为困在机动车碰撞中的患者优先考虑时间关键的伤害和干预措施:Delphi研究
Tim Nutbeam1,2, Rob Fenwick3,4, Ian Marritt5
1IMPACT; Centre for Post-Collision Research Innovation and Translation, Exeter, UK. timnutbeam@nhs.net.
概括
专家们一致认为,在机动车碰撞后,应优先对待被困的患者. 这一框架指导了医院前护理,重点关注患者的需求和可行的干预措施.
科学领域:
- 医院前的紧急医疗
- 创伤护理
- 医学共识的发展
背景情况:
- 摩托车碰撞经常导致身体受伤.
- 对于这些患者的伤害优先级和可行的早期干预存在有限的医院前共识.
- 这项研究探讨了被困人员在现场进行结构化的决策的必要性.
研究的目的:
- 发展专家对被困患者伤害分类的共识.
- 建立必要和可行的在医院前的早期护理干预措施的协议.
- 为应急人员提供临床和操作决策指导.
主要方法:
- 修改后的Delphi方法涉及多学科专家小组 (临床医生,护理人员,消防/救援人员).
- 进行了三轮的陈述改进和评级,随后进行了面对面的共识会议.
- 达成共识的定义是关于受伤时间敏感性,干预优先级和响应角色的陈述达成70%的共识.
主要成果:
- 在包括伤害分类,时间关键干预和多机构责任在内的45项声明上达成共识.
- 强烈支持早期止痛药,酸和环境保护,但需要培训和治理.
- 广泛支持扩大非临床响应者的实践范围,以应对紧急的患者需求.
结论:
- 已经建立了一个框架,以优先考虑陷入患者护理的早期干预.
- 这种共识支持以患者为中心,以能力为基础的医院前方法,强调可行性和紧迫性.
- 调查结果为标准操作程序,分类工具和培训框架提供了信息,需要进一步研究评估启发方法和实施障碍.
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