Prehospital mortality in an EMS system using medical priority dispatching:: a community based cohort study
Prehospital mortality in an EMS system using medical priority dispatching:: a community based cohort study
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DOI：
10.1016/j.resuscitation.2004.01.008
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发表时间：
2004-06-01
期刊：
影响因子：
6.5
通讯作者：
Boyd, J
中科院分区：
文献类型：
--
作者：
Kuisma, M;Holmström, P;Boyd, J
目的：本研究计划记录四个医疗优先类别（A、B、C 和 D）的院前死亡率，并评估是否可以通过更快的救护车响应来避免较低紧急类别 C 和 D（目标响应时间 20 和 90 分钟）的死亡。方法：该设计是一项基于社区的队列研究，包括专家小组对死亡情况的评估。该研究是在芬兰赫尔辛基的紧急医疗服务中心进行的。包括1999年1月1日至2002年12月31日期间所有连续的救护车呼叫（不包括院内患者转运）。院前死亡率和通过更快的救护车响应（最多 8 分钟）避免院前死亡被用作主要结局指标。结果：调度中心共优先处理151928个呼叫（A类8677个、B类41005个、C类71991个、D类30255个）。 A类院前死亡发生451起，B类发生468起，C类发生73起，D类发生8起。每 1000 次呼叫的院前死亡率分别为 52.0 (A)、11.4 (B)、1.0 (C) 和 0.3 (D)（P < 0.0001）。专家小组判断，通过更快速的救护车响应，1 例（1.3%）C 类死亡是可以避免的，24 例（32.9%）可以避免，48 例（65.8%）无法避免。 D 类死亡的相应数字分别为 0 例（0%）、5 例（62.5%）和 3 例（37.5%）。结论：在较低紧急程度的 C 类和 D 类中，使用医疗优先调度与非常低的院前死亡率相关。大约三分之一的死亡可能可以通过更快的救护车响应来避免，但代价将是蓝灯和警报器呼叫增加三倍。需要进一步研究以确定我们的结果是否适用于其他类型的 EMS 系统。 (C) 2004 Elsevier Ireland Ltd. 保留所有权利。
Objectives: This study was planned to record prehospital death rates in four medical priority categories (A, B, C and D) and to evaluate if deaths in lower urgency categories C and D (target response times 20 and 90 min) could have been avoided by a faster ambulance response. Methods: The design was a community based cohort study including an expert panel evaluation of the deaths. The study was conducted in the Emergency Medical Services in Helsinki, Finland. All consecutive ambulance calls excluding interhospital patient transfers between 1 January 1999 and 31 December 2002 were included. Prehospital mortality and avoidability of prehospital deaths by a faster ambulance response (maximum 8 min) were used as main outcome measures. Results: A total of 151928 calls were prioritised in the dispatching centre (category A 8677 calls, B 41005, C 71991 and D 30 255). Prehospital death occurred 451 times in category A, 468 times in category B, 73 times in category C and 8 times in category D calls. Respectively, the prehospital death rates per 1000 calls were 52.0 (A), 11.4 (B), 1.0 (C) and 0.3 (D) (P < 0.0001). The expert panel judged that 1 (1.3%) of category C deaths would have been avoidable, 24 (32.9%) potentially avoidable and 48 (65.8%) not avoidable by a more rapid ambulance response. The corresponding figures for category D deaths were 0 (0%), 5 (62.5%) and 3 (37.5%), respectively. Conclusions: The use of medical priority dispatching was associated with very low prehospital mortality in lower urgency categories C and D. Approximately, one-third of those deaths could probably be prevented by a faster ambulance response but the price would be a three-fold increase in calls with blue lights and siren. Further studies are needed to find out if our results are applicable to other types of EMS systems. (C) 2004 Elsevier Ireland Ltd. All rights reserved.