van Vugt A B, van Olden G D, Edwards M J
Department of Traumatology, Leiden University Hospital, The Netherlands.
Eur J Emerg Med. 1995 Dec;2(4):212-6. doi: 10.1097/00063110-199512000-00007.
The system of prehospital trauma care in the Netherlands is the subject of great concern. Although many improvements have been achieved in the last decade, there are still some deficits. Legislation concerning the minimal level of education for ambulance attendants was recently upgraded to 'registered nurse', a standard which must be achieved by 1997. Standardization with regard to extrication techniques, equipment and methods of treatment in prehospital trauma care does not yet exist. Although aware of the fact that large regional differences exist throughout the USA, a system of care in accordance with the advanced trauma life support (ATLS) standard of the American College of Surgeons (ACS) and by means of prehospital and advanced trauma life support (PHTLS) given according to the standards of the National Association of Emergency Medical Technicians (NAEMS) was considered to be the 'golden standard'. Nineteen ground ambulance and two helicopter services in different states of the USA, working according to ACS/NAEMS standard, were visited to analyse the system of care, with special reference to (para)medical education, communication, logistics, and immobilization materials and techniques. In the Netherlands all 41 central post ambulance services (CPAs) were asked to return a questionnaire. This resulted in a 90% (37 out of 41) response. The deficits of the Dutch system of care related to the PHTLS/ATLS standard are pointed out, resulting in recommendations to improve the Dutch system. The requirements of the dispatcher are far inferior to the optimal situation, which, together with the lack of technical equipment, results in serious communication problems. The Dutch ambulance attendant education, in which in the present system the education level reaches 'registered nurse' in only 91% and specialized courses are not mandatory, should be upgraded to the PHTLS level of care.
荷兰的院前创伤护理系统备受关注。尽管在过去十年中已取得诸多改进，但仍存在一些不足。有关救护人员最低教育水平的立法最近已提升至“注册护士”，这一标准必须在1997年实现。院前创伤护理在解救技术、设备及治疗方法方面尚未实现标准化。尽管意识到美国各地存在巨大的地区差异，但依照美国外科医师学会（ACS）的高级创伤生命支持（ATLS）标准以及根据美国国家紧急医疗技术人员协会（NAEMS）标准提供的院前及高级创伤生命支持（PHTLS）的护理系统被视为“黄金标准”。访问了美国不同州的19个地面救护车和2个直升机服务机构，它们按照ACS/NAEMS标准运作，以分析护理系统，特别涉及（辅助）医疗教育、通信、后勤以及固定材料和技术。在荷兰，要求所有41个中央邮政救护车服务机构（CPA）返回一份调查问卷。这导致了90%（41个中的37个）的回复率。指出了荷兰护理系统与PHTLS/ATLS标准相关的不足，从而提出改进荷兰系统的建议。调度员的要求远低于最佳情况，这与技术设备的缺乏一起导致了严重的通信问题。荷兰救护人员的教育，在当前系统中教育水平仅91%达到“注册护士”且专业课程并非强制性，应提升至PHTLS护理水平。
