利用空中运输血栓切除术候选者优化偏远和农村地区的院前资源

Pauli Vuorinen, Piritta Setälä, Sanna Hoppu
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摘要

在芬兰,每年为急性中风患者进行机械性血栓切除术的人数不断增加,越来越多的患者被送往100多公里外的综合中风中心(CSC)接受最终治疗。这使得农村乡镇在数小时内无法获得即时急救医疗服务(EMS)。在这项研究中,我们比较了两种转运方式下急救医疗服务(EMS)估计的血栓切除候选者交接后返回自己站点的时间:(1) 使用救护车地面转运至 CSC,或 (2) 使用救护车开始转运,然后直升机急救医疗服务(HEMS)继续空中转运的水路策略。我们回顾性审查了 2020 年 6 月至 2022 年 10 月期间从南奥斯特罗波茨尼亚院区到最近的 CSC(坦佩雷大学医院)的所有血栓切除术候选者的转运情况。调度协议规定,血栓切除术候选者的转运工作应立即由救护车开始,如果当地的急救中心可以提供服务,则应在会合处将患者移交给急救中心。如果没有,则通过陆路将病人运送到 CSC。我们从中央服务中心的急救服务数据库中查看了病人移交的时间和地点,并使用谷歌地图估算了返回救护站的行车时间。我们还查看了急救车驾驶员的日志,以评估他们执行任务的时间。从急救中心到救护车驻地的中位距离为188千米(IQR为149-204千米),从与急救车会合的地点到救护车驻地的中位距离为70千米(IQR为51-91千米,p < 0.001)。在 CSC 与病人交接后,估计返回车站的中位行车时间为 145 分钟(IQR 117-153 分钟),而与 HEMS 设备交接的中位行车时间为 53 分钟(IQR 38-68 分钟,p < 0.001)。在血栓切除候选患者的转运任务中,HEMS 设备占用的时间中位数为 136 分钟(IQR 127-148 分钟)。用救护车和直升机混合运送血栓切除术候选者的策略明显加快了急救资源的重新分配,使其更快地回到自己的地区。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Optimizing remote and rural prehospital resources using air transport of thrombectomy candidates
In Finland, the yearly number of mechanical thrombectomies for acute stroke is increasing and more patients are transported over 100 km to the comprehensive stroke centre (CSC) for definitive care. This leaves the rural townships without immediate emergency medical services (EMS) for hours. In this study we compare the EMS’ estimated return times to own station after the handover of a thrombectomy candidate between two transport methods: (1) using ground transportation with an ambulance to the CSC or (2) using a hydrid strategy starting the transportation with an ambulance and continuing by air with a helicopter emergency medical services unit (HEMS). We reviewed retrospectively all thrombectomy candidates’ transportations from the hospital district of South Ostrobothnia to definitive care at the nearest CSC, Tampere University Hospital from June 2020 to October 2022. The dispatch protocol stated that a thrombectomy candidate’s transport begins immediately with an ambulance and if the local HEMS unit is available the patient is handed over to them at a rendezvous. If not, the patient is transported to the CSC by ground. Transport times and locations of the patient handovers were reviewed from the CSC’s EMS database and the driving time back to ambulance station was estimated using Google maps. The HEMS unit’s pilot’s log was reviewed to assess their mission engagement time. The median distance from the CSC to the ambulances’ stations was 188 km (IQR 149–204 km) and from the rendezvous with the HEMS unit 70 km (IQR 51–91 km, p < 0.001). The estimated median driving time back to station after the patient handover at the CSC was 145 min (IQR 117–153 min) compared to the patient handover to the HEMS unit 53 min (IQR 38–68 min, p < 0.001). The HEMS unit was occupied in thrombectomy candidate’s transport mission for a median of 136 min (IQR 127–148 min). A hybrid strategy to transport thrombectomy candidates with an ambulance and a helicopter reallocates the EMS resources markedly faster back to their own district.
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