BACKGROUND The report of the Ministerial Review of Trauma and Emergency Services in Victoria, Australia, recommended that paramedics be permitted to divert to the closest hospital in incidences of life threatening situations prior to and during transport. An audit of patients that suddenly deteriorated in paramedic care was recommended by the Ministerial Review. The objective of the study was to identify the number and outcome of patients who suddenly deteriorated in the presence of paramedics. METHODS A retrospective cohort study of trauma patients who suddenly deteriorated in the presence of paramedics during 2002. As there was no standard definition, sudden deterioration was defined using a predetermined set of physiological criteria. Patient care record data of patients who suddenly deteriorated were compared with the State Trauma Registry to determine those who sustained hospital defined major trauma. Patient care records where hospital bypass was undertaken were identified and analysed. Ethics committee approval was obtained. RESULTS There were 2,893 patients that suddenly deteriorated according to predefined criteria. 2,687 (5.1% of the total trauma patients for 2002) were suitable for further analysis. The majority of patients had a sudden decrease in BP (n = 2,463) with 4.3% having hospital defined major trauma. For patients with a sudden decrease in conscious state or a total GCS score of less than 13 (n = 77), 37.7% had hospital defined major trauma; and a sudden increase/decrease in pulse rate and sudden decrease in BP (n = 65), 26.2% had hospital defined major trauma. Only 28 documented incidents of hospital bypass were identified. CONCLUSION This study suggests that the incidents of patients suddenly deteriorating in the presence of paramedics are low and the incidence of hospital bypass is not well documented.

中文翻译：

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对在护理人员在场的情况下突然恶化的患者的审查。

背景 澳大利亚维多利亚州创伤和紧急服务部部长审查报告建议允许护理人员在运输前和运输过程中发生危及生命的情况时转移到最近的医院。部长审查建议对在护理人员护理中突然恶化的患者进行审计。该研究的目的是确定在护理人员在场的情况下突然恶化的患者的数量和结果。方法 对 2002 年在护理人员在场的情况下突然恶化的创伤患者的回顾性队列研究。由于没有标准定义，突然恶化是使用一组预先确定的生理标准来定义的。将突然恶化的患者的患者护理记录数据与州创伤登记处进行比较，以确定那些遭受医院定义的重大创伤的患者。确定并分析了进行医院旁路手术的患者护理记录。获得了伦理委员会的批准。结果 根据预定标准，有 2,893 名患者突然恶化。2,687 人（占 2002 年外伤患者总数的 5.1%）适合进一步分析。大多数患者的血压突然下降 (n = 2,463)，其中 4.3% 有医院定义的严重创伤。对于意识状态突然下降或总 GCS 评分低于 13（n = 77）的患者，37.7% 有医院定义的严重创伤；脉率突然增加/减少和血压突然下降（n = 65），26。2% 有医院定义的严重创伤。仅确定了 28 起记录在案的医院绕道事故。结论 本研究表明，在护理人员在场的情况下患者突然恶化的事件很少，并且医院旁路的发生率没有得到很好的记录。