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AP077 Prehospital care of traumatised children
Abstracts, Resuscitation 2011 – Implementation / Resuscitation 82S1 (2011) S1–S34 AP076 A Simple Rule “AROW” for Termination-of-Resuscitation in Cases of Refractory Out-of-Hospital Cardiac Arrest Yoshikazu Goto 1 , Tesuo Maeda 1 , Masaaki Hashimoto 2 , Keisuke Ohta 3 , Hideo Inaba 1 1 Section of Emergency Medicine, Kanazawa University Hospital, Kanazawa, Ishikawa Prefecture, Japan 2 Department of Emergency and Critical Care, Noto General Hospital, Nanao, Ishikawa Prefecture, Japan 3 Department of Emergency and Critical Care Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa Prefecture, Japan
Background: Two out-of-hospital termination-of-resuscitation rules for emergency medical service (EMS) personnel have been proposed in Canada. The first is for use by responders providing basic life support (BLS), which includes 3 criteria: event not witnessed by EMS, no shocks are administered and no return of spontaneous circulation (ROSC). The other is for use by responders providing advanced life support (ALS), which adds 2 criteria: event not witnessed by a bystander and no bystander cardiopulmonary resuscitation. Objective: To assess the validity of the 2 rules and a simple rule “AROW”, which includes 3 criteria: no use of automated external defibrillator (A), no ROSC (RO) and event not witnessed by a bystander (W), for identifying individuals with refractory out-of-hospital cardiac arrest (OHCA). Methods: A retrospective cohort study using surveillance data prospectively submitted by EMS and clinical records of 732 OHCA cases transported to our two hospitals between January, 2006, and December, 2010. Of these, 520 met the inclusion criteria. Results: Overall survival rate to hospital discharge was 9.2% (n=48). Of 387 (74.4%) patients fulfilling the BLS rule, 2 (0.5%) survived to hospital discharge. With the other 2 rules, none of the patients survived to hospital discharge. The specificities of the BLS, “AROW” and ALS rules in identifying non-survivors were 0.958 (95% confidence interval [CI], 0.860–0.989), 1.000 (95% CI, 0.926–1.000) and 1.000 (95% CI, 0.926–1.000), respectively. The positive predictive values of the BLS, “AROW” and ALS rules for predicting non-survivors were 0.995 (95% CI, 0.981–0.999), 1.000 (95% CI, 0.987–1.000) 1.000 (95% CI, 0.969–1.000), respectively. Conclusion: The simple rule “AROW” for out-of-hospital termination-ofresuscitation showed better performance than the others in identifying OHCA patients with little chance of survival. In Japan, as EMS providers are not permitted to terminate resuscitation in the field, use of this simple clinical prediction rule may help clinicians decide whether to terminate resuscitation efforts in OHCA patients.
AP077 Prehospital care of traumatised children 1 1 Branislava Cveticanin ´ , Branka Roksandic´ 1 , Radojka Jokšic-Mazinjanin ´ , Predrag Šaponja 1 , Milena Jokšic´ 2 1 2
Institute for Emergency Medical Service Novi Sad, Novi Sad, Serbia Health Centre Beˇcej, Beˇcej, Serbia
Introduction: Trauma is the leading cause of mortality in children older than twelve months. Aim of the Study: To present the frequency of injuries, the mechanisms anatomic localisation of lesions and modalities of prehospital care of injured children. Materials and Methods: The retrospective and observational study was conducted by the Emergency Medical Service Novi Sad. The study group included traumatised children who were treated in the period between 01 January 2010 and 31 December 2010. The children were divided into five groups, according to age (infants 0–1 year, toddlers 2–5 years, children 6–9 years, pupils 10–13 years, teenagers 14–17 years). Data were processed using the SPSS 11 and Statistica 7. Results: The highest frequency of injuries was in the age group 14–17 (40.8%). The injuries were more prevalent in boys (62.1%). In this study, the highest number of children were injured as vehicle passengers (17%) and during the acidental fall (14.7%). The head injury was the most frequent injury. Prehospital analgetics were applied in 10.1% of the patients, 10.8% were immobilizated. Of all traumatized children, 40.5% were sent to trauma centres. Conclusion: Trauma as a cause of morbidity and mortality in patients under 18 possessses specific characteristics in relation to the age of patients. A good knowledge of the pediatric patophisology is necessary, with its appropriate application in prehospital conditions.
