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Introduction of a section for recording dementia improves data capture on the ambulance electronic patient record: evidence from a regional quality improvement project. 引入痴呆症记录部分可改善救护车电子病历的数据采集:来自地区质量改进项目的证据。
Pub Date : 2024-09-01 DOI: 10.29045/14784726.2024.9.9.2.29
Phil King, Patryk Jadzinski, Helen Pocock, Chloe Lofthouse-Jones, Martina Brown, Carole Fogg

Introduction: Dementia is a common co-morbidity in older people who require urgent or emergency ambulance attendance and influences clinical decisions and care pathways. Following an initial audit of dementia data and consultation with staff, a specific section (tab) to record dementia was introduced on an ambulance service electronic patient record (ePR). This includes a dementia diagnosis button and a free-text section. We aimed to assess whether and how this improved recording.

Methods: To re-audit the proportion of ambulance ePRs where dementia is recorded for patients aged ≥65 years, and to describe the frequency of recording in patients aged <65; to analyse discrepancies in the place of recording dementia on the ePR by comparing data from the new dementia tab and other sections of the ePR.

Results: We included 112,193 ePRs of patients aged ≥65 with ambulance attendance from a six-month period. The proportion with dementia recorded in patients aged ≥65 was 16.5%, increasing to 19.9% in patients aged ≥75, as compared to 13.5% (≥65) and 16.5% (≥75) in our previous audit. In this audit, of the 16.5% (n = 18,515) of records with dementia recorded, 69.9% (n = 12,939) used the dementia button and 25.4% (n = 4704) recorded text in the dementia tab. Dementia was recorded in ePR free-text fields (but not the dementia tab) in 29.7% of records. Eighteen other free-text fields were used in addition to, or instead of, the dementia tab, including the patient's social history, previous medical history and mental health. Dementia was present on the ePR of 0.4% (n = 461) of patients aged <65.

Conclusions: An ePR dementia tab enabled ambulance clinicians to standardise the location of recording dementia and may have facilitated increased recording. We would recommend other ambulance trusts capture this information in a specific section to improve information sharing and to inform care planning for this patient group.

导言:痴呆症是需要紧急救护服务的老年人的常见并发症,会影响临床决策和护理路径。在对痴呆症数据进行初步审核并征求员工意见后,救护车服务电子病历(ePR)中引入了专门记录痴呆症的部分(标签)。其中包括痴呆症诊断按钮和自由文本部分。我们旨在评估这一做法是否以及如何改进了记录工作:方法:重新审核对年龄≥65 岁的患者进行痴呆症记录的救护车电子病历比例,并描述对老年患者进行记录的频率:我们纳入了在 6 个月内有救护车出诊的 112,193 份年龄≥65 岁患者的电子病历。年龄≥65岁的患者中有痴呆症记录的比例为16.5%,年龄≥75岁的患者中这一比例增至19.9%,而在我们之前的审核中,这一比例分别为13.5%(≥65岁)和16.5%(≥75岁)。在本次审核中,16.5%(n = 18515)的痴呆记录中,69.9%(n = 12939)使用了痴呆按钮,25.4%(n = 4704)在痴呆选项卡中记录了文字。有 29.7% 的记录在 ePR 自由文本字段(但不是痴呆选项卡)中记录了痴呆。除痴呆选项卡外,还使用了其他 18 个自由文本字段,包括患者的社会病史、既往病史和精神健康状况。0.4%(n=461)的老年结论患者的电子病历中存在痴呆症:电子病历中的痴呆症选项卡使临床救护人员能够对痴呆症的记录位置进行标准化,并可能有助于增加记录。我们建议其他救护车托管机构在特定栏目中记录这一信息,以改善信息共享,并为这一患者群体的护理规划提供信息。
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引用次数: 0
The zero responder: a definition and report of current literature. 零反应者:定义和当前文献报告。
Pub Date : 2024-09-01 DOI: 10.29045/14784726.2024.9.9.2.38
Eloise Graham, John Hall, Keith Porter

The term 'zero responder' was initially devised in 2010 to describe those passing by or unharmed in a mass casualty incident, who provide life-saving care for injured persons before qualified professionals arrive. This review aims to determine how the literature defines the role of the zero responder and to explore how they can be better integrated into the emergency response. Current definitions of the zero responder in a medical setting were found through a literature search of several databases and online libraries using defined search terms. Additionally, a manual search of citations in included articles was performed to yield more results. In total, 16 papers defining the zero responder were included. These definitions were evaluated, and a revised definition was suggested to clarify the role in a medical setting relating to mass casualty incidents. The role of the zero responder can be facilitated through authority recognition and adequate equipment provision. Familiarisation with the term and role of zero responders among ambulance services is essential for effective collaboration. Further research and clarity on the integration of these two groups is necessary to facilitate effective and safe working between them.

