Pozen M W, D'Agostino R B, Sytkowski P A, Schneider R J, Berezin M M, Bremer L H, Riggen R J
Circulation. 1981 Feb;63(2):442-7. doi: 10.1161/01.cir.63.2.442.
Medical control for paramedics by means of radio and ECG telemetry is costly, time consuming, and of unproved value. We assessed the interaction between emergency room physicians and paramedics during ambulance transport of "seriously ill" cardiac patients (cardiac arrest, acute myocardial infarction, or new onset of crescendo angina pectoris) with paramedics in service. Thirty-five percent of all arrhythmias and 35% of potentially life-threatening arrhythmias were misclassified. Correct treatment was rendered in 74% of the cases, although only 65% were correctly diagnosed (p < 0.01). The principal predictive variable for misdiagnosing or incorrectly treating a patient was the presence of a potentially life-threatening arrhythmia, precisely the condition for which medical control and the paramedic system has the most to offer. Only 39% of patients with life-threatening arrhythmias were correctly diagnosed and correctly treated, whereas 64% of patients without life-threatening arrhythmias were correctly diagnosed and correctly treated (p < 0.001). Mortality reflected correct diagnosis and treatment. In-hospital and overall mortalities were 12% and 33%, respectively, for patients who were correctly diagnosed and treated (p < 0.06), compared with 20% and 43%, respectively, for patients who were incorrectly diagnosed or incorrectly treated (p < 0.04). More rigorous medical control is needed to improve the quality of patient care and outcome and to further integrate the advanced life support program into the health care system.
通过无线电和心电图遥测技术对护理人员进行医疗指导成本高昂、耗时且价值未经证实。我们评估了急诊室医生与护理人员在运送“重症”心脏病患者（心脏骤停、急性心肌梗死或进行性加重型心绞痛新发）过程中的互动情况，护理人员均在岗服务。所有心律失常中有35%以及潜在危及生命的心律失常中有35%被错误分类。74%的病例得到了正确治疗，尽管只有65%被正确诊断（p<0.01）。误诊或错误治疗患者的主要预测变量是存在潜在危及生命的心律失常，而这恰恰是医疗指导和护理人员系统最能发挥作用的情况。只有39%患有危及生命心律失常的患者得到了正确诊断和正确治疗，而64%没有危及生命心律失常的患者得到了正确诊断和正确治疗（p<0.001）。死亡率反映了正确的诊断和治疗情况。正确诊断和治疗的患者住院死亡率和总死亡率分别为12%和33%（p<0.06），相比之下，误诊或错误治疗的患者分别为20%和43%（p<0.04）。需要更严格的医疗指导来提高患者护理质量和治疗效果，并将高级生命支持计划进一步融入医疗保健系统。
