Quality of diagnosing acute poisoning by ambulance paramedics

Aim. The assessment of quality of diagnosing acute poisoning by ambulance paramedics.

Methods. Retrospective analysis of the rate of diagnostic discrepancies and undifferentiated diagnoses in 1 242 patients delivered by ambulance paramedics of Kazan to the hospital with the diagnosis of acute poisoning.

Results. Referral diagnosis of acute poisoning among patients delivered by ambulance paramedics to the diagnostic department of the hospital was not confirmed in 792 cases, among which in 683 cases admission was not needed due to the absence of indications. Among refusals of hospitalization the majority of patients (70.8 %) were in the state of intoxication of various etiologies and healthy patients. In 8.5 % of cases of diagnostic discrepancies of acute poisoning paramedics delivered to the hospital patients with severe urgent somatic pathology - urosurgical, neurological, surgical, therapeutic, etc. The rate of diagnostic discrepancies in the group of alcohol, drug, undefined substances and mushroom intoxication was higher - 71.5 %, than in the group of medication and carbon monoxide intoxication - 39.7 %. In poisoning with impaired consciousness a direct dependence of the rate of diagnostic discrepancies on the rate of impaired consciousness was observed. The rate of undifferentiated diagnoses in the first group of poisoning was also higher - 82.3 %, than in the second group - 45. 8%, but no dependence on the impairment of consciousness was observed among patients.

Conclusion. High rate of diagnostic discrepancies (63.8 %) and undifferentiated diagnoses (71.1 %) are the consequence of lack of competence in medical toxicology among ambulance paramedics. In 98.2 % of cases, the probable etiological diagnosis of the disease, suspected as acute poisoning, in the study group of patients could be diagnosed using diagnostic methods available for paramedics.