零伤员 "一词最初出现于 2010 年,用于描述在大规模伤亡事件中路过或未受伤的人员,他们在合格的专业人员到达之前为伤员提供救生护理。本综述旨在确定文献如何定义 "零反应者 "的角色,并探讨如何将他们更好地融入应急响应。通过使用定义的检索词对多个数据库和在线图书馆进行文献检索,我们发现了目前在医疗环境中对 "零反应者 "的定义。此外,还对收录文章的引文进行了人工检索,以获得更多结果。总共收录了 16 篇定义零反应者的论文。我们对这些定义进行了评估,并提出了修订后的定义,以明确零反应人员在大规模伤亡事件医疗环境中的角色。通过权威机构的认可和提供充足的设备,可以促进零反应人员发挥作用。在救护车服务中熟悉零反应者的术语和角色对于有效合作至关重要。有必要进一步研究和明确这两个群体的整合,以促进他们之间有效和安全的工作。
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引用次数: 0
College of Paramedics Research Conference 2024. 辅助医务人员学院 2024 年研究会议。
Pub Date : 2024-09-01 DOI: 10.29045/14784726.2024.9.9.2.44
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引用次数: 0
Influence of patient body weight on the probability of return of spontaneous circulation following out-of-hospital cardiac arrest: an exploratory analysis. 病人体重对院外心脏骤停后自主循环恢复概率的影响:探索性分析。
Pub Date : 2024-09-01 DOI: 10.29045/14784726.2024.9.9.2.11
Michael W Hubble, Ginny R Kaplan, Melisa Martin

Introduction: In addition to key interventions, including bystander CPR and defibrillation, successful resuscitation of out-of-hospital cardiac arrest (OHCA) is also associated with several patient-level factors, including a shockable presenting rhythm, younger age, Caucasian race and female sex. An additional patient-level factor that may influence outcomes is patient weight, yet this attribute has not been extensively studied within the context of OHCA, despite globally increasing obesity rates.

Objective: To assess the relationship between patient weight and return of spontaneous circulation (ROSC) during OHCA.

Methods: This retrospective study included adult patients from a national emergency medical services (EMS) patient record, with witnessed, non-traumatic OHCA prior to EMS arrival from January to December 2020. Logistic regression was used to evaluate the relationship between patient weight and ROSC.

Results: Complete records were available for 9096 patients, of which 64.3% were males and 25.3% were ethnic minorities. The mean age of the participants was 65.01 years (SD = 15.8), with a mean weight of 93.52 kg (SD = 31.5). Altogether, 81.8% of arrests were of presumed cardiac aetiology and 30.3% presented with a shockable rhythm. Bystander CPR and automated external defibrillator (AED) shock were performed in 30.6% and 7.3% of cases, respectively, and 44.0% experienced ROSC. ROSC was less likely with patient weight >100 kg (OR = 0.709, p <0.001), male sex (OR = 0.782, p <0.001), and increasing age and EMS response time (OR = 0.994 per year, p <0.001 and OR = 0.970 per minute, p <0.001, respectively). Patients with shockable rhythms were more likely to achieve ROSC (OR = 1.790, p <0.001), as were patients receiving bystander CPR (OR = 1.170, p <0.001) and defibrillation prior to EMS arrival (OR = 1.658, p <0.001). Although the mean first adrenaline dose (mg/kg) followed a downward trend due to its non-weight-based dosing scheme, the mean total adrenaline dose administered to achieve ROSC demonstrated an upward linear trend of 0.05 mg for every 5 kg of body weight.

Conclusions: Patient weight was negatively associated with ROSC and positively associated with the total adrenaline dose required to attain ROSC.

