Ambulance Team Research Articles

КЛИНИЧЕСКИЙ СЛУЧАЙ ОСТРОЙ ИНТОКСИКАЦИИ ФЕНОЛОМ КАК ПРОФЕССИОНАЛЬНОГО ЗАБОЛЕВАНИЯ: ОСНОВНЫЕ НОРМАТИВНЫЕ ДОКУМЕНТЫ

Abstract. Introduction. Phenol (hydroxybenzene) can cause acute poisoning that may occur through inhalation of its high concentrations or from skin contact. Acute intoxication is manifested by damaging the central nervous system with the development of cerebral disorders. Changes in the blood can manifest as redistributive leukocytosis. Aim of the study is to analyze the clinical observation of a patient with acute phenol poisoning who was admitted at the Department of Toxicology in City Clinical Hospital No. 7 named after M.N. Sadykov. Materials and Methods. Patient I. was taken by an ambulance team from enterprise N, where, while working with phenol and wearing personal protective equipment, he received a chemical injury in contact with the substance. Results and Discussion. At the admission time, the condition was assessed as stable and severe. Final diagnosis by ICD-10: T54.0: Toxic effect: Phenol and phenol homologues. Complications of the underlying disease: Toxic encephalopathy. Primary intoxication delirium. Concomitant diseases: Chemical burn with phenol (acid) of the 1st degree on an area of 6% of the body surface. Conclusions. To resolve the issue of occupational disease and examine his/her professional aptitude, the employee must be sent to the City Center of Occupational Disease within the structure of the City Clinical Hospital No. 7.

МЕДИКО-ОРГАНИЗАЦИОННЫЕ АСПЕКТЫ ОПТИМИЗАЦИИ РАБОТЫ ПРИЕМНОГО ОТДЕЛЕНИЯ БОЛЬНИЦЫ СКОРОЙ МЕДИЦИНСКОЙ ПОМОЩИ

Introduction. Public medical care accessibility and quality are strategic objectives of domestic healthcare. Successfully solving these problems is greatly facilitated by the efficient operation of 24-hour hospitals, which largely depends on the quality of the admitting department that significantly impacts the efficiency of the entire hospital. Aim of the study is to optimize the admitting department activities of a multidisciplinary emergency hospital, based on reasonably organized admission of patients, differentiated sorting, and subsequent routing of patients depending on their condition severity. Materials and Methods. The study was carried out based on Voronezh City Clinical Hospital of Emergency Medical Care No. 1, which is a 24-hour multidisciplinary hospital with a capacity of 800 beds. The study was aimed at the main activities of the admitting department of the said hospital and ways to optimize them. To achieve our goals, we used analytical, statistical, and system analysis research methods. Statistical data processing was carried out using the StatSoft STATISTICA software program. The assessment of the study results is presented in the M±SD format (M – mean, SD – standard deviation). Results and Discussion. An analysis of the structure of the medical advice-seekers in the hospital showed that 42 % of patients were delivered to the hospital by an ambulance team, 32.7 % were admitted by the medical institution, and 25.3 % appeared by “self-referral”, which, taking into account their varying condition severities and comorbidity pathologies, required additional time spent on re-issuing medical documents, re-entering patients’ personal data into the medical information system, and providing different scopes of medical care. To increase the efficiency of the admitting department and the entire hospital, the position of a hospital administrator on duty was introduced; the medical triage system (triage) was developed and implemented, which, at contacting them, allows dividing patients into 3 streams differing in the demand for homogeneous treatment and prevention measures, and queuing for such activities, which made it possible to develop universal standard operating procedures and significantly improve the key indicators of hospital activities. Conclusions. As a result, innovative approaches have been proposed to optimize the admitting department activities of an emergency hospital, related to the elements of lean healthcare, which allows differentiated medical triage followed by patients’ routing depending on their condition severity

Intraosseous versus intravenous vascular access in upper extremity among adults with out-of-hospital cardiac arrest: cluster randomised clinical trial (VICTOR trial)

ObjectiveTo compare the effectiveness of intraosseous versus intravenous vascular access in the treatment of adult patients with out-of-hospital cardiac arrest.DesignCluster randomised controlled trial.SettingThe VICTOR (Venous Injection Compared To intraOsseous injection...

