مأموريت هاي آمبولانس 115 به دنبال تروما براي اطفال در تهران

Ambulance Runs for Pediatric Trauma in Tehran

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺗﺮﻭﻣﺎ ﺑﻪ ﻋﻨﻮﺍﻥ ﺑﺰﺭﮔﺘﺮﻳﻦ ﻋﻠﺖ ﻣﺮﮒ ﻭ ﻣﻴﺮ ﮐﻮﺩﮐﺎﻥ ﭘﺲ ﺍﺯ ﻳﮏ ﺳﺎﻟﮕﻲ ﺩﺭ ﺳﻄﺢ ﺟﻬﺎﻥ ﻣﻄﺮﺡ ﻣﻲ ﺑﺎﺷﺪ ﻭ ﺍﺭﺍﺋﻪ ﺧﺪﻣﺎﺕ ﺍﻭﺭﮊﺍﻧﺲ ﭘﻴﺶ ﺑﻴﻤﺎﺭﺳﺘﺎﻧﻲ [Emergency Medical Service (EMS)] ﺑﺮﺍﻱ ﮐﻮﺩﮐﺎﻥ ﺣﺎﺩﺛﻪ ﺩﻳﺪﻩ ﺑﻪ ﻋﻨﻮﺍﻥ ﻳﮏ ﻣﺸﮑﻞ ﻗﺎﺑﻞ ﺗﻮﺟﻪ ﺩﺭ ﺳﻄﺢ ﺟﻬﺎﻥ ﺑﺎﻗﻲ ﺍﺳﺖ. ﻣﻄﺎﻟﻌﺔ ﺣﺎﺿﺮ ﺑﻪ ﻫﺪﻑ ﺑﺮﺭﺳﻲ ﺍﻧﻮﺍﻉ، ﺷﺎﺧﺺ ﻫﺎﻱ ﺯﻣﺎﻧﻲ ﺍﺭﺍﺋﻪ ﺧﺪﻣﺎﺕ ﻭ ﻣـﺮﮒ ﻭ ﻣﻴﺮ ﭘﻴﺶ ﺑﻴﻤﺎﺭﺳﺘﺎﻧﻲ ﺑﺮﺍﻱ ﻣﺄﻣﻮﺭﻳﺖ ﻫﺎﻱ ﺁﻣﺒﻮﻻﻧﺲ 115ﺗﻬـﺮﺍﻥ ﺑﻪ ﺩﻧﺒﺎﻝ ﺗﺮﻭﻣﺎ ﺑﺮﺍﻱ ﺍﻃﻔﺎﻝ ﺍﻧﺠﺎﻡ ﺷﺪ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﻣﻄﺎﻟﻌﺔ ﺣﺎﺿﺮ ﺑﻪ ﺻﻮﺭﺕ ﮔﺬﺷﺘﻪ ﻧﮕـﺮ ﺍﻧﺠﺎﻡ ﺷﺪ. ﺗﻤـﺎﻣﻲ ﺗﻤـﺎﺱ ﻫﺎﻱ ﺑﺎ ﺍﻭﺭﮊﺍﻧﺲ 115 ﺗﻬﺮﺍﻥ ﺑﻪ ﺩﻟﻴـﻞ ﺗﺮﻭﻣﺎ ﺑﺮﺍﻱ ﮐـﻮﺩﮐﺎﻥ ﺳﻨﻴﻦ 15 ﺳﺎﻝ ﻭ ﮐﻤﺘـﺮ ﮐﻪ ﺩﺭ ﻓﺎﺻﻠﻪ ﺯﻣﺎﻧﻲ ﺑﻬﻤـﻦ ﻣﺎﻩ 1384 ﻟﻐـﺎﻳﺖ ﺍﺭﺩﻳﺒﻬﺸﺖ 1385ﺛﺒﺖ ﺷـﺪﻩ ﺑﻮﺩ، ﺑﺮﺭﺳﻲ ﮔـﺮﺩﻳﺪ. ﺩﺍﺩﻩ ﻫﺎﻱ ﺩﻣـﻮﮔﺮﺍﻓﻴﮏ، ﻧﻮﻉ ﺣﺎﺩﺛﻪ، ﺷﺎﺧـﺺ ﻫﺎﻱ ﺯﻣﺎﻧﻲ ﺧﺪﻣﺎﺕ ﺍﻭﺭﮊﺍﻧﺲ ﻭ ﭘﻴﺎﻣـﺪ ﭘﻴﺶ ﺍﺯ ﺑﻴﻤﺎﺭﺳﺘـﺎﻥ )ﻣـﺮﮒ( ﺑﻴﻤـﺎﺭﺍﻥ ﺛﺒﺖ ﮔﺮﺩﻳﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﻃﻲ ﺍﻳﻦ ﻣـﺪﺕ، 335 ﻣـﻮﺭﺩ ﺗﻤـﺎﺱ ﺑﻪ ﺩﻟﻴﻞ ﺗـﺮﻭﻣﺎﻱ ﺍﻃﻔـﺎﻝ ﺑﺎ EMS ﺗﻬﺮﺍﻥ ﺍﻧﺠـﺎﻡ ﺷﺪﻩ ﺑﻮﺩ. ﺍﺯ ﺍﻳﻦ ﺑﻴﻦ 211 ﻣﻮﺭﺩ ﻣـﺮﺑﻮﻁ ﺑﻪ ﭘﺴﺮﺍﻥ ﺑﻮﺩ. ﻣﺤـﺪﻭﺩﻩ ﻭ ﻣﻴﺎﻧﮕﻴـﻦ ﺍﻧﺤـﺮﺍﻑ ﻣﻌﻴﺎﺭ( ﺳﻨﻲ ﺑﻴﻤـﺎﺭﺍﻥ ﺑﻪ ﺗﺮﺗﻴﺐ ﺑﺮﺍﺑﺮ 1 -15 ﻭ 3/6 ± 11/3 ﺳﺎﻝ ﺑـﻮﺩ. ﺗﺼﺎﺩﻓﺎﺕ ﺑﺎ 197 ﻣـﻮﺭﺩ )58/8%(، ﺷﺎﻳﻊ ﺗﺮﻳﻦ ﻧﻮﻉ ﺣﺎﺩﺛﻪ ﺑـﻮﺩ. 9 