[Analysis of actions taken by medical rescue teams in the Polish Emergency Medical Servies system. Is the model of division into specialistad basic teams reasonable?]

BACKGROUND

The Polish Emergency Medical Services (EMS) system is based on two types of medical rescue teams (MRT): specialist (S)--with system doctors and basic (B)--only paramedics.

AIM OF THE STUDY

The aim of this study is to assess the reasonability of dividing medical rescue teams into specialist and basic.

MATERIAL AND METHODS

The retrospective analysis of medical cards of rescue activities performed during 21,896 interventions by medical rescue teams, 15,877 of which--by basic medical rescue teams (B MRT) and 6,019--by specialist medical rescue teams (S MRT). The procedures executed by both types of teams were compared.

RESULTS

In the analysed group of dispatches, 56.4% were unrelated to medical emergencies. Simultaneously, 52.7% of code 1 interventions and 59.2% of code 2 interventions did not result in transporting the patient to the hospital. The qualification of S teams' dispatches is characterised by a higher number of assigned codes 1 (53.2% vs. 15.9%). It is worth emphasising that the procedures that can be applied exclusively by system doctors do not exceed 1% of interventions. Moreover, the number of the actions performed in medical emergencies in the secured region by the S team that is dispatched as the first one is comparable to that performed by B teams. The low need for usinq S teams'aid by B teams (0.92% of the interventions) was also indicated.

CONCLUSIONS

This study points to the necessity to discuss the implementation of straightforward principles of call qualification and the optimisation of the system doctors' role in prehospital activities.

[The influence of the pre-hospital application of non-invasive measurements of carboxyhemoglobin in the practice of emergency medical services in multiple and mass casualty incidents (MCI)--a case report]

In 2013 a fire broke out in the Nursing Home (NH) in the Henryszew village 5 km away from the district hospital in Zyrardów. At the time of the incident 52 residents and 16 staff members were present in the building. Due to a large number of casualties, the occurrence was classified as a potentially mass casualty incident (MCI). Troops of the State Fire Brigade, Paramedic Rescue Squads, choppers of the Helicopter Emergency Medical Service, the Police, and the NH staff took part in the rescue operation. The priority was given to the evacuation of the NH residents carried out by the NH staff and firefighters, extinguishing the fire, as well as to primary and secondary survey triage. Due to the pre-accident health state of the victims, the latter posed a considerable difficulty. A decisive role was played by the need to conduct non-invasive measurements of carboxyhemoglobin in all the casualties, which then made it possible to adequately diagnose the patients and implement proper procedures. The rescue operation was correctly followed although it proved to be a serious logistical and technical undertaking for the participating emergency services. The residents were not found to be suffering from carbon monoxide poisoning, therefore 46 of the residents safely returned to the building. The fact that all the Paramedic Rescue Squads were equipped with medical triage sets and were able to conduct non-invasive measurements of carboxyhemoglobin made it possible to introduce effective procedures in the cases of suspected carbon monoxide poisoning and abandon costly and complicated organisational procedures when they proved to be unnecessary.

[12-lead ECG teletransmission in emergency medicine teams' actions]

INTRODUCTION

Sudden health-threatening conditions with cardiovascular aetiology constitute a great number of all interventions of emergency medicine teams. Diagnostic and therapeutic abilities of modern cardiology lead to the necessity of introducing diagnostic methods which enable effective pre-hospital diagnostics in patients with circulatory system diseases also in emergency medicine. The ECG teletransmissions performed by emergency medicine teams prior to hospitalization increase the accuracy of the diagnosis and thus improve the organization of medical transport of patients to the medical centres appropriate to their medical condition.

