The Investigations On The Status Of The Emergency Deceased Cases And The Factors Influencing The Successful Rescue

ObjectiveThis investigation aimed at getting the status and death causes from the emergency deceased cases and finding the factors which influence CPR effect and the ethical factors which influence pre-hospital care in Shenzhen.MethodsThe data base were set up according to questionnaires with EpiData,added up and analyzed with SPSS 13.0(SPSS,Inc.,Chicago,IL).The comparison between constituent ratios were made withχ~2 test(Crosstabs,Pearson Chi-Square or Fisher's Exact test ).The comparison between averages was made with t test or One-Way-ANOVA.The significant factors were analyzed by binary logistic regression.The comparison of degree material was made with nonparametric test.Results1 The mass survey on the emergency dead cases in 2002-2004The pre-hospital mortality of the patients with calling for ambulance:2.37%in 2002,2.05%in 2003,2.35%in 2004 and 2.26%total.The mortality of the patients who arrived at hospitals was 9.1074/10000 in 2002,7.4420/10000 in 2003, 6.9804/10000 in 2004 and 7.8433/10000 total.The average dead age(years old): 39.96±23.51 in 2002,39.78±25.28 in 2003,39.88±22.85,and 39.87±23.88 years old total.The ratio of male to female:2.11:1 in 2002,2.12:1 in 2003,2.41:1 in 2004, and 2.22:1 total.According to ICD-10 categorization,Injury and circulation system diseases occupied the front row of the death causes Tab.and the intoxation remained the fourth position.The constituent ratio of traffic accident decreased and other impairments increased simultaneously from 2002 to 2004.The out-of-hospital deceased accounted 35.61%,35.97%and 47.62%of the emergency death cases in 2002,2003 and 2004 respectively.The average reaction time of ambulance in hospital was(2.5±2.25),(2.09±4.68) and(1.23±0.98) minutes in the 3 year respectively;the average reaching time was(7.58±4.61), (9.80±9.41) and(9.50±7.52) minutes.When the staff arrived at the spots,71.56%, 78.97%and 87.43%of the patients had had no chance to survive already.The whole city's mortalities in emergency departments were 2.6238,2.5740 and 2.4418 per ten thousands in the 3 years respectively.The period with most emergency death cases arrived at emergency room(ER) was 0:00-8:00 compared with 8:00-13:00,13:00-18:00 and 18:00-0:00.In the 3 years,all more than 98%first visiting doctor arrived in 1 minute after the patient arrived at ER;All less than 77%of senior or the second line doctor arrived in 5 minute;67.44%,76.27%and 80.57%of the consultings arrived in 30 minutes respectively.The patients died 32.81%in 30 minutes,59.76%in 60 minutes,82.43%in 3 minutes after arriving ER.In 2002,2003 and 2004,there were 1446,1373 and 1223 hospitalized emergency death cases separately in Shenzhen City,account for 45.89%,41.89%and 34.06%of the corresponding year's emergency death sum.In the 3 year respectively, 57.06%,76.5%and 76.8%of the first medical order was given in 5 minutes,44.48%, 36.35%and 36.42 of the second line or senior doctor arrived in 5 minute,21.07%, 55.82%and 36.43%of the first consultation began in 30 minutes,15.77%,24.07% and 20.26%of the blood transfusion started in 30 minutes,22.17%,27.74%and 21.22%of the operation started in 30 minutes.The regiments carried out and quality controled were improved year by year.The injured patients' average dead age was(29.86±15.32) years old. Male/female ratio was 74.16/25.84.Traffic/non-traffic trauma ratio was 42.17/57.83. The prehospital and in hospital trauma patients' mortality were 1.52%and 0.95%. The prehospital and in hospital traffic trauma patients' mortality were 2.07%and 1.03%.The prehospital and in hospital non-traffic trauma patients' mortality were 1.25%and 0.91%.2.The Investigation on the Factors Influencing CPR Effect in Shenzhen2288 cases of CA,Male:Female = 2.49:1.In 1376 pre-hospital cases,6.47% survival to hospital,6.20%for the male compared with 7.01%for the female's((χ~2 =8.653,P=0.000).935cases in ER,22.46%survival to admission,no statistical difference between the male and the female(χ~2 =0.3666,P=0.545).There was statistical difference between survival ratio pre-hospital and in ER(χ~2=150.086, P=0.000).2054 cases had age record,average age(38.60±23.67),include 1180 cases pre-hospital(40.67±24.43),and 848 cases in ER(35.63±22.26) years old((t=4.828, P=0.000).The average time from CA to CPR was(19.67±21.26) minutes,pre-hospital (21.75±21.65,n=1287) compared(16.90±20.42,n=812) in ER(t=5.115,P=0.000).218 cases(15.84%) got bystander CPR,who had higher survival ratios than the ones had no this kind of chance,no matter pre-hospital(χ~2=86.593,P=0.000) or in ER(χ~2 =7.698,P=0.021 ).There were statistical significant result with different ventilation methods pre-hospital(P=0.030,Fisher's exact test).The survival ratio was higher with intubation compared with life kiss,oxygen mask and others,but the odds hadn't emerged in ER(P= 0.313,Fisher's Exact Test).There was statistical significance with different ECG before CPR.The survival and ROSC ratio were higher with VF compared with PEA and asystole,pre-hospital (χ~2= 169.068,P= 0.000) and in ER(χ~2 = 74.098,P= 0.000).The results had no statistical differences with compression to ventilation ratio 15:2 compared with 30:2,no matter pre-hospital(χ~2= 5.410,P=0.067) or in ER(χ~2 = 1.114,P=0.573). The pre-hospital dead cases(n=939) got higher epinephrine dosage(3.16±3.05) mg compared with(2.54±2.57) mg for the survival to hospital