ﺑﻴﻤـﺎﺭ )5/1 ﭘﻴﺶ ﺍﺯ ﺭﺳﻴﺪﻥ ﺁﻣﺒﻮﻻﻧﺲ ﺑﻪ ﻣﺤﻞ ﺣﺎﺩﺛﻪ ﻓﻮﺕ ﮐﺮﺩﻧﺪ، ﺍﻣﺎ ﺩﺭ ﺣﻴﻦ ﺍﻧﺘﻘـﺎﻝ، ﻫﻴـﭻ ﺑﻴﻤﺎﺭﻱ ﺩﺭ ﺁﻣﺒـﻮﻻﻧﺲ ﻓـﻮﺕ ﻧﮑﺮﺩ. ﻣﻴﺎﻧﮕﻴـﻦ ﺯﻣﺎﻥ ﺭﺳﻴﺪﻥ ﺑﻪ ﺑﺎﻟﻴﻦ ﺑﻴﻤﺎﺭ ﺑﺮﺍﺑﺮ 6/2 ± 14/7 ﺩﻗﻴﻘﻪ ﺑﻮﺩ. ﺑﻴﻤـﺎﺭﺍﻥ ﻓـﻮﺕ ﺷـﺪﻩ ﺩﺭ ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﺑﻴﻤـﺎﺭﺍﻥ ﺯﻧﺪﻩ ﺭﺳﺎﻧﺪﻩ ﺷـﺪﻩ ﺑﻪ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺩﺍﺭﺍﻱ ﺯﻣﺎﻥ ﺭﺳﻴﺪﻥ ﺁﻣﺒﻮﻻﻧﺲ ﺑﻪ ﺑﺎﻟﻴﻦ ﮐﻮﺗﺎﻩ ﺗﺮﻱ ﺍﺯ ﻧﻈﺮ ﺁﻣﺎﺭﻱ ﺑﻮﺩﻧﺪ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺩﺭ ﺗﻬﺮﺍﻥ، ﺗـﺮﻭﻣﺎ ﻋﻠﺖ ﺣـﺪﻭﺩ ﻳﮏ ﺳﻮﻡ ﺍﺯ ﺗﻤـﺎﺱ ﻫﺎﻱ ﻣﺮﺑﻮﻁ ﺑﻪ ﺍﻭﺭﮊﺍﻧﺲ ﭘﻴﺶ ﺑﻴﻤﺎﺭﺳﺘﺎﻧﻲ ﺍﻃﻔﺎﻝ ﺭﺍ ﺑﻪ ﺧﻮﺩ ﺍﺧﺘﺼﺎﺹ ﻣﻲ ﺩﻫـﺪ، ﮐﻪ ﻧﺸﺎﻥ ﺩﻫﻨﺪﻩ ﺗﻮﺟﻪ ﺳﻴﺴﺘـﻢ EMS ﮐﺸﻮﺭ ﻭ ﺑﺮﻧﺎﻣـﻪ ﺭﻳﺰﻱ ﻫﺎﻱ ﻣـﺆﺛﺮ ﻭ ﮐﺎﺭ ﺁﻣﺪ ﺳﻴﺴﺘﻢ ﺑﻬﺪﺍﺷﺘﻲ ﮐﺸﻮﺭﻣﺎﻥ ﺟﻬﺖ ﺍﺭﺗﻘﺎﻱ ﺍﻳﻦ ﺑﺨﺶ ﺩﺭ ﮐﻮﺩﮐﺎﻥ ﻣﻲ ﺑﺎﺷﺪ. ﺍﮔﺮ ﭼﻪ ﺷﺎﺧﺺ ﻫﺎﻱ ﺯﻣﺎﻧﻲ ﺍﺭﺍﺋﻪ ﺧـﺪﻣﺎﺕ ﺑﻪ ﺍﻭﺭﮊﺍﻧﺲ ﭘﻴﺶ ﺑﻴﻤﺎﺭﺳﺘﺎﻧﻲ ﺩﺭ ﻣﻘﺎﻳﺴﻪ ﺑﺎ ﺑﺮﺧﻲ ﺍﺯ ﮐﺸﻮﺭﻫﺎ ﻣﻨﺎﺳﺐ ﺗﺮ ﻣﻲ ﺑﺎﺷﺪ، ﺍﻣﺎ ﺑﺎ ﻭﺿﻌﻴﺖ ﺍﻳﺪﻩ ﺍﻝ ﻓﺎﺻﻠﻪ ﺩﺍﺭﺩ، ﻭ ﻧﻴﺎﺯﻣﻨﺪ ﺑﺮﻧﺎﻣـﻪ ﺭﻳﺰﻱ ﻣﻲ ﺑﺎﺷﺪ. ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺍﻳﻨﮑﻪ ﻃﺒﻖ ﻣﻄﺎﻟﻌﺔ ﺣﺎﺿﺮ، ﮐﺎﻫﺶ ﺯﻣﺎﻥ ﺍﺭﺍﺋﻪ ﺧﺪﻣﺎﺕ ﺁﻣﺒﻮﻻﻧﺲ ﻫﺎ ﺑﻪ ﮐﻮﺩﮐﺎﻥ ﺩﭼﺎﺭ ﺗـﺮﻭﻣﺎ ﺑﺎ ﮐﺎﻫﺶ ﻣﻌﻨﻲ ﺩﺍﺭ ﻣـﺮﮒ ﻭ ﻣﻴﺮ ﻫﻤـﺮﺍﻩ ﺍﺳﺖ، ﺿﺮﻭﺭﺕ ﭼﻨﻴﻦ ﺗﻼﺷﻲ ﺩﻭ ﭼﻨﺪﺍﻥ ﻣﻲ ﻧﻤﺎﻳﺪ.

Introduction & Objective: Trauma is one of the leading causes of children death after 1 year old. Providing that, pre-hospital emergency care for children is still a health problem. Current study was conducted with the aim of assessment of causes, and early outcomes of pediatric ambulance runs in Tehran. Materials & Methods: Current study was a cross, sectional study. All ambulance runs for patients under 16 years between 4 months during 2005 and 2006 was assessed for demographic data, cause of call and very early outcomes. Results: In 335 calls, the cause of EMS call was pediatrics trauma. From these, 211 (63%) was for males. Mean (+ SD) age was 11.35 ± 3.65. Traffic accidents was the cause in 197 (58.5%), 9 subjects (5.1%) died before ambulance arrival, but no one died in the way to the hospital. Mean response time was 14.75 ± 6.29. Response time was significantly shorter in those who survived to hospital (18.4 ± 3.8 vs. 14.6 ± 6.6, p=0.05). Conclusions: In Tehran, one from 3 of ambulance runs for pediatric patients is due to trauma. This highlights the need for planning of health care providers in order to improve health care services in this field. Although the time intervals for ambulance arrival are somewhat accepted in comparison to some countries, but it is still far from the standards and recommended levels. According to this study shortening the response time can improve prehospital survival.