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Reasons for Calling EMS 呼叫EMS的原因
Pub Date : 2023-10-12 DOI: 10.56068/alas3711
Ricardo Angeles, Brent McLeod, Janice Lee, Sabnam Mahmuda, Alix Stocic, Michelle Howard, Gina Agarwal
Background: Frequent callers of emergency medical services comprise a disproportionate percentage of emergency department visits. This study aims to describe reasons for calling 911 and healthcare services among frequent callers in Ontario. Methods: Cross-sectional research design. A mailed self-administered survey was conducted. Participants were residents of an urban City in Canada, 18 years or older, and had called 911 at least 5 times in the past year. Dillman’s Total Design Method was used to implement the survey. Data was summarized using frequency distribution. Subgroup analyses were performed to assess for factors associated with reasons for calling in the past, reasons for calling in the future, and health services utilized. Results: Among the 67 participants, 47.8% were over 65, 50.70% were female, 85.1% were unemployed, and 38.8% lived alone. Most frequently reported reasons for having called 911 were inability to get up after a fall (41.8%), exacerbation of chronic medical conditions (37.3%), inability to get to the hospital (34.3%), experiencing severe pain (34.3%), and anxiety attacks (23.9%). Subgroup analysis showed significant associations: unemployment was associated with calling due to an alcohol or drug overdose (OR=6.50; CI: 1.16, 36.26); age over 65 had a lower odds of calling in the future for alcohol or drug overdose (OR=0.06; CI: 0.01, 0.51), for serious allergic response (OR=0.22; CI:0.081, 0.740) or for severe pain (OR=0.18; CI: 0.064, 0.518); age over 65 (OR=4.46CI=1.24-17.41) had higher odds of using Community Care Access Centers; and male participants had lower odds of using telehealth (OR=0.19; CI:0.038, 0.97). Conclusions: Policy makers should review these reasons for frequently calling 911 and implement a system to help frequent callers use more appropriate health care services including a non-ambulance response to calls related to falls, transport to medical care facilities, or anxiety attacks. This might free up ambulance services for more urgent calls.
背景:急诊医疗服务的频繁呼叫者在急诊科就诊中所占比例不成比例。本研究旨在描述安大略省频繁呼叫911和医疗服务的原因。 方法:横断面研究设计。进行了一项邮寄的自我调查。参与者是加拿大城市的居民,年龄在18岁或以上,在过去一年中至少拨打过5次911。采用Dillman总体设计法进行调查。采用频率分布对数据进行汇总。进行了亚组分析,以评估与过去打电话的原因、未来打电话的原因和使用的卫生服务相关的因素。结果:67名参与者中,65岁以上的占47.8%,女性占50.70%,无业人口占85.1%,独居人口占38.8%。拨打911最常见的原因是跌倒后无法站起来(41.8%)、慢性疾病恶化(37.3%)、无法去医院(34.3%)、经历剧烈疼痛(34.3%)和焦虑发作(23.9%)。亚组分析显示了显著的关联:失业与因酒精或药物过量而打电话相关(or =6.50;Ci: 1.16, 36.26);65岁以上的人未来因酒精或药物过量而打电话的几率较低(or =0.06;CI: 0.01, 0.51),严重过敏反应(OR=0.22;CI:0.081, 0.740)或重度疼痛(or =0.18;Ci: 0.064, 0.518);65岁以上的老年人(OR=4.46CI=1.24-17.41)使用社区护理访问中心的几率更高;男性参与者使用远程医疗的几率较低(OR=0.19;CI: 0.038, 0.97)强生# x0D;结论:政策制定者应该审查这些频繁拨打911的原因,并实施一个系统来帮助频繁的呼叫者使用更合适的卫生保健服务,包括对与跌倒、转移到医疗机构或焦虑发作有关的呼叫的非救护车响应。这可能会为更多的紧急呼叫腾出救护车服务。
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 Methods: Cross-sectional research design. A mailed self-administered survey was conducted. Participants were residents of an urban City in Canada, 18 years or older, and had called 911 at least 5 times in the past year. Dillman’s Total Design Method was used to implement the survey. Data was summarized using frequency distribution. Subgroup analyses were performed to assess for factors associated with reasons for calling in the past, reasons for calling in the future, and health services utilized.
