北京市城区院前急救网络布局的研究

目的 在借鉴有关城市公共设施布局研究的基础上,完善院前急救网络布局方法,制定北京市城区急救网络合理布局方案,使每一位患者在需要急救的时候能够得到及时、有效、公平地救治.方法 文献学习建立本研究的理论模型,在现况调查的基础上进行数据分析.结果.北京市城区不同区域、不同时间段救护车平均行驶速度不同,城区救护车平均行驶速度为(32.07±14.73)km/h,75%在19.05～26.24 km/h之间;城区道路曲度系数为1.6.以75%救护车能够达到的平均行驶速度、8 min道路行驶时间、道路曲度系数1.6为布局参数,制定理论布局方案,城区共应规划建设200个急救站.结论.在北京市城区建设200个急救站,75%的救护车在执行任务时的急救呼叫反应时间能够达到12 min,基本满足疾病对院前急救的需求,同时接近国际发达国家水平.     

2007年自贡市急救中心院前急救反应能力回顾性分析

目的：通过分析2007年自贡市急救中心院前急救反应能力,探讨其影响制约因素及解决方法。方法：回顾性分析2007年1～12月份自贡市急救中心院前出诊的全部有效病例呼救时间、出车时间、到达现场时间及出诊距离,计算出车准备时间、车辆行驶速度、应急反应时间、急救半径。结果：全年院前出诊共3336例,出车准备时间（2.06±0.93）min,车辆平均行驶速度32.17 km/h,应急反应时间（12.51±10.87）min,急救半径（5.60±5.35）km。结论：我市急救中心目前取得一定成绩,需采取多种措施进一步提高急救反应能力。     

院前心肺复苏初期成功17例救治体会

1995年我中心在上海市区院前急救65063人次，其中心跳呼吸停止3769例。一辆监护型救护车（MICU）救治346例，初期心肺复苏成功17例，成功率4．9％，邻近站一辆普通型救护车（CTA）全年救治294例，无一例成功。两者在急救速度、方法等各方面均有明显差异，现报告如下。l临床资料与方法门）病例所属虹口站1辆MICU的17例心肺复苏初期成功病例为研究组．黄浦站1辆CTA同日或邻近日17例失败病例为对照组。两组年龄、病因相似，大多为60岁以上老年人，以心血管疾病为主。（2）两组急救反应时间大多在6～15min，到达现场后判定已发生心跳呼吸…     

四种消毒法对降低救护车内物表细菌含量的分析比较

作为医疗卫生单位日常救护的交通运输工具一救护车,每天承载着运送各类危重患者的任务,由于车内接送着不同种类的病人．病种繁杂．致使车内污染状况严重．同时救护车频繁奔忙于运送病人途中,使消毒管理工作不到位．而成为车内感染的发源地,且易造成病员之间的交叉感染。为做好救护车内消毒工作．防止救护车内交叉感染,本中心对16辆救护车的污染状况、     

84消毒液喷雾降低救护车空气细菌含量研究

目的探寻高效、安全、便捷且适用于救护车内空气消毒方法。方法针对84消毒液喷雾消毒方法，从消毒时间、消毒液浓度、环境温度及车厢清洁度等因素对救护车空气除菌效果进行探讨。具体采用四因素三水平的正交设计方法进行正交试验，采集试验前后救护车内空气进行细菌培养，计算细菌杀灭率来衡量除菌效果。同时采用传统的紫外线消毒方法作为对照组，两者进行除菌效果比较。结果平均杀菌率为90．8％，除菌效果明显优于紫外线空气消毒法。各因素对除菌效果影响依次为：消毒液浓度、消毒时间、车厢清洁度及环境温度，尤以消毒液浓度影响最显著，是关键因素。结论采用84消毒液喷雾消毒救护车内空气效果可靠、安全、便捷，适应救护车工作特点。既可应用于救护车常规空气消毒，又可用于连续转运患者时的空气消毒，并可适应救护车在不同情况下使用时要求达到的环境标准要求。     

乡镇卫生院救护车使用现状及管理对策

目的：探讨乡镇卫生院使用救护车存在的误区,进一步提高救护车的管理水平,减少急救安全隐患。方法走访桂林市周边15个乡镇卫生院,对救护车及车上医疗设备进行调查,结合院前急救要求,对存在的问题逐一分析,并提出相应措施。结果乡镇卫生院对救护车仪器养护管理的认知不足,对设备管理的措施落实不到位,卫生技术人员严重匮乏,设备利用率不高。结论乡镇卫生院应管理并完善好救护车及车上仪器设备,为院前急救提供强有力的保障。     