Ambulance professionals' experiences of teamwork in the context of a team training programme – a qualitative study

BackgroundTeamwork in the context of ambulance services exhibits unique characteristics, as this environment involves a small core team that must adapt to a dynamic team structure that involves health care professionals and emergency services. It is essential to acquire a deeper understanding of how ambulance teams operate. Therefore, this study aimed to explore the experiences of ambulance professionals with teamwork and how they were influenced by the implementation of a team training programme.MethodsA qualitative descriptive study was conducted involving ambulance professionals who took part in focus group interviews carried out both before and after the implementation of a team training program across seven ambulance stations within a Norwegian hospital trust. The data were analysed using reflexive thematic analysis based on a deductive-inductive approach.ResultsOur analysis revealed 15 subthemes that characterised ambulance professionals’ experiences with teamwork and a team training programme, which were organised according to the five main themes of team structure, communication, leadership, situation monitoring, and mutual support. Ambulance professionals’ experiences ranged from the significance of team composition and interpersonal and professional relationships to their preferences regarding different communication styles and the necessity of team leaders within the ambulance service. The team training programme raised awareness of teamwork, while the adoption of teamwork tools was influenced by both individual and contextual factors. The Introduction/Identity, Situation, Background, Assessment and Recommendation (ISBAR) communication tool was identified as the most beneficial aspect of the programme due to its ease of use, which led to improvements in the structure and quality of consultations and information handover.ConclusionsThis study documented the diverse characteristics and preferences associated with teamwork among ambulance professionals, emphasising the particular importance of proficient partnerships in this context. Participation in a team training programme was perceived as a valuable reminder of the significance of teamwork, thus providing a foundation for the enhancement of communication skills.Trial registrationClinicalTrials.gov—ID: NCT05244928.

The relationship between ambulance team’s professional commitment, occupational anxiety, and resilience levels

BackgroundIndividuals who have the ability to bounce back from stressful events, to recover from their troubles and adverse environmental conditions by getting stronger each time are known as resilient people. Some professions may cause more occupational anxiety than others due to their characteristics and working conditions. In this research, we aimed to develop a professional commitment scale for the ambulance team. Another aim was to analyze the relationships between professional commitment, occupational anxiety, resilience, gender, job, seniority and working unit variables.MethodsIn the study, data were collected from a total of 1142 emergency ambulance workers working in Emergency Ambulance and Emergency Call Centers in 34 different cities in Turkey. Data were collected using the “Professional Commitment of Ambulance Team Scale (PCATS), Occupational Anxiety Scale for Emergency Medical Service Professionals (OASEMSP), and Resilience Scale for Adults (RSA). Scale development analyses were carried out using Classical Test Theory (CTT) and Item Response Theory (IRT). Regression analysis were used to examine the relationships between professional commitment, occupational anxiety, resilience, gender, job, seniority and working unit.ResultsAs a result of the exploratory factor analysis (EFA), it was determined that 8 items remaining in the professional commitment scale formed a single-factor structure, explaining 46% of the variance of professional commitment of the team. The Cronbach’s Alpha reliability value was 0.867. Confirmatory factor analysis (CFA) confirmed the results of exploratory factor analysis. The Cronbach’s Alpha reliability coefficient obtained through CTT was 0.868, and the marginal reliability coefficient within the scope of IRT was 0.877. The test-retest reliability coefficient was calculated as 0.832, which indicates that the scale is valid and reliable.ConclusionsThe study revealed that resilience has a positive effect for professional commitment while occupational anxiety has a negative effect for professional commitment. In addition, having a moderate seniority has a negative (reducing) effect for professional commitment. Other variables (gender, job, and working unit) was found to have no significant impact on professional commitment.