AP078 Ready for the emergency? Experiences and self-assessment of first- and second-year medical students at the University of Heidelberg Jan Stiepak, Kerstin Schwöbel, Dirk Lossnitzer, Hugo Katus, Michael Preusch University of Heidelberg, Department of Internal Medicine III, Heidelberg, Germany Introduction: Experiences and awareness of medical emergencies differ a lot
S27
among first-year medical students. In this study, we evaluated the participants (n=306) of a basic first aid training which is required for medical students in their first or second year. The aim was to evaluate whether or not they have previous experiences in emergency management and the impact of the training on self-assessment in basic life support. Methods: Participants had to answer a questionnaire before and after a 16 h basic first aid course. Lessons consisted of forced basic life support training and an instruction in management of the most common emergency situations. It is provided by student tutors who underwent a special training, such as paramedics or nurses. Results: Most participants had previous experience in emergency care, usually from basic life support training which is required to sign up for German driver’s license. Students did not feel well prepared to take action in emergency situations. Only 65.8% remembered the correct emergency telephone code and only 36.2% knew the correct algorithm for CPR. Participants were aware of their deficits and recognized that they will be required to respond to a medical emergency sooner or later in their career. The fact that some participants’ parents are medical doctors had no impact on their awareness of emergency situations. In self-assessment, the provided basic first aid training showed a significant improvement of basic life support skills among the participants, such as chest compression and ventilation. Participants reported furthermore a decrease in anxiety performing CPR and felt better prepared to manage an emergency situation such as cardiac arrest. Conclusion: Knowledge and experience of emergency care differ a lot among first-year medical students. Basic first aid training can improve live support skills and should be implemented in the curriculum as early as possible.
AP079 subjective perception of the correct execution of the CPR by the swim trainers, does not correspond with their quality Roberto Barcala Furelos 1 , Antonio Bores Cerezal 1 , Sergio López García 2 , Cristian Abelairas Gómez 2 , José Luis García Soidán 1 1 2
University of Vigo, Vigo, Spain University of A Coruña, Coruña, Spain
Background: The aim of this study is to evaluate the cardiopulmonary resuscitation (CPR) effectivity of people whose work is related to water activities such as swimming trainers. Drowning is one of the main reasons of death and most of the research about this matter analyzes high qualified samples in CPR performance. For example, some of these high qualified samples are staff members from different hospitals: Hospital of the University of Pennsylvania and the University Of Chicago Medical Center or twenty-three healthy volunteers, nurses and doctors of Intensive Care Unit of the Terrassa Hospital. Material and Methods: at the University of A Coruña, 40 volunteers swimming trainers were told to carry out CPR for a minute. The manikin used was the Laerdal Resusci Anne® , which automatically sends feedbacks about how deep chest compressions are and the ventilation volume. Finally they were asked to evaluate their performance in a one to ten scale. Results: Out of 40, 5 (12,5%) volunteers never had any formation about the CPR performance, 36 (90%) couldn’t manage to carry out correctly more than 50% chest compressions, 37 (92,5%) couldn’t manage to carry out correctly more than 50% ventilations. The average of all the 40 volunteers’ evaluations about their own performances in chest compressions and ventilations were higher than five. Conclusions: Most of the workers related to water activities are unable to carry out a good CPR performance, despite European Resuscitation Council guidelines of 2010. Thou they think they realize good performances. This research shows the need for a more rigorous formation in the CPR performance, which must be trained periodically.
