Manual de organización y funciones de la Dirección del Sistema de Emergencias Médicas / Manual of organization and functions of the Directorate of the Medical Emergency System

El presente manual de organización y funciones, fue adecuado como un instrumento técnico que permita agilizar los procesos institucionales, evitando la duplicidad de funciones, delimitando las responsabilidades y estableciendo los canales de comunicación e información, contribuyendo además a la transparencia en la rendición de cuentas. Así como también, detalla la dependencia jerárquica, objetivos, estructura interna, funciones y relaciones de trabajo, asignadas a cada una de las unidades organizativas que conforman la Dirección del Sistema de Emergencias Médicas. Permitiendo así el eficiente y oportuno desarrollo de todas las actividades que realizan las unidades conformadas por la Dirección

The present manual of organization and functions was suitable as a technical tool for streamlining business processes, avoiding duplication of functions, delineating responsibilities and establishing communication and information channels, further contributing to transparency in accountability. It also details the hierarchical unit, objectives, internal structure, functions and working relations assigned to each of the organizational units that make up the Directorate of the Medical Emergency System. Thus allowing the efficient and timely development of all the activities carried out by the units formed by the Directorate

Manual de procesos y procedimientos misionales para proporcionar atenciones de salud integrales en emergencias médicas prehospitalarias / Manual of Missionary Processes and Procedures for Providing Comprehensive Health Care in Pre-Hospital Medical Emergencies

El presente manual de procesos y procedimientos documenta las principales actividades que se brindan en la atención de emergencia prehospitalaria como parte del proceso de atención integral e integrada a la persona en el curso de vida, desde el Sistema de Emergencias Médicas, (SEM). Describe el sistema de operación, mediante el enfoque por procesos para la gestión de la solicitud de la atención de la emergencia médica prehospitalaria y su respuesta oportuna, promoviendo la mejora continua, el desarrollo organizacional y el mejoramiento continuo para el cumplimiento de la misión institucional, establece las bases para la ejecución de los procesos y procedimientos, unificando criterios de contenido que permite la sistematización de las actividades y la definición de la metodología para efectuarlas. Permite integrar las actividades y tareas de manera ágil, para el logro de la prestación de servicios con calidad, facilitando el cumplimiento de las normativas por ciclo de vida vigentes en el Ministerio de Salud, así como la armonización con la sistematización y uso de herramientas tecnológicas que sea necesario implementar para volver más eficaz el trabajo del talento humano

This manual of processes and procedures documents the main activities that are provided in pre-hospital emergency care as part of the process of comprehensive and integrated care for the person in the course of life, from the Medical Emergency System (EMS). Describes the operating system, through the process approach to managing the request for pre-hospital medical emergency care and its timely response, promoting continuous improvement, organizational development and continuous improvement for the accomplishment of the institutional misión, establishes the basis for the execution of processes and procedures, unifying content criteria that allow the systematization of activities and the definition of the methodology for carrying them out. It makes it possible to integrate activities and tasks in an agile manner, in order to achieve quality service delivery, facilitating compliance with the life-cycle regulations in force in the Ministry of Health, as well as harmonization with the systematization and use of technological tools that need to be implemented to make the work of human talent more effective

Plan interinstitucional para la atención en salud en el marco de los XXIV Juegos Centroamericanos y del Caribe, San Salvador 2023 / Inter-institutional plan for health care in the framework of the XXIV Central American and Caribbean Games, San Salvador 2023

Los Juegos Centroamericanos y del Caribe son un evento multideportivo, que se realizan cada 4 años desde 1926 en diferentes países de la región que comprenden América Central y la cuenca del Mar Caribe. Es el evento multidisciplinario regional más antiguo del mundo, son coordinados por la Organización Centro Caribe Sports. Para el año 2023 se estima que la fecha de realización de estos juegos será del 23 de junio al 8 de julio, esperando una afluencia masiva de atletas y delegaciones extrajeras. El Ministerio de Salud, como ente rector del Sistema Nacional Integrado de Salud, emite el presente Plan interinstitucional para la atención en salud en el marco de los XXIV Juegos Centroamericanos y del Caribe, San Salvador 2023, en la vigilancia epidemiológica, prevención y atención de la salud en casos de emergencias. El plan contiene estrategias de atención en casos de emergencias médicas (traumas, fracturas, intoxicaciones alimentarias, reacciones alérgicas, atenciones de primeros auxilios, atenciones masivas de víctimas en casos de desastres naturales y accidentes de tránsito), entre otros. Además, incluye una breve descripción del acceso a los puntos de atención médica y zonas de evacuación asignadas en los diferentes escenarios deportivos

The Central American and Caribbean Games are a multi-sport event, held every 4 years since 1926 in different countries of the region comprising Central America and the Caribbean Sea basin. It is the oldest regional multidisciplinary event in the world, coordinated by the Centro Caribe Sports Organization. For 2023 it is estimated that the date of these games will be from 23 June to 8 July, expecting a massive influx of athletes and foreign delegations. The Ministry of Health, as the governing body of the Integrated National Health System, issues this inter-institutional plan for health care within the framework of the twenty-third Central American and Caribbean Games, San Salvador 2023, in epidemiological surveillance, prevention and health care in emergencies The plan contains strategies for dealing with medical emergencies (traumas, fractures, food poisoning, allergic reactions, first-aid care, mass care of victims in cases of natural disasters and traffic accidents), among others. In addition, it includes a brief description of access to health care points and designated evacuation areas in different sports arenas

Telefonista Auxiliar de Regulação Médica / Cartilhas de Trabalho para Profissionais do SAMUFor / Medical Regulation Assistant Telephone Operator / Workbooks for SAMUFor Professionals

