The influence of induction of first responders into emergency medical service system on decreasing arrival time and on survival of critically ill patients

Izhodišča: Preživetje bolnika, ki je doživel srčni zastoj izven bolnišnice (SZIB), je odvisno od hitrega in učinkovitega ukrepanja očividcev, ki so v tistem trenutku prisotni na kraju dogodka. Glede na izkušnje in raziskave se očividci v Sloveniji, ko gre za primer SZIB, malokrat odločijo nuditi prvo pomoč. Da bi skrajšali dostopne čase in s tem izboljšali možnosti preživetja za bolnike, ki so doživeli SZIB, smo v sistem nujne medicinske pomoči (NMP) začeli vključevati prve posredovalce (PPO) in to na območjih, kjer je dostopni čas ekip NMP daljši od 10 minut. Le-ti se v sistem NMP vključujejo v svojem domačem kraju in nudijo ukrepe prve pomoči ter izvajajo temeljne postopke oživljanja z uporabo AED do prihoda ekipe NMP. Namen magistrskega dela je predstaviti pomen vključevanja PPO v sistem NMP, raziskati njihovo vlogo v verigi preživetja in ugotoviti razlike v dostopnih časih njih in ekip NMP. Metodologija: V teoretičnem delu smo uporabili deskriptivno metodologijo za opis raziskovalnega področja. V empiričnem delu pa smo uporabili kvantitativno raziskovalno metodologijo, kjer smo vključili vsa kardio-pulmonalna oživljanja (KPO) v letih 2014 in 2015 na območju Prehospitalne enote Maribor (PHE Maribor) in jih primerjali s tistimi KPO, kjer so bili aktivirani PPO. Pridobljene kvantitativne rezultate smo predstavili v obliki grafov in tabel, hipoteze pa potrdili z uporabo neparnega t-testa in univariatnega testa enega vzorca. Rezultati: V letih 2014 in 2015 je bilo na teritorialnem območju PHE Maribor opravljenih 178 intervencij, kjer je bilo potrebno KPO. Med temi 178 intervencijami so PPO izvajali KPO v 30 primerih (16,85 %). PPO so bili na zahtevo ekipe NMP aktivirani 85-krat. V 96,67 % sočasnih intervencij so bile ekipe PPO na kraju dogodka pred ekipami NMP, v povprečju 10,13 (± 6,63) minut (p < 0,001)! Povprečni dostopni čas ekip PPO od klica do prihoda je med vsemi aktivacijami bil 9,26 (± 5,18) minut, medtem ko so ekipe NMP od klica do prihoda na te iste intervencije v povprečju potrebovale 19,33 (± 7,78) minut. PPO so bili na kraju dogodka v povprečju 5,29 (± 4,42) minut po alarmiranju, najpogosteje pa v drugi minuti. Med pričakovanimi in dejanskimi dostopnimi časi PPO ni statistično pomembnih razlik (p = 0,541). Razprava in sklep: Številne raziskave v tujini in nekatere tudi pri nas so v preteklosti že pokazale, da zgolj nameščanje AED na javnih mestih ni in ne bo izboljšalo možnosti preživetja bolnikov, ki so doživeli SZIB, saj se v danem trenutku očividci dogodka redko spomnijo nanj, še redkeje pa ga tudi uporabijo. Prav tako kratkoročno ne moremo pričakovati izboljšanja možnosti preživetja z novostmi na področju oživljanja ali z agresivnejšo obravnavo bolnikov s SZIB s strani ekip NMP, saj je največji sovražnik preživetja bolnikov s SZIB dostopni čas. Glede na naše ugotovitve bi bilo smiselno, da se takšen ali podoben sistem vključevanja PPO v sistem NMP uvede po celotni državi. Nadzor nad njim naj ima Ministrstvo za zdravje, za vključevanje PPO v sistem NMP, njihovo izobraževanje in opremljenost pa naj skrbi lokalna služba NMP.Grounds: Survival of a patient who has suffered an out of hospital cardiac arrest (OHCA) depends on rapid and efficient actions of eyewitnesses who are present at the time. When it comes to OHCA - according to experience and different research - eyewitnesses in Slovenia decide to perform first aid in small number of times. To shorten arrival time and improve the chance of survival for patients who had suffered OHCA first responders (FR) have been integrated. They have been included in areas where the arrival time of emergency medical services teams (EMS) has been longer than 10 minutes. FR are included in their home town where they perform first aid and basic life support (BLS) using automated external defibrillator (AED) until the arrival of EMS team. The purpose of this Master\u27s thesis is to present the importance of integrating FR in the EMS system, to investigate their role in the survival chain and to reveal the differences in arrival times between FR and EMS teams. Methodology: In the theoretical part a descriptive methodology to describe the area of research has been used. In the empirical part quantitative research methodology has been conducted. All carried out cardiopulmonary resuscitations (CPRs) in 2014 and 2015 on the area of prehospital unit Maribor (PHE Maribor) have been included and compared with CPR where FR have been activated. Obtained quantitative results have been shown in graphs and tables. Moreover, the hypothesis have been confirmed by using an odd t-test and an univariate test of one sample. Results: In 2014 and 2015 in the territory of PU Maribor 178 interventions with CPR have been carried out. In 30 cases FR have performed CPR (16.85%). By orders of EMS team, FR have been activated 85 times. In 96.67% of concurrent interventions the FR teams have been at the scene earlier than EMS teams in average for 10.13 (±6.63) minutes (p<0.001)! Among all activations the average arrival time of FR teams from the call to arrival was 9.26 (±5.18) minutes, while EMS teams in average needed 19.33 (±7.78) minutes to get to the identical interventions. FR have arrived at the scene in average in 5.29 (±4.42) minutes after the alarming, the most common in the second minute. Between the expected and the actual arrival times of FR there are no statistically significant differences (p=0.541). Discussion and conclusion: Numerous foreign and some Slovenian research had already shown in the past that placing automated external defibrillators (AEDs) in public areas has not and will not improve the chances of survival of patients who had suffered OHCA. At that time eyewitnesses often forget about it and even less often use it. On a short term improvement of survival of patients by innovations in resuscitation or aggressive treatment of patients with OHCA by EMS teams cannot be expected. The greatest enemy of patients with OHCA is arrival time. According to our findings it would be logical to introduce this or similar system of integrating FR to EMS throughout the whole country where on one hand it should be in control of the Ministry of Health and on the other education and equipment should be in control of the local EMS