MATERIAL AND METHODS

A 12-lead ECG teletransmission system and a system of teleconsultations was set up in September 2009 at the Voivodship Emergency Service and Medical Transport Station (WSPRiTS) "Meditrans" in Warsaw. The system consists of: emergency medicine teams and the Teletransmission Centre located in the Cardiac Department of WSPRiTS "Meditrans. The WSPRiTS "Meditrans" emergency medicine teams and helicopter emergency medicine teams performed standard ECGs at the place of the incident, sending them then via telephone to the Teletransmission Centre. Performing an ECG is recommended in the following cases: a pain in the chest, collapse and syncope, perceptible cardiac arrhythmia, dyspnoea and in any case when the head of the emergency medicine team (ZRM) took the decision to perform an ECG. The ECG record as well as the information about the patient supplied by the head of the team were analyzed by a consulting doctor on 24-hour duty at the receiving station. On basis of the received information the doctor from the Teletransmission Centre instructed the ZRM as to further procedure with the patient. There were 20117 ECG teletransmissions performed within the analyzed period.

RESULTS

In the period between September 2009 and September 30th, 2012 there were 20 117 12-lead ECG teletransmissions performed, where 18139 (90.2%) were successful. 1978 (9.8%) were unsuccessful. 19 997 ECG transmissions were sent from WSPRiTS "Meditrans"ambulances and 120 by helicopter emergency teams. Women constituted 55% and men 45% of the investigated population of patients. The average age was 61 years. The average ECG transmission time was 7 minutes 10 seconds and did not extend the time of emergency medicine actions. The analysis of collected data revealed that ZRMs applied the teletransmission system particularly in cases others than acute coronary syndromes - 16 998 (93.7%) cases. The most frequent reasons to perform an ECG and consultation were pains in the chest - 23% cases, cardiac arrhythmias (18%) and collapses and syncope (13%). Among cardiac arrhythmias, arterial fibrillations (11%) were most often stated and in this group 79% cases were paroxysmal arrhythmias. During the 3 years 1141 cases of acute coronary syndromes were diagnosed in the pre-hospital period, what constituted only 6.3% of all teletransmissions. During a 9-month period 389 transports were carried out to primary health care centres from where the ECG records were then transferred to the Teletransmission Centre. In 117 cases (30%) the consultant changed the initial decision and patients were transported to other medical centres withour interventional cardiology departments.

CONCLUSIONS

The system of ECG teletransmissions and consultations was appreciated by ZRMs and significantly supported their actions. The system should be supervised and coordinated by emergency medicine centres such as the Teletransmission Centre, Emergency Departments or Emergency Rooms. ECG teletransmissions make it possible to extend the paramedics and nurses' competences as regards emergency medical actions with patients with circulatory system diseases. The introduction of ECG teletransmissions from the place of the incident and the doctor's consultation have led to the optimization of transport of patients to appropriate in respect to their condition medical centres.

[New possibilities in emergency medical transportation and emergency services of Polish Medical Air Rescue]

In Poland, two types of medical services are accomplished by the Medical Air Rescue (MAR) operating all over the country: emergency transport from the incident scene to hospital and inter-hospital transport. Helicopters or planes are used for this purpose. In 2009, helicopters performed 4359 flights to incidents and 1537 inter-hospital transports whereas planes performed 589 inter-hospital ambulance and 196 rescue flights. MAR operates from 17 bases of the Helicopter Emergency Medical Service (HEMS) and one airbase. Helicopters are mainly used when medical transport is emergent, within the operational region of a given base whereas planes when the distance between the present and target airports exceeds 250 km. In 2008, new modern aircraft were introduced to HEMS-helicopters EC 135. They fulfil all requirements of air transport regulations and are adjusted to visual (VFR) and instrumental (IFR) flights rules, at day and night. The medical cabin of EC 135 is ergonomic and functional considering the majority of rescue activities under life-saving circumstances. It is equipped with ventilator, defibrillator, infusion pumps etc. Defibrillators have 12-lead ECG, E(T)CO2, SpO2, NIBP, and IBP modules. Transport ventilators can work in a variety of ventilation modes including CMV, SIMV, SVV, BILEVEL, PCV, ASB, PPV and CPAP. The purchase of helicopters with modern avionic and medical configuration ensures high quality services of MAR for many years to come.