 Results: Among the 67 participants, 47.8% were over 65, 50.70% were female, 85.1% were unemployed, and 38.8% lived alone. Most frequently reported reasons for having called 911 were inability to get up after a fall (41.8%), exacerbation of chronic medical conditions (37.3%), inability to get to the hospital (34.3%), experiencing severe pain (34.3%), and anxiety attacks (23.9%). Subgroup analysis showed significant associations: unemployment was associated with calling due to an alcohol or drug overdose (OR=6.50; CI: 1.16, 36.26); age over 65 had a lower odds of calling in the future for alcohol or drug overdose (OR=0.06; CI: 0.01, 0.51), for serious allergic response (OR=0.22; CI:0.081, 0.740) or for severe pain (OR=0.18; CI: 0.064, 0.518); age over 65 (OR=4.46CI=1.24-17.41) had higher odds of using Community Care Access Centers; and male participants had lower odds of using telehealth (OR=0.19; CI:0.038, 0.97).
 Conclusions: Policy makers should review these reasons for frequently calling 911 and implement a system to help frequent callers use more appropriate health care services including a non-ambulance response to calls related to falls, transport to medical care facilities, or anxiety attacks. This might free up ambulance services for more urgent calls.","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136014436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Social Needs in the Prehospital Setting (SNIPS): EMS Attitudes Toward Addressing Patient Social Needs. 院前环境中的社会需求(SNIPS):EMS对解决患者社会需求的态度。
Pub Date : 2023-10-01 Epub Date: 2023-10-12 DOI: 10.56068/BNJE9301
Daniel Berger, Catherine Caldwell, Meghan E Robbins, Amelia Gurley, Jessica Mann

Introduction: There has been interest in utilizing EMS to address patients' social determinants of health, which are thought to be the cause of many unnecessary transports, particularly for "super-utilizing" patients. However, existing research is limited regarding EMS clinicians' understanding of social determinants of health and attitudes toward potential interventions.

Methods: This cross-sectional study was conducted using an internet-based survey of EMS clinicians across the United States with multiple methods of recruitment. Descriptive statistics and Chi Square Tests analyzed the data.

Results: A total of 1,112 EMTs and paramedics completed the survey with 43.4% reporting familiarity with the term, "social determinants of health," and 87.7% screening positive for burnout. Greater than 60% reported willingness to use proposed interventions to address patient social needs. Those who reported familiarity with the term, "social determinants of health," were more likely to indicate willingness to utilize interventions and to believe they were responsible for addressing their patients' social needs. Burnout had no effect on clinicians' willingness to use resources.

Discussion: Respondents showed substantial interest in using the proposed resources to address patient social needs, suggesting that EMS clinicians may be receptive to expanding their scope of responsibility to include socioeconomic interventions. EMS clinicians familiar with the term "social determinants of health" were more likely to believe they were responsible for addressing patient social needs and more willing to use interventions, suggesting a potential benefit to more education on the topic. Burnout among EMS clinicians may not be a barrier to implementing such interventions.

Conclusion: Our survey suggests that EMS clinicians may be interested in helping to address their patients' social needs. EMS clinicians should be offered education on social determinants of health in their initial training and through continuing education. Partnerships with human services agencies will be important to ensure the effectiveness of prehospital interventions.