cases(n=73) (t=1.686,P=0.092).In ER,it's(4.74±4.15) mg for the dead(n=552) and(2.79±3.55) mg for the survival to admission.The binary logistic regression was carried out with the factors which had emerged statistical significance through single factor analysis.ECG before CPR,the bystander CPR,electric shock,the CA time before CPR,adrenaline dosage,gender and age group were independent influencing factors for ROSC pre-hospital.ECG before CPR,the CA time before CPR and age groups were independent influencing factors for pre-hospital survival to hospital.ECG before CPR,electric shock,the CA time before CPR and adrenaline dosage groups were independent influencing factors for ROSC in ER.ECG before CPR,the CA time before CPR and adrenaline dosage groups were independent influencing factors in ER survival to admission.3 The ethical conflicts in pre-hospital care400 questionnaires were distributed,and 328(82%) collected back.248 nurses (30.21±6.38 years old) and 80 doctors(35.68±6.08 years old)(t=6.734,P=0.000) fulfilled the questionnaires.23.09%and 33.27%of the cases couldn't be decided how to do to fit the patients' best interest by the doctors and nurses seperatively(Z=1.375, P=0.046).The patients refused to be treated and deliveried because(23.52±19.79)% of them didn't want to pay,(22.22%±20.84)%of them believe they needn't,(4.77±5.47)%of them want to die,(19.44±18.65)%of them could not be identified,and (30.08±25.78)%of them had other reasons.(22.61±14.38)%of the patients' whole expense hadn't been paid,and(15.76±9.58 )%of them only paid a part of expense.(19.11±17.92)%of the patients' requirements go beyond the pre-hospital care's ability.(15.011±14.528)%of the patients want to get priority to be cared and deliveried,but no necessity identified by the staff.1.790±0.408 )%of the staff's CPR start were influenced by the patient's age,and(1.838±0.369)%of them influenced by the patient's behavior. 228(69.51%)staff had ever believed themselves need more knowledge and skills to fit the patients requirements,and this kind of patients accounted for(10.30±9.99) %.24.39%of the staff had ever considered if the patients could pay for the treatment when they took care of the patients.39.94%of the staff could debate with partner when they had different view about the patients best interesting.93.29%of the staff had ever met hazard when they fulfill their pre-hospital duty.59.43%of the staff whold sacrifice themselves best interesting to fulfill the patients best interesting if it's necessary.Pre-hospital emergency network's rule conflict with the patients best interesting under the(15.97±14.38)%of the circumstances.24.39%of the staff believed their individual value and decisions conflict with Pre-hospital emergency network's rule.(16.573±13.215 )%of the families and bystanders' view conflicts with the patients' decision.75.91%of the staff had ever met that the doctor in ER believed the hospital can not satisfy the patients' need.Policemen and other professional person's view conflicted with the staff's under the(13.753±14.721)%of the circumstances.361 patients or family telephone questionnaires had been done.No of the staff received tip.The ambulance velocity was the most satisfactory item(77.56% satisfactory,22.44%rather satisfactory,none don't satisfactory).Among all of the districts in Shenzhen,there was no statistical satisfactory difference about charge. Nanshan District got the most satisfactory degree on service manner(mean rank 151.800),Luohu District on remedy effect(mean rank 122.850 ),new Guangming District on ambulance velocity(mean rank 140.500),Yantian District on medical technology(mean rank 132.000),and Longgang District got the lowest satisfactory on the 4 items(mean rank 207.891,218.555,211.790,223.571 ).There were no statistical satisfactory differences on service manner,ambulance velocity and charge among public synthetic,public special and private hospitals.The public special hospitals got the most satisfactory degree on remedy effect and medical technology (mean rank 130.927 and 143.122),and the private hospitals had the lowest satisfactory degree on the 2 items(mean rank 216.513 and 196.287).ConclusionsThe pre-hospital mortality in Shenzhen was lower than that of other cities in China.The mortalities in hospital presented the trends to decrease in 2002-2004.The average emergency dead age was younger than that of other cities' in China.The number of the male emergency dead cases was 2 times more than the female.Injury and circulation system diseases were the main emergency death causes.The Shenzhen emergency network hospitals' emergency treatments were elevated on time, technology and quality factors,and the mortality,was decrease during the 3 years.ECG before CPR,the bystander CPR,electric shock,the CA time before CPR, adrenaline dosage,gender and age group were influencing factors in CPR.The nurses felt hard to decide how to do to fit the patients' best interest under more circumstances than the doctors did.The pre-hospital service staff indeed met some ethical conflicts with patients,families and bystanders,the staff in hospital, police and the emergency network's administrative rules.The ambulance velocity was the most satisfactory item.Among all of the districts in Shenzhen,Longgang District got the lowest satisfactory degree.The public special hospitals got the most satisfactory degree on remedy effect and medical technology,and the private hospitals had the lowest satisfactory degree on the 2 items.