Cayten C G, Staroscik R, Walker K, Morganroth J, Oler J
Ann Emerg Med. 1981 Aug;10(8):432-6. doi: 10.1016/s0196-0644(81)80312-5.
To determine the value of algorithms in the field, a set of cardiac clinical algorithms was developed for and tested by the City of Philadelphia paramedics. A controlled test was carried out by revising the narrative standard operating procedure to reflect algorithm content and giving the algorithms, in pocket-size booklet form, to half the Fire Rescue platoons (43 men). Baseline data included paramedics' characteristics, arrhythmia recognition and management test scores, and data on the number of patients who were discharged alive from the hospital following successful treatment of ventricular fibrillation in the field. Platoons with and without the algorithms served identical areas of the city, did not differ in response times, and were treated similarly with regard to continuing education during the study period. Paramedics who received the algorithms were encouraged, but not required, to use them. Platoons using the algorithms experienced an increase in their ventricular fibrillation patient survival rates from 10.6% to 14.5%; those platoons not using the algorithms had a decrease in patient survival rates from 11.8% to 7.0% (P = 0.0732). There was no statistically significant difference in the paramedics' scores on arrhythmia recognition and management tests given before and after use of the algorithms. Only 39% of the paramedics used the algorithms during actual patient care, but 83% used them as a study guide or for reference between runs. The data suggest that algorithm use may minimize the rate of knowledge and skill decay.
为了确定该领域算法的价值，费城护理人员开发并测试了一套心脏临床算法。通过修订叙述性标准操作程序以反映算法内容，并以袖珍手册的形式将算法分发给一半的消防救援排（43人），进行了一项对照测试。基线数据包括护理人员的特征、心律失常识别和管理测试分数，以及在现场成功治疗心室颤动后从医院存活出院的患者数量数据。有算法和没有算法的排服务于城市相同区域，响应时间没有差异，并且在研究期间接受的继续教育方式类似。鼓励但不要求接受算法的护理人员使用它们。使用算法的排的心室颤动患者存活率从10.6%提高到了14.5%；未使用算法的排的患者存活率从11.8%下降到了7.0%（P = 0.0732）。在使用算法前后进行的心律失常识别和管理测试中，护理人员的分数没有统计学上的显著差异。在实际患者护理期间，只有39%的护理人员使用了算法，但83%的护理人员将其用作学习指南或在两次出诊之间进行参考。数据表明，使用算法可能会将知识和技能衰退率降至最低。