引言:人们对利用EMS来解决患者健康的社会决定因素很感兴趣,这被认为是许多不必要的运输的原因,尤其是对于“超级利用”患者。然而,关于EMS临床医生对健康的社会决定因素和对潜在干预措施的态度的理解,现有的研究是有限的。方法:这项横断面研究采用了多种招募方法,对美国各地的EMS临床医生进行了基于互联网的调查。描述性统计和卡方检验对数据进行了分析。结果:共有1112名急救人员和护理人员完成了这项调查,43.4%的人表示熟悉“健康的社会决定因素”一词,87.7%的人表示倦怠筛查呈阳性。超过60%的人表示愿意使用拟议的干预措施来满足患者的社会需求。那些报告熟悉“健康的社会决定因素”一词的人更有可能表示愿意使用干预措施,并相信他们有责任满足患者的社会需求。倦怠对临床医生使用资源的意愿没有影响。讨论:受访者对使用拟议资源来满足患者的社会需求表现出极大的兴趣,这表明EMS临床医生可能愿意扩大他们的职责范围,将社会经济干预纳入其中。熟悉“健康的社会决定因素”一词的EMS临床医生更有可能相信他们有责任解决患者的社会需求,并且更愿意使用干预措施,这表明更多关于该主题的教育可能会带来好处。EMS临床医生的倦怠可能不是实施此类干预措施的障碍。结论:我们的调查表明,EMS临床医生可能有兴趣帮助解决患者的社会需求。EMS临床医生应在初始培训和继续教育中接受有关健康社会决定因素的教育。与人类服务机构建立伙伴关系对于确保院前干预措施的有效性至关重要。
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引用次数: 0
Paramedicine Literature Search: March-May 2023 辅助医学文献检索:2023年3月- 5月
Pub Date : 2023-07-05 DOI: 10.56068/pwlc3336
Brenda Morrissey, Shaughn Maxwell
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引用次数: 0
Goals, Services, and Target Patient Populations of Community Paramedicine in Rural United States 美国农村社区辅助医疗的目标、服务和目标患者人群
Pub Date : 2023-07-05 DOI: 10.56068/fsck6274
Chelsea McAuslan, J. Roll, Mitchell McAuslan
Introduction: Rural areas contain one-fifth of the US population and only 10% of the nation’s physicians. Community paramedicine (CP) is a growing healthcare delivery model in which emergency medical personnel provide non-emergent medical care. Community paramedics may help fill the primary healthcare gap for rural residents. This literature review provides an overview of the common goals, services, target populations, and setbacks of rural CP programs in the US. Methods: A systematic search following PRISMA protocols was completed on PubMed and Google scholar using the search terms: “community paramedicine/paramedic” and “rural, remote, frontier” between 2000-2021. Results: Rural CP program goals are to aid patients in chronic disease management and reduce emergency department visits, hospital admissions/readmissions, and healthcare costs. Programs target services toward patients who are chronically ill, post-hospital discharge, and frequent EMS users. Conclusion: CP provision of preventative and primary care services has improved health outcomes for patients with chronic disease. Programs report cost savings for the healthcare payer and patient and a reduction in ED transports and hospital readmissions. The problems identified are acquiring sustainable funding to develop CP programs and reimburse CP services, lack of consistency between CP scope of practice and educational requirements across states, role tensions with other healthcare professions, and lack of research about the safety of CP programs for patients. Future research is needed to investigate patient outcomes secondary to CP preventative and primary care services, which may identify if CPs are an effective means of helping fill the primary care gap for rural communities.
