Emergency Medical Care Of Patients Research Articles

The structure of traumatic brain injury in the city of Rostov-on-Don during the new coronavirus infection COVID 19

Objective: to study the frequency and structure of traumatic brain injury in the pre-ovoid, covid and post-ovoid periods in Rostov-on-Don.Materials and methods: to study the frequency and structure of traumatic brain injury in three years from 2019 to 2021 (in the pre-ovoid, covid and post-ovoid periods) according to the neurosurgical department and the department of combined trauma of the Emergency Medical Hospital No. 2 in Rostov-on-Don. Data processing using the IBM SPSS Statictic program version 26.0 using the χ2-Pearson criterion, in pairwise a posteriori comparative analysis, the χ2-Pearson criterion with Yates correction and likelihood correction were used. If the significance level is p<0.05, the differences are statistically significant.Results: in the pre-crisis period (2019), household trauma prevailed, the total number of hospitalized with TBI was 1,322. Of these, concussions accounted for 71%, brain contusions accounted for 28%, diffuse brain injury — 1%, street injury — 6.9%, transport injury — 6.81% and intentional injury — 24.1%. In the covid period (2020), the total number of patients admitted to the department decreased by 24%. The structure of the injury remained unchanged (concussions in 70% of cases, brain contusions in 28%, diffuse brain injury in 2%). In 2021 (completion of covid restrictions), the number of inpatient patients with TBI remained reduced (by 23%), the ratio of concussions, bruises, diffuse brain injuries remained the same.Conclusions: during the period of social isolation, there was a decrease in the number of hospitalized with TBI, which coincides with global indicators. The end of the restrictions associated with the pandemic is also characterized by a decrease in the number of patients admitted to the hospital with TBI. At the same time, a decrease in the ratio of the number of hospitalizations to the total number of deaths from head injury in 2019 and 2020 should be taken into account. from 19.83 to 14.98 in the Rostov region (according to the Federal State Statistics Service on the number of deaths from head injuries in 2019-2020), which reflects the level of accessibility of medical care. There was also a significant decrease in household, street, transport, school, sports and intentional types of TBI (p<0.05), while occupational injuries and trauma, the circumstances of which are unknown, did not significantly differ from the pre-pandemic indicators. Taking into account these results will improve the organization of emergency and emergency medical care for patients with TBI.

The results of emergency medical care for patients with paroxysmal atrial fibrillation

The main purpose of the study was to assess the quality and effectiveness of emergency medical care (EMC)in atrial fibrillation paroxysm (AF) at the prehospital stage. Materials and methods: the analysis included 111 patients who called an ambulance due to AF paroxysm. The patients were divided into groups depending on the recovery of sinus rhythm in the presence of a team. A telephone survey of patients was conducted 30 days after seeking medical help. Results: the sinus rhythm in the presence of the brigade was restored in 40% of cases. At the same time, the median recovery time of the rhythm was 32 minutes [Q1–Q3: 29–50]. 9% of patients were hospitalized. 53% of patients refused hospitalization. The probability of rhythm recovery increased with the help of a medical team and was not associated with the choice of an antiarrhythmic and the use of potassium and magnesium drugs. At the same time, in the next 30 days, complications (hospitalization, recurrence of AF and repeated call an ambulance) were observed more often among patients with restored rhythm (43% vs. 12%;p=0.00022). In 60.5% of patients who were trying to restore the rhythm, No anticoagulants were used, and in 7% 2 anticoagulants were used simultaneously. Conclusion. When providing EMC at the prehospital stage, rhythm restoration in the presence of a team is observed in 40% of cases, which is associated with a large number of complications in the next 30 days and a large percentage of errors associated with anticoagulant therapy.