A Regulação das Urgências é um processo de trabalho em que são acolhidas as solicitações de ajuda por meio de escuta telefônica qualificada, efetuada por auxiliares de regulação médica e um médico, com o propósito de identificar o grau da urgência de cada caso, desencadeando a resposta mais adequada a cada solicitação. Previsto na PORTARIA No 2.657/2004 que estabelece as atribuições das centrais de regulação médica de urgências e o dimensionamento técnico para a estruturação e operacionalização das Centrais SAMU-192, o profissional Telefonista Auxiliar de Regulação Médica (TARM) é o responsável pelo primeiro contato com o usuário através do atendimento telefônico. É esse atendimento que dá ao solicitante a primeira impressão que se tem da qualidade do serviço. É o TARM a porta de entrada ao usuário mais visitada dentro da Rede de Urgência e Emergência, responsável pelos atendimentos de urgência e solicitações de transferência interunidades de pacientes graves. É esse atendimento que dá ao solicitante a primeira impressão que se tem da qualidade do serviço.

Urgências em Saúde Mental / Cartilhas de Atendimento do SAMUFor / Mental Health Emergencies / SAMUFor Service Booklets

A obra abrange as urgências em saúde mental, desde os aspectos do atendimento pelo telefonista auxiliar de regulação médica, a decisão técnica da regulação médica baseada em protocolos até a abordagem do paciente em sofrimento mental pelas equipes do SAMU 192. Preparado para o uso do SAMU 192 - Regional Fortaleza (SAMUFor) pelo seu Núcleo de Educação Permanente (NEP), a cartilha é referência teórica para os curso de urgência em saúde mental do NEP SAMUFor, que atualmente têm como público alvo toda a Rede de Atenção Psicossocial de Fortaleza, incluindo multiplicadores da capacitação em atendimento de urgências em saúde mental de todo o Estado do Ceará. Aborda o acolhimento do chamado ao 192 para paciente em crise, identificação preliminar dos 3"S" da regulação, a anamnese dirigida, o estabelecimento do grau de urgência do chamado, a decisão e a resposta da regulação médica, o que é "crise em saúde mental", as habilidades do profissional treinado para atuar nos Primeiros Socorros Psicossociais (PSP), o papel da enfermagem e do médico, a abordagem da crise com a Comunicação Terapêutica (acolhimento, escuta ativa, identificação de fatores de risco e proteção, orientações e encaminhamentos) e as indicações de imobilização e contenção física. Os protocolos de regulação em saúde mental do SAMUFor são baseados na Classificação de Manchester e os protocolos de intervenção nos Protocolos Nacionais do SAMU 192, construídos pelo Ministério da Saúde.

Brecha de género persistente en la parada cardiaca extrahospitalaria en España durante el periodo 2013-2018 / Persistent gender gaps in out-of-hospital cardiac arrest in Spain from 2013 through 2018

Objetivos. Examinar las diferencias de género en las características de la parada cardiaca extrahospitalaria (PCRE), los tratamientos, la supervivencia, y los cambios evolutivos en España. Método. Datos de dos series temporales (2013/2014 y 2017/2018) del registro prospectivo de PCRE (OHSCAR). Se incluyeron todos los casos consecutivos en los que intervino un equipo de emergencias. Las variables dependientes fueron las variables de atención de la PCRE, la llegada al hospital con pulso espontáneo, la supervivencia global al alta, y con buenos resultados neurológicos. El sexo fue la variable independiente. Resultados. Las mujeres fueron significativamente mayores, menos propensas a presentar una PCRE en lugar público, recibir desfibrilación externa automática, tener un ritmo inicial desfibrilable y ser atendidas por una ambulancia en menos de 15 minutos. Además, menos mujeres recibieron intervención coronaria percutánea o hipotermia al ingreso hospitalario. Tanto en 2013/2014 como en 2017/2018 las mujeres tuvieron menos probabilidades de supervivencia al ingreso hospitalario (OR = 0,52; p < 0,001; OR = 0,61; p = 0,009 respectivamente), y al alta hospitalaria (OR = 0,69; p = 0,001; OR = 0,72; p = 0,001, respectivamente) y con buenos resultados neurológicos (OR = 0,50; p < 0,001; OR = 0,63; p <0,001, respectivamente). Conclusiones. En ambos periodos las mujeres tuvieron menos probabilidades de sobrevivir y de hacerlo en buenas condiciones neurológicas. Estos resultados indican la necesidad de adoptar nuevos enfoques para abordar las diferencias de género en la PCRE. (AU)

Objective. To examine gender-related differences in the management and survival of out-of-hospital cardiac arrest (OHCA) in Spain during 2 time series. Methods. Analysis of data recorded in the prospective Spanish OHCA registry (OHSCAR in its Spanish acronym) for 2 time series (2013-2014 and 2017-2018). We included all 11036 consecutive cases in which an emergency team intervened. The dependent variables were arrival at the hospital after return of spontaneous circulation, overall survival to discharge, and overall survival with good neurological outcomes. Sex was the independent variable. We report descriptive statistics, patient group comparisons, and changes over time. Results.Women were significantly older and less likely to experience an OHCA in a public place, receive automatic external defibrillation, have a shockable heart rhythm, and be attended by an ambulance team within 15 minutes. In addition, fewer women underwent percutaneous coronary interventions or received treatment for hypothermia on admission to the hospital. In 2013-2014 and 2017-2018, respectively, the likelihood of survival was lower for women than men on admission (odds ratio [OR], 0.52 vs OR, 0.61; P < .001 and P = .009 in the 2 time series) and at discharge (OR, 0.69 vs 0.72 for men; P = .001 in both time series). Survival with good neurological outcomes was also less likely in women (OR, 0.50 vs 0.63; P < .001 in both series). Conclusions. The odds for survival and survival with good neurological outcomes were lower for women in nearly all patient groups in both time series. These findings suggest the need to adopt new approaches to address gender differences in OHCA. (AU)

Persistent gender gaps in out-of-hospital cardiac arrest in Spain from 2013 through 2018. / Brecha de género persistente en la parada cardiaca extrahospitalaria en España durante el periodo 2013-2018.

