- Editorial – Jana Šeblová
- Overcrowding of emergency departments and its possible solutions – Ondřej Rennét, Jana Šeblová
PREHOSPITAL EMERGENCY CARE
- Emergency conditions in patients with long-term mechanical circulatory support – Hynek Říha, Ján Šoltés, Petr Kramář, Robert Rzyman, Peter Ivák, Jan Bruthans, Petr Pavlík, Milan Ročeň
PAEDIATRICS IN EMERGENCY MEDICINE
- Basic physiological and anatomical differences in paediatric patients – Pavel Heinige, Vladimír Mixa, Kateřina Fabichová
PHYSIOLOGY AND EMERGENCY MEDICINE
- Prehospital evaluation of fluid responsiveness – Marcela Bílská, Ida Vitvarová, Barbora Stadlerová, Tomáš Pařízek, Michal Kalina, Vladimír Černý, David Astapenko, Roman Škulec
- Consensual statement of the Section of Emergency Departments of the SEDM CzMA JEP: Triage at emergency department – Michal Pisár, Pavel Kupka, Ondřej Rennét
- How to pass the specialisation exam in emergency medicine? – Katarína Veselá, Jana Šeblová, Jana Kubalová
ETHICS, PSYCHOLOGY, LAW
- From the history of Emergency Medical Systems – Jakub Vetešník
- Programme statement of the Section of Emergency Departments of the Society of Emergency and Disaster Medicone CzMA JEP
OVERCROWDING OF EMERGENCY DEPARTMENTS AND ITS POSSIBLE SOLUTIONS
Ondřej Rennét, Jana Šeblová
The paper deals with overcrowding of emergency departments and discusses both factors leading to overcrowding and measures to reduce it. Overcrowding is defined as a situation when number of patients at emergency department exceeds either spacial and/or personnel capacity which is available at the moment. It decreases safety and quality of care significantly, increases morbidity and mortality during hospitlaization, leads to delay in necessary care and it prolongs time to diagnostics and the lenght of stay at the department. Overcrowding has a negative impact on patients´ satisfaction and increases the risk of burnout syndrom development in personnel. The sources leading to overcrowding as well as measures to prevent and reduce it have input, throughput and output components of the emergency department. Effective solutions must include systematic and multilevel responses and they must be based on data analysis of a particular department.
Key words: emergency department – overcrowding – continuity of emergency care – quality of care – safety
EMERGENCY CONDITIONS IN PATIENTS WITH LONG-TERM MECHANICAL CIRCULATORY SUPPORT
Hynek Říha, Ján Šoltés, Petr Kramář, Robert Rzyman, Peter Ivák, Jan Bruthans, Petr Pavlík, Milan Ročeň
Long-term mechanical circulatory support (MCS) devices have been an integral part of the therapy of congestive heart failure. Patients with these devices are discharged home from the hospital; subsequently, they visit the hospital for regular outpatient checkups only. Long-term MCS have brought some differences to emergency medicine, which primarily concerns the cardiovascular system.
Key words: long-term mechanical circulatory support – nonpulsatile blood flow – blood pressure – anticoagulants
BASIC PHYSIOLOGICAL AND ANATOMICAL DIFFERENCES IN PAEDIATRIC PATIENTS
Pavel Heinige, Vladimír Mixa, Kateřina Fabichová
Pediatrics is a medical specialty providing medical care to individuals from birth till nineteen years of age. During this period the human body develops dramatically. The body weight increases twenty times and the body height nearly four times compared with the birth length. Together with body growth the organs and organ systems grow and mature, too.
The development of organism is about to finish at the age of nineteen and anatomical proportions and physiological functions are comparable to adults then. However, there are significant differences compared to adults both anatomical and functional the earlier the age of a child is. We can say in general that the younger the child is the bigger differences are presented between childern and adults. The most important differences are discussed in this paper.
Key words: Child – pediatric age – anatomical and physiological differences
PREHOSPITAL EVALUATION OF FLUID RESPONSIVENESS
Marcela Bílská, Ida Vitvarová, Barbora Stadlerová, Tomáš Pařízek, Michal Kalina, Vladimír Černý, David Astapenko, Roman Škulec
In pre-hospital emergency care (PHC), we see patients with signs of shock on a daily basis. One of the earliest interventions in these patients is the administration of fluids, but this has its risks to consider. To discern whether a patient will benefit from fluid administration, fluid responsiveness assessment can help us to decide. Given the limited diagnostic options in the PNP, in this article we address the question of whether it is even feasible to assess FR in the PNP and, if so, by what methods.
Key words: fluid responsiveness – fluids – shock – preload
FROM THE HISTORY OF EMERGENCY MEDICAL SYSTEMS
The network of stations of the city’s medical emergency services developed due to the initiative of voluntary associations („Freiwillige Rettungsgesellschaft“) at the end of the 19th and the beginning of the 20th century. The organizational principles for the work of rescue squads were formulated by Baron Dr. Jaromír Mundy (Vienna, 1866), the first doctor who dedicated his professional life to rescuing. Other emergency services were established and provided care following the example of Mundy’s „Wiener Freiwillige Rettungsgesellschaft“ (1881/82). Selected trained volunteers provided transport to the hospital as fast as possible and the necessary care of the patient was provided in the hospital. The Emergency Service of the Capital Prague (1857) went throught an unique development. The Czechoslovak Red Cross (1919) participated in organization of the emergency medical service in the new state – Czechoslovakia. The service was based on voluntary work of trained laymen, the pyhsicians had mainly administrative and educational responsibilities. After the Second World War and in the 1950s, when a shortage of medicines, material and technology occured, the service was restored very slowly and it was mostly used as a transport service or as general practicioners´ visits. It was not until the 1970s and 1980s of the 20th century that a new concept of emergency care was accepted thanks to the development of anesthesiology and resuscitation. Based on the experience of the specialisation in anaesthesiology and resuscitation with life-threatening conditions the care of the patient started to be provided right on scene. Emergency teams were organized and also trained by critical or intensive care units´specialists. The responsibility of establishing, funding and management of these services had district or regional institutes of public health. A model example of such a cooperation between critical and emergency care was the Ostrava critical care unit which head physician was Jiří Dostál, MD. During the dynamic development in the 1990s the emergency medical services became independent on the hospitals and they were managed by district authorities. A huge boom of material and technical equipment, finishing of the heliopter emergency services´ network and establishing basics of current specialized center care took place that time. However, there were also lack of national concept and also the costs increased. The effort to modernize and rationalize the emergency medical services lead to the current regionally based system according the 374/2011 Sb. Law on EMS.
Key words: history of emergency medical services – Jaromír Mundy – MUDr. Jiří Dostál