THEME OF THE YEAR: SEVERE TRAUMA
On-scene risk triage of trauma patients and referral to facility of definite care
Ministry of Health Newsletter
Severe trauma – adpatation mechanisms, general principles of care
Prehospital management of multiple trauma in Emergency Medical System in Slovakia
Approximately 4 million people die worldwide every year due to accident and serious injury. Although a large proportion of patients with serious injury die on scene and in prehospital care, various sources indicate that 44 % of deaths occur after admission to hospital. Approximately one third of deaths (early death) caused by trauma is due to serious bleeding. Bleeding is an important contributing factor to other causes of death (late ones). Significant cause of so called “preventable death” due to severe trauma is a failure of early and appropriate management of patients with injuries. Early and precise identification of patients at high risk of death and following transport to the right hospital can reduce mortality in severe injuries.
The emergency health care should operate as a holistic and consistent system and in creation and development of it, have to be taken into account scientific analysis and commitment for quality survival of the largest possible proportion of patients.
Effective use of resources is also very important. However, into account, should not only be taken immediate financial effect of that money for kilometers, occupancy rate department, or staff occupancy. We also should consider the quality of survival injured and their ability to be in an active and working life in long-run point of view.
Management of care in severe trauma and the importance of Helicopter EMS in this care
The comparison of primary flights utilization of the HEMS bases in the Czech Republic from the point of view of dispatch classification and indication
Maturation of trauma system of Trauma center Level I
Jaromír Kočí, Jan Trlica, Petr Lochman, Tomáš Dědek
High quality and functional of trauma system is the corner stone of the care of trauma patiens. Tha aim of this paper is the impact of trauma system to the morbidity and mortality of the patiens.
Multiple trauma – risk stratification and scoring systems
In the group of patients with polytrauma and multiple injuries an important part of management in addition to the initial treatment, stabilization of vital functions and the right routing. A necessary condition for a correct routing is sorting and classification and a proper setting in the appropriate risk groups (ie. triage) on the assumption of the risk of death. There is no prehospital forecasting model usually used in Slovakia while the reasonable scoring may be very useful for the proper direction to trauma centre or specialized hospital. In our work we focussed on the analysis, usability and accuracy comparison of scoring systems used abroad. We confirmed that between the severity assessment by ISS anatomically and by GAP clinically is a significant correlation. Due to the limitation of the assessment of the patient’s condition and forecasting the risk by means of ISS system at the place of accident, it becomes apparent that GAP score is a better prognostic indicator of mortality in prehospital care. Literature data were compared with the mortality observed in our study while the proposal of inclusion of GAP in prehospital management of patients with severe injuries in Slovakia have been prepared.
Prehospital care of patients with severe trauma in the Ústí nad Labem Region
The quality of prehospital emergency medical care in the Falck zachranna – restrospective study of quality indicators in traumatic brain injury
Eva Havlíková, Jozef Karaš, Miroslav Humaj, Volodymyr Kizyma, Štefan Trenkler
Introduction: Traumatic brain injury (TBI) is defined as the damage to the skull and the brain caused by external mechanical force, which results in temporary or permanent impairment of central nervous system function associated with varying degrees of disorder of consciousness. Severe TBI is the leading cause of mortality and disability in children and young adults. The aim of the work is to analyze the quality of prehospital emergency medical care in TBI patients managed by Falck rescue crews.
Methods: This is a retrospective study of Falck rescue crews interventions in the year 2015. Quality indicators of crews´ activities on the scene were analyzed based on the recommendation of Slovak Society for Emergency Medicine and Disaster Medicine issued in 2015. Selected time indicators are response time and patient handover target in the hospital. These times were stratified into time slots.
Results: In 2015 overall 1,549 medical reports were analyzed to determine the quality indicators of scene performances. The analyzed indicators were determining the precise mechanism and the circumstances of the TBI, correction of hypoxia, prevention and treatment of systemic hypotension, continuous monitoring of vital functions, cervical spine immobilization of the patient and his transport to proper facilities.
Analysis of time indicators showed the response time median 8:20 minutes for doctor crews and 9:42 minutes for paramedic crews. The patient delivery to a hospital from the scene was achieved within 60 minutes (golden hour) for 76.5% patients.
Discussion: Authors present the selected group of data which could be used as a potential model basis for health policy authorities. Similar analyses are needed for the other First hour quintet diagnoses.
Education of EMS teams with the topic of trauma
Martina Vitková, Jozef Karaš, Eva Havlíková, Ivo Hybrant, Miroslava Citriaková, Volodymyr Kizyma
Falck Záchranná a.s. has created its own Educational and Training Center (ETC) which initially (when founded in 2006) acted as a education gateway to newly recruited staff. Later it has become necessary to implement the continuous medical education of all health workers in the company. Thus, the ETC has grown up to become a standalone component of the prehospital care provider. Its primary concern is to facilitate the implementation of each new device into practice as well as to cover internal needs for training and retraining of all the staff in various professional topics included recommended practices and guidelines. An essential parts of the learning process are the people who carry out training activities, mainly the personnel resources that are actively involved in the process. Crews of the Falck Záchranná a.s. treat over 170,000 patients annually. These large numbers of treated patients require high-quality care provided by the crews, clearly set rules of their management, treatment, organization of the mass causualty incidents. To comply with the required criteria it is necessary to set up a system which would be followed by all the crews on the whole territory of the company services. This is the goal of the educational process and the educational center itself.
Advanced trauma life support (ATLS®) course – why to join?
Jana Kubalová, Jakub Dědek, Jaromír Kočí
In the first part of the article the author describes the Advanced trauma life support (ATLS®) course in Czech Republic – its introduction, basic goals, funding and basic statistical data of the courses past in the Czech Republic. The second part of the article concentrates on validation of ATLS and its importance for outcome of the patient who suffered serious injury. ATLS training significantly increases knowledge and improves practical skills and the critical decision making process in managing multiple trauma patients. Given in the fact is clear reason why ATLS is a part of educational curriculum of Emergency Medicine.
Education of non-medical personnel in the problems of traige positive traumatological patient