OBJECTIVES: To examine gender-related differences in the management and survival of out-of-hospital cardiac arrest (OHCA) in Spain during 2 time series. MATERIAL AND METHODS: Analysis of data recorded in the prospective Spanish OHCA registry (OHSCAR in its Spanish acronym) for 2 time series (2013-2014 and 2017-2018). We included all 11 036 consecutive cases in which an emergency team intervened. The dependent variables were arrival at the hospital after return of spontaneous circulation, overall survival to discharge, and overall survival with good neurological outcomes. Sex was the independent variable. We report descriptive statistics, patient group comparisons, and changes over time. RESULTS: Women were significantly older and less likely to experience an OHCA in a public place, receive automatic external defibrillation, have a shockable heart rhythm, and be attended by an ambulance team within 15 minutes. In addition, fewer women underwent percutaneous coronary interventions or received treatment for hypothermia on admission to the hospital. In 2013-2014 and 2017-2018, respectively, the likelihood of survival was lower for women than men on admission (odds ratio [OR], 0.52 vs OR, 0.61; P .001 and P = .009 in the 2 time series) and at discharge (OR, 0.69 vs 0.72 for men; P = .001 in both time series). Survival with good neurological outcomes was also less likely in women (OR, 0.50 vs 0.63; P .001 in both series). CONCLUSION: The odds for survival and survival with good neurological outcomes were lower for women in nearly all patient groups in both time series. These findings suggest the need to adopt new approaches to address gender differences in OHCA.

OBJETIVO: Examinar las diferencias de género en las características de la parada cardiaca extrahospitalaria (PCRE), los tratamientos, la supervivencia, y los cambios evolutivos en España. METODO: Datos de dos series temporales (2013/2014 y 2017/2018) del registro prospectivo de PCRE (OHSCAR). Se incluyeron todos los casos consecutivos en los que intervino un equipo de emergencias. Las variables dependientes fueron las variables de atención de la PCRE, la llegada al hospital con pulso espontáneo, la supervivencia global al alta, y con buenos resultados neurológicos. El sexo fue la variable independiente. RESULTADOS: Las mujeres fueron significativamente mayores, menos propensas a presentar una PCRE en lugar público, recibir desfibrilación externa automática, tener un ritmo inicial desfibrilable y ser atendidas por una ambulancia en menos de 15 minutos. Además, menos mujeres recibieron intervención coronaria percutánea o hipotermia al ingreso hospitalario. Tanto en 2013/2014 como en 2017/2018 las mujeres tuvieron menos probabilidades de supervivencia al ingreso hospitalario (OR = 0,52; p 0,001; OR = 0,61; p = 0,009 respectivamente), y al alta hospitalaria (OR = 0,69; p = 0,001; OR = 0,72; p = 0,001, respectivamente) y con buenos resultados neurológicos (OR = 0,50; p 0,001; OR = 0,63; p 0,001, respectivamente). CONCLUSIONES: En ambos periodos las mujeres tuvieron menos probabilidades de sobrevivir y de hacerlo en buenas condiciones neurológicas. Estos resultados indican la necesidad de adoptar nuevos enfoques para abordar las diferencias de género en la PCRE.

Presentation of the Prehospital Emergency Research Network and an analysis of bibliometric indicators for scientific productivity in out-of-hospital care. / Presentación de la Red de Investigación en Emergencias Prehospitalarias (RINVEMER) y análisis bibliométrico de la producción científica en emergencias prehospitalarias.

TEXT: Through research we advance scientific understanding and its application in medical practice. Many of the advances in out-of-hospital emergency care are extracted from hospital settings, perhaps because of the difficulties inherent to our prehospital environments: heterogeneity, obstacles to data collection, biases not controlled for, among other limitations. Research networks offer opportunities to create connections among researchers and facilitate homogeneous data collection. We introduce the Prehospital Emergency Research Network (whose Spanish acronym is RINVEMER) and analyze bibliometric indicators of Spanish productivity in this specialty. Since 1975, a total of 512 articles have been published in journals with impact factors by 381 authors working in Spanish prehospital settings. The first such article published after the creation of the Web of Science appeared in 1999. The 61 authors affiliated with the emergency health services of Andalusia, a public company, made up the largest single author group. Publication productivity increased substantially in the last 2 years. A total of 63 PhD theses have been registered in this specialty - 8 of them at the University of Oviedo. With the growth of Spanish out-of-hospital research in recent years, we expect the creation of the RINVEMER network to improve collaboration among our researchers.