Mapping the processes and information flows of a prehospital emergency care system in Rwanda: a process mapping exercise

ObjectiveA vital component of a prehospital emergency care system is getting an injured patient to the right hospital at the right time. Process and information flow mapping are recognised methods...

Video support for prehospital stroke consultation: implications for system design and clinical implementation from prehospital simulations

BackgroundVideo consultations between hospital-based neurologists and Emergency Medical Services (EMS) have potential to increase precision of decisions regarding stroke patient assessment, management and transport. In this study we explored the use of real-time video streaming for neurologist–EMS consultation from the ambulance, using highly realistic full-scale prehospital simulations including role-play between on-scene EMS teams, simulated patients (actors), and neurologists specialized in stroke and reperfusion located at the remote regional stroke center.MethodsVideo streams from three angles were used for collaborative assessment of stroke using the National Institutes of Health Stroke Scale (NIHSS) to assess symptoms affecting patient’s legs, arms, language, and facial expressions. The aim of the assessment was to determine appropriate management and transport destination based on the combination of geographical location and severity of stroke symptoms. Two realistic patient scenarios were created, with severe and moderate stroke symptoms, respectively. Each scenario was simulated using a neurologist acting as stroke patient and an ambulance team performing patient assessment. Four ambulance teams with two nurses each all performed both scenarios, for a total of eight cases. All scenarios were video recorded using handheld and fixed cameras. The audio from the video consultations was transcribed. Each team participated in a semi-structured interview, and neurologists and actors were also interviewed. Interviews were audio recorded and transcribed.ResultsAnalysis of video-recordings and post-interviews (n = 7) show a more thorough prehospital patient assessment, but longer total on-scene time, compared to a baseline scenario not using video consultation. Both ambulance nurses and neurologists deem that video consultation has potential to provide improved precision of assessment of stroke patients. Interviews verify the system design effectiveness and suggest minor modifications.ConclusionsThe results indicate potential patient benefit based on a more effective assessment of the patient’s condition, which could lead to increased precision in decisions and more patients receiving optimal care. The findings outline requirements for pilot implementation and future clinical tests.

Inverted Meckel’s diverticulum as a cause of intestinal intussusception in a child: A case report

One of the causes of intussusception is the presence of Meckel’s diverticulum. Although Meckel’s diverticulum is the most common anomaly of the gastrointestinal tract, isolated cases of intussusception caused by the inversion of Meckel’s diverticulum into the lumen of the ileum have been described in world literature. Description of case. The patient was a 2-year-11-month boy who was transported by an ambulance team, with complaints of paroxysmal abdominal pain and single vomiting. Palpation revealed lower abdominal pain without signs of peritoneal irritation. The child underwent an ultrasound examination of the abdominal cavity, which revealed a layered structure consisting of the wall of the large and small intestines in the right lower quadrant. Thus, a diagnosis of intussusception was established. An attempt to conservatively straighten the intussusception during pneumoirrigoscopy was ineffective. Emergency laparoscopy was performed, and ileocecal intussusception was diagnosed, which was eliminated without technical difficulties. During the inspection of the ileum, a crater-shaped depression with a dense formation extending from it into the intestinal lumen was discovered on its antimesenteric edge 30 cm from the ileocecal angle. The operation was continued with a minilaparotomy in the right iliac region. Meckel’s diverticulum was manually inverted from the ileum, tied at the base, and cut off with the stump immersed in a purse-string suture. The postoperative period was event-free. On day 5 after the operation, the child was discharged home in a satisfactory condition. For any intussusception in children aged 1 year, the anatomical causes must be excluded, except for the possibility of an inverted Meckel’s diverticulum. Therefore, after successful intestinal disinvagination, a thorough revision of the ileum is necessary.

