CONCEPTION, MANAGEMENT, ORGANIZATION
Proposal of concept of training for school employees in the area of first aid
Primary and secondary schools have legislatively given duties in the area of giving first aid to their employees and students and also in ensuring the education of their students in this sphere. However, there is a lack of standards which would unambiguously define the content and extent of the employees and students education in first aid in context of the current system of prehospital emergency care. We present outputs of educational projects which have been focused on the complex treating of first aid for school needs in this article. We also introduce a draft concept of training for school employees and educational institutions and of proper methodology which we have prepared for this purpose and which we have tested on a target group within the project.
NATO Advanced Research Workshop: Hospitals under Fire – Planning and Operating a Hospital under Fire and Extreme Circumstances
Leo Klein, Moshe Michaelson, Gila Hyams
Whether caused by terrorism or natural disasters, mass casualties have become a contingency that must be faced by all hospitals, regardless of size. To address this issue, the NATO Partnership for Peace and the Mediterranean Dialogue programs organized three workshops in Haifa, Israel. The first was held in 2005, the second in 2009, and the third in November 2014. The objective of the last workshop was to bring together experts in the field of trauma medicine and trauma health care services, both military and civilian, to discuss methods for providing timely, effective, and efficient health care in mass casualty situations. Issues discussed included, but were not limited to: (1) hardening existing infrastructure or building new infrastructure (including communication and computer infrastructure) to resist damage from terrorism, or man-made/natural disasters, (2) use of disaster simulations and drills to prepare for mass casualties, (3) use of field hospitals to provide point-of-injury care, and (4) health care logistics for mass casualty events. Given that mass casualty situations are not everyday occurrences, the workshop also addressed the issues of cost of constant readiness, and cost of infrequent use. Preparing for mass casualty situations represents a complex sociopolitical, organizational and logistical problem. It requires co-operation at multiple levels of government and among both civilian and military health care services. A mass casualty event can occur at any time, which makes preparedness not only essential, but also an urgent precondition.
CLINICAL TOPICS AND RESEARCH
Management of acute exacerbation of chronic obstructive pulmonary disease
Darina Kováčová, Oto Masár
Health care professionals both in prehospital emergency care and in emergency departments face patients with acute exacerbation of chronic obstructive pulmonary disease more often. Precise diagnostics is due to limited diagnostic means difficult in the field. Delay in adequate therapy can have negative influlence not only for survival but also for quality of patient´s life. The presented article is a review for emergency physicians about problematics of this serious condition.
Evaluation of cooperation between Emergency medical service of the Vysočina region and University hospital´s Brno Bohunice traumacenter
Tomáš Vaňatka, Kateřina Vaníčková
Introduction: Cooperation between Emergency medical service and traumacenter and its evaluation is essential for quality of care of patients with trauma.
Methods: A retrospective analysis of 160 patients with ISS > 16 transported by helicopter and ground emergency medical service and admitted to traumacenter is presented in this article. We have analysed these parameters: time on scene and transport time, volumotherapy, koagulopathy associated with the amount of fluids, in traumacenter we have analysed lactate and hemoglobin levels and ISS (Injury Severity Score), in the prehospital phase airway management associated with hypoxia and in the year 2014 body temperature on admission, too.
Results: The most advantageous type of transport for patients is the primary HEMS run, activation by ground EMS team is disadvantageous and extends the time on scene and transport time. Fluid volume over 1500 ml increases the risk of coagulopathy, there is also an influence of volumotherapy on patient´s body temperature decrease. Nevertheless we have observed higher surival of patients with lacate level over 5 on admission in the year 2014 compared to 2013 (78 % versus 31 %).
Discussion: We have found association between fluids administered to the patients and coagulopathy occurence (median 1500 ml) and there is also a clear association between amount of administered fluids and patient´s body temperature decrease. There is profit for patients with ISS > 16 in case of primary HEMS transport compared to other types of transport. We have confirmed the lactate level as a shock state predictor. Hemoglobin level is associated with coagulopathy but not as a sole cause. New methods and procedures included in the trauma management has increased the patients´ survival.
Conclusion: We have prepared a new traumaprotocol which helps to improve evaluation of traumacenter and EMS cooperation. We have also started cooperation with Military hospital in Prague Střešovice.
Differences in Helicopter emergency medical service´s utilization in the Czech Republic
The aim of the study was to compare the use of air ambulance (HEMS) at various bases in the Czech Republic in relation to population of native catchment area. Comparing of the results suggest the existence of a huge difference between the use of individual helicopter bases. The cause of this difference is unclear, but may be a signal of irrational use (under-, as well as overuse) of this extremely expensive service. It would be appropriate to establish, monitor and publish a set of performance parameters in order to monitor appropriate use of the service.
Five years of traumatological triage in Emergency Medical Service practice in the Czech Republic
Zdeněk Tlustý, Patrik Merhaut
Retrospective analysis of EMS care of patinents with injuries during year 2014 shows the functional pre-hospital triage of injured patients in the Central Bohemian region. It compares practice before using the triage with the present system.
How do we provide cardiopulmonary resuscitation?
Táňa Bulíková, Patrícia Krajňáková, Gabriel Tomko, František Majerský
Rescue competition RESCUE LESNICA in Slovenský ráj region has tradition of more than ten years and EMS professionals like it. The last year´s competition which took place on 19 th September 2014 it was stated the Slovak championship in cardiopulmonary resuscitation (CPR). The authors present the results and analysis. The goal of the competition was to evaluate optimal parameters of CPR: adequate volume and rate of breaths, depths and frequency of compressions, correct hand position and complete release. Tables and graphs together with complete analysis of CPR of the 28 teams are presented. The team consisted of two members – Emergency medical technician, physician, dispatcher or student were the team members. One team consisted of untrained lay persons. There were differences in knowledge and skills of the teams. The best teams reached in all evaluated items 100 % or nearly 100 % (adequate volume of breaths, rate of breaths, depths and frequency of compressions, correct hand position and complete release), while the worst teams were under 30 %.
A book review Masár, O. et al.: Chapters from general medical practice
A book review Táňa Bulíková: ECG for non-cardiologists