Utilizing paramedics in pre hospital and patient care

Department of Topographical Anatomy and Operative Surgery, Medical superviser of Medical Student Association “AStudMed” State Medical and Pharmaceutical University “Nicolae Testemițanu”, Chisinau, Republic of MoldovaIntroduction: The EMS system is a very known modality that rapidly evolved from 2nd half of 20th century, the rapid development was due to changes in drift of population to urbanized areas, usage of more motor vehicles and rapid growth in population. Nowadays exist two approaches toward administration of EMS one is by physicians while another is given by paramedics. To clarify paramedics are best defined as medical professionals who provide medical care at an advanced life support level in the pre-hospital environment, usually in an acute phase of illness or injury. Purpose and Objectives: Highlightning the importance of transition of Emergency Medical Services in Moldova from physicians based system to paramedic based system in order to improve the quality of response to the emergency medical cases, decrease expenses in healthcare system in Moldova and to solve physician deficiency issue. Materials and Methods: Our analysis of EMS systems worldwide has led us to an important conclusion that even though paramedics' education period and training courses are shorter (2-4 years) than that of physicians (approximately 12 years), their skills don't fall from that of physicians in pre hospital emergency care modality. As profession of paramedics developed and has become an university based training for theoretic knowledge and practical part on ambulances and medical simulation centers. Same EMS systems that provide pre hospital care by university educated paramedics exist in developed countries like, Ben-Gurion University of Negev in Israel, University of Washington Medical Center in USA, University of Greenwich in UK, and University of Tasmania in Australia. Systems that use physicians in providing pre hospital care are France, Germany, Russian Federation, and Republic of Moldova. Results: In order to make a quality comparison of both professionals that work in those two different systems we analyzed 2 profound researches that evaluated their diagnostic and treatment skills. First research of American Heart Association (AHA) compared diagnostic abilities of paramedics and physicians in stroke patients and revealed that recognition of neurological deficits by ambulance paramedics using FAST shows good agreement with physician assessment. Second research of American journal of Emergency medicine showed that highly trained paramedics in an urban emergency medical services system can identify patients with STEMI as accurately as blinded physician reviewers. Conclusion: In conclusion and in scope of current health problems and ongoing burden and load in financing and medical personnel quota deficiencies in many healthcare systems a transition to EMS system that is administered by paramedics can be very beneficial to healthcare system problems and simultaneously keep provision of professional pre hospital medical treatment in underdeveloped countries A transition to such system requires cooperation of many "players" and effort to bring this change in EMS provision, but in the long run it will bring a cure to ongoing problems in healthcare systems

Role of the risk factors in clinical complications and types of acute myocardial infarction

Department of Cardiology, Medical superviser of Medical Student Association “AStudMed” State Medical and Pharmaceutical University “Nicolae Testemitanu”, Chisinau, Republic of MoldovaIntroduction: Acute Myocardial Infarction (AMI) is a major cause of death and disability worldwide. The diagnosis of acute MI is a clinical diagnosis based on patient symptoms, ECG changes, and highly sensitive biochemical markers, as well as information gleaned from various imaging techniques. It is important to characterize the type of MI as well as the extent of the infarct, residual LV function, and the severity of CAD and other risk factors, rather than merely making a diagnosis of MI. The ideal management of ST-segment-elevation Myocardial Infarction (STEMI) and Non- STEMI involves early diagnosis followed by rapid reperfusion therapy (PCI). Purpose and Objectives: Highlighting of importance correlation factors between, type of AMI, factors of risk and complication in patients without reperfusion therapy (PCI). Materials and methods: The retrospective research was based on the archive data of the Municipal Hospital Clinic "Sfânta Treime". Patients (N=71) had a mean age of 64,3 years, diagnosis of different type of MI and history of hospitalization in “Intensive Care Unit”. There were 2 periods of analysis (01.09.2012 to 31.10.2012 and 01.10.2013 to 31.12.2013). For data analyzes SPSS version 17 was used, p< 0,05 considered statistically significant. Results: From 71 patients that were examined, were identified common risk factor for type 2 of AMI in 56 patients which are: Arterial Hypertension (HT) 2-3rd in 85.7%, diabetes type 2 in 35.7%, dyslipidemia in 28,6%, Chronic Heart Failure NYHA 2-3 in 23.2%, anemia in 7.1% and ischemic cardiomyopathy in 7.1%. For type 3 of AMI in 10 patients HT in 70%, diabetes type 2 in 40%, dyslipidemia in 10%, and type 1 of AMI 5 patients without known risk factors. Also were identified complication for type 1 of AMI 5 patients: discirculatory encephalopathy in 40%, Killip 2, 3 and 4 each 20%. For type 2 of AMI 56 patients: Killip 2 in 50%, Killip 3 in 19.6%, Killip 4 in 10,8% other complications in 19,6%. For type 3 of AMI 10 patient: Killip 4 has 100%. The most common encountered complication for type 2 of AMI is Killip 2-findings of mild to moderate heart failure in 50%, and in type 3 are Killip 4 - cardiogenic shock in 100%. Conclusion: HT is a common risk factor in more than 50% in type 2 and 3 of AMI in Intensive Care Unit. HT is a prevalent risk factor in type 2 and 3 of AMI. Therefore patients in Intensive Care Unit with HT 2-3rd degree must be treated as patients with high risk for developing type 3 of AMI and Killip 4. According to data we can assume that patients with advanced metabolic syndrome (characterized by dyslipidemia, hypertension and diabetes mellitus) mainly develop type 2 AMI