CONCEMPTION, MANAGEMENT, ORGANIZATION
Out of hospital cardiac arrest: the outcomes of systematic developement in prehospital emergency medical care between 2012 and 2016 in Karlovy Vary region
Vojtěch Míra, Metoděj Renza, Aneta Fridrichovská, Roman Sýkora
Introduction: Current progress in care of out-of-hospital cardiac arrest (OHCA) is the cornerstone of and offers main parame¬ters in quality assesment of prehospital emergency care. There was implemented a bundle of changes in the system of care, edu¬cation and use of technical support and procedures from 2012 till 2015 in Karlovy Vary region Emergency medical service (EMS).
Aim: To evaluate the effect of EMS (see note bellow) systematic changes in prehospital emergency care, education a technical equipment on care of OHCA patiens by retrospective observation.
Methods: The list of changes in the period from March 2012 to November 2015 consits of: overall increase in number of EMS stations, impementation of physician crews rendez-vous system, dramatic decrease in physician based ambulance crews and vice versa increase in paramedic crews (without physician), education of all providers including medical dispatchers in guideli¬nes on cardiopulmonary resuscitation (CPR), internal standards for CPR, feedback evaluation of skills, improvement in technical equipment and recommendation to transport patiens after return of spontaneous circulation to cardiac arrest recieving centres (CARC). Data of all patients before the changes implementation (group CONTROL) and after its adaptation in practice (CHAN¬GE) were analysed to extract all the patients with OHCA and indication to CPR. Parameters were: response times, type of crews first on site and starting CPR, process of CPR, guidance adherence, use of trained competencies of paramedics, use of novel technologies, procedures and adherence to CARC recommendation.
Results: CONTROL (n=55) was extracted out of 6033 and CHANGE (n=52) of 8658 patient records from defined three month period before and after all the changes.
No difference in response times was observed between groups, but the CHANGE group had significantly more willingness of bystanders to CPR, the first on site were more often paramedics crews and started CPR alone, without physician. As well, the use of competencies of paramedics increased (laryngeal mask introducing, EtCO2 monitoring, intraoseal access use, LUCAS II) but in general there was no difference in following CPR guidelines. No difference was observed in patient transported do CARC and the duration of unsuccessfull CPR did not differ between two groups.
Conclusion: Changes in EMS system in Karlovy Vary region led to increase of willingness of bystanders to CPR, paramedics crews are first on site and start the CPR. The paramedic crews more often use their competencies and all this together did not affect the clinical outcome in negative way and highlihts the standardized aproach to OHCA.
(note: the main difference to anglo-american EMS systems is that paramedic crews in Czech Republic do exist, but their competencies are strictly defined and can be considered as very low and special physicians supervision is needed to bring a broad range of additional skills such as use of pharmacotherapy that is beyond the paramedics skills).
How do we provide cardiopulmonary resuscitation III?
Táňa Bulíková, Martina Vítková, Gabriel Tomko, František Majerský, Marek Žifčák, Ján Zoričák
Rescuer Competition RESCUE LESNICA has a long tradition, it is popular and frequented by the rescuers. Author of the report presents an analysis of III. Slovak Championship in CPR. It is a contest of pairs composed of a student, a driver – paramedic, a paramedic, an operator or doctor. 10 minute CPR with artificial pulmonary ventilation using a bag mask is rated. The goal is to verify the optimalisation of the CPR performed by healthcare professionals working in prehospital emergency health care. Rated individual steps are processed in tables and graphs that are in the second section compared to last years championship.
Záchrana 2016 in Humenné. In medias res. Analysis of Competition Tasks
Táňa Bulíková, Viktor Korba
The article deals with the analysis of Slovak national competition of teams of Emergency medical services professionals – Zá¬chrana 2016 (XXV. year), held in autumn in Humenne. The competition is organised by Falck Záchranná a.s. with the Association EMS under the auspices of the Ministry of Health of the Slovak Republic in cooperation with the Dispatch Centre and the Slovak Society of Emergency and Disaster Medicine.
The competition of paramedic teams and teams with physicians are the same or the cometences are specified at the begining of the task. The autor briefly describes the competition tasks and ideal solution of the tasks. The drawbacks in the performance of individual tasks are given and the results with crew doctor, without crew doctor are compared. Achieved mean scores gained by the crews are processed graphically for each task.
CLINICAL TOPICS AND RESEARCH
Jana Šeblová, Aleš Tomek, Milan Ticháček, Roman Gřegoř, Jiří Knor, Anatolij Truhlář, Marek Slabý, Ilja Deyl, Ondřej Franěk, Pavel Urbánek, Petr Hubáček, Jaromír Kočí, Roman Škulec, Ondřej Škoda, Michal Bar, Roman Herzig, Robert Mikulík, Jiří Neumann, Daniel Šaňák, David Školoudík, Daniel Václavík
Death and life borderline – and chance to survive
Near-drowning is a specific traumatic event, mostly due to recreational and sport activities. Its symptomatology and clinical tra¬jectory are complex – initiating with profound hypoxemic and hypoxic injury, followed by dyshomeostatic processes, ARDS and MODS. Mechanical injury, prolonged mechanical ventilation, pulmonary infections and long-term neuropsychological sequelae are high-risk complications of the global trajectory.
Emergency procedures are mainly organ-targeted and symptomatic; in survivors regeneration of cognitive functions is of utmost priority for quality of life.
Pain in the right upper abdomen – always a „surgical“ case? A case report
Case report presents a patient with pain in the right upper abdomen and the subsequent diagnostic process at the Department of Emergency Medicine. The cause of patient’s difficulties was the isolated right ventricular myocardial infarction. There is discus¬sion about differential diagnosis of possible causes of the pain in the right upper abdominal quadrant and posibility of research isolated right myocardial infarction.
ETHICS, PSYCHOLOGY, LAW
Experience with violence in health care professional – patient relation at Emergency Medical Service of the Capital Prague from 2004 till 2014
Jaroslav Pekara, Petr Kolouch
The aim of this paper is to present a development of violent incidents in the Emergency Medical Service (EMS) through contact with violent patients in Prague between 2004 and 2014. The issue of violence in an EMS setting has not been a priority for all the EMS in the Czech Republic. Prague’s EMS, in this regard, is an exception. On the basis of our results we can clearly state that during real situations, the paramedics and medical drivers of EMS Prague are most often exposed to verbal violence (80 % of staff per month). Approximately 80 % of staff is exposed to physical violence once a year. It has emerged that the monitoring of this issue has not only brought about insight into this topic, but it also had an impact on prevention, in particular the outputs from in-depth interviews. The resulting minimisation of violent incidents and conflicts in real situations is an example of good practice for all other EMS units that have problems with violence through mutual contact between paramedics and their patients.
Stress in paramedic´s practice
Petra Svobodová, Tibor A. Brečka
The article deals with stress in the profession of paramedics. It brings data from the research of this issue, which was implemented at the Emergency Medical Service of the Pardubice region. The main objective was to identify the most stressful situations affect their psychic, how they cope with stress and what options they have in crisis intervention.
Conference of Integrated Rescue System in Karlovy Vary on 11th November 2016
Oldřich Volf, Roman Sýkora