急性中風病患的派遣員辨識、救護技術員院前檢傷、與院前中風通報之評估

謝明儒

doi:10.6342/NTU201700197

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急性中风病患的派遣员辨识、救护技术员院前检伤、与院前中风通报之评估

Assessment of Dispatcher Recognition, Prehospital Triage, and Prehospital Notification for Patients with Acute Stroke

谢明儒 , 博士　　导师：简国龙;马惠明　　

英文 DOI： 10.6342/NTU201700197

紧急医疗系统；中风；栓溶治疗；派遣员；院前中风指标；院前通报； emergency medical service system ； stroke ； thrombolytic therapy ； dispatcher ； prehospital stroke scale ； prehospital notification

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摘要 │ 参考文献 (83) │ 国际计量

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Background and Objectives: Previous studies revealed that stroke patients utilizing emergency medical service (EMS) arrived in the emergency department earlier. Thus, it facilitated thrombolytic therapy. In Taiwan, the characteristics and the effect of EMS system on stroke care were not well studied. The objectives of the study were (1) to understand the characteristics of the communication between the caller and the dispatcher among the calls for stroke patients and the factors associated with recognition of stroke by dispatchers; (2) to evaluate the accuracy of identification of stroke patients by on-scene emergency medical technicians (EMTs) with the novel stroke assessment instrument; (3) to understand the effect of prehospital notification on the in-hospital management. 
Methods: Our study used the multicenter stroke registry connected to the tape recording and computerized dispatch systems. Thus, the data of telephone recording, past history of the patients, the prehospital and in-hospital management timeliness, and whether prenotification was performed could be collected. The characteristics of the communication between the caller and the dispatcher, the factors associated with recognition of stroke by dispatchers, the accuracy of a novel stroke assessment instrument, and the effect of prehospital notification on the time for patients receiving brain computed tomography and thrombolytic therapy were evaluated.
Results: About half of the callers were close family members, including the spouses, daughters, and sons. Less than 1% of the callers were the patients themselves. In addition, about 40% of the callers spontaneously reported that the patients were suspected as having a stroke. Nevertheless, only 17.9% of the dispatcher determined stroke dispatch for stroke patients. Stroke or symptoms of the Cincinnati Prehospital Stroke Scale (CPSS) reported by the callers spontaneously, and the dispatch protocol followed by the dispatcher were associated with dispatcher recognition of stroke. The sensitivity and the specificity of the novel instrument were 65% and 98%. The novel instrument had comparable sensitivity and improved specificity when compared with the CPSS. Prehospital notification for stroke patients shortened the median of the door-to-computed tomography time (13 vs 19 minutes, p < 0.001) and had a trend to decrease the median of the door-to-needle time (63 vs 68 minutes, p = 0.14).  
Conclusion: The dispatcher following the protocol, on-scene EMTs utilizing novel stroke assessment instrument and performing prehospital notification improved the quality of medical care of stroke patients in the EMS system.

参考文献 ( 83 ) 〈TOP〉

1.The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators. J Clin Epidemiol. 1988;41:105-114.
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2.Feigin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol. 2003;2:43-53.
连结：
3.Hsieh FI, Lien LM, Chen ST, Bai CH, Sun MC, Tseng HP, et al. Get With the Guidelines-Stroke performance indicators: surveillance of stroke care in the Taiwan Stroke Registry: Get With the Guidelines-Stroke in Taiwan. Circulation. 2010;122:1116-1123.
连结：
4.Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet Neurol. 2007;6:182-187.
连结：
5.Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics--2011 update: a report from the American Heart Association. Circulation. 2011;123:e18-e209.
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引用含有DOI的文献

DOI可强化引用精确性、增强学术圈连结，并给予使用者跨平台的良好使用经验，目前在全世界已有超过五千万个对象申请DOI。 如想对DOI的使用与概念有进一步了解，请参考 （ ） 。

DOI可强化引用精确性、增强学术圈连结，并给予使用者跨平台的良好使用经验，目前在全世界已有超过五千万个对象申请DOI。如想对DOI的使用与概念有进一步了解，请参考（）。