农村地区拥有美国五分之一的人口,却只有全国10%的医生。社区辅助医疗(CP)是一种新兴的医疗服务模式,由急诊医务人员提供非急诊医疗服务。社区护理人员可以帮助填补农村居民的初级卫生保健缺口。本文献综述概述了美国农村CP项目的共同目标、服务、目标人群和挫折。方法:按照PRISMA协议在PubMed和Google scholar上进行系统检索,检索词为2000-2021年间的“community paramedicine/paramedic”和“rural, remote, frontier”。结果:农村CP计划的目标是帮助慢性疾病患者管理,减少急诊科就诊,住院/再入院,以及医疗保健费用。项目的目标服务对象是慢性病患者、出院后患者和经常使用EMS的患者。结论:CP提供的预防和初级保健服务改善了慢性病患者的健康状况。项目报告为医疗保健支付者和患者节省了成本,并减少了急诊科的运输和医院再入院。所确定的问题是获得可持续的资金来发展CP项目和报销CP服务,在各州的CP实践范围和教育要求之间缺乏一致性,与其他医疗保健专业的角色紧张,以及缺乏关于CP项目对患者安全性的研究。未来的研究需要调查继发于CP预防和初级保健服务的患者结果,这可能会确定CP是否是帮助填补农村社区初级保健空白的有效手段。
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引用次数: 0
Inclusion of Confined Space Rescue in EMS Physician Fellowship Programs 将密闭空间救援纳入EMS医师奖学金项目
Pub Date : 2023-07-05 DOI: 10.56068/mofu4471
Michael McCartin, Katie L. Tataris, B. Heilicser, Joseph M. Weber, Lindsay Jaeger
Introduction:  In July 2021, the ACGME updated the Program Requirements for Graduate Medical Education in Emergency Medical Services to include participation in special operations trainings as a required key index procedure during an EMS fellowship. These requirements now include documentation of “participation in confined space, technical rescue, or collapse/trench training”.  EMS fellowships may have limited opportunities for fellows to actively participate in these complex events.Background:  Federal or State Urban Search and Rescue (USAR) teams present a unique opportunity to meet this training requirement. USAR teams perform search and rescue operations in collapsed structures and provide emergency medical care for entrapped survivors, task force personnel, and search canines. The physician is integrated into the Incident Command Structure of the USAR teams under the Medical Branch as the “Medical Team Manager”. This provides a defined team role in training and promotes physician level knowledge and skills in rescue operations.Methods:  The University of Chicago EMS Fellowship partnered with Illinois Task Force-1 USAR team to meet the new training requirements and participate as a Medical Team Manager on the team.Results: During the 12-month fellowship period, the EMS fellow participated in monthly USAR training that included both single day and multi-day exercises. The exercises included scenarios with complex hazardous materials, confined space rescue, high angle rescue, collapsed structure and trench rescue. With a dedicated physician role on the USAR team, the EMS fellow integrates into the response structure as a Medical Team Manager and can learn how to deliver high quality patient care in an austere environment.  USAR training fulfilled several of the new ACGME key index procedure for an EMS fellow in the special operations environment including participation in hazardous materials response training, participation in confined space, technical rescue, or collapse/trench training, and participation in vehicle rescue/extrication training. Conclusions:  EMS fellowship programs can collaborate with Urban Search and Rescue teams to provide training opportunities in confined space rescue to meet ACGME requirements for key index procedures and integrate qualified EMS physicians into USAR responses. Collaboration between EMS fellowship programs and USAR teams can be mutually beneficial.  
简介:2021年7月,ACGME更新了《急诊医疗服务研究生医学教育项目要求》,将参加特种作战培训作为EMS奖学金期间必需的关键指标程序。这些要求现在包括“参与密闭空间、技术救援或塌陷/堑壕训练”的文件。EMS研究员积极参与这些复杂活动的机会可能有限。背景:联邦或州城市搜索和救援(USAR)团队提供了一个独特的机会来满足这一培训要求。USAR小组在倒塌的建筑物中进行搜索和救援行动,并为被困的幸存者、特遣部队人员和搜救犬提供紧急医疗护理。该医生作为"医疗队经理"被纳入医务处下USAR小组的事件指挥结构。这在培训中提供了一个明确的团队角色,并提高了救援行动中医生水平的知识和技能。方法:芝加哥大学EMS奖学金与伊利诺斯州特别工作组-1 USAR团队合作,以团队医疗团队经理的身份参与新的培训要求。结果:在12个月的研究期间,EMS研究员参加了每月的USAR培训,包括一天和多天的练习。演习内容包括复杂危险物质情景、密闭空间救援、高角度救援、倒塌结构和战壕救援等。作为USAR团队的专职医生,EMS研究员作为医疗团队经理融入到响应结构中,并可以学习如何在严峻的环境中提供高质量的患者护理。USAR的培训满足了特种作战环境中EMS人员的几个新的ACGME关键指标程序,包括参加危险物质响应培训,参加密闭空间、技术救援或坍塌/沟槽培训,以及参加车辆救援/解救培训。结论:EMS奖学金项目可以与城市搜救队合作,提供密闭空间救援培训机会,以满足ACGME对关键指标程序的要求,并将合格的EMS医生整合到USAR响应中。EMS奖学金项目和USAR团队之间的合作可以是互利的。