A comparison between intraosseous and intravenous access in patients with out-of-hospital cardiac arrest: A retrospective cohort study

IntroductionThe optimal vascular access for patients with out-of-hospital cardiac arrest (OHCA) remains controversial. Increasing evidence supports intraosseous (IO) access due to faster medication administration and higher first-attempt success rates compared to intravenous (IV) access. However, the impact on patient outcomes has been inconclusive. MethodsThis retrospective cohort study in Taoyuan City, Taiwan, from January 1, 2019, to December 31, 2022, included patients aged ≥18 years with non-traumatic OHCA resuscitated by emergency medical technician paramedics (EMT-Ps) with either IVs or IOs for final vascular access. The exclusion criteria were cardiac arrest en route to the hospital and resuscitation during the coronavirus pandemic (from May 1, 2022, to October 31, 2022). The primary and secondary outcomes were sustained ROSC (≥2 h) and cerebral performance category (CPC) 1–2, respectively. Univariate logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CI) for the primary analysis. Multivariable logistic regression was employed, with variables selected based on a p-value of <0.05 in the univariate analysis. The survival benefits of different insertion sites and subgroups like general ambulance teams (with a composition that includes fewer EMT-Ps and limited experience in using IO access) were also analyzed. ResultsA total of 2003 patients were enrolled; 1602 received IV access and 401 IO access. The median patient age was 70 years, and most were male (66.6%). Compared to patients receiving IV access, the adjusted odds ratios (aORs) for primary and secondary outcomes in patients with IOs were 0.83 (95% confidence interval [CI], 0.61–1.11; p = 0.20) and 0.96 (95% CI, 0.39–2.40; p = 0.93), respectively. Different insertion sites showed no outcome differences. In the subgroups of females and patients resuscitated by general ambulance teams, the aORs for sustained ROSC were 0.55 (95% CI, 0.33–0.92; p = 0.02) and 0.62 (95% CI, 0.41–0.94; p = 0.02), respectively. ConclusionsFor patients with OHCA resuscitated by EMT-Ps, IO access was comparable to IV access regarding patient outcomes. However, in females and patients resuscitated by general ambulance teams, IV access might be favorable.

Nurses' use of an advisory decision support system in ambulance services: A qualitative study.

To illuminate from the perspective of nurses in ambulance services the experiences of using a web-based advisory decision support system to assess care needs and refer patients. Inductive and descriptive approaches. Thirteen semi-structured interviews were conducted in the spring of 2020. The data were analysed through the reflexive thematic analysis. The Swedish web-based advisory decision support system (ADSS) was found to strengthen nurses' feelings of security when they assess patients' care needs, promote their competence and professional pride, and help them manage stress. However, the system also generated difficulties for nurses to adjust to the dynamic ambulance team and revealed a discrepancy between their professional roles and responsibilities to refer patients and provide self-care advice. The nurses thought that the support system facilitated their increased participation and helped them understand patients and significant others by offering transparency in assessment and decision making. Thus, the support system provides nurses with an opportunity to strengthen patients' independence through information and education. However, in the care relationship, nurses worked to overcome patients' expectations. Nurses using the ADSS increased their security while performing assessments and referrals and found new opportunities to provide information and promote understanding of their decisions. However, nursing care values can be threatened when new support systems are introduced, especially as ambulance services become increasingly protocol-driven. These findings have implications for nurses' work environments and help them maintain consistency in making medical assessments and in providing equivalent self-care advice when referring patients to the different levels of care. The findings will also impact researchers and policymakers who formulate decision support systems. Consolidated criteria for reporting qualitative research (COREQ). None.

Lethal case of lung gangrene against the background of viral-bacterial pneumonia (COVID-19 and &lt;i&gt;Fusobacteria&lt;/i&gt;)

The respiratory system is the main target of COVID-19 infection spread by the SARS-CoV-2 virus. This study presents a case of viral–bacterial pneumonia caused by SARS-CoV-2 and Fusobacteria complicated by the development of gangrene in the lower lobe of the right lung with abscess formation. Accompanied by an ambulance team for emergency reasons, the patient was admitted for inpatient treatment with complaints of pain when coughing, dyspnea, cough with mucopurulent sputum, and fever up to 39.6°С. Chest computed tomography revealed signs of viral–bacterial pneumonia. Infiltration was determined in the lower lobe of the right lung, against which a cavity with melting lung tissue was observed. A virological test of throat and nasal swabs detected SARS-CoV-2 coronavirus RNA. Despite treatment, the patient died. Autopsy revealed signs of viral–bacterial pneumonia, a decaying cavity with purulent content, and diffuse destructive changes with hemorrhages. The cause of death of the patient was COVID-19, which caused bilateral viral–bacterial pneumonia complicated by the development of gangrene in the lower lobe of the right lung with abscess formation.

