Pre-hospital emergency medical services, phase I. Role of the Department of Community Health and Psychiatry

The Department of Community Health and Psychiatry was contracted by the Ministry of Health to assist with the implementation of a pilot programme in the Western Health Region to train fire fighters as basic level Emergency Medical Technicians (EMTs), and was responsible for its design, implementation and monitoring for the first 18 months. The course was covered in 440 hours over a 10 week period, and included training in emergency medical response, driving an emergency medical vehicle, emergency medical dispatching and inventory control. Of 76 fire fighters selected for training, 62 graduated, receiving Certificates of Merit from the Ministry of Health, Jamaica and were deployed into service on 17th April 1996. During the period 17 April to 31 December, 1996, the newly trained EMTs responded to 1,299 calls. Medical and surgical cases represented approximately 55of all calls, followed by trauma (19), motor vehicle accidents (9) and obstetric emergencies (8). Between 15and 20of calls in Montego Bay and Negril involved tourists. This first group of EMTs has performed well and was well received by the communities and the persons who used the service.

Impact of the prehospital trauma life support programme in Trinidad and Tobago

The impact of the Prehospital Trauma Life Support (PHTLS) programme, introduced in Trinidad and Tobago in 1992, was assessed by questionnaires completed by 26 medical personnel (MP); 71 ambulance personnel (AP); and 50 non ambulance paramedical personnel (NAP). Of the 23 MP, 45 AP and 38 NAP who were aware of the programme, 19 (82.6) MP, 40 (88.9) AP and 25 (65.8) NAP were able to differentiate personnel that had taken the PHTLS programme based on their performance. 32 (71.1) of the AP were PHTLS trained. 24 (53.3) and 4 (9) of the AP identified poor equipment and poor supervision, respectively, as reasons for difficulty in applying PHTLS principles. Improvements observed among those completing the PHTLS programme were: improved resuscitation techniques by 20 (86.9) MP, 38 (84.4) AP and 27 (71.1) NAP; better vital signs recording by 8 (34.8) MP, 27 (60) AP and 8 (21.1) NAP; improved immobilization by 23 (100) MP, 40 (88.9) AP and 33 (86.8) NAP; better haemorrhage control by 22 (95.6) MP, 40 (88.9) AP and 24 (63.2) NAP; appropriate splinting of fractures by 23 (100) MP, 40 (88.9) AP and 32 (84.2) NAP; and increased utilization of oxygen by 15 (65.2) MP, 31 (68.9) AP and 21 (55.3) NAP. 32 (71.1) AP with PHTLS training indicated improvement in their ability to resuscitate and transport trauma victims, with 42 (93.3) reporting improvement in overall prehospital care. Medical, paramedical and ambulance personnel all perceive a significant positive impact of PHTLS training on prehospital trauma care. Although improvements in supervision, documentation and equipment are still required, improved trauma resuscitative techniques after PHTLS training should improve trauma patient outcome in Trinidad and Tobago.

Avaliaçäo do conhecimento das equipes que prestam primeiros socorros em Passo Fundo - RS / Evaluation of knowledge levels among first-aid teams Passo Fundo, RS

Neste estudo foi avaliado o conhecimento da equipes que fazem o atendimento de primeiros socorros na regiäo de Passo Fundo. Esta avaliaçäo foi feita por meio da aplicaçäo de um questionário com perguntas básicas sobre conduta tomada nestas situaçöes. Foram avaliados integrantes do corpo de bombeiros, polícia rodoviária federal, estadual e também motoristas de ambulâncias de hospitais de Passo Fundo. Os resultados foram comparados com o nível de intruçäo, tempo de serviço na funçäo e realizaçäo de cursos sobre atendimento de primeiros socorros. Observou-se que estäo mais bem preparados para este tipo de atendimento os integrantes do corpo de bombeiros, seguidos da polícia rodoviária federal, estadual e, por último, dos motoristas de ambulâncias

¿Conoce usted las normas de traslado para pacientes críticos? / Do you know the move standards for critical patients?

Este documento tiene por objeto entregar una información que pemita asegurar que los traslados de pacientes críticos siguen los principios más eficientes y seguros para estos casos: organización, personal educado, enfoque sistemático, equipo mínimo, seguridad, eficiencia y ética. La racionalización de los cuidados del paciente crítico ha determinado una mejor evaluación, estabilización y terapia del niño grave, lactante o recién nacido. Las normas de programas como Advanced Trauma Life Support han contribuido también al mejoramiento de la atención del paciente grave. Normas generales como las de la Academia de Pediatría de los EE.UU han ayudado también en la misma dirección. Un aspecto que aún debe mejorar y que es fundamental en este país de larga y escarpada geografía, es el traslado de los pacientes graves. De hecho se ha podido observar que este se hace, casi siempre, por personal inexperimentado, con muy malos recursos y sin las medidas de seguridad necesarias. Lo usual en este momento en Chile es que el recién nacido, lactante o niño más grave de un hospital sea trasladado en una ambulancia bajo la responsabilidad de un auxiliar de enfermería que no ha sido entrenada para las emergencias mayores que se puedan presentar durante el viaje. La experiencia con equipos mejor entrenados, como el de Coyhaique y esfuerzos aislados ocasionales, es aún demasiado limitada para poder generalizar. Un trabajo nuevo, en el área del trabajo paramédico de rescate pediátrico es el que se ha iniciado en enero de 1993 en el Hospital Roberto del Río (Santiago)