Epidemiology of gastrointestinal bleedings compared in Ukraine and in the Poltava region

Acute gastrointestinal bleeding was and remains one of the severe emergency surgical diseases both in Ukraine and in other countries. The study of epidemiology, namely of the prevalence of gastrointestinal bleedings is relevant and will allow to intensify the diagnostic stage and create clearer algorithms for the treatment of this pathology. The aim of the work was to study the dynamics of emergency medical care for patients with gastrointestinal bleedings in Ukraine and the Poltava region. A statistical retrospective study of indicators of emergency medical care for patients with gastrointestinal bleedings in Ukraine and the Poltava region was conducted using data from official sources of the Center for Medical Statistics of the Ministry of Health of Ukraine. The wave-like nature of the increase in hospitalization of patients with gastrointestinal bleedings was observed in Ukraine and the Poltava region. The growth rates obtained as a result of the alignment of the dynamic series gave a clear trend towards the acceleration of the decline of this indicator: from -1.25 to -1.36 in Ukraine; and in the Poltava region before increasing the rate: from 4.85 to 3.62. During the entire studied period, the average level of hospitalization of patients with gastrointestinal bleeding after 24 hours was consistently higher in the Poltava region than in Ukraine (in Ukraine – 36.13% versus 43.16% in the Poltava region) (р<0.05). The rate of postoperative mortality in these patients in Ukraine increased (from 5.02% to 6.30%) (р<0.05)with gradual inhibition (the growth rate decreased). In the Poltava region, the level of the indicator exceeded the national level and the leveling of the dynamic series had a downward trend (from 12.4% to 10.38%) (р<0.05). Thus, the problem of gastrointestinal bleeding remains relevant at the present time, as it continues to remain one of the severe urgent surgical diseases, both in Ukraine as a whole and in its individual regions, in particular in the Poltava region. Peptic ulcer disease of the stomach and duodenum continues to remain the first nosology that causes gastrointestinal bleeding. Postoperative mortality remains high and ranges from 5% to 12%. The time of hospitalization from the onset of the disease to hospitalization is consistently higher in the Poltava region than in Ukraine (the average level in Ukraine is 36.13% versus 43.16% in Poltava region) (р<0.05).

Medical emergency card for Steinert's disease: an unmet need

Myotonic dystrophy type 1 (DM1) or Steinert's disease (ORPHA 273; OMIM #160900) is a rare disorder of genetic origin with muscular manifestations (muscle weakness and myotonia), early-onset cataracts (before 50 years of age) and systemic manifestations (cerebral, endocrine, cardiac, gastrointestinal tract, uterus, skin and immune system). Its clinical expressivity is highly variable and ranges from lethal forms in infancy to mild late-onset disease. Its low frequency prevents emergency medical professionals from becoming familiar with the essential precautions for its treatment. In order to alleviate this lack of information, those affected by DM1 have, in the countries of our environment, a medical emergency card (Tarjeta de Emergencias Medicas, TEM) that the patient should always carry with him/her and give to the physician before receiving emergency care. To define the TEM. To describe the TEM for DM1 already implemented. To list the advantages for patients and professionals of their use. Some of the TEM for DM1 currently in use in France and the United Kingdom are described. The arguments justifying their implantation in our setting are presented in detail. The TEM for DM1 managed by a physician can improve the emergency medical care of patients affected by Steinert's disease.

Emergency medical care of patients with psychiatric disorders - challenges and opportunities: Results of a multicenter survey

