Ensihoidon kiireettömien tehtävien siirto puhelimessa tehtävään hoidon tarpeen arviointiin:kuvaus resurssien käytöstä ja kustannusten jakaantumisesta

Tiivistelmä Tutkimuksen tarkoitus: Kuvata sairaanhoitajan puhelimessa toteuttaman hoidon tarpeen arvioinnin (PHTA) resurssien käyttöä ja kustannuksia ja verrata niitä ensihoidon resurssien käyttöön ja kustannuksiin. Aineisto ja menetelmät: Ensihoidon kiireettömien tehtävien määrät ja kestot kerättiin ensihoidon tietojärjestelmistä. Ensihoidon ja PHTA:n kustannukset kerättiin talousarvioista vuodelta 2018 Kainuussa ja Oulussa. Aineistosta laskettiin teoreettiset ensihoidon ja PHTA:n vuosikustannukset ja resurssien käyttö Kainuussa. Laskelmien avulla mallinnettiin Ouluun vastaavat kustannukset sekä teoreettiset säästöt. Tulokset: Vuonna 2018 Kainuussa ensihoidon kiireettömiä tehtäviä oli 5295 ja Oulussa 8598. Laskennallinen kiireettömän ensihoitotehtävän hinta oli Kainuussa 172,80€ ja Oulussa 102,70€, sekä yhden tehtävän käsittelyn hinta PHTA:lla hinta oli 7€. Ensihoitopalveluun integroidun PHTA:n tuomat teoreettiset säästöt ovat Oulussa ja Kainuussa 258 199–294 912€/vuosi. Henkilöstöresurssitarpeen väheneminen on yli 5000 tuntia vuodessa. Päätelmät: PHTA:n integroiminen ensihoitopalveluun voi tuottaa säästöjä ja hillitä ensihoidon tehtävämäärien nousua. Vapautuvat ensihoidon resurssit voitaisiin kohdentaa kiireellisten potilaiden hoitoon. PHTA:n käyttöönotto olisi mahdollista nykyisillä palvelurakenteilla

Accuracy of dispatch and prehospital triage performance in poisonings:a retrospective study from northern Finland

Abstract Background: Increasing numbers of dispatches place a burden on EMS; this study sought to assess the prehospital evaluation of poisoned patients transported to hospital. The primary aim of this study was to measure dispatch centre and EMS provider performance as well as factors contributing to the recognition of poisoning among prehospital patients. The secondary aim was to compare triage performance between dispatch centres and EMS providers. Methods: A retrospective single-centre study in Northern Finland was conducted. Patients suspected as poisonings by dispatch centres as well as other EMS-transported patients who received a diagnosis of poisoning in hospital between June 1, 2015 and June 1, 2017, were included. Results: There were a total of 1668 poisoning-related EMS missions. Dispatch centres suspected poisonings with sensitivity of 79.9% (95% CI 76.7–82.9) and specificity of 98.9% (95% CI 98.9–99.0) when all EMS missions were taken into account. In a logistic regression model, decreased state of consciousness as dispatch code (OR 7.18, 95% CI 1.90–27.05) and intravenous fluid resuscitation (OR 6.58, 95% CI 1.34–32.37) were associated with EMS transport providers not recognizing poisoning. Overtriage rate appeared significantly higher (33.6%, 95% CI 28.6–39.2) for dispatch when compared with transport (17.8%, 95% CI 13.9–22.6). Conclusion: Dispatch centres seem to suspect poisonings fairly accurately. Poisonings unrecognized by EMS providers may be linked with intravenous fluid resuscitation and decreased patient consciousness. Overtriage appears to resolve somewhat from dispatch to transport. There were no fatal poisonings in this study population

Early impact of the COVID-19 pandemic and social restrictions on ambulance mission

Abstract Background:The SARS-CoV-2 coronavirus disease 2019 (COVID-19) has had a major impact on health care services globally. Recent studies report that emergency departments have experienced a significant decline in the number of admitted patients in the early phase of the pandemic. To date, research regarding the influence of COVID-19 on emergency medical services (EMS) is limited. This study investigates a change in the number and characteristics of EMS missions in the early phase of the pandemic. Methods:All EMS missions in the Northern Ostrobothnia region, Finland (population 295 500) between 1 March to 30 June 2020 were screened and analyzed as the study group. A control group was composed from the EMS calls between the corresponding months in the years 2016–19. Results:A total of 74 576 EMS missions were screened for the study. Within the first 2 months after the first COVID-19 cases in the study area, the decline in the number of EMS missions was 5.7–13% compared with the control group average. EMS time intervals (emergency call to dispatch, dispatch, en-route, on-scene and hospital handover) prolonged in the COVID-19 period. Dispatches concerning mental health problems increased most in the study period (+1.2%, P < 0.001). Only eleven confirmed COVID-19 infections were encountered by EMS in the study period. Conclusions: Our findings suggest that the present COVID-19 pandemic and social restrictions lead to changes in the EMS usage. These preliminary findings emphasize the importance of developing new strategies and protocols in response to the oncoming pandemic waves