Volume 24, Issue 6 (Feb - Mar 2021)                   2021, 24(6): 510-519 | Back to browse issues page


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Namdar P, Kazemifar A M, Mohammadi M. The Accuracy of Diagnosis and Treatment Made by Pre-hospital Emergency Medical Technicians in Patients Admitted to Hospitals in Qazvin, Iran. Journal of Inflammatory Diseases. 2021; 24 (6) :510-519
URL: http://journal.qums.ac.ir/article-1-3128-en.html
1- Department of Surgery, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.
2- Student Research Committee, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. , mahsamohammadi@gmail.com
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1. Introduction
he main goal of the emergency system is to quickly and accurately perform the correct treatment measures instead of trying to reach an accurate diagnosis, because the initial treatment measures are always a priority in the emergency patient. On the other hand, reaching a definitive diagnosis requires high skill, while following the instructions allows pre-hospital technicians to obtain the necessary training in basic emergency medical care courses in a shorter time of 4 to 5 months compared to physicians [21]. It is also a major challenge for staff of emergency medical services to make decisions on the scene, because their ability and skill for such decisions has been questioned compared to a general practitioner [22]. Triage is essential for the initial clinical evaluation and classification of all patients referred to the emergency department to provide the most appropriate treatment [23]. An incorrect triage will result in wasted resources, overuse of ambulance transport to hospitals, limited availability of ambulances, overcrowding of emergency centers, delays in patient treatment, dissatisfaction, and adverse outcomes, while a correct triage can be useful in determining the line of treatment for patients, and facilitating the process of stabilizing their conditions and their admission [27]. Therefore, a correct on-site diagnosis can lead to better use of resources. Considering the importance of correct diagnosis in increasing the efficiency and quality of patient care services and reducing mortality and costs and given that no similar study has been conducted in Qazvin city, this study aims to determine the accuracy of pre-hospital Emergency Medical Technicians (EMTs)’ diagnosis and treatment in Qazvin, Iran.
2. Materials and Methods
This is a descriptive epidemiological study. The study population includes all patients admitted to BuAli Sina and Velayat hospitals in Qazvin, Iran during March-June 2018 (n=3200). Of these, 600 were selected randomly for the study. The sample size was determined using Cochran’s formula. The required information about the patient’s age and sex, and diagnoses and treatment measures were extracted from the emergency information sheet. Education, work experience and amount of in-service training of pre-hospital EMTs were collected based on their information registered in the Emergency Medical Center. Diagnosis and final treatment measures of patients were extracted from their files and compared with the diagnosis and initial treatment measures mentioned in the information sheet and the result was analyzed. After collecting data, all patient information was recorded in a checklist by the project manager. Data were analyzed in SPSS V. 23 software using ANOVA, Chi- square and t-test.
3. Results
Out of 600 cases, 71.7% of the initial diagnoses made by pre-hospital EMTs were correct, 8.5% were incorrect, and 19.8% were without initial diagnosis. Regarding the treatment performed by EMTs, 65.8% were correct, 3.5% were incorrect, 71.7% were without treatment, and 2.3% had incomplete treatment. The highest percentage of medical procedures with 100% correct treatment was related to EMTs who had more than 26 years of related work experience. However, according to ANOVA results, there was no significant difference between the history of work experience and the accuracy of treatment (P=0.455).
4. Discussion and Conclusion
In the study by Bahrampour et al., diagnosis of stroke made by EMTs was correct in 15 patients (34.9%), wrong in 20 patients (46.5%), and in 8 (18.6%) no diagnosed was made [27]. In the study by Shakeri et al., EMTs were in a good level in most skills, but they need to receive the necessary training in two skills in which they had no sufficient score [28]. In our study, the effect of in-service training on the accuracy of diagnosis and treatment in pre-hospital EMTs was reported. The highest rate of accurate diagnosis was related to EMTs with high school diploma (77.77%) and the highest rate of accurate treatment was related to EMTs with associate degree (67.47%) followed by those with bachelor’s degree (61.48%). Haner et al. examined the role of physician–staffed ambulances and showed that higher level of education increases the possibility of better selection and correct diagnosis. 
This study was conducted due to the importance of correct pre-hospital diagnosis and treatment in increasing the efficiency and quality of patient care services and reducing mortality rate and costs. Regardless of the issue of prevention, which is the most effective factor in reducing mortality and injuries, studies have shown that the prompt help and diagnostic and treatment measures of pre-hospital EMTs can significantly reduce mortality and potential injuries. In this study, the significant effect of education and the work experience on the accuracy of pre-hospital EMTs’ diagnostic and therapeutic measures was reported.

Ethical Considerations
Compliance with ethical guidelines

This study was approved by the Ethics Committee of Qazvin University of Medical Sciences (Code: IR.QUMS.REC.1397.252). All ethical principles were observed in this study.

Funding
This article was extracted from the MD. dissertation of third author at the Student Research Commiwttee, School of Medicine, Qazvin University of Medical Sciences, Qazvin. 

Authors' contributions
All authors contributed equally in preparing this paper.

Conflict of interest
The authors declare no conflict of interest.

Acknowledgement
We would like to thank the esteemed officials of Qazvin University of Medical Sciences and all colleagues, nurses and patients participating in the study.


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Type of Study: Research | Subject: Emergency Medicine

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