{"title":"Inclusion of Confined Space Rescue in EMS Physician Fellowship Programs","authors":"Michael McCartin, Katie L. Tataris, B. Heilicser, Joseph M. Weber, Lindsay Jaeger","doi":"10.56068/mofu4471","DOIUrl":"https://doi.org/10.56068/mofu4471","url":null,"abstract":"Introduction:  In July 2021, the ACGME updated the Program Requirements for Graduate Medical Education in Emergency Medical Services to include participation in special operations trainings as a required key index procedure during an EMS fellowship. These requirements now include documentation of “participation in confined space, technical rescue, or collapse/trench training”.  EMS fellowships may have limited opportunities for fellows to actively participate in these complex events.\u0000Background:  Federal or State Urban Search and Rescue (USAR) teams present a unique opportunity to meet this training requirement. USAR teams perform search and rescue operations in collapsed structures and provide emergency medical care for entrapped survivors, task force personnel, and search canines. The physician is integrated into the Incident Command Structure of the USAR teams under the Medical Branch as the “Medical Team Manager”. This provides a defined team role in training and promotes physician level knowledge and skills in rescue operations.\u0000Methods:  The University of Chicago EMS Fellowship partnered with Illinois Task Force-1 USAR team to meet the new training requirements and participate as a Medical Team Manager on the team.\u0000Results: During the 12-month fellowship period, the EMS fellow participated in monthly USAR training that included both single day and multi-day exercises. The exercises included scenarios with complex hazardous materials, confined space rescue, high angle rescue, collapsed structure and trench rescue. With a dedicated physician role on the USAR team, the EMS fellow integrates into the response structure as a Medical Team Manager and can learn how to deliver high quality patient care in an austere environment.  USAR training fulfilled several of the new ACGME key index procedure for an EMS fellow in the special operations environment including participation in hazardous materials response training, participation in confined space, technical rescue, or collapse/trench training, and participation in vehicle rescue/extrication training. \u0000Conclusions:  EMS fellowship programs can collaborate with Urban Search and Rescue teams to provide training opportunities in confined space rescue to meet ACGME requirements for key index procedures and integrate qualified EMS physicians into USAR responses. Collaboration between EMS fellowship programs and USAR teams can be mutually beneficial. \u0000 ","PeriodicalId":73465,"journal":{"name":"International journal of paramedicine","volume":"99 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90718244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Advanced Interventions During Prehospital Transport of Patients with Chest Pain and Suspected Acute Coronary Syndrome 胸痛合并疑似急性冠脉综合征患者院前转运中的先进干预措施
Pub Date : 2023-07-05 DOI: 10.56068/egzn2255
Mitchell Cleghorn, F. Mencl, Daniel Johnson
Objective: The aim of this study is to describe the frequency and type of advanced (ALS) interventions performed by emergency medical services (EMS) providers while caring for undifferentiated chest pain patients.Methods: This pilot study is a retrospective review of advanced interventions performed on consecutive adult patients transported by EMS with a provider impression of non-traumatic chest pain and treated under the suspected acute coronary syndrome statewide protocol from July 2013 through January 2022. The EMS system studied is a hospital-based agency which serves a large suburban to rural population in central Pennsylvania. Advanced interventions were defined a priori and included STEMI activation.Results: During the study period, there were 2 456 EMS transports out of 97 877 which met study inclusion criteria. A total of 121 advanced interventions were performed on 101 (4.1%) of these patients, the majority 79 (3.2%) of which were prehospital notification of STEMI activations. Intravenous medications were administered 25 times to 22 (0.9%) patients and advanced procedures were performed 17 times on 7 (0.3%) patients. Several patients received more than one intervention and/or medication. Patients between 60 and 65 years of age accounted for the highest number of activations (283, 11.5%) and received the largest number of interventions (28, 9.9%). Only eight patients were below the age of 45 and all were STEMI activations only.Conclusion: We found that less than 5% of included patients transported by EMS required advanced interventions with the majority of these being STEMI activations not requiring any additional interventions. Further investigation is required to determine if certain characteristics or risk-factors predict the need for out-of-hospital advanced interventions and ALS transport.
