Emergency Medical Aid Research Articles

Zbrinjavanje pacijenata sa AKS u GZZHMP Beograd

Introduction. Treating patients suffering from acute myocardial infarction with ST elevation (STEMI) represents a challenge and new treatment possibilities with better outcomes are always sought. The Emergency Medical Aid Service holds the key role in prehospital care of patients with STEMI and administers dual antiplatelet therapy: MONA (Morphine, Oxygen, Nitroglycerin, Aspirin) + clopidogrel or ticagrelor, with the aim of enhancing the reperfusion effect. Objective: To determine the incidence of prehospital treatment of STEMI with dual antiplatelet therapy, as well as the time passed from the first contact with the 194 operator to the admission of the patient to the hospital. Methods: Retrospective analysis of the period between January 1st 2014. and December 31st 2017. The diagnosis was based on medical history as described by the patient, clinical findings and ecg tracings. In patients diagnosed with STEMI, dual antiplatelet therapy was administered and monitored. Time passed from the first contact with the 194 operator to admission to the hospital was also measured. Results: Out of the total number of 8843 patients with acute coronary syndrome, who were treated by the Emergency Medical Aid Service, 2982 were diagnosed with STEMI. Dual antiplatelet therapy was administered to 40.29% of the patients in 2014, while that percentage grew to 70.01% in 2017. Of that percentage in 2017, 60.38% received MONA and ticagrelor, while 9.63% received MONA and clopidogrel. Women have been proven to suffer from STEMI at a later age (70.17±13.05 years of age) than men (61.89±13.43 years of age). Also, 75% of the patients are admitted to the hospital within 65.77 minutes from the moment of the first contact with the 194 operator. Conclusion: During the period in question, a significant rise in application of antiplatelet therapy has been noted. The transfer time of STEMI patients is an important factor of prehospital treatment. Continuous education of Emergency Medical Aid teams enables advances of diagnostic and therapeutic measures in prehospital conditions. .

ВОЗМОЖНОСТИ ИСПОЛЬЗОВАНИЯ ИНФОРМАЦИОННЫХ ТЕХНОЛОГИЙ В УПРАВЛЕНИИ ПРОЦЕССАМИ ОРГАНИЗАЦИИ СКОРОЙ МЕДИЦИНСКОЙ ПОМОЩИ

Objective: Improvement of the model of the automated control system to support the decision-making in the field of emergency medical care to the population of a large industrial center. Methods: The analysis of the activity of the ambulance station was studied the existing normative legal acts regulating the activity of emergency medical aid. A detailed study of software KGBUZ «KSSMP» – an automated control system (ASU) «MISS 03», working system of dispatching of vehicles – «AutoGRAPH». To create a model of its own software, the C++ programming language was used. Results: The model of the AnScor+ software and hardware complex created by us is organized as a distributed client-server system. The end devices are data collection terminals (mobile phones of ambulance crews running the Android operating system); a client-server Android application was developed for them. The interaction between mobile terminals, dispatcher terminals, and the MISS-03 automated control system is carried out centrally through the software of the AnScor+ server. Conclusion: The creation of such analytical services to ensure the solutions of the problems of transport logistics, automated patient flow management will allow realizing in practice the advanced algorithms of the medical emergency services, significantly improve the main performance indicators, such as the promptness of quality and the volume of medical care. Keywords: Ambulance, informatization, automated control system, healthcare, patient flows.

Hipoglikemija - iskustvo hitne pomoći u Beogradu

Hipoglikemija - iskustvo hitne pomoći u Beogradu

СУЧАСНІ ШЛЯХИ ВВЕДЕННЯ ЛІКАРСЬКИХ ПРЕПАРАТІВ ПРИ ВИКОНАННІ СЕРЦЕВО-ЛЕГЕНЕВОЇ ТА МОЗКОВОЇ РЕАНІМАЦІЇ НА ДОГОСПІТАЛЬНОМУ ЕТАПІ