BackgroundPre-clinical psychiatric emergencies are generally treated by emergency medical staff. The subsequent clinical treatment is often conditioned by interaction problems between emergency medical staff and psychiatric clinical staff.ObjectivesTo identify problems affecting interaction between emergency medical and psychiatric care of mentally ill patients and pinpoint aspects of optimized emergency care.MethodsTo shed light on the interaction problems an anonymous, questionnaire-based, nonrepresentative survey of 98 emergency physicians (EM) and 104 psychiatrists (PS) practicing in acute psychiatry was conducted between March 1, 2021 and October 1, 2021.ResultsThe chi-square test for multiple response sets revealed consistently significant differences (p < 0.001) between EM and PS with respect to the questions analyzed. Approximately 36% of EM reported not to be adequately qualified to handle psychiatric emergencies (p = 0.0001), while around 50% of respondents were neutral in their assessment in how to deal with psychiatric emergencies. 80% of EM reported a negative interaction (rejection of patients) with PS when referring a psychiatric emergency patient to the acute psychiatric unit. The most common reasons for refusal were intoxication (EM: 78.8%, PS: 88.2%), emergency physician therapy (EM: 53.8%, PS: 63.5%), and not resident in the catchment area of the hospital (EM 68.8%, PS: 48.2%). In the casuistry presented, most respondents would choose “talk down” for de-escalation (EM: 92.1%, PS: 91.3%). With respect to drug therapy, benzodiazepine is the drug of choice (EM: 70.4%, PS: 78.8%). More EM would choose an intravenously (i.v.) or a Mucosal Atomization Device (MAD) administration as an alternative to oral medication (i.v.: EM: 38.8%, PS: 3.8%, p = 0.001, MAD: EM: 36.7%, PS: 10.6%, p = 0.006). Significantly more EM would seek phone contact with the acute psychiatric hospital (EM: 84.7%, PS: 52.9%, p = 0.0107). A psychiatric emergency plan was considered useful in this context by more than 90% of respondents. The need for further training for EM with regard to treating psychiatric clinical syndromes was considered important by all respondents. In particular, the topics of “psychogenic seizure,“ “intoxication,“ and “legal aspects of psychiatric emergencies” were considered important (Mann-Whitney U test, p < 0.001).ConclusionThe interaction-related problems identified in the emergency medical care of pre-clinical psychiatric patients relate to non-modifiable, structural problems, such as insufficient admission capacity and non-existent or inadequate monitoring capabilities in acute psychiatric hospitals. However, factors such as the education and training of EM and communication between EM and PS can be improved. Developing personalized emergency care plans for psychiatric patients could help to optimize their care.

Transformation of the ambulance service during the COVID-19 pandemic: correlation and thematic analysis

BACKGROUND: Ensuring the availability and quality of an ambulance service, including specialized ambulance, medical care, and specialized medical care in emergency and emergency form for fatal diseases, accidents, injuries, poisoning, and other conditions that require urgent medical intervention is an integral part of the national security system and one of the most important areas of health development in the Russian Federation. During the COVID-19 pandemic, such tasks appeared in the organization of emergency and emergency medical care for patients as a prompt distribution to inpatient departments, considering the severity of the patients condition, their covid status, and the availability of free places in medical organizations in a specific region, compliance with the waiting time prescribed for emergency medical care, and cutting off the non-core calls.&#x0D; AIM: To determine the optimal organizational structure of the ambulance service in the subject of the Russian Federation.&#x0D; MATERIALS AND METHODS: Collection and statistical processing of information regarding the work of ambulance services in a specific region were carried out. Correlation-thematic analysis using the Pearsons coefficient was performed.&#x0D; RESULTS: During the under covid period from 2016 to 2019, the overall mortality rate showed a clear downward trend. However, during the pandemic, even without taking into account the excess mortality, there was an increase, while, in 2020, when compared with 2019, the increase was 12%. Moreover, despite the increase in excess mortality in 2021 relative to that in 2020 by almost four times, the total mortality (excluding COVID) remained almost at the same level. In addition, it should be noted that, in regions where the ambulance service was represented by a single legal entity during the epidemic, excess mortality was lower in comparison with that in the regions where ambulance service was represented by departments within the Central District hospitals.&#x0D; CONCLUSION: The period of the coronavirus epidemic has largely transformed the healthcare system. The presence of a Unified Dispatching Service or a unified ambulance service in a region has a positive effect on the quality indicators of its healthcare system. In addition, the formation of new units in the structure of the ambulance service, such as a department for remote counseling, allows not only to ensure more accessibility to patients but also to effectively use the financial resources of an institution.