北京市120急救网络呼叫反应时间的研究

目的为了以完善的急救体系迎接2008年奥运会，有必要了解北京市120急救网络院前急救呼叫反应时间的现状，分析其影响因素，并以此为切人点探索北京市院前急救的现状和存在的问题。方法采用定量分析和定性访谈相结合的方法，描述和分析北京急救中心2005年下半年的调度数据。结果北京市总体120急救网络呼叫反应时间中位数为16．5min，四分位数间距为14．3min；北京市总体120急救网络呼叫反应时间在5min内的占2．28％，而30min以上的占19．20％；城区、郊区和中心直属与非直属之间呼叫反应时间差异具有统计学意义。结论当前北京市120网络院前急救呼叫反应时间过长，与国外先进国家相比还存在一定的差距，需进一步从不同角度探讨与分析其影响因素，并加以解决。     

救护车转运病人时护士应注意自身安全

根据纽约州卫生部（ＮＹＳＤＯＨ）急救医疗服务局（ＢＥＭＳ）在１９９８年所作的统计，过去６年中，平均每年有３８５辆救护车发生事故，平均６４０人受伤。据全国性的统计，救护车由于撞车每年可致６２人死亡。有关部门对事故所作调查表明：这些事故的发生７３％在公路交汇处，５３％在晴天，６０％在干燥的路面。因此，事故的发生既非视线不良，也非路滑、ＢＥＭＳ指出：救护车车灯闪烁，警笛鸣叫，不顾交通法规的极高的车速，极有可能发生死亡或严重损伤。另据了解，部分护士认为在救护车中不必使用安全带，她们认为用安全带后难以靠近…     

救护车内空气及物品细菌数量监测与控制对策

目的监测救护车内空气及物品细菌数量，探讨减少细菌数量的方法。方法建立严格的消毒管理制度，对救护车内空气用紫外线照射或空气消毒片熏蒸、物品更换消毒等措施，防止交叉感染发生，比较消毒前后结果。结果救护车内污染情况严重；消毒后细菌培养数下降，差异有统计学意义（均p〈0．01）。结论救护车内经过严格的消毒管理，可杜绝通过救护车引起的交叉感染。     

北京市ICU专科护士资格认证培训效果评价

目的探讨ICU专科护士资格认证培训效果。从而提高培训质量,改进教学方法。方法采用自设问卷,对北京市17所三级甲等医院的经北京市ICU专科护士资格认证培训、在ICU持证上岗1年以上的护士进行问卷调查,内容包括护士在接受培训后专业理论、临床实践、教学能力、科研能力方面的改变。结果培训后,ICU专科护士在职业认知、临床实践、教学示教、科研意识改善方面均提高。不同工作年限的ICU护士,培训效果差异无统计学意义。ICU专科护士在专业会诊与咨询方面能力较弱。结论统一的ICU专科培训提高了护士的临床实践能力、教学能力和科研意识。     

Evaluating Degradation with Fragment Formation of Prehospital Succinylcholine by Mass Spectrometry

Objectives: Pharmaceutical manufacturers recommend refrigerating succinylcholine at a temperature range of 2–8°C. With widespread use of prehospital succinylcholine on ambulances without refrigeration, it is important to understand the stability of this drug. Using mass spectrometry, this study investigated the degradation of the succinylcholine compound before and after its exposure to ambulance cabin temperatures, while removing light exposure. A 10% degradation threshold was set as not appropriate for human use, in accordance with U.S. Food and Drug Administration guidelines. Methods: The study used 17 vials of succinylcholine sealed with duct tape in light‐resistant bags. The bags were placed in climate controlled compartments in two ambulances: one stationed in a garage and the other stationed outdoors. Mass spectrometry analysis was used to examine drug degradation at Time 0, the 14th day of the first month, and monthly from Time 0 to 7 months. Results: The degradation products of succinyl monocholine (SMC) and choline are already present at Day 0. Ten percent degradation was achieved at approximately 90 days into the experiment. Temperature in the ambulance climate controlled compartment was 70°F, with a range from 56 to 89°F during the 6‐month time period. Conclusions: Identifiable breakdown fragments of succinylcholine have been identified using mass spectrometry with fresh drug upon receipt from the manufacturer. Ten percent degradation was not observed until approximately 90 days after being placed on ambulances. Temperature variations did not significantly contribute to degradation of succinylcholine, and it is safe for injection until approximately 90 days in similar climates. ACADEMIC EMERGENCY MEDICINE 2010; 17:631–637 © 2010 by the Society for Academic Emergency Medicine     

