A systematic review of ePCR systems on reducing the response time of prehospital medical care

Background Poor communication at the time of patient handover is recognized as a root cause of a considerable proportion of preventable deaths. Despite several advantages, the Patient Care Report (PCR) implementation may include insufficient details for demonstrating the functional status of the patients during the actual response which can further prolong the response time. Healthcare entities have been emphasizing the need to implement e-PCR systems. This systematic review aimed to examine the impact of e-PCR systems on reducing response time of prehospital care. Methods Literature search was carried out using the relevant search terms and keywords with inclusion and exclusion criteria. N=6 researchers that focused on the impact of e-PCR systems on reducing response time of prehospital medical care were included within this review. Results The findings indicated that ePCR implementation led to prominent improvements in the quality of the care services provided by the healthcare organisation. Additionally, ePCR reduces the response rate by data standardization. Conclusion The implementation of e-PCR systems ensures the availability of records and automates reporting on given quality metrics. Moreover, the implementation of e-PCR systems also improved response time and increased the out of hospital rates of survival. However, fear of increasing the ambulance run time, compromise on the availability of ambulance, and challenges in integration with the existing information systems implemented within the hospitals, were some of the most common challenging situations associated with implementing e-PCR systems.

Prospects for the development of technical devices and dosage forms for the use of medical protection.

The article assesses the current level of technical devices and dosage forms intended for the use of medical protective equipment, discusses global trends and prospects for their short-term and medium-term development. Considered foreign samples autoinjectors, portable inhalers, patch pump, nasal, transdermal and buccal forms. Presents indicators of the effectiveness of various dosage forms, their advantages and disadvantages, discusses ways to overcome the latter in the provision of medical care in the prehospital stages and in transporting the wounded and affected. When assessing the possibility of using medical protection in various technical devices or dosage forms, it is necessary to consider the characteristics of their manufacturability and the readiness of the domestic production base for mass production and state registration as medicines or medical products. It was concluded that in the short term for the development of domestic medical remedies it is advisable to introduce inhaled and intranasal forms of drugs for use in the prehospital medical care.

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.

DEVELOPMENT OF PCI-CAPABLE HOSPITALS NECESSITY CALCULATION ALGORITHM

Introduction. Today there is no method to assess whether number of PCI-capable centers in Russia corresponds to the real needs. The aim of the study was to develop a PCI-capable hospitals necessity calculation algorithm. Material and methods. We used population densities, maximum/optimal distances (areas) to which delivery of patients with acute coronary syndrome by sanitary transport is possible and maximum/optimal areas where patients can be transported by ambulance transport. Then we calculated the density threshold values: Group 1: 53 persons/km2 or more; Group 2: 53-27 people/km2; Group 3: 27-18 people/km2; Group 4: 18-8 people/km2; Group 5: 8 persons/km2 and less. Results. Formulas were proposed for calculating the need for PCI-centers. For group 1: population/60000 people, for group 2: area/11,310 km2, group 3: area/31,416 km2, group 4 with functioning of sanitary aviation: area/70,686 km2 (additional strengthening of the prehospital medical care); in the absence of functioning sanitary aviation: area/31,416 km2 (also additional strengthening of the pre-hospital stage of medical care); for group 5: population/600,000 in large cities (in addition, the use of sanitary aviation, increased prehospital medical care, the organization of primary vascular departments). Discussion. The existing amount of percutaneous interventions in Russia is not enough to meet the real needs for this treatment. At the same time, simple multiplying of PCI-centers is not expedient. Conclusion. According to the developed algorithm, in Russia it is necessary to organize 239 PCI-centers 24/7. In regions with a high population density it is possible to combine several cathlabs in one center.

Disaster and Mass Casualty Incident Responses by Doctor Car

Introduction:Ambulances with physicians, known as Doctor Car, and Tokyo DMAT are the two prehospital care systems responsible for medical team dispatch in the Tokyo area. While there are 25 designated hospitals for DMAT, Doctor Car is only available at four hospitals. Our hospital incorporates both systems. While the prehospital care system must be utilized at the time of disaster, Doctor Car was dispatched 418 times in 2017, and the use of DMAT is less than ten times per year.Aim:To review the past disaster responses of our hospital.Methods:The study reviews three cases where our hospital responded to mass casualty incidents and disasters with either Doctor Car or DMAT. The first case was the treatment of crush syndrome caused by a collapsed parking slope. It took more than 24 hours for the rescue, in which the team treated patients during transport and at the hospital. The second case was our response to a mass stabbing incident committed at a facility for the disabled. In collaboration with the onsite rescue team, we conducted triage, hemostasis, transfusion, etc. The third case was caused by a fire in a building under construction. We provided treatments like triage and tracheal intubation on the spot.Results:Because paramedics are allowed to conduct only a limited amount of treatments, dispatch of the medical team to the site is effective.Discussion:For a medical team to be effective at the dispatched site, the team must be accustomed not only to the specific need of medical care during disasters but also prehospital medical care, which may include the abilities to ensure safety during transport and on-site and adapt to the prehospital environment. Doctor Car is a useful way to realize such abilities.