TEXTO: La investigación permite mejorar el conocimiento científico y su aplicación a la práctica profesional. En la asistencia extrahospitalaria, muchos de los avances provienen de entornos hospitalarios, quizás debido a dificultades inherentes al entorno extrahospitalario (heterogeneidad, dificultad en la recogida de datos, sesgos no controlados). Las redes de investigación permiten, entre otras cosas, la interconexión de distintos investigadores y la homogenización en la recogida de datos. En este artículo presentamos la Red de Investigación en Emergencias Prehospitalarias (RINVEMER) y los resultados de un análisis bibliométrico de la producción científica en emergencias prehospitalarias en España. Desde 1975 se han publicado 512 trabajos en revistas indexadas en la Web of Science (el primero en 1999), realizados por 381 investigadores españoles del ámbito de las emergencias prehospitalarias [máximo en Empresa Pública de Emergencias Sanitarias (EPES) de Andalucía, con 61 autores], con un claro incremento en los últimos 2 años. Además, se han realizado 63 tesis doctorales (máximo en Universidad de Oviedo, con 8). La producción científica en emergencias extrahospitalarias en España ha crecido sustancialmente en los últimos años, y la creación de RINVEMER permitirá mejorar las interconexiones entre los investigadores.

Presentación de la Red de Investigación en Emergencias Prehospitalarias (RINVEMER) y análisis bibliométrico de la producción científica en emergencias prehospitalarias / Presentation of the Prehospital Emergency Research Network and an analysis of bibliometric indicators for scientific productivity in out-of-hospital care

La investigación permite mejorar el conocimiento científico y su aplicación a la práctica profesional. En la asistencia extrahospitalaria, muchos de los avances provienen de entornos hospitalarios, quizás debido a dificultades inherentes al entorno extrahospitalario (heterogeneidad, dificultad en la recogida de datos, sesgos no controlados). Las redes de investigación permiten, entre otras cosas, la interconexión de distintos investigadores y la homogenización en la recogida de datos. En este artículo presentamos la Red de Investigación en Emergencias Prehospitalarias (RINVEMER) y los resultados de un análisis bibliométrico de la producción científica en emergencias prehospitalarias en España. Desde 1975 se han publicado 512 trabajos en revistas indexadas en la Web of Science (el primero en 1999), realizados por 381 investigadores españoles del ámbito de las emergencias prehospitalarias [máximo en Empresa Pública de Emergencias Sanitarias (EPES) de Andalucía, con 61 autores], con un claro incremento en los últimos 2 años. Además, se han realizado 63 tesis doctorales (máximo en Universidad de Oviedo, con 8). La producción científica en emergen- cias extrahospitalarias en España ha crecido sustancialmente en los últimos años, y la creación de RINVEMER permitirá mejorar las interconexiones entre los investigadores.

Through research we advance scientific understanding and its application in medical practice. Many of the advances in out-of-hospital emergency care are extracted from hospital settings, perhaps because of the difficulties inherent to our prehospital environments: heterogeneity, obstacles to data collection, biases not controlled for, among other limitations. Research networks offer opportunities to create connections among researchers and facilitate homogeneous data collection. We introduce the Prehospital Emergency Research Network (whose Spanish acronym is RINVEMER) and analyze bibliometric indicators of Spanish productivity in this specialty. Since 1975, a total of 512 articles have been published in journals with impact factors by 381 authors working in Spanish prehospital settings. The first such article published after the creation of the Web of Science appeared in 1999. The 61 authors affiliated with the emergency health services of Andalusia, a public company, made up the largest single author group. Publication productivity increased substantially in the last 2 years. A total of 63 PhD theses have been registered in this specialty — 8 of them at the University of Oviedo. With the growth of Spanish out-of-hospital research in recent years, we expect the creation of the RINVEMER network to improve collaboration among our researchers.

Regimento interno SAMUFor / Normas de Conduta Técnica e Gestora para Profissionais do SAMU 192 - Regional Fortaleza / SAMUFor Internal Regulations / Technical and Management Conduct Rules for SAMU 192 - Fortaleza Regional Professionals

Trata-se do Volume 1 da coleção "Normas de Conduta Técnica e Gestora para Profissionais do SAMU 192 - Regional Fortaleza" (SAMUFor), que publiciza o Regimento Interno do SAMUFor. Divide-se em três capítulos: 1. Normatização Vigente; 2. Normatização Municipal Vigente; e 3. Regimento Interno SAMUFor. Esse terceiro capítulo divide-se em: Regimento Interno do SAMU 192 ­ Regional Fortaleza; Regimento Interno da Gerência SAMUFor; Regimento Interno dos Órgãos de Assessoria da Gerência do SAMUFor; Regimento Interno do Núcleo Médico; Regimento Interno do Núcleo de Enfermagem; Regimento Interno do Núcleo de Farmácia; Regimento Interno do Núcleo Administrativo; Regimento Interno do Núcleo de Educação Permanente; e Regimento Interno da Central de Regulação das Urgências

E-learning on medical emergencies for Dentistry students: a randomized controlled trial / E-learning em emergências médicas para estudantes de Odontologia: um ensaio clínico randomizado

This study comparedtwo teaching pedagogies to addressmedical emergencies in dental officevisitsandevaluateddental school students' knowledge about medical emergencies.This randomized controlled trial involved54senior undergraduate dental students at theFederal University of Santa Mariadivided in two groups:students who received instruction via face-to-face traditional expository class;andstudents whoreceived the same instruction via distant learning format.The students were randomly allocated to the groupsby the randomiser.orgwebsite. Data were obtained by comparing the scores students received from answering to a semi-structured questionnaire containing inquiries on ethical and legal implications, and diagnosis and management of medicalemergencies in a dental officebefore and after the instruction. Before the instruction, 96%of studentsfrom the two groupslackedknowledge about the ethical and legal implications related to the dentist obligation to deal with medical emergencies. After the instruction, both groups increasedtheir knowledge similarly as there was no significant difference in the comparison between learning about medical emergencies through lectures and thorough an e-learning format.Both teaching methods presented satisfactory results, which makes the e-learning method an option as a didactic strategy (AU).

