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P19 Education of emergency medicine for general practitioners in Slovenia
EMS, Training, Techniques, Experimental
S30 P25
PIY
DEVELOPMENT IRELAND DOWLING
OF A CARDIAC
CHAIN
OF SURVIVAL
IN A RURAL
AREA OF
EDUCATION SLOVENIA
OF EMERGENCY
HRIBAR P., HRIBAR-HABINC
J, BURY G
MEDICINE
FOR GENERAL PRACTITIONERS
IN
M.
Insmute of Anaestheamlogy.hvers~ty MedIcal Centre, 61000 LJublJans,ZaloHka 7, Slovema Although much experience wtth the chain of survival mncept exists in urban ares, less 1s known of its impact in rural ares. In 1591, an opportunity to test the concept arose when community demand for an improvement in pre-hospital emergeng care services in Donegal led to the adoption of the chain of survival as the means to achieve this. Donegal is the most northwesterly of Ireland’s counties and has a population of 123,oM); about half the population is located in coastal rural areas, remote from acote hospital services. Programs were planned to provide widespread cardiac awareness and CPR training in the community, to create and train a statutory cardiac ambulance service (using advisory defibrillators) and to train general practitioners in the provision of ACLS support. This report describes the setting-up and impact of the program in its first 18 moo&: Behveen 2,oM) and 3,ooO people have attended cardiac awareness courses, five districts have operational cardiac ambulance services and many Gh have received ACLS training. During this time, of 18 attempted defibrilbtions by ambulance crews, six have resulted in ROSC and survival to three months. The imolications of the “ro~ramrne for other rural areas will be discussed
INTRODUCTION:
In Slovema the emergency medune IS camed out by general practmoners
In LJubljanaand Cel~especial umts for the emergency medune are organued Smce 1985 we have been teachmg the physuans ACLS theory and skdl and smce 1990 they have beencommg to Unwerslty MedIcal Centre m LjublJanaand General Hospital Cel~efor standardized trammg METHODS:
List of education I month ofemergency medul medune, I month of
anaesthemology.3 weeks ofsurgxal emergency (IO lectures i practre), 2 weeks ofpedutnc intens,ve care Anaestheslology 14 days m operatmg and emergency rooms, 14 days ,n ICU Pracocal sklllness 50 mtubatmns. 50 I v cannulatmns, 20 mhalatlonal anaestheslaand 20 controled vent&latmnsby mask, J CPCR and transpon ventdator, 8 two-hour lectures (hterature Included). IO use of detibnlator and final M C Q test In ICU central venous cannulat,on, treatment of p”l~&wma, head m~wes. sepsx ARDS Fmal colloquy
Key words: Rural Chain of Survival Community
RESULTS: Durmg 1985.1994 there were 75 courses ofACLS (6-hours each) wth ,718 partqxmts
From 1990.199440 general practmones took pan m education of Insntote of
Anaesthesmlogy in LJubtJana They performed 79% of programed number of mtubatwns. 92% of anaestheswprocedures by mask and 105% ofI v and central venous cannulatibns, 82% passed written test and colioquv There was a shortage of ttme for pracosmg the treatment of shock states I” emergency room CONCLUSIONS:
The value of ACLS and emergency medune educatmn of general
practitmners 1salready reflected I” better prehospttal treatment The practmoners should have more practxe I” hospital emergency cases The educations should be repeated ,n two t,, three years
Educatmo ACLS Emergency medlcme
PI72 HOW COULD WE IMPROVE THE EFFICACY OF THE “CHAIN OF SURVIVAL” IN PATIENTS WITH OUT-OF-HOSPITAL CARDIAC ARREST ? MOLS I’., BEAUCARNE E., ROBERT PH., LANGEN C., MULLER M. Emergency department, Saint-Pierre University Hospital, Brussels.
The “Chain of Survival” represents the most adequate sequence of events leading to the best possible chances of survival of out-of-hospital cardiac arrests (CA). The higher the “ercentaee of ventricular fibrillation (VF) on arrival of the EMT D’s, thz higher ;he perc&tage of long term survivors. If we suppose the time of intervention by the first tier (EMT D’s) and the medical team (MICU team) to be relatively irreducible, the time needed to activate the emergency medical system (EMS) determines the efficacy of the chain of survival
P20 NEAR-DROWNING:
Aim : to evaluate 1. The intervention time m patients with asystole, VF and VF with restoration of a systemic circulation (ROSC) 2. The % of cases in which help was sent out before the occurrence of a CA (call for thoracic pam or arrhythmia). &gk CA-100 Call % Call for thoracic pain or arrhythmia 100.1st tier arrival IOO-MICU arrival
Asystole 08’55” i: O’OY
FV 05’34” f 0’32”
FV with ROSC M’37” f 01’49 *
2,7 % uszo” i 0’09” 1?03- f 0’20”
7,1 % 05’28” t- 0’21” 13’10”~0’40”
9,6 % ’ 05’34” f 01’37” 10’25” f 01’09”
* p < 0,05 (columns 2 ami 3 are compared to column Ii
1. The time needed to activate the EMS seems to be the maior limitine factor when the efficacy of the chain of survival is considered 2. People should be educated to call EMS not only in cases of apparent death but also in cases of thoracic pan or arrhythmia.
