- Editorial – Jana Šeblová
CONCEPTION, MANAGEMENT, ORGANIZATION
- Draft methodology for evaluating emergency preparedness – Irena Švarcová, Josef Navrátil
CLINICAL TOPICS AND RESEARCH
- The bystander-witnessed collapse with CPR and shockable rhythm as the main predictor of a successful survival after out-of-hospital cardiac arrest – Michal Plodr, Jaroslava Krenčíková, Monika Praunová, Anatolij Truhlář
- Ultrasound guided peripheral vein cannulation in pre-hospital emergency care – Roman Škulec, Jitka Callerová
- Non-technical skills observation during resuscitation – David Peřan, Jana Kubalová
- Carbon monoxide intoxication in prehospital care – two case reports – Táňa Bulíková
ETHICS, PSYCHOLOGY, LAW
- Communication with client with hearing impairment in prehospital emergency care – Martina Muknšnáblová
- Resuscitation anytime and under all circumstances? – Jana Šeblová
- Newborn Life Support from participant´s point of view – Robert Pleskot
- Contents of the year 2017
DRAFT METHODOLOGY FOR EVALUATING EMERGENCY PREPAREDNESS
IRENA ŠVARCOVÁ, JOSEF NAVRÁTIL
The paper presents a draft methodology for evaluating emergency preparedness of emergency medical services (EMS). Evaluation of the current state of emergency preparedness has shown that procedures used by regional EMS in the Czech Republic in executing emergency preparedness tasks are not identical in all stipulated areas. Current procedures used to evaluate and improve the quality of emergency response preparedness of the EMS are neither harmonized nor comprehensively controlled. While standards establishing binding recommendations for dealing with mass casualty incidents are in place, no suitable instruments currently exist for a comprehensive evaluation of emergency preparedness.
Key words: Emergency preparedness evaluation – mass casualty incidents – indicators – criteria – methodology – emergency situation – emergency medical services
THE BYSTANDER-WITNESSED COLLAPSE WITH CPR AND SHOCKABLE RHYTHM AS THE MAIN PREDICTOR OF A SUCCESSFUL SURVIVAL AFTER OUT-OF-HOSPITAL CARDIAC ARREST
MICHAL PLODR, JAROSLAVA KRENČÍKOVÁ, MONIKA PRAUNOVÁ, ANATOLIJ TRUHLÁŘ
The authors present a retrospecitve analysis of outcomes of out-of-hospital cardiac arrest (OHCA) treated in the Hradec Králové region within the one year period from January to December, 2016. The aim of the study was to determine a relation between a quality survival and an initial rhythm, bystander-witnessed collapse with cardiopulmonary resuscitation (CPR) before the arrival of Emergency Medical Service. The bystander-witnessed collapse with CPR and shockable rhythm was the main predictor of a successful survival after OHCA with 43,5 % survival rate to hospital discharge with a good neurological outcome (5,5 patients/100 000/year). In case of bystander-witnessed collapse without CPR, a higher number of patients, in comparison with unwitnessed collapses, was handed over at the hospital with return of spontaneous circulation (ROSC) (33,9 vs. 10,4 %), however, the neurological outcome was the same in both groups (1,8 vs. 2,0 %). In the group of bystander-witnessed collapses with CPR, 18,9 % of patients, regardless of the initial rhythm (p < 0,0001), survived to hospital discharge with good neurological outcomes. None of the patients survived asystole with the good neurological outcome regardless any other factors. The study confirmed that witnessed cardiac arrest with shockable rhythm and bystander-witnessed CPR leads to the best chance for the quality survival after OHCA.
Key words: cardiopulmonary resuscitation – out-of-hospital cardiac arrest – ventricular fibrillation
ULTRASOUND GUIDED PERIPHERAL VEIN CANNULATION IN PRE-HOSPITAL EMERGENCY CARE
ROMAN ŠKULEC, JITKA CALLEROVÁ
Introduction: Ultrasound guidance of peripheral venous catheter (PVC) insertion can increase the success rate of cannulation. Therefore, we have decided to assess this method in pre-hospital emergency care (PEC). We compared the method of ultrasound guided PVC insertion and conventional cannulation technique with regard to the success of the first attempt of PVC insertion, the overall success of the cannulation and the time required to introduce PVC.
