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Titolo:
ONLINE MEDICAL CONTROL VERSUS PROTOCOL-BASED PREHOSPITAL CARE
Autore:
ROTTMAN SJ; SCHRIGER DL; CHARLOP G; SALAS JH; LEE S;
Indirizzi:
UNIV CALIF LOS ANGELES,SCH MED,CTR EMERGENCY MED,CTR PREHOSP CARE,SUITE 300,924 WESTWOOD BLVD LOS ANGELES CA 90024
Titolo Testata:
Annals of emergency medicine
fascicolo: 1, volume: 30, anno: 1997,
pagine: 62 - 68
SICI:
0196-0644(1997)30:1<62:OMCVPP>2.0.ZU;2-Z
Fonte:
ISI
Lingua:
ENG
Soggetto:
HOSPITAL PULMONARY-EDEMA; STANDING ORDERS; COMMAND ERRORS; DEVIATIONS; SYSTEM;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
18
Recensione:
Indirizzi per estratti:
Citazione:
S.J. Rottman et al., "ONLINE MEDICAL CONTROL VERSUS PROTOCOL-BASED PREHOSPITAL CARE", Annals of emergency medicine, 30(1), 1997, pp. 62-68

Abstract

Study objective: To compare on-scene time, appropriateness of therapy, and accuracy of paramedic clinical assessments when prehospital carewas provided with the use of on-line medical control (OLMC) by EMS-certified nurses from a single base station or by paramedics using chiefcomplaint-based protocols. Methods: We assembled a prospective before-and-after series to compare OLMC (phase 1) and protocol (phase 2) care rendered by all paramedics in a single urban municipality using a single base station. The subjects were consecutively enrolled patients who met protocol inclusion criteria and presented with altered level ofconsciousness, nontraumatic chest pain, or shortness of breath. For both phases, EMS and corresponding ED records were compiled, ail references identifying phase were removed. After establishing interrater reliability, we randomly assigned charts to one of two reviewers for scoring. Complaint-specific scoring elements included on-scene time, assessments performed, presence or absence of indications for common treatments, treatments given, paramedic diagnosis, and emergency physician diagnosis. The percentages of inappropriate treatment decisions and paramedic diagnostic accuracy (versus that of the receiving emergency physician) were calculated. Results: Phase 1 comprised 287 patients, phase 2 294. Interrater reliability between the two scorers was high. Of 2,190 elements scored jointly, the raters agreed in 97%, with kappa-values ranging from .6 to 1.0. On-scene time was 1 minute shorter during phase 2 (95% confidence interval [CI] for difference in median time, 0to 2 minutes, P<.03). From phase 1 to phase 2 (relative risk [RR], 1.5; 95% CI, 1.0 to 2.1), inappropriate treatment decisions decreased from 7.4% to 5.1%. The percentage of cases in which paramedics and physicians were in complete diagnostic agreement was high (77% to 78%) and did not change across phases. Conclusion: The use of protocols resulted in smalt improvements in both on-scene time and the appropriateness of therapeutic decisions, without a change in agreement between paramedic and physician. Protocol care for these three chief complaints is clinically safe and, by reducing training and staffing considerations, may offer a cost-effective alternative to OLMC.

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Documento generato il 24/09/20 alle ore 05:01:17