Clinical case of treatment of true drowning in fresh water

Drowning is the third leading cause of unintentional injury death worldwide. The largest number of victims of drowning falls on the young able- bodied population.Objective. There are no recent intensive care protocols for drowning, it is relevant to formulate guidelines for the treatment of drowning. Clinical observation. A 25-year-old female patient was taken by an ambulance team to the intensive care unit with a directional diagnosis ‘drowning in fresh water’ of three degree of severity. The patient had got on ventilator with closed aspiration system. Emergency bronchoscopy was performed during which 200 ml of fluid aspirated into the lungs was removed. Respiratory support was determined by stepwise increase of the PEEP level and decrease in FiO2 level taking into account respiratory index. Given the development of a pro-inflammatory mediator response, lactatacidosis, hemolysis, hyperhydration, a high risk of infectious complications, it was decided to start extracorporeal treatment early by continuous veno-venous hemodiafiltration and de-escalation of systemic antibacterial therapy with meropenem by prolonged infusion. Against the background of the ongoing treatment, we managed to achieve target respiratory parameters and stabilize central hemodynamic parameters by the end of the first day, prevent the development of renal damage, correct water-electrolyte and metabolic disorders, and avoid severe septic complications. Vasopressor support was discontinued on the 4th day, and on the 5th day the patient was switched to independent breathing. The patient`s stay in the intensive care unit was 6 days.Conclusions. Stepwise respiratory therapy using closed suction systems and urgent bronchoscopy prevent direct damage to the alveoli and ongoing translocation of fluid into the vascular bed. Prescribing broad-spectrum antibiotics prior to the growth of clinical and laboratory signs of infectious lung lesions allows to reduce the risk of severe septic complications with pulmonary destruction parenchyma. Early onset extracorporeal treatment by CVVHDF allows to correct homeostasis disorders, eliminate hypervolemia, prevent the development of acute renal damage as a result of hemolysis.

Comparison of the Utilization of Disaster Medical Assistance Teams (DMATs) and Multiple Physician-staffed Helicopters in Mass Casualty Responses

Abstract Objective To investigate the differences between doctor helicopters (DHs) and disaster medical assistance teams (DMATs) based on past examples and the current situation in Shizuoka Prefecture. Methods First, we examined cases in Shizuoka Prefecture from 2014 to 2023, where incidents involving five or more injured individuals were simultaneously managed using multiple DHs. Next, we investigated the presence of DMATs in Shizuoka Prefecture and assessed their role in disaster responses within the prefecture. Results Since 2014, there have been eight incidents in Shizuoka Prefecture where multiple DHs were deployed to respond to mass casualties. In contrast, Shizuoka DMATs were placed on standby three times during the same period, with one active deployment during a disaster caused by a landslide in Atami. The other two cases were managed solely by DHs and ambulance teams. Conclusion Localized disasters in Shizuoka Prefecture have seen the effective use of multiple DHs for timely patient transportation, particularly when suitable weather conditions permit. In contrast, DMATs are primarily deployed for extended medical activities lasting more than one day. This differentiation highlights the importance of choosing the appropriate medical response approach based on the nature and scope of the disaster.