Виконання базових алгоритмів сучасного клінічного протоколу раптової зупинки кровообігу (РЗК), вимагає, зокрема, якнайшвидшого забезпечення венозного доступу. Водночас, саме відсутність кровообігу є тим несприятливим фактором, який суттєво ускладнює, а, нерідко, унеможливлює успішну реалізацію цієї методики, ламаючи при цьому всі ланки серцево-легеневої та мозкової реанімації, відповідно, зводячи її ефективність до фатального мінімуму. Такі випадки, зокрема, спостерігаються у пацієнтів із РЗК на тлі гіповолемії тяжкого ступеня, гіпоксії, у наркоманів тощо.Мета – дослідити та проаналізувати альтернативні внутрішньовенному шляхи введення медикаментів при раптовій зупинці кровообігу за умов діяльності бригади екстреної (швидкої) медичної допомоги.Матеріали і методи. Проведено детальний аналіз альтернативних методик внутрішньовенному способів введення лікарських засобів, їх порівняльну характеристику, оцінено переваги та недоліки, зважаючи при цьому на їх практичну доступність, вартість, адаптацію до вікової характеристики постраждалих, які перебувають в стані клінічної смерті. Використовуючи бібліосемантичний, аналітичний методи та метод системного аналізу, проведено ???Результати. Після проведення детального аналізу методик та шляхів введення медикаментів при раптовій зупинці кровообігу лікарями екстреної (швидкої) медичної допомоги (Е(Ш)МД), зважаючи на важкість, а подекуди неможливість забезпечення внутрішньовенного доступу, слід вважати внутрішньо-кістковий доступ найбільш ефективним засобом введення медикаментів під час виконання реанімаційних заходів. Наступним за ефективністю, складністю проведення, особливо за умов масового випадку після викоричтання класичного внутріщньовенного доступу, є внутрішньокістковий доступ.На сьогоднішні цей спосіб вважається хорошою альтернативою іншим методам, оскільки при дотриманні нескладних технічних вимог досягається терапевтичний ефект від введених медикаментів, аналогічний тому, що й при внутрішньовенних інфузіях.Основною перевагою внутрішньокісткового доступу, порівняно з досліджуваними (ендотрахеальний, внутрішньосерцевий, внутрішньоартеріальний), складними за технікою виконання, які загрожують розвитком значних ускладнень, є можливість його застосування у немовлят та дітей молодшого віку, знайти вену в яких, як правило, достатньо важко. Також даний спосіб вважається хорошою альтернативою іншим методикам, тому що за дотримання нескладних технічних вимог при цьому досягається якісний терапевтичний ефект від введених медикаментів.Висновки. Якісна теоретична підготовка, наявність необхідного сучасного медичного спорядження, практичне професійне освоєння стандартних і сучасних альтернативних методик донесення медикаментів при раптовій зупинці кровообігу лікарями Е(Ш)МД сприятимуть дотриманню основних положень клінічних протоколів лікування даного термінального стану, а в кінцевому результаті приведуть до зниження догоспітальної та ранньої госпітальної летальності.

China's Belt and Road Initiative from a global health perspective.

China's Belt and Road Initiative from a global health perspective.

Philippine Academy of Rehabilitation Medicine emergency basic relief and medical aid mission project (November 2013–February 2014): the role of physiatrists in Super Typhoon Haiyan

Background: Physiatrists have provided humanitarian assistance in recent large-scale global natural disasters. Super Typhoon Haiyan, the deadliest and most costly typhoon in modern Philippine history, made landfall on 8 November 2013 resulting in significant humanitarian needs.Methods: Philippine Academy of Rehabilitation Medicine physiatrists conducted a project of 23 emergency basic relief and medical aid missions in response to Super Typhoon Haiyan from November 2013 to February 2014. The final mission was a medical aid mission to the inland rural community of Burauen, Leyte. Summary data were collected, collated, and tabulated; project and mission evaluation was performed.Results: During the humanitarian assistance project, 31,254 basic relief kits containing a variety of food and non-food items were distributed and medical services including consultation, treatment, and medicines were provided to 7255 patients. Of the 344 conditions evaluated in the medical aid mission to Burauen, Leyte 85 (59%) were physical and rehabilitation medicine conditions comprised of musculoskeletal (62 [73%]), neurological (17 [20%]), and dermatological (6 [7%]) diagnoses. Post-mission and project analysis resulted in recommendations and programmatic changes to strengthen response in future disasters. Physiatrists functioned as medical providers, mission team leaders, community advocates, and in other roles.Conclusions: This physiatrist-led humanitarian assistance project met critical basic relief and medical aid needs of persons impacted by Super Typhoon Haiyan, demonstrating significant roles performed by physiatrists in response to a large-scale natural disaster. Resulting disaster programing changes and recommendations may inform a more effective response by PARM mission teams in the Philippines as well as by other South-Eastern Asia teams comprising rehabilitation professionals to large-scale, regional natural disasters.Implications for rehabilitationLarge-scale natural disasters including tropical cyclones can have a catastrophic impact on the affected population.In response to Super Typhoon Haiyan, physiatrists representing the Philippine Academy of Rehabilitation Medicine conducted a project of 23 emergency basic relief and medical aid missions from November 2013 to February 2014.Project analysis indicates that medical mission teams responding in similar settings may expect to evaluate a significant number of physical medicine and rehabilitation conditions.Medical rehabilitation with participation by rehabilitation professionals including rehabilitation doctors is essential to the emergency medical response in large-scale natural disasters.