导言:除了包括旁观者心肺复苏术和除颤在内的关键干预措施外,院外心脏骤停(OHCA)的成功复苏还与几个患者层面的因素有关,包括可电击心律、年龄较小、白种人和女性。另外一个可能影响抢救结果的患者层面因素是患者体重,尽管肥胖率在全球范围内不断上升,但在 OHCA 的背景下,这一因素尚未得到广泛研究:评估患者体重与 OHCA 期间自发性循环恢复(ROSC)之间的关系:这项回顾性研究纳入了全国急救医疗服务(EMS)患者记录中的成年患者,这些患者在 2020 年 1 月至 12 月期间,在急救医疗服务到达之前发生了有目击者在场的非创伤性 OHCA。研究采用逻辑回归法评估患者体重与 ROSC 之间的关系:共有 9096 名患者的完整记录,其中 64.3% 为男性,25.3% 为少数民族。参与者的平均年龄为 65.01 岁(SD = 15.8),平均体重为 93.52 千克(SD = 31.5)。81.8%的心跳骤停推测为心脏原因,30.3%的心跳骤停表现为可电击心律。旁观者心肺复苏和自动体外除颤器(AED)电击的比例分别为 30.6% 和 7.3%,44.0% 的患者获得了 ROSC。体重大于 100 千克的患者出现 ROSC 的几率较低(OR = 0.709,P 结论:体重大于 100 千克的患者出现 ROSC 的几率较低):患者体重与 ROSC 呈负相关,与达到 ROSC 所需的肾上腺素总剂量呈正相关。
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引用次数: 0
Stroke survivor views on ambulance redirection as a strategy to increase access to thrombectomy in England 英国中风幸存者对救护车改道作为增加血栓切除术机会的策略的看法
Pub Date : 2024-06-01 DOI: 10.29045/14784726.2024.6.9.1.1
Abi Alton, Darren Flynn, David Burgess, Gary A. Ford, Chris Price, Martin James, Peter McMeekin, Michael Allen, Lisa Shaw, Philip White
Introduction: Intravenous thrombolysis and mechanical thrombectomy are effective time-sensitive treatments for selected cases of acute ischaemic stroke. While thrombolysis is widely available, thrombectomy can only be provided at facilities with the necessary equipment and interventionists. Suitable patients admitted to other hospitals require secondary transfer, causing delays to treatment. Pre-hospital ambulance redirection to thrombectomy facilities may improve access but treatment eligibility cannot be confirmed pre-hospital. Some redirected patients would travel further and be displaced without receiving thrombectomy. This study aimed to elicit stroke survivor and carer/relative views about the possible consequences of introducing a conceptual, idealised ambulance redirection pathway.Methods: Focus groups were undertaken using a topic guide describing four hypothetical ambulance redirection scenarios and their possible consequences: earlier treatment with thrombectomy; delayed diagnosis of non-stroke ‘mimic’ conditions; delayed thrombolysis treatment; and delayed diagnosis of haemorrhagic stroke. Meetings were audio recorded, transcribed verbatim and data analysed thematically using emergent coding.Results: Fifteen stroke survivors and carers/relatives participated in three focus groups. There was wide acceptance of possible low-risk consequences of ambulance redirection, including extended travel time, being further from home and experiencing longer hospital stays. Participants were more uncertain about higher-risk consequences, including delays in diagnosis/treatment for patients unsuitable for thrombectomy, but remained positive about ambulance redirection overall. Participants rationalised acceptance of higher-risk consequences by recognising that redirected patients would still access appropriate treatment, even if delayed. In addition, acceptance of ambulance redirection would be increased if there were robust clinical evidence showing net benefit over secondary transfer pathways.Conclusions: Participant views were generally supportive of ambulance redirection to facilitate access to thrombectomy. Further research is needed to demonstrate overall benefit in an NHS context.
导言:静脉溶栓和机械性血栓切除术是针对特定急性缺血性中风病例的有效、时效性强的治疗方法。虽然溶栓治疗可广泛使用,但血栓切除术只能在具备必要设备和介入专家的机构进行。其他医院收治的合适患者需要二次转院,导致治疗延误。院前救护车将患者转送至血栓切除术机构可改善患者的就医条件,但治疗资格无法在院前得到确认。一些被转送的患者会走得更远,在没有接受血栓切除术的情况下被转移。本研究旨在了解中风幸存者和照护者/亲属对引入概念化、理想化的救护车转送路径可能造成的后果的看法:方法: 使用主题指南开展焦点小组讨论,该指南描述了四种假设的救护车转送情景及其可能的后果:提早进行血栓切除术治疗;延迟诊断非中风 "模拟 "病症;延迟溶栓治疗;延迟诊断出血性中风。对会议进行了录音、逐字记录,并使用突发编码对数据进行了主题分析:15 名中风幸存者和照护者/亲属参加了三个焦点小组。大家普遍接受救护车改道可能带来的低风险后果,包括延长旅行时间、离家更远以及住院时间更长。对于较高风险后果,包括不适合进行血栓切除术的患者的诊断/治疗延误,参与者较为不确定,但总体上对救护车转运仍持肯定态度。与会者认为,即使延误,被转送的患者仍可获得适当的治疗,从而合理地接受了较高风险后果。此外,如果有确凿的临床证据显示救护车转运比二次转运途径更有净效益,那么参与者对救护车转运的接受度会更高:与会者普遍支持通过救护车转运来促进血栓切除术的实施。需要开展进一步研究,以证明在国家医疗服务体系中的整体效益。
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引用次数: 0