Comparison of the utilization of disaster medical assistance teams and multiple physician-staffed helicopters in mass casualty responses

To investigate the differences between doctor helicopters (DHs) and disaster medical assistance teams (DMATs), based on past examples and the current situation in Shizuoka Prefecture. First, we examined cases in Shizuoka Prefecture from 2014 to 2023, wherein incidents involving five or more injured individuals were managed using multiple DHs simultaneously. Next, we investigated the presence of DMATs in Shizuoka Prefecture and assessed their role in disaster responses within the prefecture. Since 2014, there have been eight incidents in Shizuoka Prefecture wherein multiple DHs were deployed to respond to mass casualties. Shizuoka DMATs were placed on standby thrice during the same period, with one active deployment during a disaster caused by a landslide in Atami. The other two cases were managed solely by DHs and ambulance teams. Localized disasters in Shizuoka Prefecture have seen the effective use of multiple DHs for timely patient transportation, particularly when weather conditions were suitable. By contrast, DMATs are primarily deployed for extended medical activities lasting more than one day. This differentiation highlights the importance of choosing an appropriate medical response approach based on the nature and scope of a disaster.

Клинический случай развития гангрены легкого после инфицирования SARS-CoV-2 у пациентки с хронической обструктивной болезнью легких

COVID-19 is characterized by an unpredictable course, comorbidity, and high mortality in some patients. The article describes a case of the development of viral-bacterial pneumonia caused by SARS-CoV-2 and Fusobacteria, complicated by the development of gangrene of the lower lobe of the right lung with areas of decay. Case description. The patient was admitted for inpatient treatment, brought in by an ambulance team for emergency indications, complaining of pain when coughing, shortness of breath, body temperature increase up to 38.50C. Computed tomography of the chest: signs of viral-bacterial pneumonia. Infiltration in the region of the lower lobe of the right lung with melting lung tissue was determined. The diagnosis of COVID-19 was confirmed by PCR examination of nasopharyngeal swab. Diagnosis: New coronavirus infection COVID-19, severe course. Complications of the main disease: Bilateral viral-bacterial pneumonia. Gangrenous abscess of the left lung. On the background of the started treatment, a lethal outcome occurred. Autopsy revealed signs of viral-bacterial pneumonia and a decaying cavity with purulent contents, diffuse destructive changes with hemorrhages. Conclusion. The patient died as a result of viral-bacterial pneumonia, complicated by the development of gangrene of the lower lobe of the right lung with areas of decay and abscess formation and acute respiratory failure.

Жедел медициналық жәрдем қызметін цифрландыру туралы

Information technologies are becoming an integral part of the medical industry in Kazakhstan, playing an increasingly important role every year in improving the quality and accessibility of healthcare. The introduction of digital solutions makes it possible to significantly optimize the processes of medical care, improving diagnosis, treatment and monitoring of patients' condition. Digitalization has affected not only hospitals and primary health care organizations, but also the emergency medical service. To date, the figures help to analyze the main indicators of emergency medical care, such is the indicator of the efficiency of the ambulance team's arrival, the indicator of successful resuscitation, the analyzed cases help to update the reasons for non-compliance, which today improve the work of emergency medical care. In this manuscript, we wanted to report the results of the review and analysis of the main techniques used to digitalize the emergency medical service. The development of a system of indicators in an integrated medical information system contributes to a deeper analysis of the activities of the ambulance service and allows you to identify both positive and negative trends in its work. This makes it possible to make informed decisions to improve processes and improve the quality of services provided, which ultimately has a beneficial effect on the health and well-being of the region's population. The introduction of a navigation system for tracking the movement of teams made it possible to exclude unauthorized arrivals, misuse of vehicles, as well as unreasonably long stay on call. As a result, it was possible to significantly improve the efficiency of the arrival of the brigades. The provision of organizational and methodological assistance to employees of call service departments of the 4th category of urgency, as well as constant monitoring of their work with the identification and timely correction of deficiencies, allowed to increase the proportion of timely serviced calls.

Motorcycle Road Traffic Injuries in a Tertiary Hospital in Nigeria: A Reflection of the Trauma Care Crisis.