The system of provision of emergency medical aid to patients with acute myocardial infarction; the 30 year experience

Aim. The aim of the study was to compare characteristics of the prehospital stage of acute myocardial infarction (AMI) in the residents of Tomsk in 1984 and, 30 years later, in 2013. Materials and methods. The study was based on the materials of research and information database of the WHO epidemiology program “Acute Myocardial Infarction Register” that has been operating in Tomsk since 1984. A total of 713 and 832 AMI cases, registered in 1984 and 2013 respectively were analyzed. The analysis did not include episodes of patient’s death at the prehospital stage. Results: The study revealed a significant increase in the number of AMI patients seeking medical help during the first hours and the first days after onset of the disease, improvement in the quality of AMI diagnosis by primary care physicians, and a significant increase in the number of patient hospitalized within the first six hours and the first days from initial medical examination. All these factors were responsible for a significant increase in the number of AMI patients admitted to the specialized cardiology department within the first six hours and the first days after the onset of AMI. Conclusion. Despite positive dynamics of certain parameters characterizing the system of emergency medical care for AMI patients at the prehospital stage in Tomsk, its activities during the period of interest cannot be considered satisfactory due to untimely provision of medical aid to many AMI patients and the unacceptably low hospital admission rate especially during the first hours after the onset of AMI. Further optimization of preventive health education at the population level is required to improve medical awareness first of all in regard to early clinical manifestations of AMI.

Diagnostics of methyl alcohol intoxication: possibilities
 and prospects

Intake of toxic alcohols especially methyl alcohol posses a serious threat to health. Despite relatively low toxicity of methanol (hazard class III), its metabolite formic acid resulting from biotransformation of methyl alcohol by alcohol dehydrogenase is ranked among substances creating a high risk of toxic action. The long period of methanol toxification (~48 hr) makes difficult diagnostics of intoxication and therefore delays provision of emergency medical aid. It imposes high requirements on express diagnostics of methyl alcohol intoxication (Т51.1 ICD-10). The main diagnostic modality - routine evaluation of osmolar and anion gaps, has advantages and disadvantages. Drawbacks of emergency medical aid to the victims of methyl alcohol intoxication necessitates the search for new diagnostic options some of which sre discussed in the present article.

Mental disturbances on anti-terrorist combatants in Ukraine

In Ukraine, the significant participants of the “Anti-Terroristic Operation” (ATO) need to provide a system of psychiatric, psychotherapeutic assistance. The 6 groups of disorders:– non-pathological reaction (Z65.5);– pathological reactions (F43.0);– neurotic disturbances (F45);– psychotic disturbances (F44);– PTSD (F43.1);– chronic personality changes (F62.0).The system of complex assistant was provided. Step 1: emergency psychological assistance. It is carried out on the basis of crisis intervention, that is defined as the emergency and urgent medical and psychological first aid, aimed at the return of the victim to the adaptive level of functioning, preventing progredient development of mental disorders, reducing the negative impact of a traumatic event. Step 2: medical and psychological support. The purpose is the relief of mental and behavioral disorders, prevention (secondary and tertiary), psychological maladjustment, progressive course of mental disorders, with the purpose, rational, suggestive, cognitive-behavioral (CBT), and others. The aim of psychotherapy is to support the patient's assistance, processing traumatic material revaluation of the crisis, a change of attitude, increased self-esteem, develop realistic perspectives and active life position. It is important to restore a sense of competence and design future in which you can use a good past experiences. Step 3: the primary goal of treatment is relief of anxiety and fear, stress, adaptation to the human life and activity in conditions of continuing psychogenic. The most effective method of psychotherapy in these cases is CBT. Step 4: supportive. All steps developed by multimodal model of psychotherapy.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