Exploration of Indole Compounds as Candidate for Radiation Mitigators

In this study, to develop radiomitigators capable of the emergency medical care of patients involved in radiation accidents, we investigated the radiomitigative effects and their underlying mechanisms of indole compounds such as DIM, GRM, and INM. The human normal fibroblast cell line, MRC-5 cells were administered 0.1% DMSO or each indole compound at 10 µM within 50-60 minutes after X-irradiated with 0-4 Gy. Next, we evaluated the alteration in the number of alive cells, clonogenic potential, DNA double-strand breaks, DNA damage repair activities, and protein expression related to regulate the oxidative stress response. Our results showed that DIM treatment suppressed radiation-induced decrease in the number of alive cells and clonogenic potential. Then, DIM treatment significantly decreased DNA double-strand breaks and highly increased Nrf2 via increased phospho-GSK-3β (Ser9) expression. These findings suggest that, in part, increased expression of p-GSK-3β (Ser9) by DIM treatment reduced DNA double-strand breaks via activation of Nrf2, resulting mitigated radiation-induced a decrease in the number of alive cells and clonogenic potential. Therefore, DIM, not GRM and INM, is a potential candidate for radiomitigators that can be applied to the radiation emergency medicine.

Effectiveness of use of local hemostatic agents for external bleeding by visiting ambulance teams

The alternative use of local hemostatic agents based on chitosan is the gentlest method of stopping bleeding, with minimal damaging effect on tissues, in comparison with the imposition of a hemostatic tourniquet or a pressure bandage.Goal. To evaluate the effectiveness of temporary stopping of external bleeding with the help of local hemostatic agents based on chitosan in powder and bandage forms and to determine the expediency of their use by visiting ambulance teams.Materials and methods. Specialists of the field teams of Ambulance and Medical Emergency Care Station n. a. A. S. Puchkov (Moscow, Russia) used local hemostatic agents based on chitosan in the form of a powder, a bandage in comparison with traditional hemostatic agents (a hemostatic tourniquet to stop arterial bleeding and a pressure bandage). The criteria for hemostasis were the absence of wetting of the pressure bandage and the absence of the need for a hemostatic tourniquet.Results. 103 patients were included in the main group, and 106 patients with arterial and venous bleeding from wounds of various localization were included in the control group. The age of patients in the compared groups ranged from 18 to 94 years. When using hemostatic powder and bandage, primary hemostasis was achieved in 99 patients in 96.1 % of cases, compared with the control group in 76 patients in 67.9 % of cases.Conclusions. Simplicity and ease of use, the speed of stopping bleeding and achieving results, as well as the absence of the need for special skills among specialists in the use of hemostatic agents, improved the quality of emergency medical care for patients with bleeding and allowed them to be recommended as a dressing for emergency medical care.

Особенности выполнения респираторной поддержки у пациентов с тяжелой патологией во время проведения санитарно-авиационной эвакуации

The aim of the study is to identify and to analyze the features of respiratory support in patients with severe acute respiratory failure when performing air ambulance evacuation by light class helicopters by specialists of aeromedical teams. Materials and methods. We used materials containing data on the frequency and peculiarities of ventilator usage and tracheal intubation during emergency medical care for patients with acute respiratory failure over the last 5 years (2016-2020). During this period emergency medical care was provided to 53579 patients, 298 of whom were in extremely severe and serious condition requiring ventilator usage and tracheal intubation. The following methods were used in the study: historical, statistical, analytical. Results of the study and their analysis. Trauma prevailed among nosological forms in patients with acute respiratory failure. Artificial lung ventilation with tracheal intubation should be started before the patient is transported to the helicopter cabin. During air ambulance evacuation of patients with acute respiratory failure by helicopter of light class, doctors should take differentiated approach to the choice of type and mode of respiratory support and of method of airway patency assurance.