Motorcycle is a popular and growing form of intracity transportation in many Nigerian cities owing mainly to poorly developed transport systems.It contributes significantly to road traffic injuries (RTIs), which are a leading cause of death and disabilities in low- and middle-income countries. There is a lack of information on the quality of care received and the treatment outcome in patients with motorcycle RTIs in Ibadan and many cities in Nigeria. This study evaluated the characteristics of motorcycle-related RTIs, the quality of care received, and the outcome of the patients managedin a trauma reference center in Ibadan, Nigeria. This is a prospective cohort study. All patients involved in motorcycle road traffic crashes who presented to the emergency department of the University College Hospital, Ibadan, between August 2020 and May 2021, were included in the study. Data on patients' demographics, history of the crash, injuries sustained, definitive care, and the outcome of in-hospital care were obtained from patients (and/or their carers)and the medical records. A total of 156patients were seen, out of which 74.4% were males. About 76.2% were less than 45 years with a mean age of 35.7 ± 16.3 years, and the peak age group was 18-44 years. About 37 (23.7%) patients were involved in motorcycle/motorcycle collisions, whereas 67 (42.9%) were involved in motorcycle/car collisions. Riders accounted for 59.6% (93), and although 62% (97) of the patients presented within six hours of the crash, only 10.9% (17) presented within one hour. About 48% received some form of prehospital care rendered by officials of the Federal Road Safety Corps, police officers, or passers-by, and none was attended by a dedicated emergency ambulance team. The head and the limbs were the most affected anatomical areas, while orthopedic and neurosurgical procedures were the most required emergency surgical interventions. About 66.7% were discharged home with only 21.2% of them fit to return to pre-trauma function at discharge, and the mortality rate was 17.3%. Patients who presented at 7-24 hours (AOR = 2.99; 95% CI = 1.04-8.62; p-value = 0.043) and >24 hours after the accident (AOR = 5.65; 95% CI = 1.64-19.53; p-value = 0.006) were 2.99 and 5.65 times, respectively, more likely to die from motorcycle-related accident compared to those who presented within the first six hours. This study identified the growing burden of disabilities and mortalities related to motorcycle RTIs. It highlights the lack of prehospital trauma care, which is a reflection of the deficiency of a national,regional, or jurisdictional trauma systemand the critical need to develop a functional trauma system.

Craniofacial wound from a traumatic pistol injury in a 3-year-old child

With the advent of traumatic self-defense weapons among Russian civilians (weapons of limited destruction and nonlethal kinetic weapons), several studies on injuries among the adult population have been published in the medical literature. Skull injuries are the most severe, often fatal, injuries. To date, there are only isolated descriptions of such injuries in children.&#x0D; Description of the observation. According to the parents, the 3-year-old boy shot himself in the face with an Osa-4 pistol at home. He did not lose consciousness, and the bleeding was light. He was admitted to the central district hospital, from where he was evacuated by an ambulance team to Children’s City Clinical Hospital No. 9 named after. G.N. Speransky, Moscow. Upon admission, the patient was in a serious condition, conscious, and lethargic, reacted negatively to examination, and had 14 points on the Glasgow coma scale, and his hemodynamics was stable. Local status: In the upper part of the dorsum of the nose, a bullet entry hole was observed in the form of a bruised wound of irregular shape, pronounced swelling in the area of the left orbit, and hematoma of the upper eyelid. X-ray images of the skull showed a shadow of a foreign body (bullet) in the projection of the left orbit and ethmoidal labyrinth. The location and extent of damage were clarified by computed tomography. Under endotracheal anesthesia, a supraorbital trans-eyebrow approach on the left with layer-by-layer tissue dissection along the wound canal exposed a part of the bullet, wedged into the medial wall of the orbit and cells of the ethmoid bone. The bullet was removed, and bone fragments and layer-by-layer sutures were removed. Diagnosis: Gunshot causing a blind craniofacial non-penetrating wound in the dorsum of the nose and left orbit, multiple comminuted fractures of the ethmoid bones and superior and medial walls of the left orbit, contusion of the basal parts of the left frontal region of the brain, blunt trauma OS stage 2, local contusion, and retinal hemorrhage The postoperative period passed without complications. The child received a combination of antibacterial and restorative therapy. Vision was preserved, no neurological disorders were detected, and the cosmetic result was good. The patient was discharged in satisfactory condition under the supervision of an ophthalmologist, neurologist, and maxillofacial surgeon. This observation is presented to demonstrate damage to skull structures from traumatic weapons and will aid in further generalization of the treatment results of this type of wound in children. Prevention of injuries in children from traumatic weapons requires extensive educational work among parents who own these weapons.

