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LONG-TERM OUTCOME AND QUALITY OF LIFE AFTER MECU PERFORMED PREHOSPITAL LIFE-SAVING TREATMENT.

A. Fedder, N.K. Schønemann, A.M. Christensen, P. Juelsgaard.

MECU Aarhus. Aarhus University Hospital, Aarhus, Denmark.

Introduction: The traditional way to evaluate the effect of prehospital treatment is survival until discharge from the hospital (1). The objective of this study is to determine long-term survival and changes in Quality of Life (QoL) for patients receiving prehospital life-saving treatment.

Methods: To measure QoL, the EuroQoL questionnaire is used (2). The General Practitioner (GP) of the patient is interviewed. Measuring QoL by using another person than the patient has formerly been evaluated and acceptable agreement was determined (3). Retrospectively analysis of data collected by the MECU doctors on a standardized chart in the period 1.1.2000 - 31.12.2000, and data received from the Central Hospital database with focus on survival data. The MECU-doctor estimates condition after given treatment as: 1: Unchanged, 2: Improved, 3: Considerable improved, 4: Life-saving, 5: Worsened and 6: Dead. In case of a life-saving treatment, this statement is given when it is estimated that it would be unlikely that the patient would have reached the hospital alive, unless advanced treatment was given on scene. A medical audit of the MECU doctors evaluation, performed in 1997, concluded that in all the cases evaluated, the audit commission agreed with the statement of the MECU-doctors. Values presented in mean and range.

Results: In the study period the MECU was dispatch 4860 times. In 80 (1,7 %) cases the treatment was estimated as been life-saving. Fifty three (66,3 %) of these patients were discharged from hospital and 48 (60,0 %) patients were a live after one year. The GP was interview at least one year after the incident (mean 19,1 month, range 14-25). In 36 (75,0 %) of the cases the GP could give a full answer to EuroQoL questionnaire, in 6 (12,5 %) cases only a partly answer and in 6 (12,5 %) cases there had been no contact between the GP and the patient. Of the 36 patients, 32 (89,9 %) have had no reduction in QoL, after the incident.

Conclusion: To reduce death from prehospital catastrophic illness, early and effective treatment is crucial and procedures performed by the MECU-staff are essential in this setting. These results indicate that even in critical illness, good long-term results can be achieved, with advanced treatment on site, not only with respect to survival, but also with regard to QoL.            

References. 1. Brice et al. Prehosp. Emerg Care. 2000;4: 144-150. 2. EuroQol . Health Policy, 16 (1990) 199-208. 3: Badia et al. Intensive Care med (1996) 22: 1379-1384.