Progressivity of Basic Elements of the Slovenian National Alpine Ski School

Progressivity of Basic Elements of the Slovenian National Alpine Ski School Ski school programmes in different countries are adapted to the local conditions and skiing trends. The aim of the study was to establish the progressivity of the three basic elements of the Slovenian ski school in terms of the duration of individual turns and their phases. Eight participants were recorded as they performed three basic elements of the Slovenian national ski school: wedge curves – E1, turns with a wedge push-off – E2 and basic swinging – E3. According to the ski school, the elements were divided into phases. The results of the computer-aided video analysis showed that in the beginning types of skiing in the same conditions on the same length of terrain, the average durations of turns and the times of comparable initiation and steering phases of the elements shortened on the methodical upward scale (from E1 to E3). The number of turns executed on the same length of terrain from E1 to E3 increased. A larger step in motor task complexity was indicated when a pole plant was included in skiing elements. Further, relatively large differences were observed in time durations among subjects executing the same elements. In conclusion, it can be assessed that the basic elements of the ski school are placed gradually in terms of progressivity in time durations. Progresivita základních elementů slovinské národní školy alpského lyžování Programy lyžařských škol v různých zemích jsou přizpůsobeny místním podmínkám a lyžařským trendům. Cílem této studie bylo stanovit progresivitu tří základních prvků slovinské lyžařské školy, pokud jde o dobu trvání jednotlivých zatočení a jejich fází. U osmi účastníků bylo zaznamenáno, jak provádějí tři základní prvky ze slovinské národní lyžařské školy: E1 – oblouk z pluhu; E2 – oblouk z přívratu vyšší lyží E3 – paralelní oblouk. Podle lyžařské školy byly prvky rozděleny do fází. Výsledky počítačové video- analýzy ukázaly, že na začátku lyžování za stejných podmínek a stejné délky terénu, je průměrná doba zatáčení a časů srovnatelného zahájení a řízení fází, jsou tyto prvky dle metodické vzestupné škály zkráceny (od E1 po E3). Počet zatočení provedených na stejné délce terénu se zvýšil; od E1 po E3. Delší pokrok byl v motorické komplexnosti úlohy, indikován při jejich začleněného do lyžařských prvků. Poměrně velké rozdíly mezi subjekty, které prováděli stejné prvky, byly zaznamenány v době jejich trvání. Na závěr lze usuzovat, že základní prvky lyžařské školy jsou postupně z hlediska progresivity podle času jejich trvání, implementovány

The Waist Width of Skis Influences the Kinematics of the Knee Joint in Alpine Skiing

Recently alpine skis with a wider waist width, which medially shifts the contact between the ski edge and the snow while turning, have appeared on the market. The aim of this study was to determine the knee joint kinematics during turning while using skis of different waist widths (65mm, 88mm, 110mm). Six highly skilled skiers performed ten turns on a predefined course (similar to a giant slalom course). The relation of femur and tibia in the sagital, frontal and coronal planes was captured by using an inertial motion capture suit, and Global Navigation Satellite System was used to determine the skiers’ trajectories. With respect of the outer ski the knee joint flexion, internal rotation and abduction significantly decreased with the increase of the ski waist width for the greatest part of the ski turn. The greatest abduction with the narrow ski and the greatest external rotation (lowest internal rotation) with the wide ski are probably the reflection of two different strategies of coping the biomechanical requirements in the ski turn. These changes in knee kinematics were most probably due to an active adaptation of the skier to the changed biomechanical conditions using wider skis. The results indicated that using skis with large waist widths on hard, frozen surfaces could bring the knee joint unfavorably closer to the end of the range of motion in transversal and frontal planes as well as potentially increasing the risk of degenerative knee injuries