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ANAESTHESIOLOGISTS IN PREHOSPITAL CARE – NEED FOR
NIGHT SHIFT?
C. S. Høyer
1, E. Frischknecht Christensen 1,2,MD
1Department
of Anaesthesiology and Intensive Care, 2 Mobile Emergency Care Unit,
Aarhus Kommunehospital, Aarhus University Hospital, Denmark.
Background
A Mobile
Emergency Care Unit (MECU) manned with an anaesthesiologist and an assistant
work in a rendez-vous-system with ambulances, covering an urban area with
approximately 330.000 inhabitants.
From an
around-the-clock-service, as from May 1st this year it was reduced to
be inservicein
service between07:00-23:59.
Purpose
The
purpose of this study was to compare all patients admitted to the traumacenter
during night (00:00-06:59) and day/evening (07:00-23:59) in terms of prehospital
level of consciousness, injury severity and primary referral from emergency room.
Method
From our
traumadatabase time of admittance, Glascow Coma Scale score (GCS), endotracheal
intubation (prehospital or in the emergency room), Injury Severity Score (ISS)
and primary referral was registered for patients admitted in the period
1998-2000.
Statistics:
chi-square and Mann-Whitney-test.
Results
A total
of 750 patients were admitted during the three years. For 708 patients the exact time of arrival was registered.
96
patients (13.6 %) arrived during night, while 612 (86,4 %) arrived during day.
ISS
could be calculated for 639 patients. Another
42 patients were not injured and ISS could therefore not be calculated.
|
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00:00-06:59 |
07:00-23:59 |
Significance |
|
N |
96 |
612 |
|
|
Age,
median (range) |
25,5
(12-60) |
30,5
(0-89) |
p<0,01 |
|
Males |
68
(71.0 %) |
399
(65.2 %) |
ns |
|
Intubated |
21
(21.9 %) |
95
(15.5 %) |
ns |
|
ISS,
median (range) |
9
(1-59) (91 ptt) |
9
(1-75) (548 ptt) |
ns |
|
To
operation theatre |
13
(14 %) |
89
(14.5 %) |
ns |
|
To
intensive care unit |
56
(58.3 %) |
282(46.1
%) |
p=0,02 |
Discussion and conclusion
Fewer
patients were admitted during night. There
were no difference in injury severity score and in the number of patients
needing immediate surgery, but, there were significantly more patients who
needed intensive care during night.
During
night there was a tendency towards a higher rate of intubation, though not
significantly.
Even
though the number of traumapatients is smaller, our study indicates more severe
injuries during night; thus indicating the need for the MECU throughout the
night.
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