Major Trauma Triage Tool Study (MATTS) expert consensus-derived injury assessment tool 重大创伤分诊工具研究 (MATTS) 专家共识衍生的损伤评估工具
Pub Date : 2024-06-01 DOI: 10.29045/14784726.2024.6.9.1.10
Gordon Fuller, Nathan Howes, Roderick Mackenzie, S. Keating, Janette Turner, Christopher Holt, Joshua Miller, Steve Goodacre
Introduction: Major trauma centre (MTC) care has been associated with improved outcomes for injured patients. English ambulance services and trauma networks currently use a range of triage tools to select patients for bypass to MTCs. A standardised national triage tool may improve triage accuracy, cost-effectiveness and the reproducibility of decision-making.Methods: We conducted an expert consensus process to derive and develop a major trauma triage tool for use in English trauma networks. A web-based Delphi survey was conducted to identify and confirm candidate triage tool predictors of major trauma. Facilitated roundtable consensus meetings were convened to confirm the proposed triage tool’s purpose, target diagnostic threshold, scope, intended population and structure, as well as the individual triage tool predictors and cut points. Public and patient involvement (PPI) focus groups were held to ensure triage tool acceptability to service users.Results: The Delphi survey reached consensus on nine triage variables in two domains, from 109 candidate variables after three rounds. Following a review of the relevant evidence during the consensus meetings, iterative rounds of discussion achieved consensus on the following aspects of the triage tool: reference standard, scope, target diagnostic accuracy and intended population. A three-step tool comprising physiology, anatomical injury and clinical judgement domains, with triage variables assessed in parallel, was recommended. The triage tool was received favourably by PPI focus groups.Conclusions: This paper presents a new expert consensus derived major trauma triage tool with defined purpose, scope, intended population, structure, constituent variables, variable definitions and thresholds. Prospective evaluation is required to determine clinical and cost-effectiveness, acceptability and usability.
导言:主要创伤中心(MTC)护理与改善受伤病人的治疗效果有关。英国的救护车服务和创伤网络目前使用一系列分流工具来选择将病人分流到重创中心。标准化的全国分诊工具可以提高分诊的准确性、成本效益和决策的可重复性:方法:我们开展了一项专家共识程序,以推导和开发供英国创伤网络使用的重大创伤分流工具。我们开展了一项基于网络的德尔菲调查,以确定并确认候选分诊工具的重大创伤预测指标。召开圆桌共识会议,以确认拟议分诊工具的目的、目标诊断阈值、范围、目标人群和结构,以及各个分诊工具预测因子和切点。此外,还举行了公众和患者参与(PPI)焦点小组会议,以确保服务用户对分流工具的可接受性:德尔菲调查从 109 个候选变量中筛选出两个领域的九个分流变量,经过三轮调查后达成了共识。在共识会议期间对相关证据进行审查后,经过反复讨论,就分诊工具的以下方面达成了共识:参考标准、范围、目标诊断准确性和目标人群。会议建议采用一种三步式工具,包括生理、解剖损伤和临床判断领域,并同时评估分诊变量。分诊工具得到了公众宣传焦点小组的好评:本文介绍了一种新的专家共识衍生的重大创伤分流工具,该工具具有明确的目的、范围、目标人群、结构、组成变量、变量定义和阈值。需要进行前瞻性评估,以确定临床和成本效益、可接受性和可用性。
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引用次数: 0
Is the Calgary-Cambridge Model of consultation a suitable communication tool for students and newly qualified paramedics? A qualitative study 卡尔加里-剑桥咨询模式是否是适合学生和新晋护理人员的沟通工具?定性研究
Pub Date : 2024-06-01 DOI: 10.29045/14784726.2024.6.9.1.23
Claire Hastings
Introduction: The Calgary-Cambridge Model (C-CM), developed by Kurtz and Silverman in 1996, is a communication tool developed for doctors. Since its publication, it has been adopted by various healthcare professionals; however, no previous research has been identified that evaluates its use in paramedic practice. This study aims to explore the experience of students and newly qualified paramedics (NQPs) applying the C-CM in practice, and establish their experiences and perceptions of its suitability as a communication tool in the pre-hospital environment.Methods: This MSc research project, conducted in April‐May 2021, applied qualitative methods with thematic analysis to written reflections and semi-structured interview transcripts discussing the implementation of C-CM in paramedic practice. A convenience-quota sample of 11 participants, consisting of third-year