An experience of organizing activities of Emergency and Elective Advisory Service and Medical Evacuation Department under ongoing armed conflict (an example of Luhansk People’s Republic of Ukraine)

Relevance. Timely tertiary assistance is the most important predictor of victim survival; for this, fairly fast patient transfer directly to a specialized institution or rapid arrival of highly qualified doctors are required. Here, rescuers and medical personnel should cooperate. However, so-called sanitary aviation defined as a single service of the Ministry of Emergency Situations and the Ministry of Health actually cannot operate in the Luhansk People’s Republic (LPR), Republic of Ukraine, during the armed conflict. Functions of sanitary aviation in the LPR are assigned to the Emergency and Elective Advisory Service and Medical Evacuation Department of the Lugansk Republican Center for Emergency Medical Care and Disaster Medicine (Center). Intention. Summarize the experience of organizing the work of the Emergency and Elective Advisory Medical Aid and Medical Evacuation Department of the Lugansk Republican Center for Emergency Medical Care and Disaster Medicine over the first year of operation. Methodology. The sources of information for this purpose were official statistical data (plans and reports of the Center, reports of public health institutions of the LPR). Results and Discussion. The analysis showed that emergency and planned consultative specialized medical assistance to individuals in the territory of the LPR in the context of unfinished armed conflict is rendered both outside the health care institution, and in the settings of any LPR hospital free of charge round-the-clock and without delay in the mode of daily activities and high availability. More than 75 highly qualified medical professionals work in the department of the Center, of which 9 have doctorate degrees. For their transportation, specialized sanitary vehicles with up-to-date equipment are used (based on the Peugeot Boxer and Ford Transit). However, their deficiency amounts to 90%. On-site and further assistance in the evacuation process includes various interventions, anesthesia and intensive care, and television and medical technology. In general, over 2016 the Department received 1230 calls, of which 640 – from medical institutions in Lugansk, the rest – from the regions of the Republic. At the same time, 1336 patients (956 adults and 380 children) were examined and 249 surgical procedures were performed on site (195 adults and 54 children). The staff of Center also deliver medical equipment, blood, medicines etc. to the health care institutions of the LPR. The Center significantly improved the quality of tertiary medical care for the population in case of sudden diseases and life-threatening conditions in remote areas of the LPR. Conclusion. It is necessary to resolve issues with modern equipment of sanitary transport, training in emergency medical care using algorithms with proven effectiveness, as well as establishing interactions between the specialists of the Center and the health care institutions of the LNR to improve the outcomes of medical and sanitary care for the population of the LPR in the context of the unfinished armed conflict.

Urgences et médecine de catastrophe

Human concentration, the development of technologies, threats of destruction, and contamination are at the origin of an awareness of the need for civilian assistance. Urgent medical aid, which is developing and moving towards network medicine, in partnership with all the structures contributing to the emergency, is contributing to the rationalization of social policy. The actors of emergency medical aid thus contribute to safeguarding, while improving, a health and social sector, which is now one of the foundations of democracy and one of its foundations in the face of the challenges of the future.

Mental and behavior disorders among combatants in Ukraine

in Ukraine, the significant participants of the “anti-terroristic operation” (ATO) need to provide a system of psychiatric, psychotherapeutic assistance.The 6 groups of disorders:– non-pathological reaction (Z65.5);– pathological reactions (F43.0);– neurotic disturbances (F45);– psychotic disturbances (F44);– PTSD (F43.1);– chronic personality changes (F62.0).The system of complex assistant was provided. Step 1: emergency psychological assistance. It is carried out on the basis of crisis intervention, that is defined as the emergency and urgent medical and psychological first aid, aimed at the return of the victim to the adaptive level of functioning, preventing progredient development of mental disorders, reducing the negative impact of a traumatic event.Step 2: medical and psychological support. The purpose is the relief of mental and behavioral disorders, prevention (secondary and tertiary), psychological maladjustment, progressive course of mental disorders, with the purpose, rational, suggestive, cognitive behavioral (CBT), and others. The aim of psychotherapy is to support the patient's assistance, processing traumatic material revaluation of the crisis, a change of attitude, increased self-esteem, develop realistic perspectives and active life position. It is important to restore a sense of competence and design future in which you can use a good past experiences. Step 3: the primary goal of treatment is relief of anxiety and fear, stress, adaptation to the human life and activity in conditions of continuing psychogenic. The most effective method of psychotherapy in these cases is CBT. Step 4: supportive. All steps developed by multimodal model of psychotherapy.Disclosure of interestThe author has not supplied his declaration of competing interest.