Methods: We performed a pseudo-randomized prospective clinical trial. Patients meeting the inclusion and exclusion criteria were randomized to the ultrasound guided insertion of PVC (UPVC group) using a portable ultrasonographic device or conventional peripheral vein cannulation without ultrasonographic control (CPVC group). We monitored and compared the goals of the study.
Results: A total of 58 patients were enrolled, they were 60.8±13.4 years old. The success rate of the first attempt was 91.9% in the UPVC group was 91.9 % and 76.2% in the CPVC group (p=0.204). Overall success rate was higher in the UPVC than in the CPVC group (100.0 % versus 90.5 %, p=0.050). An analysis of a subgroup of the patients in whom overall success has been reached, we did not identify the difference in the time required for the procedure (UPVC group: 75±56, CPVC group: 95±91 s, p=0.300).
Conclusions: Regardless of the small sample size, we identified a trend towards higher success of the first attempt of cannulation and higher overall success associated with ultrasound guided cannulation compared to conventional procedure without visualization of the venous circulation. The time required for cannulation did not differ between groups.
Key words: pre-hospital emergency care – peripheral venous cathether – ultrasound guidance
NON-TECHNICAL SKILLS OBSERVATION DURING RESUSCITATION
DAVID PEŘAN, JANA KUBALOVÁ
Eighty percent of errors occur as a result of human failure. CRM first originated in aviation and medicine has adopted these procedures into its own processes. Non-technical skills consist of four areas (Teamwork and Team Leading, Decision-making, Task management, Situational awareness) under the umbrella of communication. Based on experience of colleagues from United Kingdom (Cooper et al, 2010; Napier et al, 2009) we build a form for non-technical skills observation. We observe non-technical skills in 31 medical teams. The medical and healthcare environment generally has very advanced technologies, including devices that monitor whether technology is being used properly. The potential space for error is in non-technical skills that, based on our observation, should be trained and given adequate attention within CRM.
Key words: non-technical skills – resuscitation – CRM
CARBON MONOXIDE INTOXICATION IN PREHOSPITAL CARE
Motto: „Experience is the best teacher.“ Marcus Tullius Cicero
Carbon monoxide (CO) poisoning is a major health, social and economic problem for most of the developed countries in the world. It occupies the first place between accidental intoxications in Europe and North America. There are 125–150 people per year in the country (2–3 cases per 100,000 inhabitants per year) , with mild forms of intoxication – about 30% are not properly diagnosed for nonspecific symptoms in the first contact. The most common mistaken diagnoses are: influenza, fatigue and depressive syndrome, gastroenteritis, alcohol and other poisoning, stroke, and others. [2,3] Those who survived have permanent neurological consequences, memory disorders, personality changes. The article presents the basic characteristics of CO intoxication, its incidence, symptoms, diagnosis and treatment in prehospital care. Two short case reports from the emergency medical service are presented in the paper.
Key words: carbon monoxide – intoxication – oxygen therapy – carbon monoxide detector
COMMUNICATION WITH CLIENT WITH HEARING IMPAIRMENT IN PREHOSPITAL EMERGENCY CARE
There is not just one, single, optimal way or kind of communication for communication with deaf people but there is a broad spectrum of means or options that can be used to overcome communication barriers. The communication with deaf people runs at 2 levels – there is an intracultural level (when two or more deaf people are communicating with each other e.g. via sign language) and intercultural level (a communication between hearing and deaf people). The overall spectrum of means include oral communication, simultaneous communication, total communication, bilingual communication and others. A hard of hearing patient is typically recommended to use a hearing aid or cochlea implant based on the hearing defect’s location. There are many types of hearing aids, the most common types include hanging, pocket, intra-aural or spectacle hearing aids. Not always the patients have hearing aids with them, if so the communication has to be adjusted to actual possibilities.
Key word: hearing impairment – prehospital care – communication – deaf