德国某地区养老院紧急医疗响应情况评估

Evaluation of emergency medical responses to nursing homes in a local area of Germany.

作者信息

Gaik Christine, Wulf Hinnerk, Mann Valesco, Humburg Dennis, Vojnar Benjamin

机构信息

Department of Anesthesiology and Intensive Care Medicine, University Hospital Giessen and Marburg, Campus Marburg and Philipps University of Marburg, Baldingerstraße, 35033, Marburg, Germany.

Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy, Agaplesion Evangelical Hospital Mittelhessen, Paul-Zipp-Straße 171, 35398, Giessen, Germany.

出版信息

BMC Emerg Med. 2025 Aug 5;25(1):148. doi: 10.1186/s12873-025-01306-9.

DOI:10.1186/s12873-025-01306-9

PMID:40765042

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12326612/

Abstract

BACKGROUND

In rural areas with low population density, emergency medical services (EMS) are often the first source of acute medical care in nursing homes (NHs) when nursing staff are unable to manage the situation, and no specialist practitioner is immediately available. This study analysed EMS responses to NHs in a German region to evaluate their frequency, causes, and outcomes.

METHODS

This cross-sectional study analysed EMS responses to NHs in a German region from July 2020 to December 2024. Prehospital patient care was assessed using the ABCDE approach, with additional analysis of feedback codes transmitted to the control centre. Data were presented through descriptive statistics.

RESULTS

Among 81,727 EMS responses, 55,900 were acute emergencies, including 5,738 cases to NHs. The median age of NH patients was 84 years (IQR 78–89), with 41% male and 59% female. Spontaneous breathing was unremarkable in 72% (4,141/5,738) of cases. A pulse rate of 60–100 beats per minute was recorded in 71% (4,093/5,738), and systolic blood pressure ranged between 100 and 140 mmHg in 45% (2,572/5,738). Neurologically, 80% (4,570/5,738) were classified as ‘alert’, and 12% (674/5,738) as ‘responsive to speech’. The most common diagnoses included fractures (face, head, extremities) and pneumonia. In 81.6% of cases, disturbances in all vital signs were classified as ‘low’ to ‘moderate’.

CONCLUSION

Most EMS responses to NHs involved patients with stable vital signs, and critically acute conditions were rare. Hospital admissions were predominantly ‘non-urgent’, with patients mainly transferred to primary care hospitals, which typically offer basic medical services, suggesting lower medical complexity. Falls and related injuries, particularly suspected hip fractures, were the leading reason for EMS utilisation. These findings highlight the need for targeted strategies to enhance the management of ‘non-urgent’ cases within NHs and to reduce avoidable hospital admissions, which may partly result from limited access to medical support.

TRIAL REGISTRATION

This study was registered in the German Clinical Trials Register on 17 December 2024 (ID DRKS00035675).

摘要

背景

在人口密度较低的农村地区，当护理人员无法处理相关情况且没有专科医生即时可用时，紧急医疗服务（EMS）往往是养老院（NHs）急性医疗护理的首要来源。本研究分析了德国某地区紧急医疗服务对养老院的响应情况，以评估其频率、原因和结果。

方法

这项横断面研究分析了2020年7月至2024年12月德国某地区紧急医疗服务对养老院的响应情况。院前患者护理采用ABCDE方法进行评估，并对传输至控制中心的反馈代码进行额外分析。数据通过描述性统计呈现。

结果

在81727次紧急医疗服务响应中，55900次为急性紧急情况，其中5738次是针对养老院的情况。养老院患者的中位年龄为84岁（四分位距78 - 89岁），男性占41%，女性占59%。72%（4141/5738）的病例自主呼吸情况正常。71%（4093/5738）的病例心率记录为每分钟60 - 100次，45%（2572/5738）的病例收缩压在100至140 mmHg之间。在神经方面，80%（4570/5738）被归类为“警觉”，12%（674/5738）被归类为“对言语有反应”。最常见的诊断包括骨折（面部、头部、四肢）和肺炎。在81.6%的病例中，所有生命体征的紊乱被归类为“低”至“中度”。

结论

紧急医疗服务对养老院的大多数响应涉及生命体征稳定的患者，严重急性病症很少见。住院治疗大多为“非紧急”情况，患者主要被转至通常提供基本医疗服务的基层医疗医院，这表明医疗复杂性较低。跌倒及相关损伤，尤其是疑似髋部骨折，是紧急医疗服务使用的主要原因。这些发现凸显了制定针对性策略以加强养老院“非紧急”病例管理并减少可避免住院的必要性，这部分可能是由于获得医疗支持有限所致。