对德国一个主要城市67,975次紧急部署的分析——更有效地派遣急诊医生的标准。

IF 2.1 3区 医学 Q2 EMERGENCY MEDICINE
Yacin Keller, Anne Schrimpf, André Gries
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引用次数: 0

摘要

目的:在紧急医疗服务中高效地调度配备医生的车辆需要明确的标准,以确保及时分配资源,改善患者预后,并最大限度地减少高压条件下的响应时间。本研究的目的是确定确保急诊医生得到安全管理和有效部署的标准。方法:回顾性分析德国德累斯顿市(2021年1月1日- 2021年12月31日)的救援服务部署情况。基于高级生命支持和高级创伤生命支持算法中的ABCDE方法,分析了由通信人员确定的救援任务指示,以及现场存在的生命体征异常(如气道、呼吸、循环和残疾)。在特定特派团执行的具体紧急医疗程序被分配给各自的主管级别(CL): CL1:为医生保留的侵入性措施;CL2:经过培训的护理人员可在紧急情况下独立使用的侵入性措施;CL3:标准措施;CL4:仅提供咨询;CL5:没有措施。结果:总共分析了67,975个任务。派遣特派团的最常见原因是内部指征,如心血管和肺部急症(28.4%)和创伤指征(20.4%)。尽管在36.5%的病例中派遣了医生,但只有13.9%的任务使用了侵入性措施(CL1/CL2)。内部适应症(11.8%)和复苏(19.6%)经常需要CL1措施。在过敏(44.2% vs. 1.9%)、神经(12.5% vs. 3.4%)和心理(6.1% vs. 0.7%)适应症中,CL2测量的应用频率高于CL1测量。在大多数干预措施(62.2%)中,只有标准能力(CL3)被用作最高水平的能力。对于大多数任务适应症,在存在至少一个生命体征异常的情况下,侵入性措施(CL1/CL2)的可能性显著增加。结论:结果显示了优化急诊医生调度的机会。生命体征异常的存在应在未来给予更多的考虑。对于高概率需要CL1/CL2措施的案例,查询算法可以支持高效的调度。此外,需要CL2措施但很少采取CL1措施的紧急情况可以由急救护理人员独立处理,特别是如果他们在需要CL1措施的情况下可以获得远程急救医生的支持。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Analysis of 67,975 Emergency Deployments in a Major German City - Criteria for More Efficient Dispatching of Emergency Physicians.

Objectives: Efficient dispatching of physician-staffed vehicles in emergency medical services requires clear criteria to ensure timely allocation of resources, improve patient outcomes, and minimize response time under high-pressure conditions. The aim of this study was to identify criteria ensuring that emergency physicians are safely managed and efficiently deployed.

Methods: Rescue service deployments in the city of Dresden, Germany (01/01/2021-12/31/2021), were analyzed retrospectively. The rescue mission indications determined by the telecommunicator, along with the presence of vital sign abnormalities at site - such as airway, breathing, circulation, and disability - based on the ABCDE approach from the Advanced Life Support and Advanced Trauma Life Support algorithms, were analyzed. Specific emergency medical procedures carried out in the particular mission were assigned to the respective competence level (CL): CL1: invasive measures reserved for physicians; CL2: invasive measures that paramedics are trained to use independently in emergency situations; CL3: standard measures; CL4: counseling only; and CL5: no measures.

Results: In all, 67,975 missions were analyzed. Missions were most frequently dispatched for internal indications, such as cardiovascular and pulmonary emergencies (28.4%), and traumatological indications (20.4%). Despite the physician being dispatched in 36.5% of cases, invasive measures (CL1/CL2) were only used in 13.9% of missions. Internal indications (11.8%) and resuscitation (19.6%) frequently required CL1 measures. CL2 measures were more frequently applied than CL1 measures for allergic (44.2% vs. 1.9%), neurological (12.5% vs. 3.4%), and psychological (6.1% vs. 0.7%) indications. In most interventions (62.2%), only the standard competencies (CL3) were used as the highest level of competence. For most mission indications, the probability of invasive measures (CL1/CL2) increased significantly in the presence of at least one vital sign abnormality.

Conclusions: The results show opportunities for optimizing emergency physician dispatch. The presence of a vital sign abnormality should be given greater consideration in the future. Query algorithms for detecting cases with a high probability of requiring CL1/CL2 measures could support efficient dispatching. Furthermore, emergencies requiring CL2 but rarely CL1 measures could be handled independently by emergency paramedics, particularly if they have access to the support of a tele-emergency physician for situations where CL1 measures become necessary.

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来源期刊
Prehospital Emergency Care
Prehospital Emergency Care 医学-公共卫生、环境卫生与职业卫生
CiteScore
4.30
自引率
12.50%
发文量
137
审稿时长
1 months
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.
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