AP080 The use of auxiliary material rescue by lifeguards CPR does not guarantee quality Roberto Barcala Furelos 1 , Antonio Bores Cerezal 1 , Cristian Abelairas Gómez 2 , Sergio López García 2 , Rubén Navarro Patón 3 1
University of Vigo, Vigo, Spain University of A Coruña, A Coruña, Spain 3 University of Santiago de Compostela, Santiago de Compostela, Spain 2
Background: Following the research line of Prieto Saborit (2003), Palacios (2010) (who compared two aquatic rescues, one of them with the torpedo buoy and the other one without it) our purpose in this study is to analyze how rescue equipment influences blood lactate level [La] and cardiopulmonary resuscitation (CPR) quality performance, as lactic acid is a fatigue indicator generated in muscles. Fatigue has high influence in CPR quality performance. Material and Methods: 20 lifeguards were told to carry out 4 rescues (50 m running – 75 m swimming – 75 m dragging the manikin – 10 m dragging the manikin to dry sand – 5 min CPR); without equipment (WE), with torpedo buoy (TB), with floppy (F) and with flippers (FR). [La] was measured in different situations: before
Background: Two out-of-hospital termination-of-resuscitation rules for emergency medical service (EMS) personnel have been proposed in Canada. The first is for use by responders providing basic life support (BLS), which includes 3 criteria: event not witnessed by EMS, no shocks are administered and no return of spontaneous circulation (ROSC). The other is for use by responders providing advanced life support (ALS), which adds 2 criteria: event not witnessed by a bystander and no bystander cardiopulmonary resuscitation. Objective: To assess the validity of the 2 rules and a simple rule “AROW”, which includes 3 criteria: no use of automated external defibrillator (A), no ROSC (RO) and event not witnessed by a bystander (W), for identifying individuals with refractory out-of-hospital cardiac arrest (OHCA). Methods: A retrospective cohort study using surveillance data prospectively submitted by EMS and clinical records of 732 OHCA cases transported to our two hospitals between January, 2006, and December, 2010. Of these, 520 met the inclusion criteria. Results: Overall survival rate to hospital discharge was 9.2% (n=48). Of 387 (74.4%) patients fulfilling the BLS rule, 2 (0.5%) survived to hospital discharge. With the other 2 rules, none of the patients survived to hospital discharge. The specificities of the BLS, “AROW” and ALS rules in identifying non-survivors were 0.958 (95% confidence interval [CI], 0.860–0.989), 1.000 (95% CI, 0.926–1.000) and 1.000 (95% CI, 0.926–1.000), respectively. The positive predictive values of the BLS, “AROW” and ALS rules for predicting non-survivors were 0.995 (95% CI, 0.981–0.999), 1.000 (95% CI, 0.987–1.000) 1.000 (95% CI, 0.969–1.000), respectively. Conclusion: The simple rule “AROW” for out-of-hospital termination-ofresuscitation showed better performance than the others in identifying OHCA patients with little chance of survival. In Japan, as EMS providers are not permitted to terminate resuscitation in the field, use of this simple clinical prediction rule may help clinicians decide whether to terminate resuscitation efforts in OHCA patients.
AP077 Prehospital care of traumatised children 1 1 Branislava Cveticanin ´ , Branka Roksandic´ 1 , Radojka Jokšic-Mazinjanin ´ , Predrag Šaponja 1 , Milena Jokšic´ 2 1 2
Institute for Emergency Medical Service Novi Sad, Novi Sad, Serbia Health Centre Beˇcej, Beˇcej, Serbia
Introduction: Trauma is the leading cause of mortality in children older than twelve months. Aim of the Study: To present the frequency of injuries, the mechanisms anatomic localisation of lesions and modalities of prehospital care of injured children. Materials and Methods: The retrospective and observational study was conducted by the Emergency Medical Service Novi Sad. The study group included traumatised children who were treated in the period between 01 January 2010 and 31 December 2010. The children were divided into five groups, according to age (infants 0–1 year, toddlers 2–5 years, children 6–9 years, pupils 10–13 years, teenagers 14–17 years). Data were processed using the SPSS 11 and Statistica 7. Results: The highest frequency of injuries was in the age group 14–17 (40.8%). The injuries were more prevalent in boys (62.1%). In this study, the highest number of children were injured as vehicle passengers (17%) and during the acidental fall (14.7%). The head injury was the most frequent injury. Prehospital analgetics were applied in 10.1% of the patients, 10.8% were immobilizated. Of all traumatized children, 40.5% were sent to trauma centres. Conclusion: Trauma as a cause of morbidity and mortality in patients under 18 possessses specific characteristics in relation to the age of patients. A good knowledge of the pediatric patophisology is necessary, with its appropriate application in prehospital conditions.