The fast emergency vehicle pre-emption system improved the outcomes of out-of-hospital cardiac arrest

PurposesAmbulance response time is a major factor associated with survival in out-of-hospital cardiac arrests (OHCAs); the fast emergency vehicle pre-emption system (FAST?) aids response time by controlling traffic signals. This eight-year observational study investigated whether FAST? implementation reduced response times and improved OHCA outcomes.MethodsData was prospectively collected from 1161 OHCAs that were not witnessed by emergency medical technicians from April 1, 2003, to March 31, 2011. The study took place in Kanazawa city, where ambulances without FAST? (non–FAST?-equipped) were being progressively replaced by new FAST?-equipped ambulances. OHCA data, including the response times recorded in seconds, were collected and compared between the FAST?-equipped and non–FAST?-equipped ambulances. OHCA outcomes were subsequently compared in the subgroup of OHCAs managed by emergency medical technicians without tracheal intubation or epinephrine administration. The primary end-point of this study was one-year (1-Y) survival.ResultsThe median response time significantly differed between the FAST?-equipped and non–FAST?-equipped groups at 327 and 381 s, respectively. The 1-Y survival rates were 7.0% in the FAST?-equipped group and 2.8% in the non–FAST?-equipped group. Logistic regression analysis revealed that the dispatch of a FAST?-equipped ambulance was an independent factor for 1-Y survival (adjusted odds ratio = 3.077, 95% confidence interval = 1.180-9.350).ConclusionsThe FAST? implementation significantly reduced ambulance response times and improved OHCA outcomes in Kanazawa city.     

Emt knowledge of ambulance traffic laws

Objective. The safe operation of ambulances using warning lights and siren requires both the public and emergency medical technician (EMT) drivers to understand and obey relevant traffic laws. However, EMTs may be unfamiliar with these laws. The purpose of this study was to evaluate EMTs' knowledge of traffic laws related to the operation of ambulances with warning lights and sirens. Methods. North Carolina EMTs participating in a statewide EMS conference October 6–8, 1995, completed a five-question survey. Knowledge of ambulance speed limits, yielding at intersections, yielding in roadways, and following distances was assessed using a multiple-choice format. Demographic data pertaining to EMT age, years of experience, paid vs volunteer status, driver's education courses, and past accident involvement were also obtained. Proportions were compared using chi-square analysis, alpha = 0.05. Results. Two-hundred ninety-three of 308 (95%) EMTs attending the conference completed questionnaires. The median number of correct responses to the five knowledge questions was 1 (range 0–4). Thirty-three percent of the EMTs knew that other vehicles are required by law to yield while either approaching or being overtaken by an ambulance with warning lights and sirens; 2% knew that due regard for safety is the only requirement of an ambulance approaching a red light at an intersection; 14% knew that the minimum following distance behind an ambulance is one city block; and 28% knew that there is no speed limit on ambulances with warning lights and sirens. Respondents were more likely to score above the median if they had taken one or more emergency driver's education courses or had nine years or more of EMS experience. Conclusion. In this sample, EMT knowledge of basic traffic laws pertaining to ambulance operation is poor. Emergency driver's education courses and increased experience appear to be related to increased knowledge scores. Increased training for EMTs about traffic laws may improve the safe operation of ambulances.     

Using a Discrete‐event Simulation to Balance Ambulance Availability and Demand in Static Deployment Systems

