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首页> 外文期刊>The American Journal of Surgery >Does increased emergency medical services prehospital time affect patient mortality in rural motor vehicle crashes? A statewide analysis.
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Does increased emergency medical services prehospital time affect patient mortality in rural motor vehicle crashes? A statewide analysis.

机译：紧急医疗服务的院前时间增加是否会影响农村机动车碰撞中的患者死亡率？全州范围的分析。

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BACKGROUND: Fatality rates from rural vehicular trauma are almost double those found in urban settings. It has been suggested that increased prehospital time is a factor that adversely affects fatality rates in rural vehicular trauma. By linking and analyzing Alabama's statewide prehospital data, emergency medical services (EMS) prehospital time was assessed for rural and urban vehicular crashes. METHODS: An imputational methodology permitted linkage of data from police motor vehicle crash (MVC) and EMS records. MVCs were defined as rural or urban by crash location using the United States Census Bureau criteria. Areas within Alabama that fell outside the Census Bureau definition of urban were defined as rural. Prehospital data were analyzed to determine EMS response time, scene time, and transport time in rural and urban settings. RESULTS: Over a 2-year period from January 2001 through December 2002, data were collected from EMS Patient Care Reports and police crash reports for the entire state of Alabama. By using an imputational methodology and join specifications, 45,763 police crash reports were linked to EMS Patient Care Reports. Of these, 34,341 (75%) were injured in rural settings and 11,422 (25%) were injured in urban settings. A total of 714 mortalities were identified, of which 611 (1.78%) occurred in rural settings and 103 (.90%) occurred in urban settings (P < .0001). When mortalities occurred, the mean EMS response time in rural settings was 10.67 minutes and 6.50 minutes in urban settings (P < .0001). When mortalities occurred, the mean EMS scene time in rural settings was 18.87 minutes and 10.83 minutes in urban settings (patients who were dead on scene and extrication patients were excluded from both settings) (P < .0001). When mortalities occurred, the mean EMS transport time in rural settings was 12.45 minutes and 7.43 minutes in urban settings (P < .0001). When mortalities occurred, the overall mean prehospital time in rural settings was 42.0 minutes and 24.8 minutes in urban settings (P < .0001). The mean EMS response time for rural MVCs with survivors was 8.54 minutes versus a mean of 10.67 minutes with mortalities (P < .0001). The mean EMS scene time for rural MVCs with survivors was 14.81 minutes versus 18.87 minutes with mortalities (patients who were dead on scene and extrication patients were excluded) (P = .0014). CONCLUSIONS: Based on this statewide analysis of MVCs, increased EMS prehospital time appears to be associated with higher mortality rates in rural settings.
机译：背景：农村车辆创伤致死率几乎是城市环境中的两倍。已经提出，增加院前时间是对农村车辆创伤中的死亡率造成不利影响的因素。通过链接和分析阿拉巴马州全州的院前数据，评估了农村和城市车辆碰撞的紧急医疗服务（EMS）院前时间。方法：一种估算方法允许将来自警车碰撞（MVC）和EMS记录的数据链接起来。根据美国人口普查局的标准，按崩溃地点将MVC定义为农村还是城市。阿拉巴马州内超出人口普查局对城市的定义的区域被定义为农村。对院前数据进行分析，以确定在农村和城市环境中的EMS响应时间，场景时间和运输时间。结果：从2001年1月到2002年12月的2年中，数据是从阿拉巴马州全州的EMS患者护理报告和警察失事报告中收集的。通过使用估算方法和联接规范，将45,763起警察失事报告与EMS患者护理报告相关联。其中，在农村地区受伤34,341（75％），在城市地区受伤11,422（25％）。总共确定了714人死亡，其中611人（1.78％）发生在农村地区，而103人（.90％）发生在城市地区（P <.0001）。当发生死亡事故时，农村地区的EMS平均响应时间为10.67分钟，而城市地区的平均EMS反应时间为6.50分钟（P <.0001）。当发生死亡时，农村地区的EMS现场平均时间为18.87分钟，城市地区的平均EMS时间为10.83分钟（现场死亡的患者和自拔患者均不包括在这两种设置中）（P <.0001）。当发生死亡时，农村地区的EMS平均运输时间为12.45分钟，城市地区为7.43分钟（P <.0001）。当发生死亡时，农村地区的总体平均住院前时间为42.0分钟，而城市地区的总体平均住院时间为24.8分钟（P <.0001）。有幸存者的农村MVC的平均EMS响应时间为8.54分钟，而有死亡者的平均EMS响应时间为10.67分钟（P <.0001）。有幸存者的农村MVC的平均EMS现场停留时间为14.81分钟，而有死亡病例的平均EMS现场停留时间为18.87分钟（现场死亡的患者和排除的患者除外）（P = 0.0014）。结论：基于对全国MVC的这种全州分析，增加的EMS院前时间似乎与农村地区较高的死亡率相关。

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