Accouchement inopiné extrahospitalier : prise en charge et facteur de risque

To estimate the frequency of accidental out-of-hospital deliveries (OHDs), to describe the home care and the complications occurred, and to identify risk factors. A retrospective case-control study from 1st January 2012 to 31 December 2012 in Lyon urban area. Cases were identified from the Emergency Medical Aid Service 69 (SAMU 69) registry and control from the birth registry of the maternity corresponding to the case, recruiting two controls per case. The frequency of the OHDs was 0.3% [0.2-0.4]. At home, the prophylactic administration of oxytocin was performed in 18.3% [9.31-27.3] of cases and prevention of neonatal hypothermia was performed in 45.7% [34.1%-57.3%] of cases. Multiparity [OR: 3.43 (1.65-7.23)], a precarious situation [OR: 37.63 (5.02-7.81)], and lack of antenatal care [OR: 3.36 (2.72-4.15)] were OHDs' risk factors. The practical prevention of postpartum hemorrhage, and that of the home neonatal hypothermia could be improved. Points of vigilance for the medical teams to look for during the pregnancy monitoring are precariousness and less than 3 consultations scheduled.

Design and Research of Emergency Transport Security Decision Support System

With China's rapid growth in the number of cars, traffic accidents, traffic congestion and other problems have become the bottleneck of urban economic development. Our cities are in the "abnormal" crisis-prone period. The impact of disasters on people's lives emergencies growing, life and property of residents pose a great threat. As a modern city traffic arteries, any relief activities are inseparable from the smooth roads. And the roads open is the main form of transport security, is the distribution of emergency supplies, personnel, emergency medical aid and other emergency rescue preconditions, while smooth roads can reduce the loss of life and property losses to a minimum to reduce incidents. Therefore, actively carry out research and development organization to protect emergency transportation and emergency transportation decision support system, providing useful information for disaster prevention and relief, reduce the degree of disaster losses, improve our ability to deal with major disasters is important.

Research on City Rapid Medical Decision System Based on GIS

In order to guarantee the validity of the city emergency rescue, it will need to feedback goods demand and injuries to guide accident emergency rescue center in a timely, and also we need to fully grasp with emergency supplies and emergency hospital. Considering the effectiveness of city emergency rescue and timeliness, the paper analyzes and design Rescue Decision Support System for city distribution of emergency supplies and search of wounded man based on GIS. Emergency medical aid model established in this paper, taking ArcGIS+VS2005 as the development platform, C# as development language, design and development the preliminary city emergency medical rescue simulation system based on GIS.

First-ever population-based study on status epilepticus in French Island of La Reunion (France) – Incidence and fatality

PurposeWe aimed to determine the incidence and case-fatality of first-ever status epilepticus (SE) among the general population living in La Reunion Island, a French overseas territory in the Indian Ocean near Madagascar. MethodsWe recruited cases (1st July 2004–30th June 2005) in a population-based manner using neurology, neurosurgery, electroencephalogram, emergency, paediatric and neuroradiology services; emergency medical aid service; emergency and admission service of private and public clinics; neurologists (public and private); private paediatricians and practitioners of various rural hospitals. All cases had an electroencephalogram (EEG) and were assessed by an epileptologist. Standard definition and classification schemes were used. Those with known epilepsy were not part of this analysis. ResultsSixty-five cases (males: n=41, 63.1%) had epileptologist-confirmed SE, with 38.5% (n=25) being >60 years of age. Global incidence rate was 8.52/100 000 (95% confidence interval 6.5–10.5). A bimodal age distribution with high frequency and incidence among young (<10 years age) (frequency: 12.3%; incidence 6.6/100,000) and aged (>60 years) (frequency: 40.0%; incidence 35.0/100,000) was observed. We found that 60%, 32.3%, 6.7% had convulsive, partial and non-convulsive SE respectively (1% remained unclassified). Of the cases identified, 44.6%, 38.5%, 16.9% had unprovoked, provoked or cryptogenic seizures respectively. The most important aetiological factors identified included: stroke (27.7%), alcoholism/toxicity (18.5%), cryptogenic (16.9%), infections (10.8%). Mortality was 18.5%. ConclusionThe incidence of SE incidence in La Reunion Island was lower than that described elsewhere. The status type was found to be dependent on aetiology and age. The study confirms that SE is more frequent in men and in older adults and is associated with significant short-term case mortality.