Objectives: To improve ambulance response time, matching ambulance availability with the emergency demand is crucial. To maintain the standard of 90% of response times within 9 minutes, the authors introduce a discrete‐event simulation method to estimate the threshold for expanding the ambulance fleet when demand increases and to find the optimal dispatching strategies when provisional events create temporary decreases in ambulance availability. Methods: The simulation model was developed with information from the literature. Although the development was theoretical, the model was validated on the emergency medical services (EMS) system of Tainan City. The data are divided: one part is for model development, and the other for validation. For increasing demand, the effect was modeled on response time when call arrival rates increased. For temporary availability decreases, the authors simulated all possible alternatives of ambulance deployment in accordance with the number of out‐of‐routine‐duty ambulances and the durations of three types of mass gatherings: marathon races (06:00–10:00 hr), rock concerts (18:00–22:00 hr), and New Year’s Eve parties (20:00–01:00 hr). Results: Statistical analysis confirmed that the model reasonably represented the actual Tainan EMS system. The response‐time standard could not be reached when the incremental ratio of call arrivals exceeded 56%, which is the threshold for the Tainan EMS system to expand its ambulance fleet. When provisional events created temporary availability decreases, the Tainan EMS system could spare at most two ambulances from the standard configuration, except between 20:00 and 01:00, when it could spare three. The model also demonstrated that the current Tainan EMS has two excess ambulances that could be dropped. The authors suggest dispatching strategies to minimize the response times in routine daily emergencies. Conclusions: Strategies of capacity management based on this model improved response times. The more ambulances that are out of routine duty, the better the performance of the optimal strategies that are based on this model.     

Population-level Spatial Access to Prehospital Care by the National Ambulance Service in Ghana

Background: Conditions requiring emergency treatment disproportionately affect low- and middle-income countries (LMICs), where there is often insufficient prehospital care capacity. To inform targeted prehospital care development in Ghana, we aimed to describe spatial access to formal prehospital care services and identify ambulance stations for capacity expansion. Methods: Cost distance methods were used to evaluate areal and population-level access to prehospital care within 30 and 60 minutes of each of the 128 ambulance stations in Ghana. With network analysis methods, a two-step floating catchment area model was created to identify district-level variability in access. Districts without NAS stations within their catchment areas were identified as candidates for an additional NAS station. Additionally, five candidate stations for capacity expansion (e.g., addition of an ambulance) were then identified through iterative simulations that were designed to identify the stations that had the greatest influence on the access scores of the ten lowest access districts. Results: Following NAS inception, the proportion of Ghana's landmass serviceable within 60 minutes of a station increased from 8.7 to 59.4% from 2004 to 2014, respectively. Over the same time period, the proportion of the population with access to the NAS within 60-minutes increased from 48% to 79%. The two-step floating catchment area model identified considerable variation in district-level access scores, which ranged from 0.05 to 2.43 ambulances per 100,000 persons (median 0.45; interquartile range 0.23-0.63). Seven candidate districts for NAS station addition and five candidate NAS stations for capacity expansion were identified. The addition of one ambulance to each of the five candidate stations improved access scores in the ten lowest access districts by a total 0.22 ambulances per 100,000 persons. Conclusions: The NAS in Ghana has expanded its population-level spatial access to the majority of the population; however, access inequality exists in both rural and urban areas that can be improved by increasing station capacity or adding additional stations. Geospatial methods to identify access inequities and inform service expansion might serve as a model for other LMICs attempting to understand and improve formal prehospital care services.     

北京市中学生道路交通伤害的流行病学调查

目的 了解北京市中学生道路交通伤害的特点,为预防和控制青少年道路交通伤害提供参考依据.方法 采用典型的方法,分别确定具有城区、近郊区和远县特征的区县各1个.然后确定每个区县的2所初中和2所高中作为被调查学校.最后,采用整群抽样的方法,对每个被调查初中学校的初一、初二年级和高中学校的高一、高二年级各两个班的所有学生进行调查.结果 北京市中学生过去1年内发生道路交通事故的比例达14.0%,其中男生交通事故发生率为16.5%,女生为11.5%,男女生发病率差异有统计学意义(x2=59.808,P＜0.01),初中学生高于高中学生.交通事故发生率有明显的中心城区倾向(x2=158.282,P＜0.01).各种交通方式中以骑自行车发生交通事故的比例最高,为1913%.2004年中学生因道路交通伤害受伤的比例为37.0%,男女生之间、各种交通方式之间差异无统计学意义,但年级越高、距离中心城区越远发生道路交通伤害的比例越大.结论 道路交通事故和道路交通伤害已经成为影响北京市中学生健康和安全的重要问题,必须采取积极的措施,预防和降低青少年道路交通事故和交通伤害的发生.     