目的:本研究的目的是描述急诊医疗服务(EMS)提供者在照顾未分化胸痛患者时进行的晚期(ALS)干预的频率和类型。方法:这项试点研究是对2013年7月至2022年1月期间EMS运送的连续成年患者的先进干预措施的回顾性回顾,这些患者的提供者印象为非创伤性胸痛,并在疑似急性冠状动脉综合征的全州方案下治疗。所研究的EMS系统是一家以医院为基础的机构,服务于宾夕法尼亚州中部郊区到农村的大量人口。高级干预措施是先验定义的,包括STEMI激活。结果:在研究期间,97 877辆EMS运输车中有2 456辆符合研究纳入标准。对101例(4.1%)患者进行了121次晚期干预,其中79例(3.2%)是院前STEMI激活通知。22例(0.9%)患者接受静脉药物治疗25次,7例(0.3%)患者接受先进手术17次。一些患者接受了一种以上的干预和/或药物治疗。60 - 65岁的患者激活次数最多(283次,11.5%),接受干预的次数最多(28次,9.9%)。只有8例患者年龄在45岁以下,且均为STEMI激活。结论:我们发现通过EMS转运的患者中不到5%需要高级干预,其中大多数是STEMI激活,不需要任何额外的干预。需要进一步调查以确定某些特征或风险因素是否预测院外高级干预和渐冻症转移的需要。
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引用次数: 0
Dialogues 对话
Pub Date : 2023-07-05 DOI: 10.56068/mhtq8016
C. Hitchcock, C. Cunningham, Ryan Houser
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引用次数: 0
Publication as a Catalyst for Professional Dialogue 出版作为专业对话的催化剂
Pub Date : 2023-04-03 DOI: 10.56068/iqkb4918
Michael Gunderson
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引用次数: 0
Safe Pediatric Ground Ambulance Transport 安全儿科地面救护车运输
Pub Date : 2023-04-03 DOI: 10.56068/mesg1218
Anne R. Stoklosa, M. Zafron, K. Bass, Denise F. Lillvis
Background: Ambulance crashes that result in child injury or death are preventable with the use of proper restraints. This systematic review assesses aspects relevant to the proper use of pediatric restraints: EMS professionals’ resources and training, knowledge, attitudes, and behaviors. It also identifies barriers to using restraints. Methods: PubMed and Web of Science were searched using free-text search terms between the years 2000 and 2020. Inclusion criteria included human research, pediatric population, ambulance as the mode of transportation, peer-reviewed journals, and English full-texts. After initial screening and inclusion, a snowball methodology was used to further identify potentially relevant articles. The methodology was carried out by two independent reviewers.  Results: The original search yielded 80 publications after de-duplication between databases, and two additional articles were identified independently of the search through snowball sampling. Four publications met inclusion criteria for final analysis. Two studies were survey-based among EMS personnel aiming to identify knowledge, behaviors, and barriers to child transport. One study used qualitative data collection by interviews of ambulance personnel. The final study was a combination of survey and observational data. Of note, there were no studies that evaluated an intervention. Conclusion: Based on this review, there is a lack of research in the realm of safe pediatric ambulance transport. There is a need for quality improvement studies to address the barriers that were identified by previous literature and to improve the overall safety and compliance of pediatric safety restraints during transportation to the hospital.