A PROSPECITVE
STUDY OF THREE
YEARS
Ch. GARCIA, R BATALLA, F PARRAMON, J VUAPLANA, A ALVAREZ, N ESTANOL, A VILLALO Hospital Josep Trueta Gimna Spain Sctvicio Anestesia y Reanimacion Objectives: To evaluate the cases of near-drowning inour geographical area. Design: Proqective study. Patients: Behvecn May-October for three consecutive years, 107 patients arrived at “or hospital, both directly and also referred to us from smaller hospitals in the area. Main Outcome Measures: Age. primary transport (ambulance non-medical personal) Pa02 at arrived at hospital, Pa02 after two hours of treatment, pH at admission and pH after tw hours of treatment and discharge time. Results: The mean age was 29 5 years with range of 1 to 78.82 patients (77%) suffered the accident in the seat (salt water) and 25 (23%) in swiming-pool. The primary transport was with oxygen therapy in 37% of patients. The mean Pa02 at arrived at hospital was 60 mm Hg, and after hvo hours of treatment was 104 mmHa. The first mean “H was 7 09 and hv” h&s later was 7 32. The mean Glasgow score w-12. Eleven patients (10%) died, in all cases the GSC was 3-4 at admission in the hosdtal. 14 “atients (13%) needed ICU. 55 (52%) were discharged in one week, and 27 patients (25%) were discharged in one day The “umber of deaths by drowning in situ is not knom to us. Conclusion: Hypoxia and acidosis arc present in the majority of patients. However recovery is normally achieved following a few- hours of treatm&t. -1s c&landing the absence df neurological deficits, (probablv due to the lack of primary tranrtwrt with trained CPR staff). -
.
Key words: Near-drownmg.
Hypoxm Ac~dosls
.
S30 P25
PIY
DEVELOPMENT IRELAND DOWLING
OF A CARDIAC
CHAIN
OF SURVIVAL
IN A RURAL
AREA OF
EDUCATION SLOVENIA
OF EMERGENCY
HRIBAR P., HRIBAR-HABINC
J, BURY G
MEDICINE
FOR GENERAL PRACTITIONERS
IN
M.
Insmute of Anaestheamlogy.hvers~ty MedIcal Centre, 61000 LJublJans,ZaloHka 7, Slovema Although much experience wtth the chain of survival mncept exists in urban ares, less 1s known of its impact in rural ares. In 1591, an opportunity to test the concept arose when community demand for an improvement in pre-hospital emergeng care services in Donegal led to the adoption of the chain of survival as the means to achieve this. Donegal is the most northwesterly of Ireland’s counties and has a population of 123,oM); about half the population is located in coastal rural areas, remote from acote hospital services. Programs were planned to provide widespread cardiac awareness and CPR training in the community, to create and train a statutory cardiac ambulance service (using advisory defibrillators) and to train general practitioners in the provision of ACLS support. This report describes the setting-up and impact of the program in its first 18 moo&: Behveen 2,oM) and 3,ooO people have attended cardiac awareness courses, five districts have operational cardiac ambulance services and many Gh have received ACLS training. During this time, of 18 attempted defibrilbtions by ambulance crews, six have resulted in ROSC and survival to three months. The imolications of the “ro~ramrne for other rural areas will be discussed
INTRODUCTION:
In Slovema the emergency medune IS camed out by general practmoners
In LJubljanaand Cel~especial umts for the emergency medune are organued Smce 1985 we have been teachmg the physuans ACLS theory and skdl and smce 1990 they have beencommg to Unwerslty MedIcal Centre m LjublJanaand General Hospital Cel~efor standardized trammg METHODS:
List of education I month ofemergency medul medune, I month of
anaesthemology.3 weeks ofsurgxal emergency (IO lectures i practre), 2 weeks ofpedutnc intens,ve care Anaestheslology 14 days m operatmg and emergency rooms, 14 days ,n ICU Pracocal sklllness 50 mtubatmns. 50 I v cannulatmns, 20 mhalatlonal anaestheslaand 20 controled vent&latmnsby mask, J CPCR and transpon ventdator, 8 two-hour lectures (hterature Included). IO use of detibnlator and final M C Q test In ICU central venous cannulat,on, treatment of p”l~&wma, head m~wes. sepsx ARDS Fmal colloquy
