Factors associated with the occurrence of prehospital medical interventions provided by physicians among non-trauma patients: a single-centre retrospective observational study in Japan

• Main Authors: Tomohiro Abe, Kenshi Iwatani, Takeshi Aoyama, Tatsunori Ameda
• Format: Article
• Language: English
• Published: BMJ Publishing Group 2019-08-01
• Series: BMJ Open
• Online Access: https://bmjopen.bmj.com/content/9/8/e029186.full

ObjectivesPhysician-staffed prehospital units are widely used in many countries. The criteria for predicting fatal injury are well recognised for trauma victims, but there are no criteria for predicting critical condition for non-trauma patients. This study aimed to identify the factors associated with non-trauma cases receiving prehospital interventions by physicians.DesignRetrospective observational study.SettingPhysician-staffed prehospital unit (car) at a single-base hospital in a suburban city in Japan.ParticipantsParticipants were 1058 non-trauma patients who received prehospital medical examinations from April 2014 to December 2017.Outcome measuresThe outcome was the occurrence of physician-only interventions (POIs) exceeding paramedics’ competencies. Univariate analysis and multiple logistic regression analysis were performed. Patient’s age and gender, presumed disease category, type of location of the emergency, time of alarm, activation time, activator’s occupation, time to arrival, transportation time and the destination facility were included as covariates.ResultsPOIs were provided to 380 (36%) patients. Patient’s age, presumed disease category, type of location of the emergency, activator’s occupation, time to arrival, transportation time and the destination facility were identified as potential independent factors. Multiple logistic regression analysis found that patient’s age, presumed disease category, type of location of the emergency, transportation time and destination facility were the significant independent factors. Transportation times of more than 15 min (adjusted ORs (AORs)=4.17, 95% CI 2.59 to 6.72, p<0.01) or 10 to 14 min (AOR=3.66, 95% CI 2.32 to 5.79, p<0.01) and patient age of 40–59 years (AOR=3.16, 95% CI 1.66 to 6.01, p<0.01) were the strongest independent factors.ConclusionsThis study identified the factors associated with non-trauma cases receiving prehospital POIs. Patient’s age, presumed disease category, type of location of the emergency and transportation time are independent factors associated with requiring POIs.