Esteestudocomparouduaspedagogiasdeensinoparalidarcomemergênciasmédicasemconsultasodontológicaseavaliouoconhecimentodealunosdocursoodontologiasobreemergênciasmédicas.Esteensaioclínicorandomizadoenvolveu54alunosdoúltimoanodocursodeodontologiadaUniversidadeFederaldeSantaMaria,divididosemdoisgrupos:alunosquereceberaminstruçãopormeiodeaulaexpositivatradicionalpresencial;ealunosquereceberamamesmainstruçãopormeiodoformatodeensinoadistância.Osalunosforamalocadosaleatoriamenteaosgrupospelositerandomiser.org.Osdadosforamobtidospormeiodacomparaçãodaspontuaçõesrecebidaspelosalunosaoresponderaumquestionáriosemiestruturadocontendoindagaçõessobreimplicaçõeséticaselegais,ediagnósticoemanejodeemergênciasmédicasemconsultórioodontológicoanteseapósainstrução.Antesdainstrução,96%dosalunosdosdoisgruposdesconheciamasimplicaçõeséticaselegaisrelacionadasàobrigaçãododentistaemlidarcomemergênciasmédicas.Apósainstrução,os dois grupos aumentaram seus conhecimentos de forma semelhante,poisnãohouvediferençasignificativanacomparaçãoentreoaprendizadosobreemergênciasmédicaspormeiodepalestrasepormeiodoformatoe-learning.Ambososmétodosdeensinoapresentaramresultadossatisfatórios,o que torna o método e-learning uma opção como estratégia didática (AU).

Prevalence and Therapeutic Approach of Acute Pain in Emergency Provided by Triage Nursing / Prevalencia y enfoque terapéutico del dolor agudo en Urgencias brindado por la enfermería de triaje / Prevalência e abordagem terapêutica da dor aguda em pronto-socorro oferecidas pela enfermagem de triagem

ABSTRACT Objective: This work sought to assess the effectiveness of the treatment applied in patients with acute pain in the emergency service by triage nursing. Materials and Methods: Cross-sectional, observational descriptive study of quantitative approach, with measures of central tendency in 348 patients, conducted in 2016. An ad hoc questionnaire was used, elaborated by the emergency service, which assesses the intensity of pain through a numerical scale and a pain intervention protocol that includes physical and pharmacological measures. Results: After applying the first treatment, 80.17 % of the patients experienced improvement; 7.18 % required a second treatment and, of these, 87.5 % improved and 12.5 % suffered no modifications. The nursing staff treated the patients according to the protocol, with AINES and Metamizole, primarily. The rest were remitted to medical evaluation and another 40 patients rejected treatment. Conclusions: A high percentage of patients exist who improve their perception of pain after the first treatment administered by the triage nursing personnel. The results suggest revising and updating the protocol in the first treatment.

RESUMEN Objetivo: valorar la efectividad del tratamiento aplicado en pacientes con dolor agudo en el servicio de urgencias por la enfermería de triaje. Materiales y métodos: estudio descriptivo observacional, de corte transversal y de abordaje cuantitativo, con medidas de tendencia central en 348 pacientes, realizado en 2016. Se utilizó un cuestionario ad hoc, elaborado por el servicio de urgencias, que valora la intensidad del dolor mediante escala numérica y un protocolo de intervención ante el dolor que incluye medidas físicas y farmacológicas. Resultados: tras la aplicación del primer tratamiento, el 80,17 % de los pacientes experimentó mejoría; el 7,18 % requirió un segundo tratamiento y, de este, el 87,5 % mejoró y el 12,5 % no sufrió modificaciones. El personal de enfermería trató a los pacientes según el protocolo, con AINES y Metamizol, mayoritariamente. El resto fue dirigido a valoración médica y otros 40 pacientes rechazaron el tratamiento. Conclusiones: existe un alto porcentaje de pacientes que mejoran su percepción de dolor tras el primer tratamiento administrado por el personal de enfermería de triaje. Los resultados sugieren revisar y actualizar el protocolo en el primer tratamiento.

RESUMO Objetivo: avaliar a efetividade do tratamento aplicado em pacientes com dor aguda no serviço de pronto-socorro pela enfermagem de triagem. Materiais e métodos: estudo descritivo observacional, de corte transversal e de abordagem quantitativa, com medidas de tendência central em 348 pacientes, realizado em 2016. Foi utilizado um questionário ad hoc, elaborado pelo serviço de pronto-socorro, que avalia a intensidade da dor mediante escala numérica, e um protocolo de intervenção ante a dor que incluiu medidas físicas e farmacológicas. Resultados: após a aplicação do primeiro tratamento, 80,17 % dos pacientes experimentaram melhora; 7,18 % necessitaram segundo tratamento e, destes, 87,5 % melhoraram e 12,5 % não sofreram alterações. A equipe de Enfermagem tratou os pacientes segundo o protocolo, com AINEs e Metamizol, predominantemente. Os demais foram dirigidos à avaliação médica, e outros 40 pacientes recusaram o tratamento. Conclusões: existe alta porcentagem de pacientes que melhoram sua percepção da dor após o primeiro tratamento receitado pela equipe de enfermagem de triagem. Os resultados sugerem revisar e atualizar o protocolo no primeiro tratamento.

Use of emergency medical transport and impact on time to care in patients with ischaemic stroke. / Utilización de transporte sanitario urgente por los pacientes con ictus isquémico e impacto en los tiempos de atención.

