- Editorial – Jana Šeblová
PREHOSPITAL EMERGENCY CARE
- The form for a structured patient´s information handover – creation by action research and modified Delphi method – David Peřan, Jaroslav Pekara, Jaroslav Valášek, Patrik Cmorej
SYSTEMS ORGANIZATION AND MANAGEMENT
- Standardization of care in emergency medical services and standards of care – David Peřan, Jaroslav Pekara, Patrik Cmorej
- Point of care ultrasonographic diagnostics of deep venous thrombosis of the lower extremities in emergency medicine – Barbora Pakostová, Roman Škulec, Tomáš Pařízek, Vladimír Černý
PHYSIOLOGY AND EMERGENCY MEDICINE
- Acute stress response – can we feel it in our bones? – David Astapenko, Vladimír Černý
- How to pass the specialisation exam in emergency medicine? – Katarína Veselá, Jana Kubalová, Jana Šeblová
- The benefits of simulation-based exercises for performance quality of emergency medical services professionals – Jitka Gurňáková, Peter Gröpel
ETHICS, PSYCHOLOGY, LAW
- Decision making and stroke awareness: looking for meaningfull strategies – Iva Šmídová, Lucie Vondráčková, Robert Mikulík
- Česká republika centrem evropské urgentní medicíny pro rok 2019 – Kongres EUSEM 12. – 16. 10. 2019, Kongresové centrum Praha – Jana Šeblová, Jaroslav Pekara, David Peřan
- Review of the book „lékařská první pomoc“ (First Medical aid) – Patrik Christian Cmorej
THE FORM FOR A STRUCTURED PATIENT´S INFORMATION HANDOVER – CREATION BY ACTION RESEARCH AND MODIFIED DELPHI METHOD
David Peřan, Jaroslav Pekara, Jaroslav Valášek, Patrik Cmorej
Failures in communication have been identified as a major cause of preventable medical errors and of poor handovers resulting in adverse effects for the patient. Miscommunication and information loss during handover are acknowledged as contributing factors to adverse events. Patient safety can be improved by ameliorating the handover process and by standardising the processes. The quality of patient handover varies, the chief differences being in the handover method, language, level of education and expertise. For this reason, the Prague Emergency Medical Services decided to standardise the process of information handover from pre-hospital to in-hospital care.
This paper presents a process for choosing and creating a system of structured information handover using action research and the modified Delphi method.
The presented system contains essential information for identifying the pre-hospital care provider and the crew, the basic disease or injury, the patient’s vital signs and the treatment. The system is tailored to both low and high priority patients.
Key words: Standardisation – Pre-notification – Emergency Medicine – Pre-hospital Care – Safety
STANDARDIZATION OF CARE IN EMERGENCY MEDICAL SERVICES AND STANDARDS OF CARE
David Peřan, Jaroslav Pekara, Patrik Cmorej
Introduction: Emergency medical services as well as other health care providers follow the standards of care that include both the organization of services and the medical care.
Method: The aim of the article is to identify, by means of qualitative research method – thematic analysis – individual standards or parts of regulations applicable to the emergency medical services environment, which can be improved by standardization of the procedure, including the application of guidelines, algorithms, checklists and other cognitive aids, to improve safety of patients.
Results: Four documents were identified in which areas for standardization were searched and four groups of codes were identified – (1) General recommendations for improving care, (2) Standardizing health care, (3) Standardizing communication, (4) Technical and organizational processes.
Conclusion: All analysed documents contain areas suitable for process standardization. The analysis shows that the biggest area for standardization is the medical care. Non-technical skills are also at the forefront, and a lot of space is also devoted to communication, especially in the area of handover of information about patients. The last area is the management and application of drugs, the prevention of infections and the technical preparation of equipment.
