DOI: https://doi.org/10.22263/2312-4156.2024.4.63
A.E. Horbach1, A.N. Volosheniuk2
Evaluation of the efficiency and quality of emergency medical care provided to patients with severe mechanical injuries at the pre-hospital stage
1Baranovichi Central Polyclinic, emergency and urgent medical care station, Baranovichi, Republic of Belarus
2The Institute for Advanced Training & Retraining of Healthcare Personnel of the educational institution “Belarusian State Medical University”, Minsk, Republic of Belarus
Vestnik VGMU. 2024;23(4):63-69.
Abstract.
The increase in the number of natural and man-made disasters leads to an increase in the frequency of severe damage among the population. The provision of emergency medical care at the pre-hospital stage is becoming a critical aspect in the work of a primary care physician. In severe mechanical injury, the “golden hour” principle is considered to be the standard. In this regard, emergency medical care should be provided without further delay.
Objectives. To assess of the effectiveness of the emergency medical care provision (EMC) at the pre-hospital stage in a large city, to develop a recommendation enabling the improvement of the protocols for the provision of EMC.
Material and methods. The article analyzes the quality of medical care for patients with severe mechanical injuries at the pre-hospital stage when studying the accompanying sheets of ambulance teams and medical records of 140 victims, with severe mechanical injuries above 16 according to the ISS scale.
Results. Spinal injuries in 54.5% of cases, were not mentioned in the emergency medical records, but in 96 out of 99 cases patients with this injury were transported “lying on the shield”. Pelvic lesions were not diagnosed in 67.4% of cases. Tracheal intubation or laryngeal mask was applied in 8 out of 19 victims. Anesthesia in 35% of cases was not carried out at all. In most cases, tramadol was used – in 17.1%, promedol – in 13.6%, fentanyl – in 11.4%. Immobilization of the cervical spine was performed in only 50.8% of cases.
Conclusions. It is necessary to minimize the time interval between injury and the beginning of medical care, diagnosis at the pre-hospital stage should be based on a syndromic approach, anesthesia in case of severe mechanical injury at the pre-hospital stage should preferably be carried out with fentanyl or promedol, the qualification and methodological skills of the EMC teams should be improved based on the Institute for Advanced Training & Retraining of Healthcare Personnel of the BSMU.
Keywords: combined trauma, polytrauma, medical care provision, pre-hospital stage, transport immobilization, anesthesia, infusion therapy, acute respiratory disorders.
References
1. Bagnenko SF, Stozharov VV, Miroshnichenko AG, i dr. Standards of emergency medical care for trauma victims (by the example of victims of road traffic accidents). Skoraya Med Pomoshch'. 2007;8(3):18-21. (In Russ.)
2. Hu W, Freudenberg V, Gong H, Huang B. The «Golden Hour» and field triage pattern for road trauma patients. J Safety Res. 2020 Dec:75:57-66. doi: http://dx.doi.org/10.1016/j.jsr.2020.08.001
3. Korotkevich IA, Miroshnichenko AG, Stozharov VV, Klimantsev SA. Analysis of the significance of the factor of time of prehospital care for the outcome in victims with shockogenic injuries. Skoraya Med Pomoshch'. 2009;10(S2):12-7. (In Russ.)
4. David EC. R A Cowley, the “Golden Hour”, the “Momentary Pause”, and the “Third Space”. Am Surg. 2017 Dec;83(12):1401-6.
5. Duke M, Tatum D, Sexton K, Stuke L, Robertson R, Sutherland M, et al. When Minutes Fly by: What is the True “Golden Hour” for Air Care? Am Surg. 2018 Jun;84(6):862-7.
6. Lerner EB, Moscati RM. The golden hour: scientific fact or medical “urban legend”? Acad Emerg Med. 2001 Jul;8(7):758-60. doi: http://dx.doi.org/10.1111/j.1553-2712.2001.tb00201.x
7. Okada K, Matsumoto H, Saito N, Yagi T, Lee M. Revision of ‘golden hour’ for hemodynamically unstable trauma patients: an analysis of nationwide hospital-based registry in Japan. Trauma Surg Acute Care Open. 2020 Mar;5(1):e000405. doi: http://dx.doi.org/10.1136/tsaco-2019-000405
8. Shchedrenko VV, Gumanenko EK, Moguchaya OV, Yakovenko IV, Anikeev NV, Kalinivich GA, i dr. Organization of medical care for victims with combined craniocerebral trauma in cities with different population size and ways of its improvement. Vestn Travmatologii Ortopedii im NN Priorova. 2008;(1):3-7. (In Russ.)
Submitted 16.04.2024
Accepted 28.08.2024
Information about authors:
A.E. Horbach – doctor of the intensive care team, Baranovichy Central Polyclinic, emergency and urgent medical station, https://orcid.org/0009-0002-6404-1705,
e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Aliaksandr E. Horbach;
A.N. Volosheniuk – Candidate of Medical Sciences, associate professor of the Chair of Emergency Medical Aid and Disaster Medicine, the Institute for Advanced Training and Retraining of Healthcare Personnel of the Educational Institution “Belarusian State Medical University”, https://orcid.org/0009-0002-5355-9919
