Palumbo L, Kubincanek J, Emerman C, Jouriles N, Cydulka R, Shade B
Department of Emergency Medicine, MetroHealth Medical Center, Cleveland, OH 44109, USA.
Am J Emerg Med. 1996 Jul;14(4):388-90. doi: 10.1016/S0735-6757(96)90056-X.
Inappropriate use of emergency medical services (EMS) for nonemergencies strains EMS resources and limits efficiency. Protocol-driven dispatch systems attempt to correct the imbalance that exists between demand and available resources by prioritizing 911 calls. This study compared dispatch priority decisions with apparent patient need, based on emergency department (ED) presentation, by matching 320 ED charts with corresponding EMS dispatch and run information. The priorities assigned by the system based on dispatch information were compared with those assigned by a three-member panel of physicians based on ED presentation. The physicians and dispatchers agreed on the need for advanced life support (ALS) versus basic life support (BLS) transport 74% of the time. There was only 43% agreement on the more detailed 4-level classification system. The system assigned the highest level of dispatch utilizing combined ALS and first responders to a significantly greater degree than did the physicians. It was concluded that protocol systems for setting dispatch priorities utilize EMS resources to a higher degree than actually required based on ED presentation.
将非紧急情况误用作紧急医疗服务（EMS）会耗尽EMS资源并降低效率。基于协议的调度系统试图通过对911呼叫进行优先级排序来纠正需求与可用资源之间存在的不平衡。本研究通过将320份急诊科（ED）病历与相应的EMS调度和运行信息相匹配，根据急诊科就诊情况，将调度优先级决策与明显的患者需求进行了比较。将系统根据调度信息分配的优先级与由三名医生组成的小组根据急诊科就诊情况分配的优先级进行了比较。医生和调度员在74%的时间里就高级生命支持（ALS）与基本生命支持（BLS）转运的需求达成了一致。在更详细的四级分类系统上，达成一致的比例仅为43%。与医生相比，该系统在更大程度上使用联合ALS和急救人员分配了最高级别的调度。得出的结论是，用于设置调度优先级的协议系统比基于急诊科就诊情况实际所需的程度更高地利用了EMS资源。