Expert assessment of the suitability of treatment and diagnostic measures in providing emergency care to patients with acute coronary syndrome

It is known that it is possible to affect the extent of myocardial damage and, as a result, mortality only in the first hours of its development. Therapeutic tactics in ACS with elevation of the ST segment involves the restoration of coronary blood flow, the main method is the reperfusion of the coronary artery by systemic thrombolysis or PCI in a specialized hospital. The effectiveness of treatment is inversely related to the time spent.&#x0D; The aim of the study was to examine the opinion of specialists on the feasibility of implementing the items of the protocol of emergency medical care for patients with ACS at the place of call.&#x0D; Materials and methods. During the study the method of expert evaluations, which consisted of gathering information by interviewing experts and summarizing the individual opinions of experts into a general concept was used. The experts were 48 emergency physicians. The method of expert evaluation included the following stages: development of the questionnaire; survey of experts; summary of examination materials; calculation of statistical indicators; interpretation of the obtained results and formulation of conclusions.&#x0D; Results. In order to assess the actions of the emergency team, depending on the need to conduct them for diagnosis and emergency care for patients with ACS at the scene, we calculated the feasibility indexes for each item of the protocol. In the future, we divided the treatment and diagnostic measures for ACS with ST segment elevation according to the level of expediency at the scene into four groups (n): n1 – high level, n2 – sufficient level and n3 – low level and n4 – very low level. According to the results of the ranking, the scope of measures to be implemented by the head of the emergency team at the ACS with elevation of the ST segment on arrival on call, as well as measures that, according to interviewed experts, are not required at this stage and can be carried out during transportation of the patient to a specialized hospital.&#x0D; Conclusions. Based on the results of the calculation of feasibility indices and subsequent ranking of treatment and diagnostic measures for the relevant groups (n1, n2, n3, n4) from 37 items of the study, to assist patients with ACS with ST segment elevation at the scene, it is recommended to perform 16

ANALYSIS OF ORGANIZATIONAL COMPONENTS OF EMERGENCY MEDICAL CARE FOR PATIENTS WITH ACUTE CORONARY SYNDROME IN POLTAVA REGION OF UKRAINE

The aim of our research was to study the structure of patients with acute coronary syndrome and determine the organizational components of medical care for patients with suspected acute coronary syndrome in Poltava region. Material and methods: For our study was on the one hand statistical reports of health care institutions for 2016-2018, and on the other – a survey of doctors and paramedics of emergency medical care teams on tactics management of patients with AMI. The methodological apparatus used to achieve the set goals was based on the determination of relative values and analysis of time series. Results: The number of patients hospitalized with acute coronary syndrome is growing every year: from 82 people in 2012 to 489 in 2018. According to the monitoring conducted in Poltava region, emergency medical care for patients with acute coronary syndrome with ST segment elevation in 2018 in the cities was provided in the amount of 717, while in rural areas – 288. Conclusions: Data from the analysis of emergency medical care for patients with acute coronary syndrome showed that among patients with ST-segment elevation, urban residents predominate; in 90.6% of cases, the time to the patient’s hospitalization was less than 120 minutes.

Эффективность различных способов временной остановки наружного кровотечения на догоспитальном этапе оказания помощи

Objective. To estimate the efficiency of different methods of temporary external hemostasis at the pre-hospital stage of emergency medical care, taking into account the localization of injuries. Material and Methods. The cases (n=86) of prehospital emergency medical care for patients with external bleeding were studied. The data on the victims (age, gender), clinical status (type and location of injuries, type of bleeding), the volume of emergency care, the hemostasis methods used to control bleeding, their efficiency, side effects, difficulty of use were collected, and the duration of the pre-hospital stage were also taken into account. Results. The study found out that the most common cause of external bleeding is domestic accident (45.35%) of cases. By the nature of tissue damage, the cut wounds prevailed. Multiple or combined injuries occurred in 13.95% of cases. A tourniquet was the main method of hemostasis. Contact hemostatic agents were used only in 2.32% of cases at the pre-hospital stage. In some cases, when attempting to control the external bleeding, several hemostatic agents were sequentially used due to the lack of their efficacy. In 17.4% of cases, the victims with multiple or combined injuries received intravenous administrationof the systemichemostatic agents. In the complex of anti-shock measures in patients with severe trauma 77.91% of the prehospital patients underwent infusion therapy. Isotonic crystalloid solutions were used. A reliable increase in the duration of the prehospital stage of victims who underwent to a combination of hemostasis methods and intravenous infusion has been registered. The increase in the length of the prehospital stay occurs at the expense of the time required for creation of venous access and initiate infusion. The authors propose the algorithm for temporal control of external bleeding during emergency medical care at the pre-hospital stage. Conclusion. The main principles that need to be guided in the choice of any methods for stopping of bleeding are the speed and reliability of hemostasis for entire time of evacuation and the minimum damaging effect on the tissues. What this paper adds The effectiveness of various methods for temporal external hemostasis at the pre-hospital stage of emergency medical treatment taking into account the localization of injuries was estimated. It has been established that the main principles that must be followed in choosing any of the methods for stopping the bleeding are the speed and reliability of hemostasis for the entire duration of evacuation and the minimal tissue damage.

