T Spichiger1, A Fiorentino2, S Dénéreaz1, S Vuilleumier2
1. ES ASUR, Vocational Training College for Registered Paramedics and Emergency Care, CH-1052 Le Mont-sur-Lausanne
2. La Source, School of Nursing, University of Applied Sciences and Arts of Western Switzerland (HES-SO), CH-1004 Lausanne
As in many European countries, Switzerland is experiencing a major shift in health issues due to aging population and the constant increase of chronic diseases. Consequently, ambulance interventions have drastically raised, challenging the emergency system1. This shift is associated with a large proportion of patients having a low severity score (patient NACA score 0-3), which accounts for more than 80% of the ambulance interventions (Figure 1).
The paramedic’s role, initially aimed at responding to life-threatening situations, may now be challenged by the ongoing epidemiologic changes in the population.
Our study investigates the adequacy of paramedic skills to respond to this unpreceded raise of non-urgent patients.
Figure 1. Prehospital NACA score distribution in Vaud canton Switzerland
in 2017, primary interventions. Source: Direction Générale de la Santé
Vaud (2018) [Personal Communication].
The National Advisory Committee of Aeronautics (NACA) score is used by
EMS in Vaud canton to grade the severity of a patient’s illness or injuries2.
For instance, a NACA 0 is assigned to a patient with no injury or disease
while a NACA 5 means acute threat to life.
A literature review, including grey literature, was undertaken. Interviews were conducted with emergency healthcare providers, Swiss Paramedics Association executives, educational programs managers and Public Health representatives.
Figure 2. Focus groups by profession: perceptions and conceptions about emblematic situations in low NACA score patient management by the paramedics.
References:
1. Pittet, V., Burnand, B., Yersin, B., & Carron, P. N. (2014). Trends of pre-hospital emergency medical services activity over 10 years: a population-based registry
analysis. BMC Health Serv Res, 14, 380. doi:10.1186/1472-6963-14-380
2. Darioli V., Taffé P., Carron PN., Dami F., Vallotton L., Yersin B., Schoettker P., Pasquier M. (2018). Evaluation of the discriminative performance of the
prehospital National Advisory Committee for Aeronautics score regarding 48-h mortality. Eur J Emerg Med. 2018 Oct 10. doi: 10.1097/MEJ.0000000000000578