Low-cost improvements in prehospital trauma care in a Latin American city
Low-cost improvements in prehospital trauma care in a Latin American city
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DOI：
10.1097/00005373-200001000-00020
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发表时间：
2000-01-01
影响因子：
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通讯作者：
Jurkovich, GJ
中科院分区：
文献类型：
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作者：
Arreola-Risa, C;Mock, CN;Jurkovich, GJ
目的：院前急救是降低创伤死亡率的重要组成部分。在欠发达国家，稀缺的资源决定了院前急救的任何改进都必须是低成本的。在一个拉丁美洲的城市，最近的努力，以改善院前护理包括增加救护车调度的网站数量从两个到四个和引入院前创伤生命支持（PHTLS）course.Methods：增加调度网站的影响进行了评估，通过比较响应时间之前和之后完成的变化。PHTLS的效果进行了评估，比较院前治疗开始前3个月（n = 361创伤患者）和6个月后（n = 505），结果：响应时间从平均15.5 +/- 5.1分钟，当有两个地点的调度，9.5 +/- 2.7分钟，当有四个地点。在开始PHTLS课程后，院前创伤护理得到改善。在所有创伤患者中，使用颈椎固定的比例从39%增加到67%。对于呼吸窘迫的患者，口咽气道的使用（16-39%）、抽吸的使用（10-38%）和输氧的使用（64-87%）有所增加。对于水肿患者，大口径静脉输液管的使用从26%增加到58%。改善的院前治疗没有增加平均现场时间（治疗前5.7 +/- 4.4分钟与治疗后5.9 +/- 6.8分钟）。运送途中死亡的患者比例从治疗前的8.2%下降到治疗后的4.7%。这些改进需要一个最小的增加（16%），在救护车服务budgets.Conclusion：增加派遣和增加培训的PHTLS课程的形式，在这个拉丁美洲城市的院前护理的过程中，导致减少院前死亡的网站。这些改进费用低，应考虑在其他欠发达国家使用。
Objective: Prehospital care is a critical component of efforts to lower trauma mortality, In less-developed countries, scarce resources dictate that any improvements in prehospital care must be low in cost. In one Latin American city, recent efforts to improve prehospital care have included an increase in the number of sites of ambulance dispatch from two to four and introduction of the Prehospital Trauma Life Support (PHTLS) course.Methods: The effect of increased dispatch sites was evaluated by comparing response times before and after completion of the change. The effect of PHTLS was evaluated by comparing prehospital treatment for the 3 months before initiation of the course (n = 361 trauma patients) and the 6 months after (n = 505),Results: Response time decreased from a mean of 15.5 +/- 5.1 minutes, when there were two sites of dispatch, to 9.5 +/- 2.7 minutes, when there were four sites. Prehospital trauma care improved after initiation of the PHTLS course. For all trauma patients, use of cervical immobilization increased from 39 to 67%. For patients in respiratory distress, there were increases in the use of oropharyngeal airways (16-39%), in the use of suction (10-38%), and in the administration of oxygen (64-87%), For hypotensive patients, there was an increase in use of large-bore intravenous lines from 26 to 58%. The improved prehospital treatment did not increase the mean scene time (5.7 +/- 4.4 minutes before vs. 5.9 +/- 6.8 minutes after). The percent of patients transported who died in route decreased from 8.2% before the course to 4.7% after. These improvements required a minimal increase (16%) in the ambulance service budget.Conclusion: Increase in sites of dispatch and increased training in the form of the PHTLS course improved the process of prehospital care in this Latin American city and resulted in a decrease in prehospital deaths. These improvements were low cost and should be considered for use in other Less developed countries.