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Programme September 7, 2012

Programme September 7, 2012. Emergency medicine ABCDE approach Anaphylaxis Water, electrolytes EOLD in Pacific Štefan Trenkler, MD, PhD. KLINIKA ANESTÉZIOLÓGIE A INTENZÍVNEJ MEDICÍNY LF UPJŠ A FNLP KOŠICE.

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Programme September 7, 2012

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  1. Programme September 7, 2012 • Emergency medicine • ABCDE approach • Anaphylaxis • Water, electrolytes • EOLD in Pacific Štefan Trenkler, MD, PhD

  2. KLINIKA ANESTÉZIOLÓGIE A INTENZÍVNEJ MEDICÍNY LF UPJŠ A FNLP KOŠICE Emergency medical system in SlovakiaStefan Trenkler, MD. PhD. Kaim UPJS LF a UN LP Košice Košice 2012

  3. Anaesthesia – 4 elements 1. Anaesthesia 2. Intensive (Critical) care medicine 3. Emergency medicine 4. Analgesia

  4. Chain of survival

  5. Emergency medicine • Goal:emergency medical service1. prehospital2. intrahospital3. interhospital4. mass disasters • Patients- life threatening situations, 1th hour quintet- damaged organs- damaged extermities- pain therapy

  6. ACS Cardiac arrest Respiratory arrest Stroke Polytrauma

  7. Emergency Life threatening situations, death probable wt intervention Airway Breathing Circulation Neurology E.g. polytrauma, cardiac arrest Urgent Wt urgent therapy the situation wil progress to severe damage E.g. ACS, stroke Emergency situations < Urgent Low probability of worthening E.g. fracture

  8. Emergency medical system • Patient oriented • Availability 24/256 - geografical (distance, time) - social (for all) - financial • Capacity- prehospital- emergency department

  9. Emergency medicine - structure • Dispatcher centres of EMS • Emergency medical system –Zdravotná Záchranná Služba (ZZS) • Emergency department Oddelenie (klinika) urgentnej medicíny / pracovisko urgentného príjmu

  10. Integrated rescue system since 2006 Ministry of health Ministry of interior Regional crisis centre Mining dept. 8 Dispatcher centres EMS dept. Mountain dept. Police dept. Fire dept. EMS stations Fire stations Training center Koncepcia organizácie a rozvoja IZS do r. 2010, Osob príloha ZdN č. 26, jún 2006

  11. Legislative rules - EMS Act: • Act No. 129/2002 Coll. on the Integrated rescue system • Act No. 579/2004 Coll. on the Emergency medical services and on the amendment and supplement of certain laws • 6 Acts – Healthcare reform (2005) Regulation: • No. 30/2006 Emergency medical services (fundamental change of the system)

  12. Integrated rescue system - Dispatcher centres Goverment organized 8 regional integrated centres – EMS department, Fire department, Police department 1x Mining department (Prievidza); 1x Mountain department (Poprad) GPS tracking system of ambulances Unified telephone number 112 (temporary operational direct calls 155 EMS, 150 fire, 158 police) Staff: 4 – 6 operators: former ICU nurses, paramedics 1 medical doctor present Training centre

  13. EMS system – mixed system Two types of ambulances: 1. medical: physician + paramedic + driver (paramedic) 2. paramedical: paramedic + driver (paramedic) Dispatcher decides which ambulance will be sent Ambulances: mostly Mercedens and Volkswagen Equipment: goverment defined list of standard technology, medicaments and materials EMS providers: There are ~25 state/hospital/private providers (1 to 91 stations); licence 2010 - 2014 No official fire department ambulances in the system Payment: fixed monthly payments (government regulated) for medical/paramedical ambulances + kilometers Source: Health insurance companies

  14. Záchranná zdravotná služba (ZZS) • ambulance physician based RLP • ambulance paramedics based RZP • ambulance mobile intensive care unit (MIJ) • ambulance - helicopters

  15. Stations of medical/paramedical EMSSLOVAKIA 2001 91 STATIONS 110 ambulances 1 amb/50 000 inhab • Weaknesses: • Low number of amb/long resp. time (=>30 min) • High number of emerg. call centers (155 =>80) • Differences and insuficiency of facilities, premisses, equipment • Splited organization and management

  16. Stations of medical/paramedical EMSSLOVAKIA 2010 270 stations 1 amb/25 000 inhab • Strengths: • Better access (response time< 15 min) • Less emerg call centers (80 => 8) • Good premisses, equipment - uniformity • Unification in organization and management, education, standards, protocols

  17. EMS Slovakia 2010 – 270 stations • Falck Záchranná a.s., Košice 90 • Záchranná služba Bratislava 53 • Záchranná služba Košice 38 • Zamed s.r.o., Komárno 20 • LSE s.r.o., Limbach 19 • NsP: Trnava, Nitra, Trenčín, Poprad, Prešov Martin, Levoča, Dolný Kubín, N. Zámky, Trstená, Čadca, L. Mikuláš, Krompachy, Brezno, Skalica, SNV, Bardejov, Komárno, Skalica ... 50 220

  18. HEMS 7 regional heliports around the country; 7 private Direct call 18155 Incorporated in EMS – dispatcher centres Helicopters: Agusta A109 K2, AS355 F2 Ecureuil. Night operations

  19. Emergency department

  20. Interhospital transport

  21. Intravenous kanyla Normal saline Peroral analgesics BLS Mask/bag ventilation Using of medicaments should be consulted with the dispatcher centre doctor or doctor of own company In complicated cases they ask for doctor based ambulance Paramedics - competences

  22. Education • Drivers- 101 hours introductory course- 2 years study at nursing school • Paramedics: - 3 years bachelor study of emergency medicine (for high school graduated)- 1 year specialized study for nurses with praxis- specialization in anaesthesia and intensive medicine accepted • Medical doctors- Postgraduate specialization in emergency medicine, 5 years- Specialization in anaesthesia and intensive medicine accepted

  23. Qualification of EM specialists II. Education and training – indipendent speciality, 5 years, final board examination • 22 months of practicing at prehospital EM care department, • 12 months at ICU • 1 month at dispatch center • 6 months at Surgical dept. • 6 months at Internal and cardiology dept. • 3 months at Pediatric dept • 2 moths at Neurology and Psychiatry • 2 months at Obstetric dept • 6 months at CPO (central addmition dept) • Accreditation – education program was accredited with Accreditation commitee of Ministry of Health

  24. Qualification of EM specialists I. • Scope of practice- diagnosis- emergency procedures – CPR, intubation, coniotomy, i.v. and c.v. access- emergency procedures of vital functions support (vasoactive drugs, sedation, anaesthesia, volume resusccitation etc.), chest drainage, pericardial drainage, cardiostimulation, artificial ventilation, delivery, etc

  25. START triage

  26. Triage label

  27. Public relations

  28. Education

  29. Thank you Stefan.trenkler@upjs.sk

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