Neighborhood Poverty and 9-1-1 Ambulance Response Time

Background: Are 9-1-1 ambulances relatively late to poorer neighborhoods? Studies suggesting so often rely on weak measures of neighborhood (e.g., postal zip code), limit the analysis to particular ambulance encounters (e.g., cardiac arrest responses), and do little to account for variations in dispatch priority or intervention severity. Methods: We merged EMS ambulance contact records in a single California county (n = 87,554) with tract-level data from the American Community Survey (n = 300). After calculating tract-level median ambulance response time (MART), we used ordinary least squares (OLS) regression to estimate a conditional average relationship between neighborhood poverty and MART and quantile regression to condition this relationship on 25th, 50th, and 75th percentiles of MART. We also specified each of these outcomes by five dispatch priorities and by three intervention severities. For each model, we estimated the associated changes in MART per 10 percentage point increase in tract-level poverty while adjusting for emergency department proximity, population density, and population size. Results: Our study produced three major findings. First, most of our tests suggested tract-level poverty was negatively associated with MART. Our baseline OLS model estimates that a 10 percentage point increase in tract-level poverty is associated with almost a 24 s decrease in MART (?23.55 s, 95% confidence interval [CI] ?33.13 to ?13.98). Results from our quantile regression models provided further evidence for this association. Second, we did not find evidence that ambulances are relatively late to poorer neighborhoods when specifying MART by dispatch priority. Third, we were also unable to identify a positive association between tract-level poverty and MART when we specified our outcomes by three intervention severities. Across each of our 36 models, tract-level poverty was either not significantly associated with MART or was negatively associated with MART by a magnitude smaller than a full minute per estimated 10 percentage point increase in poverty concentration. Conclusion: Our study challenges the commonly held assumption that ambulances are later to poor neighborhoods. We scrutinize our findings before cautiously considering their relevance for ambulance response time research and for ongoing conversations on the relationship between neighborhood poverty and prehospital care.     

时序预测模型对广州市急救需求量的预测价值北大核心CSCD

目的探讨时序预测模型中的差分自回归滑动平均(ARIMA)和自回归(AR)模型在预测广州市急救调度日出车数量方面的价值。方法采用Matlab仿真软件对广州市2021年1月1日至2021年12月31日的急救调度出车记录分析计算日出车数量时间序列,对该序列进行时序预测模型辨识,得到ARIMA(1,1,1)、AR(4)以及AR(7)模型,利用这些模型对日出车数量做出预测拟合。ARIMA(1,1,1)模型将数据分为训练集和测试集,参数运算采用Prony方法,预测拟合未来的出车数量;AR(4)和AR(7)模型采用均匀系数,预测当天出车数量。结果ARIMA(1,1,1)、AR(4)以及AR(7)都可以实现对日出车数量的有效预测,ARIMA(1,1,1)的预测拟合误差随着预测时间的延长下降。两个月内的急救调度日出车量预测拟合平均绝对百分比误差(MAPE)低于6%,结果基本都位于95%置信区间内,利用模型的残差分析验证了模型显著有效。结论ARIMA模型可以对两个月内的急救调度日出车量做长期预测拟合,AR模型可以对急救调度日出车量做短期有效预测。     

E MERGENCY M EDICAL S ERVICES AND C ULTURAL D ETERMINANTS OF AN E MERGENCY IN K ARACHI,P AKISTAN

Objectives. The study was conducted to understand the prehospital system in Karachi, the mode of transport that adult inpatients use to reach the emergency departments (EDs), and the barriers to the use of ambulances. Methods. The study consisted of two parts. The first part involved interviewing the administrators of major ambulance services in Karachi. The second part consisted of a structured interview of randomly selected adult inpatients admitted to one government and one private hospital. Results. Seven ambulance service administrators were interviewed. The interviews revealed that ambulances in Karachi are mainly involved in transporting patients from hospital to hospital or to home. A large number of calls are for transporting dead bodies. A total of 92 patients were interviewed (58 male, 34 female). Admission complaints included abdominal pain (22), blunt trauma (11), penetrating trauma (3), chest pain (6), shortness of breath (4), hematemesis (3), acute focal weakness (4), high fever (4), and other (32). The most common mode of transport to the ED was taxi (53, 58%), followed by private car (21, 23%). Specific reasons for not using ambulances included a perception that the patient was not sick enough (34, 45%), slow response of the ambulance services (17, 23%), not knowing how to find one (8, 11%), and the high cost (6, 8%). Conclusion. In case of a medical emergency, most people in Karachi do not use ambulances. The reasons for this low usage include not only poor accessibility, but also cultural barriers and lack of education in recognition of danger signs.