P013: Emergency medicine in dental practice: shaping an educational curriculum

Introduction: There is increasing public demand for dentists and their professional regulators to mitigate medical risk to patients in private dental clinics – especially those that offer procedural sedation. Recent high-profile adverse events reported in the media suggest an urgent need to address this issue. However, there is a paucity of knowledge in the literature regarding how best to do so. We aim to explore opportunities for multidisciplinary emergency medical training of dentists, and to offer an informed perspective to assist with the preliminary development of a structured educational program. Methods: We employ Gioia Methodology, an established standard for inductive qualitative research and thematic analysis. Interviewees were recruited via email and selected to ensure a broad and knowledgeable perspective. We conducted individual semi-structured 1-hour interviews of 6 dentists, 4 medical anesthesiologists, 3 emergency physicians, and 1 oral and maxillofacial surgeon. Several interviewees had leadership roles in Canadian dental regulatory agencies and educational institutions. Data from these interviews was contemporaneously analyzed and organized into “first-order concepts”, “second-order themes” and “aggregate dimensions.” Results: Our findings demonstrated 12 first-order concepts. Dentists require "leadership from professional regulators", and "accreditation by recognized training institutions" to "ensure competence in initial emergency medical care of patients". "Customized training programs" led by "multidisciplinary instructors" – including emergency physicians – should ensure "pre-operative medical risk assessment", "appropriate intra-operative patient monitoring", and "the ability to recognize common medical emergencies". Emergency medical skills training should focus upon "teamwork within the office", "early activation of EMS", “ABC skills", and the administration of "emergency medications". Conclusion: Dentists require a very broad skillset to safely manage patients in their practice, especially when procedural sedation is required. Our aggregate dimensions provide an overview of our recommendations: we suggest that dentists must work with their regulators and educators to "build upon an existing culture of patient safety" by fostering "competence in the prevention, recognition and initial management of medical emergencies" in the dental practice setting.

Аналіз якості надання екстреної медичної допомоги хворим з гострим коронарним синдромом на догоспітальному етапі

Аналіз якості надання екстреної медичної допомоги хворим з гострим коронарним синдромом на догоспітальному етапі

The main aspects of improvement of emergency medical care for patients with acute coronary syndrome

Objectives - to develop the main strategies of emergency medical care improvement for patients with acute coronary syndrome, in order to to reduce the morbidity and mortality in the population of a large industrial region. Material and methods. The study was conducted on the basis of the Moscow regional ambulance station. We used the content analysis, logical, system analysis, the method of mathematical statistics. Results. In the period 2017-2018, in the region's population, there is a tendency for decrease in the number of calls for ambulance teams caused by acute coronary syndrome. During the analyzed period, we noticed the reduction of the number of cases of pre-hospital thrombolytic therapy (by 17.5%). The response time to the patient's call not more than 20 minutes was observed in 92.9% of cases, the number of lethal outcomes in presence of the ambulance team decreased by 4. 6%. The results can be explained by the dynamic development of the infrastructure of cities and districts of the Moscow Region, by the improvement of road networks, by the complete renewal of the service's motor vehicle fleet, and by the opening of a number of new specialized medical institutions. A set of medical and organizational measures has been developed and put into practice in the ambulance service of the region, aimed at further improvement of the system of ambulance care for patients with acute coronary syndrome at the prehospital stage. Conclusion. The mortality reduction, preservation and improvement of public health can be achieved only through the comprehensive sustainable development of the region’s infrastructure, improvement of the organizational structure of the emergency medical service, mandatory use of algorithms and standards for the provision of medical care to patients at all stages.

