Chwallek Daniel, Schweda Adam, Neukirchen Martin, Risse Joachim, Hense Jörg, Teufel Martin, Tewes Mitra
Department of Palliative Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, Essen, Germany.
J Palliat Care. 2025 Oct;40(4):329-335. doi: 10.1177/08258597231221916. Epub 2024 Feb 19.
Differences in the German emergency medical service (EMS) can be seen in the countryside in contrast to the city with regard to travel distances to hospitals and in the access routes of EMS-physicians. In order to investigate the success of establishment of palliative crisis cards associated with training and the rural and urban EMS structures, two urban and two rural EMS areas were compared using the Paramedic Palliative Care Test (PARPACT). The PARPACT includes test items on palliative knowledge (PK, maximum score: 15 points) and palliative self-efficacy expectations (PSE, maximum score: 18 points), as well as items on palliative attitudes in dealing with palliative care patients. We used a 4-point Likert-type scale. For data analysis, nonparametric tests (χ-test and Mann-Whitney test) were used in addition to descriptive analysis (frequencies, means, medians, standard deviations, and ranges). In total, 291 out of 750 ambulance or EMS personnel participated in the voluntary survey. Rural ambulance or EMS personnel answered the PK-questions correctly more often on average (mean: 11.19, SD: 1.85) than urban ambulance or EMS personnel (mean: 9.18, SD: 2.39; Mann-Whitney test: =5040.000, =.001). In addition, ambulance or EMS personnel with the highest level of training (3-year-trained paramedics) performed better in PK (mean: 10.38, SD: 2.31) than less intensively training ambulance or EMS personnel (mean: 9.58, SD: 2.43; Mann-Whitney -test: =8446.500, =.004). In terms of PSE, rural ambulance or EMS personnel also achieved higher mean PSE-scores (mean: 12.55, SD: 2.60) than urban ambulance or EMS personnel (mean: 9.77, SD: 3.41; Mann-Whitney -test: =5148.500, =.001). Better training in the EMS is associated with improved PK compared to less qualified nonphysician EMS staff. The establishment of palliative crisis cards and the structures in the city alone do not lead to improved knowledge and PSE.
与城市相比，德国紧急医疗服务（EMS）在农村地区的差异体现在前往医院的行程距离以及EMS医生的出诊路线上。为了调查与培训以及农村和城市EMS结构相关的姑息危机卡的建立成效，使用护理人员姑息治疗测试（PARPACT）对两个城市和两个农村的EMS区域进行了比较。PARPACT包括关于姑息知识（PK，最高分：15分）和姑息自我效能期望（PSE，最高分：18分）的测试项目，以及处理姑息治疗患者时的姑息态度项目。我们使用了4点李克特量表。在数据分析中，除了描述性分析（频率、均值、中位数、标准差和范围）外，还使用了非参数检验（χ检验和曼-惠特尼检验）。在750名救护车或EMS人员中，共有291人参与了这项自愿调查。农村救护车或EMS人员回答PK问题的平均正确率（均值：11.19，标准差：1.85）高于城市救护车或EMS人员（均值：9.18，标准差：2.39；曼-惠特尼检验：=5040.000，=0.001）。此外，接受最高水平培训（3年制护理人员）的救护车或EMS人员在PK方面的表现（均值：10.38，标准差：2.31）优于培训强度较低的救护车或EMS人员（均值：9.58，标准差：2.43；曼-惠特尼检验：=8446.500，=0.004）。在PSE方面，农村救护车或EMS人员的平均PSE得分（均值：12.55，标准差：2.60）也高于城市救护车或EMS人员（均值：9.77，标准差：3.41；曼-惠特尼检验：=5148.500，=0.001）。与资质较低的非医生EMS工作人员相比，EMS中更好的培训与PK的提高相关。仅在城市建立姑息危机卡和相关结构并不会带来知识和PSE的改善。