paramedic students and recent NQPs, were recruited. This research is reported using Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guidelines.Results: Eleven participants were recruited in total; nine consented to reflective writing analysis and interviews, two consented to writing analysis only. Analysis of the writing samples allowed for a deductive approach to the interview plan. Participants consisted of seven males and four females. All eleven participants (ten British and one Indian) spoke English as a first language. Ages ranged from 18 to 59 years. Career status was 46.2% third-year students and 53.8% NQPs. Four major themes were identified: barriers to implementation of the C-CM in practice; impact of C-CM on paramedic practice; C-CM as a teaching and learning tool in paramedic practice; and adaptation of C-CM for paramedic practice.Conclusions: Participants suggested that implementation of C-CM leads to improved structure and shared decision-making; however, adaptions to make it more paramedic-focused would be welcomed. The diversity of patients and their preferences can make its implementation challenging, and the negative feedback received from experienced ambulance staff was a significant concern to participants.
简介卡尔加里-剑桥模式(C-CM)由 Kurtz 和 Silverman 于 1996 年开发,是一种针对医生的沟通工具。自其发布以来,已被各种医疗保健专业人士所采用;然而,此前尚未发现有研究对其在辅助医务人员实践中的使用情况进行评估。本研究旨在探讨学生和新获得资格的辅助医务人员(NQPs)在实践中应用 C-CM 的经验,并确定他们对 C-CM 作为院前环境中沟通工具的适用性的体验和看法:本理学硕士研究项目于 2021 年 4 月至 5 月进行,采用定性方法,对讨论辅助医务人员在实践中实施 C-CM 的书面反思和半结构式访谈记录进行主题分析。本研究采用方便配额抽样法,招募了 11 名参与者,包括三年级护理专业学生和新近获得国家资格证书的人员。本研究采用定性研究综合报告标准(COREQ)报告指南进行报告:共招募了 11 名参与者,其中 9 人同意进行反思性写作分析和访谈,2 人只同意进行写作分析。通过对写作样本的分析,可以对访谈计划进行演绎。参与者包括七名男性和四名女性。所有 11 名参与者(10 名英国人和 1 名印度人)的第一语言都是英语。年龄从 18 岁到 59 岁不等。职业状况为 46.2% 的三年级学生和 53.8% 的 NQPs。研究确定了四大主题:在实践中实施 C-CM 的障碍;C-CM 对辅助医疗实践的影响;C-CM 作为辅助医疗实践中的教学工具;C-CM 在辅助医疗实践中的适应性:与会者认为,C-CM 的实施改善了结构和共同决策;但是,他们欢迎对其进行调整,使其更加以辅助医务人员为重点。患者及其偏好的多样性可能会使其实施具有挑战性,经验丰富的救护人员提供的负面反馈也是与会者非常关注的问题。
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引用次数: 0
Ambulance service recognition of health inequalities and activities for reduction: An evidence and gap map of the published literature 救护车服务对健康不平等的认识和减少不平等的活动:已发表文献的证据和差距图
Pub Date : 2024-06-01 DOI: 10.29045/14784726.2024.6.9.1.47
Fiona Bell, Ruth Crabtree, Caitlin Wilson, E. Miller, Rachel Byrne
Background: Emergency medical services (EMS) are often patients’ first point of contact for urgent and emergency care needs. Patients are triaged over the phone and may receive an ambulance response, with potential conveyance to the hospital. A recent scoping review suggested disparities in EMS patient care in the United States. However, it is unknown how health inequalities impact EMS care in other developed countries and how inequalities are being addressed.Objectives: This rapid evidence map of published literature aims to map known health inequalities in EMS patients and describe interventions reducing health inequalities in EMS patient care.Methods: The search strategy consisted of EMS synonyms and health inequality synonyms. The MEDLINE/PubMed database was searched from 1 January 2010 to 26 July 2022. Studies were included if they described empirical research exploring health inequalities within ambulance service patient care. Studies were mapped on to the EMS care interventions framework and Core20PLUS5 framework. Studies evaluating interventions were synthesised using the United Kingdom Allied Health Professions Public Health Strategic Framework.Results: The search strategy yielded 771 articles, excluding duplicates, with two more studies added from hand searches. One hundred studies met the inclusion criteria after full-text review. Inequalities in EMS patient care were predominantly situated in assessment, treatment and conveyance, although triage and response performance were also represented. Studies mostly explored EMS health inequalities within ethnic