AP078 Ready for the emergency? Experiences and self-assessment of first- and second-year medical students at the University of Heidelberg Jan Stiepak, Kerstin Schwöbel, Dirk Lossnitzer, Hugo Katus, Michael Preusch University of Heidelberg, Department of Internal Medicine III, Heidelberg, Germany Introduction: Experiences and awareness of medical emergencies differ a lot
S27
among first-year medical students. In this study, we evaluated the participants (n=306) of a basic first aid training which is required for medical students in their first or second year. The aim was to evaluate whether or not they have previous experiences in emergency management and the impact of the training on self-assessment in basic life support. Methods: Participants had to answer a questionnaire before and after a 16 h basic first aid course. Lessons consisted of forced basic life support training and an instruction in management of the most common emergency situations. It is provided by student tutors who underwent a special training, such as paramedics or nurses. Results: Most participants had previous experience in emergency care, usually from basic life support training which is required to sign up for German driver’s license. Students did not feel well prepared to take action in emergency situations. Only 65.8% remembered the correct emergency telephone code and only 36.2% knew the correct algorithm for CPR. Participants were aware of their deficits and recognized that they will be required to respond to a medical emergency sooner or later in their career. The fact that some participants’ parents are medical doctors had no impact on their awareness of emergency situations. In self-assessment, the provided basic first aid training showed a significant improvement of basic life support skills among the participants, such as chest compression and ventilation. Participants reported furthermore a decrease in anxiety performing CPR and felt better prepared to manage an emergency situation such as cardiac arrest. Conclusion: Knowledge and experience of emergency care differ a lot among first-year medical students. Basic first aid training can improve live support skills and should be implemented in the curriculum as early as possible.
AP079 subjective perception of the correct execution of the CPR by the swim trainers, does not correspond with their quality Roberto Barcala Furelos 1 , Antonio Bores Cerezal 1 , Sergio López García 2 , Cristian Abelairas Gómez 2 , José Luis García Soidán 1 1 2
University of Vigo, Vigo, Spain University of A Coruña, Coruña, Spain
Background: The aim of this study is to evaluate the cardiopulmonary resuscitation (CPR) effectivity of people whose work is related to water activities such as swimming trainers. Drowning is one of the main reasons of death and most of the research about this matter analyzes high qualified samples in CPR performance. For example, some of these high qualified samples are staff members from different hospitals: Hospital of the University of Pennsylvania and the University Of Chicago Medical Center or twenty-three healthy volunteers, nurses and doctors of Intensive Care Unit of the Terrassa Hospital. Material and Methods: at the University of A Coruña, 40 volunteers swimming trainers were told to carry out CPR for a minute. The manikin used was the Laerdal Resusci Anne® , which automatically sends feedbacks about how deep chest compressions are and the ventilation volume. Finally they were asked to evaluate their performance in a one to ten scale. Results: Out of 40, 5 (12,5%) volunteers never had any formation about the CPR performance, 36 (90%) couldn’t manage to carry out correctly more than 50% chest compressions, 37 (92,5%) couldn’t manage to carry out correctly more than 50% ventilations. The average of all the 40 volunteers’ evaluations about their own performances in chest compressions and ventilations were higher than five. Conclusions: Most of the workers related to water activities are unable to carry out a good CPR performance, despite European Resuscitation Council guidelines of 2010. Thou they think they realize good performances. This research shows the need for a more rigorous formation in the CPR performance, which must be trained periodically.
AP080 The use of auxiliary material rescue by lifeguards CPR does not guarantee quality Roberto Barcala Furelos 1 , Antonio Bores Cerezal 1 , Cristian Abelairas Gómez 2 , Sergio López García 2 , Rubén Navarro Patón 3 1
University of Vigo, Vigo, Spain University of A Coruña, A Coruña, Spain 3 University of Santiago de Compostela, Santiago de Compostela, Spain 2
Background: Following the research line of Prieto Saborit (2003), Palacios (2010) (who compared two aquatic rescues, one of them with the torpedo buoy and the other one without it) our purpose in this study is to analyze how rescue equipment influences blood lactate level [La] and cardiopulmonary resuscitation (CPR) quality performance, as lactic acid is a fatigue indicator generated in muscles. Fatigue has high influence in CPR quality performance. Material and Methods: 20 lifeguards were told to carry out 4 rescues (50 m running – 75 m swimming – 75 m dragging the manikin – 10 m dragging the manikin to dry sand – 5 min CPR); without equipment (WE), with torpedo buoy (TB), with floppy (F) and with flippers (FR). [La] was measured in different situations: before