Comparing performance and impact of first responders on outcome in prehospital emergency medicine in Switzerland

作者：Urwyler Natalie^*; Theiler Lorenz; Schoenhofer Johann; Kaempfen Bruno; Stave Christopher; Greif Robert

来源：Emergencias, 2012, 24(6): 426-432.

• Accuracy of Diagnosis
• Prehospital Emergency Medicine
• Emergency Medical Services
• Emergency Physician
• Paramedics
• Postgraduate Training

Background: Contradictory results are reported in the medical literature on effectiveness of first responders in prehospital emergency medicine. In this study we evaluated responders performance and impact on outcome. %26lt;br%26gt;Methods: In a retrospective cohort study we evaluated the accuracy of diagnoses by emergency physicians, paramedics, and general practitioners. We compared the diagnosis made in the prehospital emergency situation to the diagnosis at discharge from the hospital. Primary outcome was the impact of accuracy of diagnosis on mortality. Secondary outcomes were, 1) time on scene, 2) duration of hospitalization. The influence of clinical experience and postgraduate training on accuracy of diagnoses was of particular interest. %26lt;br%26gt;Results: We evaluated 1 241 diagnoses. Patients admitted with a wrong or missing diagnosis showed an increased mortality risk (P = 0.04, OR 1.9; CI 1.04-3.34). The time spent on scene and the duration of his/her hospital stay was shorter if the diagnosis was correct. Emergency physicians, paramedics and general practitioners made diagnoses with comparable accuracy (P = 0.139) but emergency physicians showed a significant increase in accuracy correlated to their years of clinical experience (P %26lt; 0.001). After postgraduate year six they reached a level of diagnostic accuracy %26gt; 90%. This effect could not be shown for paramedics or general practitioners. %26lt;br%26gt;Conclusion: A correct diagnosis in prehospital emergency medicine reduces mortality and length of hospital stay. Trained emergency physicians make diagnoses with a high degree of accuracy. Therefore, they should be increasingly integrated into prehospital emergency medicine, particularly for more severe cases. [Emergencias 2012;24:426-432]

• 出版日期2012-12