Delayed help-seeking for emergency medical care of patients with acute coronary syndrome/myocardial infarction: review of studies

The review article provides an analysis of domestic and foreign studies evaluating the dynamics of temporary indicators of prehospital medical care for patients with acute coronary syndrome (ACS)/myocardial infarction (MI). It was noted that the delay in applying for medical care of patients with ACS/MI is currently a significant factor determining the effectiveness of the treatment of these diseases. Over the past decades, modern treatment methods and bright-line health system recommendations have appeared. Significant progress has been made in reducing the time from calling an ambulance to receiving treatment, especially in developed countries. However, in spite of the efforts made, the problem of late appealability of patients is still unresolved. In the world and inRussia, experience aimed to educate patients in terms of ACS/MI symptoms and the importance of timely help-seeking has been gained at the population level. There is no doubt that along with organizational measures aimed to treat cardiovascular patients, increasing public awareness of the ACS symptoms and emergency aid should be considered as one of the priority areas.

The Emergency Medical Care of Patients With Acute Myocardial Infarction.

Optimizing the emergency medical care chain might shorten the time to treatment of patients with ST-elevation myocardial infarction (STEMI). The initial care by a physician, and, in particular, correct ECG interpretation, are critically important factors. From 1999 onward, data on the care of patients with myocardial infarction have been recorded and analyzed in the Berlin Myocardial Infarction Registry. In the First Medical Contact Study, data on initial emergency medical care were obtained on 1038 patients who had been initially treated by emergency physicians in 2012. Their pre-hospital ECGs were re-evaluated in a blinded fashion according to the criteria of the European Society of Cardiology. The retrospective re-evaluation of pre-hospital ECGs revealed that 756 of the 1038 patients had sustained a STEMI. The emergency physicians had correctly diagnosed STEMI in 472 patients (62.4%), and they had correctly diagnosed ventricular fibrillation in 85 patients (11.2%); in 199 patients (26.3%), the ECG interpretation was unclear. The pre-hospital ECG interpretation was significantly associated with the site of initial hospitalization and the ensuing times to treatment. In particular, the time from hospital admission to cardiac catheterization was longer in patients with an unclear initial ECG interpretation than in those with correctly diagnosed STEMI (121 [54; 705] vs. 36 [19; 60] minutes, p <0.001). After multivariate adjustment, this corresponded to a hazard ratio* of 2.67 [2.21; 3.24]. Pre-hospital ECG interpretation in patients with STEMI was a trigger factor with a major influence on the time to treatment in the hospital. The considerable percentage of pre-hospital ECGs whose interpretation was unclear implies that there is much room for improvement.

病院前情報から抽出した不応需因子の検討(Analysis of factors relating to the refusal of emergency medical care for patients transported by ambulance: dealing with refused cases of ambulance transport)