minority populations, populations with protected characteristics and the core issue of social deprivation. Studies evaluating interventions reducing health inequalities (n = 5) were from outside the United Kingdom and focused on older patients, ethnic minorities and those with limited English proficiency. Interventions included community paramedics, awareness campaigns, dedicated language lines and changes to EMS protocols.Conclusions: Further UK-based research exploring health inequalities of EMS patients would support ambulance service policy and intervention development to reduce health inequality in urgent and emergency care delivery.
背景:急诊医疗服务(EMS)通常是病人需要紧急护理时的第一个接触点。患者通过电话进行分诊,可能会得到救护车的响应,并有可能被送往医院。最近的一项范围审查表明,美国的急救医疗服务(EMS)患者护理存在差异。然而,在其他发达国家,健康不平等是如何影响急救医疗服务的,以及如何解决不平等问题,目前尚不得而知:这份已发表文献的快速证据图旨在绘制已知的急救病人健康不平等现象图,并描述减少急救病人护理中健康不平等现象的干预措施:搜索策略包括急救服务同义词和健康不平等同义词。检索时间为 2010 年 1 月 1 日至 2022 年 7 月 26 日的 MEDLINE/PubMed 数据库。凡是对救护车服务患者护理中的健康不平等现象进行实证研究的研究均被纳入。研究结果与急救服务护理干预框架和 Core20PLUS5 框架相对应。使用英国联合卫生专业公共卫生战略框架对评估干预措施的研究进行综合:该搜索策略共搜索到 771 篇文章,排除了重复的文章,另外还通过人工搜索增加了两项研究。经全文审阅后,100 项研究符合纳入标准。急救病人护理中的不平等主要体现在评估、治疗和转运方面,尽管分流和响应性能也有体现。大多数研究都探讨了少数民族人群、受保护特征人群以及社会贫困这一核心问题中的急救医疗服务健康不平等现象。对减少健康不平等的干预措施进行评估的研究(n = 5)来自英国以外,主要针对老年患者、少数民族和英语水平有限的人群。干预措施包括社区辅助医务人员、宣传活动、语言专线和改变急救协议:以英国为基础,对急救医疗服务患者的健康不平等现象进行进一步研究,将有助于制定救护服务政策和干预措施,减少紧急和急诊医疗服务中的健康不平等现象。
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引用次数: 0
A systematic review of post-traumatic growth in ambulance personnel: facilitators and prevalence rates 对救护人员创伤后成长的系统审查:促进因素和流行率
Pub Date : 2024-06-01 DOI: 10.29045/14784726.2024.6.9.1.34
Molly Abdo, Annette Schlösser
Introduction: Ambulance personnel are exposed to traumatic and stressful situations, which can increase the risk of mental health conditions, such as post-traumatic stress disorder (PTSD). High rates of PTSD have been found in ambulance personnel (Petrie et al., 2018), but no review is available to examine post-traumatic growth (PTG - positive psychological change following a trauma) in this population. This literature review provides an overview of the prevalence rates and facilitators that may contribute to PTG in ambulance personnel.Methods: A systematic search was conducted on EBSCOhost in January 2024 across the following six databases: Academic Search Ultimate, PsycINFO, PsycARTICLES, MEDLINE, ERIC and Cumulative Index to Nursing and Allied Health Literature (CINAHL) Ultimate.Results: Eleven papers were identified for this review. Pooled prevalence of PTG was moderate (52%), and facilitators for PTG were grouped into five categories: coping style/strategies, resilience, personality traits, gender and incident characteristics.Conclusions: Numerous facilitators contributed to the development of PTG, although these did not arise in all papers. The quality of research ranged from satisfactory to excellent. Evidence suggested that adaptive coping style, high levels of resilience, the absence of a personality trait (neuroticism) and being female may facilitate PTG. Further research is needed to support the reliability of findings.
导言:救护人员会面临创伤和压力环境,这可能会增加罹患创伤后应激障碍(PTSD)等精神疾病的风险。在救护人员中发现创伤后应激障碍的发病率很高(Petrie 等人,2018 年),但目前还没有文献综述对这一人群的创伤后成长(PTG - 创伤后的积极心理变化)进行研究。本文献综述概述了创伤后成长在救护人员中的流行率以及可能促进创伤后成长的因素:2024 年 1 月在 EBSCOhost 上对以下六个数据库进行了系统检索:学术搜索终极版、PsycINFO、PsycARTICLES、MEDLINE、ERIC 和护理及相关健康文献累积索引(CINAHL)终极版:本综述共找到 11 篇论文。PTG的总体发生率为中等(52%),PTG的促进因素分为五类:应对方式/策略、复原力、人格特质、性别和事件特征:尽管并非所有论文都提到了 PTG,但许多促进因素对 PTG 的发展起到了推动作用。研究质量从满意到优秀不等。有证据表明,适应性应对方式、高度复原力、无人格特质(神经质)和女性可能会促进 PTG 的发展。还需要进一步的研究来证明研究结果的可靠性。
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引用次数: 0
Sex differences in the pre-hospital ambulance delay, assessment and treatment of patients with acute coronary syndrome: a rapid evidence review. 急性冠状动脉综合征患者院前救护车延误、评估和治疗中的性别差异:快速证据回顾。
Pub Date : 2024-03-01 DOI: 10.29045/14784726.2024.3.8.4.21
Holly de Banke Munday, Gregory Adam Whitley