Abstract 16067: The Impact of a Prehospital Mobile Cloud ECG Transmission System on Myocardial Damage and Mid-Term Mortality in Patients With ST-Elevation Myocardial Infarction

Background: Guidelines recommend that the door-to-balloon time (DTBT) should be reduced to ninety minutes or less in patients with STEMI. As such, it is critical that ambulance teams are adequately trained and equipped to identify STEMI utilizing ECG recorders and telemetry when necessary. Aims: This single-center study aims to evaluate the impact of the prehospital mobile cloud 12-lead ECG transmission system (SCUNA ® , MEHERGEN GROUP) on reducing DTBT, myocardial damage, and mortality in STEMI patients. Methods: In June 2018, SCUNA were integrated into the regional emergency medical service (EMS) departments in Uki and Kamimashiki cities in Kumamoto, Japan. We examined and compared door-to-catheterization laboratory time (DTCT), DTBT, peak CK, CK-MB levels, as well as 1-year mortality rates of STEMI cases in the four years before and after the introduction of the SCUNA. From June 2014 to May 2022, a total of 338 STEMI patients were transferred to our institute by ambulances from the two EMS departments. After excluding 29 patients with onset to reperfusion times exceeding 24 hours and 66 patients who were transferred without the use of SCUNA following its introduction, 243 consecutive STEMI patients who underwent emergency percutaneous coronary intervention (PCI) were included in the study. The patients were divided into two groups, 130 patients prior to SCUNA introduction (Pre-SCUNA), 113 patients after SCUNA introduction (Post-SCUNA). Results: There were no significant differences in age, gender, past medical history or Killip classification between the two groups. DTCT, DTBT, and onset to reperfusion time (OTRT) were significantly reduced in the Post-SCUNA group compared to the Pre-SCUNA group (Pre-SCUNA: 40 min vs. Post-SCUNA: 25 min; p &lt; 0.01, 71 min vs. 53 min; p &lt; 0.01, and 201 min vs. 166 min; p = 0.02, respectively). No significant differences were observed between peak CK and CK-MB levels in the two groups. Kaplan-Meier analysis revealed that SCUNA did not improve 30-day and 1-year outcomes compared with the Pre-SCUNA groups. Conclusion: While the prehospital mobile cloud ECG transmission system effectively reduced DTBT, it did not lead to a notable reduction in myocardial damage or mortality rates.

Legal aspects, responsibilities and possibilities of providing emergency medical care by a district pediatrician at the patient’s home

The authors raise an issue of job responsibilities of a district paediatrician in case of a home visit, as well as of the standards for packing first-aid kits and emergency medical care kits. The provisions of the applicable legal acts are provided. The proceedings of international conventions on primary medical care for children, current federal clinical guidelines, paediatric medical care standards and procedures, orders of the Ministry of Health of the Russian Federation were analysed. We paid attention to the experience of foreign countries, as well as the regions of the Russian Federation in providing emergency medical care to the paediatric population. A survey among local paediatricians was conducted: 30 district paediatricians (10 persons from each of three children’s outpatient departments in different districts of St. Petersburg) answered questions on the algorithm for activities during home visit if emergency care was required. The results of the survey and analysis of the applicable legal acts showed that the district paediatrician is responsible for the life and health of his/her patients. However, there is no single standard regulating the responsibilities to provide emergency care to the child by the district pediatrician during home visit, and the volume of this care has not been established. Urgent conditions require immediate medical care right when they are detected by a paediatrician on call, until an ambulance team arrives. In conclusion, the authors determined that the creation of unified algorithms for emergency medical care to be provided by a paediatrician on call encompasses a number of medical, ethical and legal aspects. The development of this document is certainly a necessity and requires a balanced, judicious approach.