INTRODUCTION: According to numerous studies, using emergency medical services (EMS) to transport stroke patients to hospitals decreases diagnostic and treatment delays. OBJECTIVES: To determine the frequency of use of EMS by stroke patients in Bizkaia (Spain), analyse the factors associated with using EMS, and study the impact of EMS on time to care. METHODS: We gathered data from 545 patients hospitalised for acute ischaemic stroke and recruited consecutively. Data were obtained from the patients' medical histories and interviews with the patients themselves or their companions. We studied the following variables: previous health status, stroke symptoms and severity (NIHSS), type of transport, and time to medical care. Univariate and multivariate analyses were performed to identify factors associated with use of EMS and care delays. RESULTS: Patients transported to hospital by the EMS accounted for 47.2% of the total. Greater stroke severity, arriving at the hospital at night, and poor functional status at baseline were found to be independently associated with use of EMS. Use of EMS was linked to earlier arrival at the hospital. Door-to-imaging times were shorter in the EMS group; however, this association disappeared after adjusting for stroke severity. Revascularisation was more frequent among patients transported by the EMS. CONCLUSIONS: EMS transport was associated with shorter prehospital delays. Effective health education programmes should be developed to promote EMS transport for patients with stroke symptoms. In-hospital stroke management should also be improved to reduce time to medical care.

Comparison of the Simple Triage and Rapid Treatment system versus the Prehospital Advanced Triage Model in multiple-casualty events. / Comparación de los sistemas de triaje META y START en un ejercicio simulado de múltiples víctimas.

OBJECTIVES: . The main purpose of this simulation of a multiple-casualty event was to compare the performance of 2 triage methods: the Simple Triage and Rapid Treatment (START) system and the Prehospital Advanced Triage Model (META in its Spanish acronym). The secondary objectives were to analyze times, order of evacuations, and appropriateness of treatments. MATERIAL AND METHODS: Cluster randomized trial that included 16 groups assigned to use either the START system or the META for managing casualties in a simulated event (an airline crash). Each group had 4 members. We recorded times, order of evacuation, and appropriateness of treatment. RESULTS: The mean (SD) evacuation time was 48 minutes and 39 seconds (15 minutes, 52 seconds) in the START arm and 48 minutes and 4 seconds (17 minutes, 21 seconds) in the META arm (P=.829). The patients with greatest need of immediate care were evacuated more quickly in the META arm (31 minutes and 36 seconds [8 minutes, 27 seconds]) than in the START arm (41 minutes and 6 seconds [10 minutes, 39 seconds]) (P=.024). Evacuation of the subgroup of patients requiring emergency surgery was also faster in the META arm (24 minutes and 12 seconds [4 minutes] than in the START arm (44 minutes and 49 seconds [8 minutes, 36 seconds]) (P=.001). Analysis of the order of evacuation under the 2 triage systems revealed that 14 of the first 19 patients evacuated required immediate medical care and 5 of the first 14 evacuated required priority surgical treatment in the START arm. In the META arm, all of the first 14 patients evacuated required immediate medical care and 5 of the first 7 patients evacuated required priority surgical treatment. The rate of appropriate treatment was 92% in the META arm and 63% in the START arm (P=.023). CONCLUSION: Use of the META system might improve prehospital times and the order of evacuation of patients, particularly patients who need immediate medical care or urgent surgery. The META might also increase the likelihood of appropriate treatment in multiple-casualty events.

OBJETIVO: El objetivo principal fue comparar dos sistemas de triaje (Simple Triage and Rapid Treatmet, START vs. Modelo Extrahospitalario de Triaje Avanzado, META) en un mismo incidente simulado de múltiples víctimas (IMV). Los objetivos secundarios fueron analizar los tiempos y el orden de evacuación, y la adecuación del tratamiento. METODO: Ensayo aleatorizado por conglomerados que incluyó 16 grupos de 4 miembros asignados al sistema de triaje START o META en un ejercicio simulado de gestión a las víctimas de un accidente aéreo. Se recogieron los tiempos y el orden de evacuación, y la adecuación del tratamiento. RESULTADOS: El tiempo de evacuación total fue de 48 min 39 s (DE 15 min 52 s) en el grupo START y de 48 min 4 s (DE 17 min 21 s) en el grupo META (p = 0,829). Los pacientes con necesidad de atención inmediata se evacuaron más rápidamente en el grupo META que en el START, tanto en el grupo completo (31 min 36 s [DE 8 min 27 s] vs 41 min 6 s [DE 10 min 39s ]; p = 0,024) como en los que además precisaban tratamiento quirúrgico urgente (24 min 12 s [DE 4 min] vs 44 min 49 s [DE 8 min 36 s]; p = 0,001). El orden de evacuación de pacientes fue: los de necesidad de atención inmediata en las 19 primeras posiciones (14 de 19) y de atención inmediata con prioridad quirúrgica en las 14 primeras posiciones (5 de 14) en el grupo START; y los de necesidad de atención inmediata en las 14 primeras posiciones (14 de 14) y de atención inmediata y con prioridad quirúrgica en las 7 primeras posiciones (5 de 7) en el grupo META. La frecuencia de tratamiento adecuado fue de un 92% en el caso del META y de un 63% en el caso del START (p = 0,023). CONCLUSIONES: El triaje META, en comparación con el START, podría mejorar los tiempos extrahospitalarios y el orden de evacuación de los pacientes, especialmente en el caso de aquellos con necesidad de atención inmediata y de atención inmediata con prioridad quirúrgica, así como la adecuación del tratamiento, en los IMV.

False Positive STEMI Activations in a Regional Network: Comprehensive Analysis and Clinical Impact. Results From the Catalonian Codi Infart Network.

