Health care quality indicators in emergency medical services
Jozef Karaš, Eva Havlíková
Currently, there is a real need for quality measurement in healthcare. The final goal of healthcare provision is to fulfill the expectations of individuals, patients and all inhabitants of our society. On the other hand, the healthcare should be accessible, effective, safe, cost efficient and compliant to modern medical knowledge. Authors present the quality indicators implemented in the emergency prehospital field, their advantages and limitations are discussed.
Quality of the prehospital care in the Falck zachranna – restrospective study of quality indicators in chest pain management
Eva Havlíková, Jozef Karaš, Miroslav Humaj, Martina Vitková, Volodymyr Kizyma, Štefan Trenkler
Introduction: Chest pain belongs to the First hour quintet diagnoses. It is a general term for unpleasant subjective dyscomfort in the chest. It covers the whole spectrum of sensations starting from burning, stinging or squeezing to a stabbing dyscomfort which the patient is unable to describe further. The cause could be a life threatening condition as well as a „trivial“ situation. Acute coronary syndrome (ACS), a condition associated with a poor prognosis and high risk of mortality, may be presented as a chest pain. The ACS patient requires a prompt professional examination and subsequent provision of proper medical care. The aim of the work is to analyze the quality of prehospital emergency medical care in chest pain patients managed by Falck rescue teams.
Methods: This is a retrospective study of interventions provided by Falck rescue teams in the years 2012–2014. Quality indicators of the teams´ medical activities on scene were analyzed based on both the Ministry of Health Methodological guidelines for reperfusion treatment of acute myocardial infarction with ST segment elevation, No. 17207 / 2007 and the updated Recommendation of the Slovak Society of Cardiology and the Slovak Society for Emergency Medicine and Disaster Medicine from 2013. The selected time indicators were EMS response times and patient handover times in the hospital. These times were stratified into time slots.
Results: Overall 1,759 in the year 2012, 1,489 in the year 2013 and 927 in the year 2014 medical reports were analyzed to determine the quality indicators of scene performances. The analyzed data included the parametres such as determining of precise onset of symptoms, taking of 12-lead ECG within 10 minutes on the scene, monitoring of vital functions, realization of intravenous access and crystalloid administration, proper oxygenotherapy and transport to facilities.
Analysis of time indicators was based on the 9,049 interventions in 2012, 8,778 in 2013 and 7,552 in 2014. Response time median in 2012 was 8:30 min, in 2013 – 8:18 min and in 2014 – 8:56 min.
Discussion: Authors present the selected groups of data which could be used as a potential model basis for health policy authorities. Similar analyses need to be fulfilled for the other First hour quintet diagnoses.
Major disasters and Emergency Medical Services´ activity in some European countries
Irena Švarcová, Josef Navrátil, Vlasta Neklapilová
The author compares some selected activities of Emergency Medical Services in mass-casualty emergencies in Norway, the UK, Spain and the Czech Republic. Emergency preparedness plans, procedural steps applied in emergencies with a large number of victims give rescue teams a theoretical framework for their work at the scene of injury. The correctness and practicality of such plans will only be tested under real emergency conditions. The analysis of published studies showed not only positive responses to EMS performance during emergencies, but also shortcomings in the legislation, equipment availability or on-site intervention management of individual countries. The submitted information may also be the impetus for establishing appropriate metrics applicable to the assessment of the quality of EMS preparedness for emergencies.
Preparing the Next Generation of Health Aid Workers: Humanitarian Disaster Simulations
Sarah Kesler, Eric James, Ed Lord
Simulations provide an excellent way to experiment with new methods, build skills of seasoned workers and develop new professionals. This learning methodology remains a relatively new approach used in international humanitarian response. The University of Minnesota conducts an interdisciplinary three-day course on the basics of Humanitarian Relief. Now in its fourth year, the majority of the course is presented in a simulation based format. Student participants are presented with a plethora of humanitarian challenges that closely match the “real world” for an accelerated and rewarding learning experience. We describe in more detail the objectives of the course and the logistics of how it is conducted.
Crisis preparedness of health care facilities
Doleček Martin, Urbánek Pavel, Koukal Antonín
Hospitals are among the institutions involved in liquidation of consequences of emergencies with mass disabilities of health. Coherence and uniformity of the concept of emergency preparedness plans of hospitals complicates their variability in terms of the extent and type of care, including complex centers’ care. Another big problem is either no or minimal experience with emergencies and mass-income of patients. Purely theoretical grounding in these cases is not sufficient. It is very useful to have practical experience in real situations, or at least be able to see in practice how to solve specific pitfalls in emergency planning in other facilities with the possibility of transferring this information to specific situations of own hospital facilities. Another pitfall in practice is that the creation of emergency preparedness plans must involve more experts from different departments, including medical staff. Thus, all those who are involved in creating plans, should have experience with that, which especially for smaller devices is unrealistic. Educational program „The readiness of health facilities to emergencies and crisis situations“ aims to eliminate these problems in preparing hospitals for emergencies with mass disabilities of health and to train all staff of hospitals that may take part in the development of plans of the emergency preparedness from nurses after to managers.
CLINICAL TOPICS AND RESEARCH
Telephone assisted resuscitation: evaluation of its effectivity and event analysis in Hradec Králové Region in the year 2014
Michal Plodr, Monika Praunová, Vladimír Švába, Jaroslava Krenčíková, Dana Bejrová, Zdeněk Hrstka, Libor Seneta, Jiří Mašek, Jiří Páral
Objective: The analysis of the emergency calls with dispatch-assisted CPR helps to follow and compare the effectiveness of the dispatchers’ procedures as well as to set up standards for evaluation of a quality management system.
Design and methods: We reviewed dispatch recordings of 552 identified out-of-hospital cardiac arrests (OHCA) by dispatchers between January 1, 2014 and December 31, 2014. The group was divided to the confirmed cardiac arrests and non-confirmed cardiac arrest subgroup. Evaluation with regard to recognition of OHCA and survival rate to hospital discharge with a good neurological status (CPC 1,2) was performed.
Results: Out of 552 calls with DA-CPR the confirmed cardiac arrest was in 418 cases and 134 cases with non-confirmed cardiac arrest. The median time to cardiac arrest identification was 39 s, the median time to the first chest compression was 2 min 30 s. The overall survival rate to hospital discharge (CPC 1,2) was 8, 4 %, resp. 34 % for patients with initial fibrillation.
Conclusion: Cardiac arrest is identified by dispatchers within the recommended one minute, but the first chest compression is still delayed. A good prognosis for the patients with initial fibrillation was proved. Emphasis on dispatchers´ continual education is highly recommended.
ETHICS, PSYCHOLOGY, LAW
Aggression and emergency health care professionals
Veronika Karolína Netušilová, Tibor A. Brečka
Aggression has many different types and forms. As a possible prevention of escalation of aggression against health professionals providing care in the first line, there is important to determine sources of aggression. Respondents – paramedics from emergency medical services – have themselves identified possible sources of the most common triggers of aggression towards themselves as healthcare professionals.
CZECH RESUSCITATION COUNCIL
Czech Resuscitation Council Newsletter
Sudden cardiac death in adults during sport activity: a quite rare event
Czech Resuscitation Council´s President Anatolij Truhlář, MD about RESUSCITATION 2015