背景:救护车碰撞导致儿童受伤或死亡是可以预防使用适当的约束。本系统综述评估了与正确使用儿科约束相关的方面:EMS专业人员的资源和培训、知识、态度和行为。它还确定了使用约束的障碍。方法:使用2000 - 2020年间的自由文本检索词对PubMed和Web of Science进行检索。纳入标准包括人类研究、儿科人群、救护车作为交通方式、同行评议期刊和英文全文。在初步筛选和纳入后,采用滚雪球方法进一步确定可能相关的文章。该方法由两名独立审稿人执行。结果:原始搜索在数据库之间进行重复删除后产生80篇出版物,另外两篇文章通过滚雪球抽样独立于搜索。四篇出版物符合最终分析的纳入标准。两项研究以调查为基础,在EMS人员中进行,旨在确定儿童运输的知识、行为和障碍。一项研究通过对救护人员的访谈收集了定性数据。最后一项研究结合了调查和观察数据。值得注意的是,没有研究评估干预措施。结论:在此综述的基础上,在儿童救护车安全运输领域的研究还很缺乏。有必要进行质量改进研究,以解决先前文献中确定的障碍,并提高儿科安全约束在送往医院过程中的总体安全性和依从性。
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引用次数: 0
Matched Cohort Study of Open Thoracostomies Performed by Ground Medics 地面医务人员开胸手术的匹配队列研究
Pub Date : 2023-04-03 DOI: 10.56068/qmbv3502
Alison A Smith, A. Ciaraglia, Benjamin Axtman, CJ Winckler, D. Wampler, Maxwell A. Braverman, C. P. Shahan, Rachelle Babbitt Jonas, Michael Shiels, B. Eastridge, Ronald M Stewart, Susannah E. Nicholson, Donald J. Jenkins
Background: Tension pneumothorax resulting from chest trauma is a rapidly fatal condition that requires prompt treatment.  Prehospital open thoracostomy (POT) is a potentially lifesaving intervention that can be performed in the field to treat tension pneumothorax. However, the results from POT performed by ground EMS providers have not been well-studied. The objective of this study was to compare outcomes for patients with chest trauma who underwent POT performed by ground EMS providers with a matched cohort who did not undergo this procedure in the field. Methods: A retrospective chart review of consecutive adult patients presenting to a Level I trauma center with chest trauma were analyzed from 2017-2020. Outcomes were compared to a patient cohort who did not undergo POT matched by severity of injury and prehospital CPR. Results: A total of 14 POT patients were identified.  Majority of POT were bilateral (n=11/14, 78.6%) and all of these patients (n=14/14) had prehospital cardiac arrest. Return of spontaneous circulation was obtained in 2 patients with penetrating injuries (14.3%). There was no difference in total and scene EMS time compared to the matched cohort without POT (p>0.05). Conclusions: This study demonstrated that open thoracostomies could be performed by ground EMS units without increasing prehospital time for severely injured trauma patients and greater achievement of ROSC. Larger, prospective, multi-institutional analyses are needed to further evaluate outcomes.
背景:胸外伤引起的紧张性气胸是一种迅速致命的疾病,需要及时治疗。院前开胸术(POT)是一种潜在的挽救生命的干预措施,可以在现场进行治疗张力性气胸。然而,由地面EMS提供者实施的POT的结果尚未得到充分研究。本研究的目的是比较由地面EMS服务提供者进行POT治疗的胸外伤患者与未在现场进行POT治疗的匹配队列患者的结果。方法:回顾性分析2017-2020年在一级创伤中心连续就诊的胸部创伤成人患者的病历。结果与未接受POT的患者队列进行比较,这些患者与损伤严重程度和院前CPR相匹配。结果:共鉴定出14例POT患者。大多数POT为双侧(n=11/14, 78.6%),所有患者(n=14/14)均发生院前心脏骤停。穿透性损伤2例(14.3%)恢复自发循环。与对照组相比,总EMS时间和现场EMS时间均无差异(p>0.05)。结论:本研究表明,地面EMS可以在不增加严重创伤患者院前时间的情况下进行开胸手术,并且可以实现更高的ROSC。需要更大的、前瞻性的、多机构的分析来进一步评估结果。
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引用次数: 0
期刊
International journal of paramedicine
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