Where There Are No Emergency Medical Services-Prehospital Care for the Injured in Mumbai, India
Where There Are No Emergency Medical Services-Prehospital Care for the Injured in Mumbai, India
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DOI：
10.1017/s1049023x00007883
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发表时间：
2010-04-01
影响因子：
2.2
通讯作者：
Vatkar, Arvind
中科院分区：
文献类型：
--
作者：
Roy, Nobhojit;Murlidhar, V;Vatkar, Arvind
简介：在像孟买这样的人口稠密的城市，缺乏有组织的院前紧急医疗服务（EMS）系统，但存在一个非正式的网络，受害者可以通过该网络到达创伤中心。这项基线研究描述了孟买目前可用的院前护理和交通。方法：通过采访 170 名随机选择的患者，从两个月期间（2005 年 7 月至 8 月）一级城市创伤中心收治的 454 名患者中随机选择的 170 名患者，创建了一个前瞻性创伤数据库。结果：孟买的受伤受害者通常是由好心的撒玛利亚路人 (43.5%) 救起的，与普遍看法相反，他们帮助了警察（89.7%）。获救后，受害者几乎立即开始被送往医院。没有人等待急救车到达，因为根本就没有救护车。出租车是救护车最受欢迎的替代品（39.3%）。印度的创伤患者通常是二十多岁的年轻人，来自较低的社会经济阶层。他大部分时间都住在政府医院，因为私立医院不愿意为重伤者提供创伤护理。由于复苏消耗品成本高昂，部分原因是提供者缺乏紧急护理培训，接受院前护理的伤员得不到充分和不适当的护理。与铁路事故受害者 (OR = 0.41) 和乘出租车前来的人 (OR = 0.54) 相比，那些更有可能接受院前护理的人遭受道路交通伤害 (比值比 (OR) = 2.3) 和由政府救护车运送的人 (OR = 10.83)。结论：目前，由于没有 EMS 系统，院前护理是公民的责任，利用社会资源网络。消除这种制度并将责任转嫁给国家是很容易的。争论的焦点是，在公立医院资金匮乏的资源匮乏环境中，国家资助的 EMS 系统是否足够强大。考虑到发达国家EMS系统的资金成本较高，且没有足够的证据表明EMS的院前现场干预确实改善了结果，孟买在其拥挤的城市交通中实施先进的EMS系统时必须谨慎行事。墨西哥城和雅加达等类似城市在实施 EMS 系统方面取得的成功有限。也许，在共享和帮助他人不仅是可取的，而且是整体经济生存所必需的文化中，加强现有的出租车司机和警察非正式提供者网络，并通过培训、通过道路和汽车燃料税为快速运输提供资金以及监管私人救护车提供者，可能会更具成本效益。
Introduction: In a populous city like Mumbai, which lacks an organized prehospital emergency medical services (EMS) system, there exists an informal network through which victims arrive at the trauma center. This baseline study describes the prehospital care and transportation that currently is available in Mumbai.Methods: A prospective trauma database was created by interviewing 170 randomly selected patients from a total of 454 admitted over a two-month period (July-August 2005) at a Level-I, urban, trauma center.Results: The injured victim in Mumbai usually is rescued by a good Samaritan passer-by (43.5%) and contrary to popular belief, helped by the police (89.7%). Almost immediately after rescue, the victim begins transport to the hospital. No one waits for the EMS ambulance to arrive, as there is none. A taxi cab is the most popular substitute for the ambulance (39.3%). The trauma patient in India usually is a young man in his late-twenties, from a lower socioeconomic class. He mostly finds himself in a government hospital, as private hospitals are reluctant to provide trauma care to the seriously injured. The injured who do receive prehospital care receive inadequate and inappropriate care due to the high cost of consumables in resuscitation, and in part due to the providers' lack of training in emergency care. Those who were more likely to receive prehospital care suffered from road traffic injuries (odds ratio (OR) = 2.3) and those transported by government ambulances (OR = 10.83), as compared to railway accident victims (OR = 0.41) and those who came by taxi (OR = 0.54).Conclusions: Currendy, as a result of not having an EMS system, prehospital care is a citizen responsibility using societal networks. It is easy to eliminate this system and shift the responsibility to the state. The moot point is whether the state-funded EMS system will be robust enough in a resource-poor setting in which public hospitals are poorly funded. Considering the high funding cost of EMS systems in developed countries and the insufficient evidence that prehospital field interventions by the EMS actually have improved outcomes, Mumbai must proceed with caution when implementing advanced EMS systems into its congested urban traffic. Similar cities, such as Mexico City and Jakarta, have had limited success with implementing EMS systems. Perhaps reinforcing the existing network of informal providers of taxi drivers and police and with training, funding quick transport with taxes on roads and automobile fuels and regulating the private ambulance providers, could be more cost-effective in a culture in which sharing and helping others is not just desirable, but is necessary for overall economic survival.