INTRODUCTION AND OBJECTIVES: ST-segment elevation myocardial infarction (STEMI) network activation by a noncardiologist reduces delay times but may increase the rate of false-positive STEMI diagnoses. We aimed to determine the prevalence, predictors, and clinical impact of false-positive activations within the Catalonian STEMI network (Codi Infart). METHODS: From January 2010 through December 2011, all consecutive patients treated within the Codi Infart network were included. Code activations were classified as appropriate if they satisfied both electrocardiogram and clinical STEMI criteria. Appropriate activations were classified as false positives using 2 nonexclusive definitions: a) "angiographic" if a culprit coronary artery was not identified, and b) "clinical" if the discharge diagnosis was other than STEMI. RESULTS: In total, 5701 activations were included. Appropriate activation was performed in 87.8% of the episodes. The rate of angiographic false positives was 14.6%, while the rate of clinical false positives was 11.6%. Irrespective of the definition, female sex, left bundle branch block, and previous myocardial infarction were independent predictors of false-positive STEMI diagnoses. Using the clinical definition, hospitals without percutaneous coronary intervention and patients with complications during the first medical contact also had a false-positive STEMI diagnoses rate higher than the mean. In-hospital and 30-day mortality rates were similar for false-positive and true-positive STEMI patients after adjustment for possible confounders. CONCLUSIONS: False-positive STEMI diagnoses were frequent. Outcomes were similar for patients with a true-positive or false-positive STEMI diagnosis treated within a STEMI network. The presence of any modifiable predictors of a false-positive STEMI diagnosis warrants careful assessment to optimize the use of STEMI networks.

[Prehospital emergency care of patients with acute heart failure in Spain: the SEMICA study (Emergency Medical Response Systems for Patients with Acute Heart Failure)]. / Atención prehospitalaria a los pacientes con insuficiencia cardiaca aguda en España: estudio SEMICA.

OBJECTIVES: To study the means of emergency transport used to bring patients with acute heart failure (AHF) to hospital emergency departments (EDs) and explore associations between factors, type of transport, and prehospital care received. MATERIAL AND METHODS: We gathered the following information on patients treated for AHF at 34 Spanish hospital EDs: means of transport used (medicalized ambulance [MA], nonmedicalized ambulance [NMA], or private vehicle) and treatments administered before arrival at the hospital. Twenty-seven independent variables potentially related to type of transport used were also studied. Indicators of AHF severity were triage level assigned in the ED, need for admission, need for intensive care, in-hospital mortality, and 30-day mortality. RESULTS: A total of 6106 patients with a mean (SD) age of 80 years were included; 56.5% were women, 47.2% arrived in PVs, 37.8% in NMAs, and 15.0% in MAs. Use of an ambulance was associated with female sex, age over 80 years, chronic obstructive pulmonary disease, a history of AHF, functional dependency, New York Heart Association class III-IV, sphincteral incontinence, labored breathing, orthopnea, cold skin, and sensory depression or restlessness. Assignment of a MA was directly associated with living alone, a history of ischemic heart disease, cold skin, sensory depression or restlessness, and high temperature; it was inversely associated with a history of falls. The rates of receipt of prehospital treatments and AHF severity level increased with use of MAs vs. NMAs vs. PV. Seventy-three percent of patients transported in MAs received oxygen, 29% received a diuretic, 13.5% a vasodilator, and 4.7% noninvasive ventilation. CONCLUSION: Characteristics of the patient with AHF are associated with the assignment of type of transport to a hospital ED. Assignment appears to be related to severity. Treatment given during MA transport could be increased.

OBJETIVO: Investigar, en los pacientes diagnosticados de insuficiencia cardiaca aguda (ICA) en servicios de urgencias hospitalarios (SUH), su forma de llegada, los factores asociados al tipo de transporte usado y el tratamiento prehospitalario administrado. METODO: En pacientes diagnosticados consecutivamente de ICA en 34 SUH españoles se recogió: forma de llegada (transporte sanitario medicalizado ­TSM­, no medicalizado ­TSNM­ o propio ­TP­) y tratamiento prehospitalario administrado. Se estudiaron 27 variables independientes potencialmente relacionadas con el tipo de transporte utilizado. Como indicadores de gravedad se registraron nivel de triaje en urgencias, necesidad de ingreso y de cuidados intensivos, mortalidad intrahospitalaria y a 30 días. RESULTADOS: Se incluyeron 6.106 pacientes [edad: 80 años (DE:10), 56,5% mujeres]; 47,2% llegaron en TP, 37,8% en TSNM y 15,0% en TSM. El uso de transporte sanitario se asoció a ser mujer, edad > 80 años, enfermedad pulmonar obstructiva crónica, antecedentes de ICA, dependencia funcional, NYHA III-IV, incontinencia esfínteres y presentar disnea, ortopnea, piel fría y depresión del sensorio/inquietud. La asignación de TSM se asoció directamente a vivir solo, antecedente de cardiopatía isquémica, presentar piel fría, depresión del sensorio o inquietud y temperatura elevada e inversamente al antecedente de caídas. Los traslados en TP, TSNM y TSM registraron porcentajes crecientes de tratamiento prehospitalario, y su gravedad también fue progresivamente creciente. El 73% de pacientes trasladados con TSM recibió oxígeno, el 29% diurético, el 13,5% vasodilatador y el 4,7% ventilación no invasiva. CONCLUSIONES: Existen características del paciente con ICA relacionadas con el tipo de recurso asignado para su traslado al SUH, y dicha asignación parece corresponderse con la gravedad del episodio. El tratamiento durante el TSM podría incrementarse.

[Incidence of acute agitation and variation in acute agitation management by emergency services]. / Incidencia y variabilidad de manejo de la agitación aguda en los servicios de emergencias médicas.

