PubMed · 15156677
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Gene Gandy. 2004. Immobilization errors in EMS.. https://pubmed.ncbi.nlm.nih.gov/15156677/
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BACKGROUND: Our aim was to better understand why inhabitants in a typical Norwegian town use out-of-hours services in primary care, and whether introduction of a patient list system (Fastlegeordningen) in 2001 had any influence on this choice. We analyzed changed use of out-of-hours service in Stavanger, Norway (approx. 110,000 inhabitants) from 1989 to 2002. METHODS: Changes in the number of consultations and home visits between 4 to 11 pm seven days a week, were assessed in the light of changes in operational presumptions for both the out-of-hours service and the family physicians' day-time service. RESULTS: There was a steady increase in the number of consultations and home visits from 1989 to 1997, except for in 1994. The absolute increase in the proportion of the population who sought this kind of care was 4.6%, i.e. a relative increase of 20%. From 1997 to 2002, there was an absolute decrease in consultations and home visits of 5.3%, or a 19% relative reduction. The percentage of patient encounters in patients' homes, decreased from 25% in 1989 to 11% in 2002. The number of consultations and home visits in the evenings during the first 17 months after the list system was introduced, decreased (absolute value) with 2.2% (1.7-2.6), i.e. a 10% relative decrease, as compared to those during a similar period two years earlier. INTERPRETATION: A 20 % change in the use of out-of-hours service during few years, indicates that patients have used the service for other purposes than the intended emergency care. The demand for out-of-hours service is most influenced by the availability of primary care physicians during daytime. The list system has most likely encouraged both doctors and patients to promote the "personal doctor" to solve everyday health emergencies during the day.
The major goal of a trauma system is to enhance the community health. This occurs through a process of assessment, policy development, and ongoing assurance. This can be achieved by (1) identifying risk factors in the community and creating solutions to decrease the incidence of injury, (2) providing optimal care during the acute and the late phase of injury, including rehabilitation, and (3) maintaining the objective to decrease overall injury-related morbidity and mortality and years of life lost. Disaster preparedness also is an important function of trauma systems, and using an established trauma system network facilitates the care of victims of natural disasters or terrorist attacks.
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