要旨【背景】救急搬送不応需件数の増加に対する解決策は，依然として見出されていない。こうした状況の中，断らない施設を指定すべきという意見も出されているが，断らない救急施設に求められる体制や断らないことで予測される事態についての議論は，十分になされていない。我々は，不応需事例の多くには拒否され易い特定の因子があり，不応需は，ある程度予測可能であると考えている。不応需事例を根絶するためには，こうした事例の搬入要請がくることを前提として地域で対策を立てることが必要である。【目的】当院へ搬送された不応需事例の集積データを示し，こうした事例を受け入れるための方法について考察した。【対象】過去3年間で直近の医療圏を越えて当院へ搬送された事例1,255例と比較対象として同期間内に当院の直近医療圏からの搬送事例7,288例について検討した。【方法】上記検討事例の搬送救急隊地区，病院前情報から抽出した症状または専門領域，搬送時間帯，その他救急施設が受け入れ時に考慮すると予測される因子などを調べ，これらの因子を専門領域，特殊背景，時間帯の要素に分類し，その頻度を調べた。【結果】不応需は時間帯の要素が大きく，深夜（22:00–6:00）に最も多く発生していた。不応需された専門領域は，頻度順に，耳鼻咽喉科，眼科，精神科であった。特殊背景因子としては，入院適応が予想される扶養高齢者，アルコール関連，高エネルギー事故，刑務所や暴力などが関与している警察関連が不応需となり易い因子であった。【結語】我々が行った不応需事例の検討では，不応需となり易い因子が明らかになった。不応需を根絶するためには，一旦全ての患者をER（emergency room）型医療施設が受け入れ，救急医が院内専門医の協力のもとで専門分野にかかわらない診療を行うこと，そして最終的に転送が必要となった場合に転送可能な医療機関を確保することが不可欠と思われる。

Mitigative Effects of a Combination of Multiple Pharmaceutical Drugs on the Survival of Mice Exposed to Lethal Ionizing Radiation.

It is important to establish an easy-to-use therapeutic protocol for the emergency medical care of patients involved in radiation accidents to reduce the radiation-related casualties. The present study aimed to establish an optimum therapeutic protocol using currently approved pharmaceutical drugs to increase the survival of victims exposed to lethal radiation. Different combinations of four drugs-recombinant human erythropoietin (EPO), granulocyte-colony stimulating factor (G-CSF), c-mpl receptor agonist romiplostim (RP) and nandrolone decanoate (ND)-were administered to mice within 2 h after exposure to a lethal 7 Gy dose of γ-irradiation. On day 30 after irradiation, the condition of the mice was analyzed using various hematological parameters, such as the number of peripheral blood cells, bone marrow cells, hematopoietic progenitor cells and the expression of cell surface antigens. Approximately 10% of the untreated irradiated control mice survived for 21 days, but all of the control mice died by day 30. The combined administration of G-CSF, EPO and RP for five days immediately after irradiation led to a complete survival of the irradiated mice until day 30. However, the treatment with G-CSF, EPO and RP with ND led to only 75% survival at day 30. The hematological analyses showed that the numbers of almost all of hematopoietic cells in the surviving mice treated with effective medications recovered to the levels of non-irradiated mice. The present findings show that the combination of G-CSF, EPO and RP may be a useful countermeasure for victims exposed to accidental lethal irradiation.

Basic principles of intensive care for patients with polytrauma at an early stage. Ways to optimize

Treatment of patients with polytrauma is complex and still unsolved problem. The mortality in polytrauma in both developing and developed countries, in spite of the progress of medical science is still at a high level, but its outcome is largely dependent on the timeliness and adequacy of treatment and preventive measures.The aim of this study was to analyze the state of systems and emergency medical care to patients with polytrauma in developed countries and the possibility of implementation of the protocols in the Ukraine.Results. The basic principles of the organization of emergency for patients with polytrauma in the prehospital and early hospital stage are considered, key areas of intensive care of these patients at an early stage of specialized care are analyzed. Shortcomings of emergency medical care for patients with polytrauma in hospitals of Ukraine and ways of their correction and reform are shown that can improve the quality of care for patients with polytrauma and increase the survival rate of these patients.Conclusions. Organization of EMC for patients with severe trauma should be based on three main principles:1. The minimum amount of time from the time of trauma to the necessary delivery of emergency medical care in the prehospital phase.2. Creation of specialized trauma centers to provide timely specialized and skilled care for patients with severe trauma at the hospital stage.3. Ensuring continuity of pre-hospital and hospital stages of EMC and in specialized centers