James Hart, J Priyanka Vakkalanka, Uche Okoro, Nicholas M Mohr, Azeemuddin Ahmed
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引用次数: 0
Abstract
Objectives: Survival from out-of-hospital cardiac arrests (OHCA) remains lower in rural areas. Longer Emergency Medical Services (EMS) response times suggests that rural OHCA survival may need to rely more on early bystander intervention. This study compares the rates of bystander Cardiopulmonary Resuscitation (CPR) between rural and urban areas and examines societal factors associated with bystander CPR.
Methods: This study was a retrospective cohort study using merged county-level data from the National Emergency Medical Services Information System (NEMSIS) sample from 2019 and 2020, the 2019 American Community Survey, and the Bureau of Health Care Workforce data. We included all adults (age ≥ 18) with OHCA who were treated by an EMS clinician reporting data to NEMSIS, with the primary exposure of OHCA rurality, and the primary outcome of bystander CPR by a member of the public. Rurality was assigned using the Rural Urban Commuting Area code associated with the OHCA location. Cases were excluded if there was an indication for witnesses identified as health care personnel, the incident occurred at a health care site, or geographical data were not available. The association between patient- and community-level covariates and bystander CPR were measured using generalized estimating equations to model the adjusted odds ratios (aOR) and 95% confidence intervals (CI), clustering on county.
Results: A total of 99,171 OHCA patients were identified and 60.9% (n = 60,380) received bystander CPR. Patients with OHCA living in isolated small rural towns (aOR: 1.57, 95%CI: 1.28-1.91) were more likely to have bystander CPR when compared to those living in urban cities. The odds of bystander CPR was lower in counties with larger populations of those without high school diplomas (e.g. >15% vs ≤6%, aOR: 0.56; 95%CI: 0.51-0.61), non-Caucasian populations (e.g. >40% vs ≤10%, aOR: 0.83; 95%CI: 0.76-0.91), and older populations (e.g. >14% vs ≤9%, aOR: 0.82; 95%CI: 0.74-0.91).
Conclusions: We observed lower rates of bystander CPR in communities with lower education, higher rates of non-Caucasian populations, and older populations. Our findings emphasize the need for public interventions in bystander CPR training to meet the needs of diverse community characteristics, and particularly in areas where EMS response times may be longer.
目的:农村地区院外心脏骤停(OHCA)的存活率仍然较低。较长的紧急医疗服务(EMS)响应时间表明,农村地区的 OHCA 存活率可能需要更多地依靠旁观者的早期干预。本研究比较了农村和城市地区旁观者心肺复苏(CPR)的比率,并研究了与旁观者心肺复苏相关的社会因素:本研究是一项回顾性队列研究,使用的是2019年和2020年国家紧急医疗服务信息系统(NEMSIS)样本、2019年美国社区调查和卫生保健劳动力局数据合并后的县级数据。我们纳入了所有由向 NEMSIS 报告数据的急救医疗服务临床医生治疗的 OHCA 成人(年龄≥ 18 岁),主要暴露于 OHCA 农村地区,主要结果为旁观者心肺复苏(bystander CPR by a member of public)。根据与 OHCA 地点相关联的农村城市通勤区代码分配农村地区。如果有迹象表明目击者为医护人员、事件发生在医护场所或无法获得地理数据,则排除病例。使用广义估计方程对患者和社区层面的协变量与旁观者心肺复苏之间的关系进行测量,以县为单位建立调整后的几率比(aOR)和 95% 置信区间(CI)模型:共发现 99,171 名 OHCA 患者,60.9%(n=60,380)的患者接受了旁观者心肺复苏术。与居住在城市的 OHCA 患者相比,居住在偏远农村小镇的 OHCA 患者更有可能接受旁观者心肺复苏(aOR:1.57,95%CI:1.28-1.91)。在没有高中文凭(例如:>15% vs ≤6%,aOR:0.56;95%CI:0.51-0.61)、非白种人(例如:>40% vs ≤10%,aOR:0.56;95%CI:0.51-0.61)较多的县,旁观者心肺复苏的几率较低、例如,>40% vs ≤10%,aOR:0.83;95%CI:0.76-0.91)和老年人群(例如,>14% vs ≤9%,aOR:0.82;95%CI:0.74-0.91):我们观察到,在教育程度较低、非白种人比例较高和年龄较大的社区,旁观者心肺复苏的比例较低。我们的研究结果表明,有必要对旁观者心肺复苏培训进行公共干预,以满足不同社区特点的需求,尤其是在急救服务响应时间较长的地区。
期刊介绍:
Prehospital Emergency Care publishes peer-reviewed information relevant to the practice, educational advancement, and investigation of prehospital emergency care, including the following types of articles: Special Contributions - Original Articles - Education and Practice - Preliminary Reports - Case Conferences - Position Papers - Collective Reviews - Editorials - Letters to the Editor - Media Reviews.