Lindbeck G H, Burns D M, Rockwell D D
Department of Emergency Medicine, Pre-Hospital Program, University of Virginia Health Sciences Center, Charlottesville, USA.
Acad Emerg Med. 1995 Jul;2(7):592-6. doi: 10.1111/j.1553-2712.1995.tb03595.x.
To describe experience with an out-of-hospital provider program for the recognition and field management of allergic reactions by advanced life support (ALS) and basic life support (BLS) providers.
Data sheets completed between June 1, 1988, and August 31, 1993, and records from receiving sites (physicians' offices or EDs) were reviewed for information regarding the presentation of the allergic reaction, the time course and treatment provided out of hospital, and the clinical outcome at the receiving health care facility.
Thirty-seven data sheets were completed during the study period. Fourteen (38%) of the providers were BLS providers. The epinephrine was supplied from the emergency medical services (EMS) provider's personal kit in 35% of the cases, from an EMS vehicle in 57% of the cases, and by the patient in 8% of the cases. Availability of the kits allowed administration of epinephrine prior to the arrival of the first EMS vehicle in 41% of the instances and prior to physician on-line medical command in 65% of all the instances (predominantly by BLS providers). Overall, 77% of the patients experienced alleviation of their symptoms of respiratory difficulty, swelling, or rash after epinephrine administration, while 20% were unchanged and 3% worsened. All patients receiving epinephrine had an ED diagnosis of allergic reaction, and no adverse event was encountered on follow-up of the patients treated.
Severe allergic reactions can be reliably identified and safely managed by out-of-hospital providers, including BLS providers. Providing personal anaphylactic treatment kits and increasing the pool of providers trained to manage allergic reactions (including BLS providers) can often decrease the time to treatment.
描述一个院外提供者项目的经验，该项目用于高级生命支持（ALS）和基础生命支持（BLS）提供者识别和现场处理过敏反应。
回顾了1988年6月1日至1993年8月31日期间填写的数据表，以及接收地点（医生办公室或急诊科）的记录，以获取有关过敏反应表现、院外处理的时间过程和治疗情况，以及接收医疗机构的临床结局的信息。
在研究期间共填写了37份数据表。其中14名（38%）提供者为BLS提供者。35%的病例中肾上腺素由紧急医疗服务（EMS）提供者的个人急救箱提供，57%的病例中由EMS车辆提供，8%的病例中由患者提供。急救箱的可用性使得在第一辆EMS车辆到达之前有41%的情况能够给予肾上腺素，在所有情况中有65%（主要是BLS提供者）在医生在线医疗指导之前给予肾上腺素。总体而言，77%的患者在给予肾上腺素后呼吸困难、肿胀或皮疹症状得到缓解，20%无变化，3%病情恶化。所有接受肾上腺素治疗的患者在急诊科均被诊断为过敏反应，且对接受治疗的患者进行随访时未遇到不良事件。
院外提供者，包括BLS提供者，能够可靠地识别严重过敏反应并进行安全处理。提供个人过敏治疗急救箱并增加接受过管理过敏反应培训的提供者（包括BLS提供者）数量通常可以缩短治疗时间。
