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首页> 外文期刊>Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine >Changing role of EMS –analyses of non-conveyed and conveyed patients in Finland
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Changing role of EMS –analyses of non-conveyed and conveyed patients in Finland

机译：芬兰未传达和传达患者的EMS-AnAnalyses的作用

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Emergency Medical Services (EMS) and Emergency Departments (ED) have seen increasing attendance rates in the last decades. Currently, EMS are increasingly assessing and treating patients without the need to convey patients to health care facility. The aim of this study was to describe and compare the patient case-mix between conveyed and non-conveyed patients and to analyze factors related to non-conveyance decision making. This was a prospective study design of EMS patients in Finland, and data was collected between 1st June and 30th November 2018. Adjusted ICPC2-classification was used as the reason for care. NEWS2-points were collected and analyzed both statistically and with a semi-supervised information extraction method. EMS patients’ geographic location and distance to health care facilities were analyzed by urban–rural classification. Of the EMS patients (40,263), 59.8% were over 65?years of age and 46.0% of the patients had zero NEWS2 points. The most common ICPC2 code was weakness/tiredness, general (A04), as seen in 13.5% of all patients. When comparing patients between the non-conveyance and conveyance group, a total of 35,454 EMS patients met the inclusion criteria and 14,874 patients (42.0%) were not conveyed to health care facilities. According the multivariable logistic regression model, the non-conveyance decision was more likely made by ALS units, when the EMS arrival time was in the evening or night and when the distance to the health care facility was 21-40?km. Furthermore, younger patients, female gender, whether the patient had used alcohol and a rural area were also related to the non-conveyance decision. If the patient’s NEWS2 score increased by one or two points, the likelihood of conveyance increased. When there was less than 1 h to complete a shift, this did not associate with either non-conveyance or conveyance decisions. The role of EMS might be changing. This warrants to redesign the chain-of-survival in EMS to include not only high-risk patient groups but also non-critical and general acute patients with non-specific reasons for care. Assessment and on-scene treatment without conveyance can be called the “stretched arm of the emergency department”, but should be planned carefully to ensure patient safety.
机译：紧急医疗服务（EMS）和急诊部门（ED）在过去几十年中已越来越多的出勤率。目前，EMS越来越多地评估和治疗患者，无需将患者传达给医疗机构。本研究的目的是描述并比较输送和非传达患者之间的病例混合，并分析与非传送决策相关的因素。这是芬兰EMS患者的前瞻性研究设计，并在2018年6月1日至11月30日之间收集了数据。调整后的ICPC2分类被用作护理的原因。在统计上收集并分析新闻2点，并以半监督信息提取方法分析。通过城乡分类分析了EMS患者的地理位置和与医疗保健设施的距离。在EMS患者（40,263）中，59.8％超过65岁，46.0％的患者有零新闻2分。最常见的ICPC2码是弱点/疲劳，一般（A04），如13.5％的患者所示。在比较非传送和运输集团之间的患者时，共有35,454名EMS患者达到纳入标准，14,874名患者（42.0％）没有传达给医疗保健设施。根据多变量的逻辑回归模型，ALS单位更有可能做出的非传送决定，当时EMS到达时间在晚上或夜晚，当与医疗保健设施的距离为21-40公里时。此外，年轻患者，女性性别，是否患者是否使用过酗酒和农村地区也与非传送决定有关。如果患者的新闻2得分增加一两分，则运输的可能性增加。当不到1小时才能完成班次时，这并未与非传送或运输决策联系起来。 EMS的作用可能正在发生变化。这项认股权证重新设计了EMS中的生存链，不仅包括高风险患者组，而且包括非批判性和一般急性患者的护理。没有传送的评估和现场治疗可以称为“急诊部的拉伸臂”，但应仔细计划以确保患者安全。

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