“120”出诊救护车资源使用合理性分析

Reasonability analysis of use of pre-hospital ambulance resources

目的分析救护车急救患者的非必须救治和必须救治情况以及急救车资源使用的合理性,以期为救护资源的合理使用提供科学依据。方法救护车到达现场后,急救医生和护士根据现场情况,将2019年11月沈阳市内五个行政区的"120"急救车接诊的10617名患者分为两组,即非必须救治组患者和必须救治组患者,并对两组人员的各类特征进行比较。结果患者男性5134例(占48.3%),女性5483例(占51.6%),36.8%的患者(3902名)为非必须救治患者,沈河区的"非必须救治"患者比例最高(46.7%)。非必须救治组男性患者比例高于必须救治组(P<0.01)。在时间分组上,08:01-17:00接听到"120"电话的量最多,08:01-17:00非必须救治患者占比最多,00:01-08:00非必须救治患者占比最少(P<0.01)。必须救治和非必须救治组在各个年龄段中的分布差异有统计学意义(P<0.01),18岁以下非必须救治患者占比最高,41~65岁占比最少。在院患者由其医护人员拨打"120"电话者中,只有64%被急救人员评估为"必须救治",患者本人和家庭成员拨打电话送来的非必须救治患者占比最多,接近50.0%,而警察或路人打电话送来的非必须救治患者占比最少(P<0.01)。主诉的患者中,有35.9%(1718/4780)不需要急救帮助。3902例非必须救治患者中:只有一小部分(4.1%)被认为处于紧急状态但没有生命危险;既不威胁生命也不紧急的患者最多(占85.0%)。不需要紧急医疗帮助的患者中,55.0%的患者能够自行驾车或乘坐出租车到达医院就诊,由医务人员拨打"120"急救电话但并不需要急救车服务的患者中,有90.0%也仅仅需要一辆能够平躺下的车即可。结论沈阳市内院前急救接诊患者中有很大比例的患者并不需要用救护车接诊。医护人员在院前缺乏针对患者的有效评估,影响了急救资源使用的合理性。建议院前急救管理部门为使用救护车服务制定明确的标准,以保证患者的安全,更加合理地利用急救资源。

Objective To understand and differentiate the necessary and non-necessary treatment of ambulance patients,in order to analyze reasonability of use of ambulance resources and furthermore to provide scientific basis for the rational scheduling ambulance resources.Methods The patients using"120"ambulance in five administrative districts of Shenyang City in November 2019 were divided into two groups,namely necessary and non-necessary treatments,by the emergency doctors and nurses after ambulances arrived at the call sites.Their characteristics were analyzed.Results Totally 10617 patients including 5134 males(48.3%)and 5483 females(51.6%)called"120"to use ambulances.Among them 3902 patients(36.8%)were assessed in the non-necessary treatment group.The highest proportion of patients in non-necessary treatment was in Shenhe District(46.7%).The proportion of male patients in non-necessary treatment group was higher than that in necessary treatment group(P<0.01).In terms of call time,the proportion of patients in non-necessary treatment group calling"120"during 8:00 to 17:00 was the highest and calling"120"during 0:00 am to 8:00 am was the lowest.The highest proportion of patients in non-necessary treatment was among patients with age under 18 years old,while the lowest was among the patients with age between 41 to 65 years old.Among the patients who called"120"by their medical staff,only64%were assessed as"necessary treatment"by the emergency personnel;among the patients who called"120"by themselves and/or their family members,nearly 50%was assessed as non-necessary treatment,while the least proportion of non-necessary treatment was noted among the patients who called"120"by the police or passers-by(P<0.05).Among 3902 cases in non-necessary treatment group,only a small part(4%)was considered to be in emergency but not life-threatening;85%of the patients were in neither life-threatening nor urgent conditions.Among the patients who did not need emergency medical help,55%could drive or take a taxi to the hospital for treatment.Even called by medical staff,90%the patients in non-necessary treatment group only needed a car in which they could lie down.Conclusions In Shenyang,a large proportion of patients receiving pre-hospital emergency treatment do not actually need ambulance.The lack of effective assessment of patients after receiving the calling affects the rationality of the use of emergency resources.The pre-hospital emergency management department should establish clear standards for the use of ambulance services,so as to ensure the safety of patients and make more rational use of emergency resources.