Background: Chest pain is a frequent symptom suffered by adult patients attended by ambulance. Evidence suggests female patients may suffer different symptoms to their male counterparts, potentiating differences in pre-hospital time delays, assessment and treatment.

Objective: To explore the sex differences in the pre-hospital ambulance delay, assessment and treatment of patients with acute coronary syndrome (ACS).

Methods: A rapid evidence review was conducted following the Cochrane rapid review guidelines. MEDLINE and CINAHL Complete were searched via EBSCOhost on 2 February 2023, and reference lists of included studies and reviews were screened. The Joanna Briggs Institute checklist for analytical cross-sectional studies was used to perform critical appraisal, and a narrative synthesis was conducted.

Results: From 216 articles screened, nine were included, representing over 3.1 million patients from five different countries. Female patients were more likely to suffer delays in time to first electrocardiogram (ECG) and delays in transport time to the emergency department by ambulance. Female patients were also less likely to receive an ECG, aspirin, glyceryl trinitrate and other analgesics.

Conclusion: There are sex disparities in the pre-hospital ambulance delay, assessment and treatment of patients with ACS. Future research is urgently needed to fully understand the reasons for these observations.

背景:胸痛是乘坐救护车的成年患者经常出现的症状。有证据表明,女性患者的症状可能与男性患者不同,从而加剧了院前时间延误、评估和治疗方面的差异:探讨院前救护车对急性冠状动脉综合征(ACS)患者的延误、评估和治疗中的性别差异:方法:根据 Cochrane 快速综述指南进行快速证据综述。于 2023 年 2 月 2 日通过 EBSCOhost 对 MEDLINE 和 CINAHL Complete 进行了检索,并对纳入研究和综述的参考文献列表进行了筛选。采用乔安娜-布里格斯研究所(Joanna Briggs Institute)横断面研究分析核对表进行批判性评价,并进行叙述性综合:从筛选出的 216 篇文章中,纳入了 9 篇,代表了来自 5 个不同国家的 310 多万名患者。女性患者更有可能在首次心电图检查(ECG)和救护车送往急诊科的时间上出现延误。女性患者接受心电图检查、服用阿司匹林、三硝酸甘油酯和其他止痛药的可能性也更小:结论:院前救护车对急性心肌梗死患者的延误、评估和治疗存在性别差异。结论:院前救护车对急性心肌梗死患者的延误、评估和治疗存在性别差异,亟需未来的研究来充分了解这些现象的原因。
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引用次数: 0
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British paramedic journal
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