Key words: Rural Chain of Survival Community
RESULTS: Durmg 1985.1994 there were 75 courses ofACLS (6-hours each) wth ,718 partqxmts
From 1990.199440 general practmones took pan m education of Insntote of
Anaesthesmlogy in LJubtJana They performed 79% of programed number of mtubatwns. 92% of anaestheswprocedures by mask and 105% ofI v and central venous cannulatibns, 82% passed written test and colioquv There was a shortage of ttme for pracosmg the treatment of shock states I” emergency room CONCLUSIONS:
The value of ACLS and emergency medune educatmn of general
practitmners 1salready reflected I” better prehospttal treatment The practmoners should have more practxe I” hospital emergency cases The educations should be repeated ,n two t,, three years
Educatmo ACLS Emergency medlcme
PI72 HOW COULD WE IMPROVE THE EFFICACY OF THE “CHAIN OF SURVIVAL” IN PATIENTS WITH OUT-OF-HOSPITAL CARDIAC ARREST ? MOLS I’., BEAUCARNE E., ROBERT PH., LANGEN C., MULLER M. Emergency department, Saint-Pierre University Hospital, Brussels.
The “Chain of Survival” represents the most adequate sequence of events leading to the best possible chances of survival of out-of-hospital cardiac arrests (CA). The higher the “ercentaee of ventricular fibrillation (VF) on arrival of the EMT D’s, thz higher ;he perc&tage of long term survivors. If we suppose the time of intervention by the first tier (EMT D’s) and the medical team (MICU team) to be relatively irreducible, the time needed to activate the emergency medical system (EMS) determines the efficacy of the chain of survival
P20 NEAR-DROWNING:
Aim : to evaluate 1. The intervention time m patients with asystole, VF and VF with restoration of a systemic circulation (ROSC) 2. The % of cases in which help was sent out before the occurrence of a CA (call for thoracic pam or arrhythmia). &gk CA-100 Call % Call for thoracic pain or arrhythmia 100.1st tier arrival IOO-MICU arrival
Asystole 08’55” i: O’OY
FV 05’34” f 0’32”
FV with ROSC M’37” f 01’49 *
2,7 % uszo” i 0’09” 1?03- f 0’20”
7,1 % 05’28” t- 0’21” 13’10”~0’40”
9,6 % ’ 05’34” f 01’37” 10’25” f 01’09”
* p < 0,05 (columns 2 ami 3 are compared to column Ii
1. The time needed to activate the EMS seems to be the maior limitine factor when the efficacy of the chain of survival is considered 2. People should be educated to call EMS not only in cases of apparent death but also in cases of thoracic pan or arrhythmia.
A PROSPECITVE
STUDY OF THREE
YEARS
Ch. GARCIA, R BATALLA, F PARRAMON, J VUAPLANA, A ALVAREZ, N ESTANOL, A VILLALO Hospital Josep Trueta Gimna Spain Sctvicio Anestesia y Reanimacion Objectives: To evaluate the cases of near-drowning inour geographical area. Design: Proqective study. Patients: Behvecn May-October for three consecutive years, 107 patients arrived at “or hospital, both directly and also referred to us from smaller hospitals in the area. Main Outcome Measures: Age. primary transport (ambulance non-medical personal) Pa02 at arrived at hospital, Pa02 after two hours of treatment, pH at admission and pH after tw hours of treatment and discharge time. Results: The mean age was 29 5 years with range of 1 to 78.82 patients (77%) suffered the accident in the seat (salt water) and 25 (23%) in swiming-pool. The primary transport was with oxygen therapy in 37% of patients. The mean Pa02 at arrived at hospital was 60 mm Hg, and after hvo hours of treatment was 104 mmHa. The first mean “H was 7 09 and hv” h&s later was 7 32. The mean Glasgow score w-12. Eleven patients (10%) died, in all cases the GSC was 3-4 at admission in the hosdtal. 14 “atients (13%) needed ICU. 55 (52%) were discharged in one week, and 27 patients (25%) were discharged in one day The “umber of deaths by drowning in situ is not knom to us. Conclusion: Hypoxia and acidosis arc present in the majority of patients. However recovery is normally achieved following a few- hours of treatm&t. -1s c&landing the absence df neurological deficits, (probablv due to the lack of primary tranrtwrt with trained CPR staff). -
.
Key words: Near-drownmg.
Hypoxm Ac~dosls
.