系统在降低发病率和死亡率方面起着关键作用，尤其是在低收入和中等收入国家。我们旨在研究印度南部一家三级医院急诊科患者中，EMS的使用情况以及救护车上可用于提供院前护理的资源。
收集并分析有关院前转运实践的数据，如到达方式、EMS的使用情况、救护车上可用的资源、就诊主诉、分诊类别和人口统计学细节。对时间敏感型主诉进行亚组分析。对变量进行单因素和多因素分析，以找出救护车使用的预测因素。
该研究纳入了3935名患者。最常见的时间敏感型主诉是创伤（17%）和胸痛（11.5%）。最常用的转运方式是私家车（45.6%）。29.8%的患者乘坐救护车到达。97.7%的救护车未配备高级心脏生命支持设备，87.1%没有随车医护人员。64.5%的院内患者转运通过救护车，83.8%的转运没有陪同人员。在有时间敏感型主诉的患者中，EMS的使用不足（急性冠状动脉综合征患者中为46.8%，创伤患者中为34%，早期急性缺血性卒中患者中为56.5%）。
EMS服务利用不足。大多数救护车没有配备足够的设备/人员来进行院前干预。需要国家层面的政策来鼓励公众使用EMS，并且需要采取紧急措施来改善其提供的服务。