OBJECTIVES: To describe the management of acute agitation by Spanish emergency medical services (EMS) and assess the incidence of acute agitation. MATERIAL AND METHODS: Observational descriptive study based on aggregate data from unpublished internal EMS reports. RESULTS: Seven participating emergency services received 4 306 213 emergency calls in 2013; 111 599 (2.6%, or 6.2 calls per 1000 population) were categorized as psychiatric emergencies. A total of 84 933 interventions (4.2%, or 4 per 1000 population) were required; 37 951 of the calls concerned agitated patients (1.9%, or 2 cases per 1000 population). Only 3 EMS mandated a specific procedure for their responders to use in such cases. CONCLUSION: The agitated patient is a common problem for EMS responders. Few teams apply specific procedures for managing these patients.

OBJETIVO: Evaluar la incidencia y el manejo de la agitación aguda por los servicios de emergencias médicas (SEM) en España. METODO: Estudio observacional descriptivo que utiliza datos agregados de las memorias de actividad o datos internos no publicados de los SEM. RESULTADOS: Durante el año 2013, los 7 SEM participantes recibieron 4.306.213 llamadas, de las cuales 111.599 (2,6%; 6,2 llamadas/1.000 habitantes) fueron categorizadas como psiquiátricas. Las actuaciones requeridas por motivos psiquiátricos fueron 84.933 (4,2% del total de actuaciones; 4,0 actuaciones/1.000 habitantes) y, de estas, 37.951 fueron por pacientes agitados (1,9% del total de actuaciones; 2,0 actuaciones/1.000 habitantes). Solo 3 SEM disponían de un procedimiento específico para los equipos asistenciales de atención al paciente psiquiátrico y al paciente agitado. CONCLUSIONES: El paciente agitado es un problema común en los equipos asistenciales de los SEM. Pocos de estos equipos cuentan con procedimientos específicos de actuación ante estos casos.

[Mass gatherings: a systematic review of the literature on large events]. / Gestión de la atención médica en las reuniones masivas de personas (mass gatherings): revisión sistemática.

OBJECTIVES: We reviewed the literature on mass gatherings published worldwide to determine event types and topics or epidemiologic aspects covered. Articles using the term mass gatherings indexed in the Scopus database between 2000 and 2015 were reviewed. Of the 518 returned, we selected 96 with relevant information. The main event types studied were related to sports (46%), music (25%) or religious/social content (23%), and the most commonly studied locations were the United States (n=21), the Kingdom of Saudi Arabia (n=17), Australia (n=11), and the United Kingdom (n=10). The four most often studied events were the Hajj (n=17), the Olympic games (n=13), World Youth Day (n=8), and the FIFA World Cup (n=6). The main topics studied were models of health care (n=55), health care evaluation by means of rates of patients presenting for care or transferred to hospitals (n=21), respiratory pathogens (n=18), syndromic surveillance (n=10), and the global spread of diseases (n=10). Mass gatherings are an emerging area of study addressed by various medical specialties that have focused on studying the health care models used at such events. Emergency medicine is particularly involved with this research topic.

OBJETIVO: Se revisa la gestión de las reuniones masivas de personas a nivel mundial con el propósito de conocer los eventos, temas y aspectos epidemiológicos abordados. Para ello, se realizó una búsqueda bibliográfica de los documentos que utilizaban el concepto "mass gathering" indexados en la base de datos Scopus entre 2000 y 2015. De los 518 documentos recuperados se seleccionaron 96 con información relevante para su análisis específico. Los principales tipos de eventos estudiados fueron los deportivos (46%), musicales (25%) y religiosos/sociales (23%) desarrollados en Estados Unidos (n = 21), Reino de Arabia Saudita (n = 17), Australia (n = 11) y Reino Unido (n = 10). Los cuatro principales eventos fueron el Hajj (n = 17), Juegos Olímpicos (n = 13), Día de la Juventud (n = 8) y mundiales de fútbol (n = 6), y se evaluaron los diferentes modelos de asistencia sanitaria (n = 55), los ratios de presentación de pacientes y de traslado a hospitales (n = 21), los patógenos respiratorios (n = 18), la vigilancia sindrómica (n = 10) y la globalización de enfermedades (n = 10). Creemos que las reuniones masivas de personas constituyen un área de conocimiento incipiente vinculada con diferentes especialidades médicas, particularmente la medicina de emergencias, que se centra en la investigación de los modelos de asistencia sanitaria.

Protocolos de Regulação das Urgências / Normas de Conduta Técnica e Gestora para Profissionais do SAMU 192 - Regional Fortaleza / Emergency Regulation Protocols / Technical and Management Conduct Rules for SAMU 192 - Fortaleza Regional Professionals

Trata-se do Volume 2 da coleção "Normas de Conduta Técnica e Gestora para Profissionais do SAMU 192 - Regional Fortaleza" (SAMUFor), que publiciza os Protocolos de Regulação das Urgências do SAMUFor. Discorre sobre os conceitos de acolhimento e classificação de risco, ética em urgência e telemedicina, como um guia para a decisão técnica da Regulação das Urgências da Rede de Atenção às Urgências e Emergências de Fortaleza. Divide-se em 11 Protocolos Técnicos, 25 Protocolos Clínicos, 10 Protocolos em Trauma, 02 Protocolos em Obstetrícia e 02 Protocolos em Pediatria. Sua construção foi baseada na Classificação de Risco de Manchester de forma a "fazer conversar" os protocolos de acolhimento e classificação de risco pré-hospitalar móvel do SAMUFor com os protocolos do pré-hospitalar fixo e das portas de entrada das urgências em Fortaleza.