Pepe P E, Mattox K L, Duke J H, Fisher P B, Prentice F D
City of Houston Center for Resuscitation and Emergency Medical Services, TX 77002-1595.
Crit Care Med. 1993 Sep;21(9):1279-86. doi: 10.1097/00003246-199309000-00009.
Despite the universal proliferation of emergency medical services programs throughout the United States since 1970, only a few have ever documented a valid lifesaving effect, particularly in large, urban centers. The purpose of this study was to demonstrate the effect of specialized physician supervision on the effectiveness of an emergency medical services system.
Prospective, cohort study.
Large, urban municipality (population 2 million).
Evaluation of victims of out-of-hospital sudden cardiac death cases, before (n = 152) and after (n = 200) the introduction of specialized physician supervision for the emergency medical services system.
The hiring of a full-time, salaried emergency medical services system physician whose principal duties would be to provide intensive individualized training, direct operational supervision, and continuous system monitoring, including frequent on-scene oversight of emergency medical services personnel.
Comparison of existing hospital discharge rates for out-of-hospital sudden cardiac death cases to those rates achieved 5 yrs after recruitment of the specialized emergency medical services system physician. A dramatic increase in hospital discharge rates was demonstrated for sudden death patients presenting with ventricular fibrillation, from zero at year 0 (0 of 152 patients survived), to 21% (42 of 200 patients) by year 5 (p < .001). This result was achieved despite the fact that all other related factors (budget, paramedic numbers, response times) significantly worsened during the comparison periods.
The introduction of the new factor into the emergency medical services system (specialized physician supervision) was associated with significantly improved patient outcome. In view of current suboptimal outcome statistics found in most municipal emergency medical services programs across the United States, future goals of medical community leaders should be directed at efforts to properly train, certify, and establish appropriate positions for physicians who specialize in emergency medical services system supervision.
自1970年以来，尽管急诊医疗服务项目在美国各地普遍推广，但只有少数项目记录了有效的救生效果，尤其是在大型城市中心。本研究的目的是证明专科医生监督对急诊医疗服务系统有效性的影响。
前瞻性队列研究。
大型城市（人口200万）。
对急诊医疗服务系统引入专科医生监督之前（n = 152）和之后（n = 200）的院外心脏性猝死病例受害者进行评估。
聘请一名全职、有薪的急诊医疗服务系统医生，其主要职责是提供强化个性化培训、直接操作监督和持续系统监测，包括对急诊医疗服务人员进行频繁的现场监督。
将院外心脏性猝死病例的现有医院出院率与招聘专科急诊医疗服务系统医生5年后的出院率进行比较。结果显示，出现心室颤动的猝死患者的医院出院率大幅上升，从第0年的零（152例患者中无存活者）升至第5年的21%（200例患者中有42例存活）（p <.001）。尽管在比较期间所有其他相关因素（预算、护理人员数量、反应时间）显著恶化，但仍取得了这一结果。
在急诊医疗服务系统中引入新因素（专科医生监督）与患者预后显著改善相关。鉴于美国大多数城市急诊医疗服务项目目前的结果统计不理想，医学界领导人未来的目标应致力于为专门从事急诊医疗服务系统监督的医生提供适当培训、认证并设立合适职位。