Quality assessment of X-rays interpreted via teleradiology for Médecins Sans Frontières

Summary Médecins Sans Frontières (MSF) is a humanitarian organisation which provides emergency medical aid in challenging settings; field staff often diagnose and treat patients using limited resources and without the expertise of specialists. Teleradiology is available for MSF sites which use digital computed radiography (CR) imaging or conventional film and chemistry. We conducted a retrospective study of the quality of X-rays utilised by MSF for teleradiology diagnosis over a one-year period. All plain X-ray examinations referred for interpretation using two MSF teleradiology platforms in 2012 were assessed against 15 image criteria and further evaluated as being either diagnostic or non-diagnostic. The sites studied sent an average of 115 images (range 10-452). Images were a mixture of chest, skeletal and abdominal radiographs. The majority of the images were CR (n = 597, 74%). Three sites were MSF/Epicentre installed and operated (Epicentre is a research facility affiliated with MSF); five sites were operated by the ministry of health, imaging patients referred by MSF. The sites performing poorest for quality were all facilities which used film and chemistry (53% non-diagnostic images). The sites performing better for quality were facilities which used CR digital imaging (12% non-diagnostic images), two of which had also undergone radiographer training. Our study suggests that transitioning to CR digital imaging has the potential to improve image quality compared to film and chemistry. Radiography training should be made a priority for all sites with X-ray services. The continued utilisation of X-ray services by MSF where images have proven to be consistently poor should be re-considered.

Intelligent Information System of Diagnosis and Monitoring Application in the Emergency Medical Aid for Poisonings by Toxic Substances

According to statistical data, a considerable increase in the number of acute carbon monoxide poisonings has been observed in Azerbaijan in the last few years. The difficulty of diagnosis is caused by the fact that the same symptoms and even syndromes may be seen in case of poisonings by different toxic substances. For this reason, the problem of necessity of performing differential diagnosis becomes urgent. The danger of poisonings is that they can be the causes of serious pathologies with the passage of time. This article is proposing development of a system carrying out differential diagnosis and monitoring, based on up-to-date methods of evidence medicine.

Ray diagnostics at pathology of large joints in hemophilic living in Kazakhstan

The combined ray diagnostics has been used to estimating the degree of joint injury at hemophilia and advisability of osteodensitometric monitoring of the level of mineral density of bone tissue before and after endoprosthesis replacement of large joints in hemophilic patients living in Kazakhstan. The study has been carried out at the Chair of Radiology No. 1 of the Medical University of Astana. The results of examination and treatment of 43 patients with hemophilic arthropathia of large joints have been analyzed. The patients were treated in the Polytrauma Department in the period of 2010 to 2011 inthe Republican Scientific Center of Emergency Medical Aid (Astatna), where endoprosthesis replacement of large joints in hemophilic patients have been conducted for the first time among countries of Central Asia and highly efficient methods of early diagnostics (osteodensitometric instrumentation) have been implemented. This has allowed the timely prophylaxis, treatment, and rehabilitation of patients with osteoporosis and hemophilia, as well as prediction of stability of endoprosthesis in postoperative period.

Diagnostic and Treatment Features of Urgent Adolescent Gynecological Pathology in Emergency Ambulance Assistance

The pediatric anatomo-physiological features knowledge is required in the diagnosis and treatment of urgent adolescent gynecological pathology. The article presents the structure, special features of diagnostics and treatment of acute gynaecological pathology in girls from 0 to 18 years of age at the stage of Emergency Medical Aid, delivered in hospital by Emergency crews in the city of Saint-Petersburg on the basis of 1024 cases, on the period 2009–2010