Key words: Standardisation – Standards – Emergency Medicine – Pre-hospital care – Safety
POINT OF CARE ULTRASONOGRAPHIC DIAGNOSTICS OF DEEP VENOUS THROMBOSIS OF THE LOWER EXTREMITIES IN EMERGENCY MEDICINE
Barbora Pakostová, Roman Škulec, Tomáš Pařízek, Vladimír Černý
The complete compression ultrasound has been considered to be an imaging method of the first choice for diagnostics of deep vein thrombosis (DVT). However, it is an expert examination, time consuming and not always immediately available. Thus, methods of Point-of-Care ultrasound, especially two-region compression ultrasound may be used in an emergency setting. In the article, the authors present an overview of Point-of-Care ultrasound methods of DVT diagnostics, including a critical appraisal of its reliability and a practical instruction for carrying out the examination.
Key words: emergency medicine – deep vein thrombosis – ultrasound
ACUTE STRESS RESPONSE – CAN WE FEEL IT IN OUR BONES?
David Astapenko, Vladimír Černý
An acute stress reaction is a phylogenetically conserved response of the organism to impending or ongoing tissue damage. The reaction involves activation of the sympathetic nervous system and the neuroendocrine axis of the hypothalamus – pituitary gland – adrenal glands. Bone tissue cells, osteoblasts, produce hormone osteocalcin, which is responsible for precipitation of the entire reaction. It increases skeletal muscle endurance, decreases insulin resistance and sharpens short term memory. In fact, we are not dependent on the level of catecholamines in the acute phase, but their clinical indications are indisputable.
Key words: acute stress response – osteocalcin – adrenal glands
THE BENEFITS OF SIMULATION-BASED EXERCISES FOR PERFORMANCE QUALITY OF EMERGENCY MEDICAL SERVICES PROFESSIONALS
Jitka Gurňáková, Peter Gröpel
This cross-sectional replication study tested whether simulation use and years of practice predicted the quality of performance among emergency medical services (EMS) professionals. Data were collected during a simulation-based EMS competition (Rallye Rejvíz). Participants were 63 EMS professionals, which was 38 % of all competitors. They had in average 7.51 years of healthcare practice and 5.10 years of EMS practice and had previously participated in 4.40 simulation events. The prior participation in simulation events correlated significantly with participants’ competition performance (r = 0.26, p = 0.049). In contrast, neither the years of healthcare practice nor the years of EMS practice significantly predicted performance. Furthermore, there was an interaction of simulation use and years of EMS practice: less experienced EMS professionals benefited more from prior simulation use (β = –0.32, p = 0.018). These results partly replicate previous literature and support the benefits of simulation use as a relevant educational method for EMS professionals.
Key words: simulation – emergency medical services – paramedic – performance – Rallye Rejvíz
DECISION MAKING AND STROKE AWARENESS: LOOKING FOR MEANINGFULL STRATEGIES
Iva Šmídová, Lucie Vondráčková, Robert Mikulík
Aim: Reaction of the lay public to a stroke event is often insufficient. The aim of this research was to identify the sources of stroke knowledge of stroke patients or their relatives who called emergency for suspected stroke event, and the key moments for the decision to call emergency. Findings indicate direction in more effective management of cases in Emergency medicine.
Sample and methods: This is a qualitative study using semi- -structured deep personal interviews. 12 stroke patient were interviewed, 6 relatives of stroke patients and, in two cases, both patient and his/her relative. Also, 6 meetings with hospital personnel were conducted.
Results: The decision to call ambulance was based on previous stroke experience and realization that something was wrong. Also, other people and their knowledge or experience were important. The decision making is set in the complex setting with patient’s concerns about accepting patient’s role and expectations connected to it. The recovery process is connected both to hopes and uncertainties about the outcome.
Conclusions: When the patients do not have previous stroke experience and the doctor is not called by a witness of the event, then the decision to call a doctor is based not on the recognition of the stroke symptoms, but on the perception that something is terribly wrong. For the educational campaigns to be more effective, they need to be targeted to the high-risk subgroups. This knowledge was derived from the experience and life situation of the cases included in the study. Multidisciplinary cooperation connecting not only medical but also social approach could be beneficial in emergency medicine.
Key words: Stroke – Awareness – Decision making – Health care – Community health education