Regional Emergency Medical Services, RAV Brabant Midden-West-Noord, Gruttostraat 14, 5212VM, s-Hertogenbosch, the Netherlands.
Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands.
Scand J Trauma Resusc Emerg Med. 2024 May 1;32(1):39. doi: 10.1186/s13049-024-01207-z.
Procedural sedation and analgesia (PSA) is a technique of administering sedatives to induce a state that allows the patient to tolerate painful procedures while maintaining cardiorespiratory function, a condition that is frequently desired prehospital. Non-physician prehospital clinicians often have a limited scope of practice when it comes to providing analgesia and sedation; sometimes resulting in a crew request for back-up from physician-staffed prehospital services.". This is also the case if sedation is desirable. Advanced practice providers (APPs), who are legally authorized and trained to carry out this procedure, may be a solution when the physician-staffed service is not available or will not be available in time.
The aim of this study is to gain insight in the circumstances in which an APP, working at the Dutch ambulance service "RAV Brabant MWN" from January 2019 to December 2022, uses propofol for PSA or to provide sedation. With this a retrospective observational document study we describe the characteristics of patients and ambulance runs and evaluates the interventions in terms of safety.
During the study period, the APPs administered propofol 157 times for 135 PSA and in 22 cases for providing sedation. The most common indication was musculoskeletal trauma such as fracture care or the reduction of joint dislocation. In 91% of the situations where propofol was used, the predetermined goal e.g. alignment of fractured extremity, repositioning of luxated joint or providing sedation the goal was achieved. There were 12 cases in which one or more adverse events were documented and all were successfully resolved by the APP. There were no cases of laryngospam, airway obstruction, nor anaphylaxis. None of the adverse events led to unexpected hospitalization or death.
During the study period, the APPs performed 135 PSAs and provided 22 sedations. The success rate of predetermined goals was higher than that stated in the literature. Although there were a number of side effects, their incidences were lower than those reported in the literature, and these were resolved by the APP during the episode of care. Applying a PSA by an APP at the EMS "RAV Brabant MWN" appears to be safe with a high success rate.
程序镇静和镇痛（PSA）是一种给予镇静剂以诱导患者能够耐受疼痛程序同时保持心肺功能的技术，这种情况在院前经常需要。非医师院前临床医生在提供镇痛和镇静方面的实践范围往往有限；有时会导致机组人员请求医师配备的院前服务提供支持。如果需要镇静也是如此。当医师配备的服务不可用或无法及时提供时，具有法律授权和培训资格执行此程序的高级实践提供者（APP）可能是一种解决方案。
本研究的目的是深入了解 2019 年 1 月至 2022 年 12 月期间在荷兰救护车服务“RAV Brabant MWN”工作的 APP 使用异丙酚进行 PSA 或提供镇静的情况。通过回顾性观察性文件研究，我们描述了患者和救护车运行的特征，并根据安全性评估干预措施。
在研究期间，APP 为 135 例 PSA 和 22 例镇静治疗共使用了 157 次异丙酚。最常见的指征是肌肉骨骼创伤，如骨折护理或关节脱位复位。在使用异丙酚的 91%情况下，达到了预定的目标，例如骨折肢体的对齐、脱位关节的重新定位或提供镇静的目标。有 12 例记录了一个或多个不良事件，所有事件均由 APP 成功解决。没有出现喉痉挛、气道阻塞或过敏反应的情况。没有不良事件导致意外住院或死亡。
在研究期间，APP 进行了 135 例 PSA 并提供了 22 例镇静治疗。预定目标的成功率高于文献报道。尽管有一些副作用，但它们的发生率低于文献报道，并且在护理过程中由 APP 解决。在 RAV Brabant MWN 的 EMS 中，由 APP 进行 PSA 似乎是安全的，成功率较高。
