This short letter from the field is offered as a rapid communiqué of the emergency medical situation in Mosul and surrounding areas on the eve of the final onslaught to liberate the city. This letter is based on emergency medical work at two World Health Organization (WHO) and Ministry of Health (MoH) Iraq lead Role II+ Field Hospital facilities south of Mosul City from April to June 2017; these facilities are currently and temporarily managed and administered by private medical industry until full handover to MoH Iraq, with WHO support and expert facilitation. The prominence of non-state actors in the conflict, using hybrid warfare tactics that maximize casualties, makes health security a particular challenge for the global community. This challenge requires health leaders and other actors in the region to set clear strategic goals that support public health of the many millions displaced, maimed and affected by the war. Whether in clinical medicine, development, peace and stability operations, or global health diplomacy, the shared values and conviction to best serve vulnerable communities and mitigate morbidity must embrace the lessons of evidenced based practice derived from military medical experience. WHO is leading the charge in disaster response for the conflict in Iraq, and many challenges remain. This might also include developing a new process in emergency medical response that utilizes private contracting to improve efficiency in delivery and overall sustainability.

• Klíčová slova
• Damage control resuscitation (DCR), Damage control surgery (DCS), Health security, Mosul, Northern Iraq, Tactical combat casualty care (TCCC), War and disaster medicine,
• MeSH
• lidé MeSH
• mobilní zdravotnické jednotky * MeSH
• Světová zdravotnická organizace MeSH
• urgentní zdravotnické služby organizace a řízení   MeSH
• vedení války * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH
• Geografické názvy
• Irák MeSH

BACKGROUND: Efficient trials of interventions for patients with out-of-hospital cardiac arrest (OHCA) should have adequate but not excess power to detect a difference in outcomes. The minimum clinically important difference (MCID) is the threshold value in outcomes observed in a trial at which providers should choose to adopt a treatment. There has been limited assessment of MCID for outcomes after OHCA. Therefore, we conducted an international survey of individuals interested in cardiac resuscitation to define the MCID for a range of outcomes after OHCA. METHODS: A brief survey instrument was developed and modified by consensus. Included were open-ended responses. The survey included an illustrative example of a hypothetical randomized study with distributions of outcomes based on those in a public use datafile from a previous trial. Elicited information included the minimum significant difference required in an outcome to change clinical practice. The population of interest was emergency physicians or other practitioners of acute cardiovascular research. RESULTS: Usable responses were obtained from 160 respondents (50% of surveyed) in 46 countries (79% of surveyed). MCIDs tended to increase as baseline outcomes increased. For a population of patients with 25% survival to discharge and 20% favorable neurologic status at discharge, the MCID were median 5 (interquartile range [IQR] 3, 10) percent for survival to discharge; median 5 (IQR 2, 10) percent for favorable neurologic status at discharge, median 4 (IQR 2, 9) days of ICU-free survival and median 4 (IQR 2, 8) days of hospital-free survival. CONCLUSION: Reported MCIDs for outcomes after OHCA vary according to the outcome considered as well as the baseline rate of achieving it. MCIDs of ICU-free survival or hospital-free survival may be useful to accelerate the rate of evidence-based change in resuscitation care.

• Klíčová slova
• Cardiac arrest, Methods, Randomized trails, Survey,
• MeSH
• analýza přežití MeSH
• kardiopulmonální resuscitace * škodlivé účinky   metody   MeSH
• lidé MeSH
• mezinárodní spolupráce MeSH
• průzkumy a dotazníky MeSH
• urgentní zdravotnické služby * metody   organizace a řízení   MeSH
• výsledky intenzivní péče MeSH
• výzkum zdravotnických služeb organizace a řízení   MeSH
• zástava srdce mimo nemocnici terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Research Support, N.I.H., Extramural MeSH

BACKGROUND: Out of hospital cardiac arrest (OHCA) has a poor outcome. Recent non-randomized studies of ECLS (extracorporeal life support) in OHCA suggested further prospective multicenter studies to define population that would benefit from ECLS. We aim to perform a prospective randomized study comparing prehospital intraarrest hypothermia combined with mechanical chest compression device, intrahospital ECLS and early invasive investigation and treatment in all patients with OHCA of presumed cardiac origin compared to a standard of care. METHODS: This paper describes methodology and design of the proposed trial. Patients with witnessed OHCA without ROSC (return of spontaneous circulation) after a minimum of 5 minutes of ACLS (advanced cardiac life support) by emergency medical service (EMS) team and after performance of all initial procedures (defibrillation, airway management, intravenous access establishment) will be randomized to standard vs. hyperinvasive arm. In hyperinvasive arm, mechanical compression device together with intranasal evaporative cooling will be instituted and patients will be transferred directly to cardiac center under ongoing CPR (cardiopulmonary resuscitation). After admission, ECLS inclusion/exclusion criteria will be evaluated and if achieved, veno-arterial ECLS will be started. Invasive investigation and standard post resuscitation care will follow. Patients in standard arm will be managed on scene. When ROSC achieved, they will be transferred to cardiac center and further treated as per recent guidelines. PRIMARY OUTCOME: 6 months survival with good neurological outcome (Cerebral Performance Category 1-2). Secondary outcomes will include 30 day neurological and cardiac recovery. DISCUSSION: Authors introduce and offer a protocol of a proposed randomized study comparing a combined "hyperinvasive approach" to a standard of care in refractory OHCA. The protocol is opened for sharing by other cardiac centers with available ECLS and cathlab teams trained to admit patients with refractory cardiac arrest under ongoing CPR. A prove of concept study will be started soon. The aim of the authors is to establish a net of centers for a multicenter trial initiation in future. ETHICS AND REGISTRATION: The protocol has been approved by an Institutional Review Board, will be supported by a research grant from Internal Grant Agency of the Ministry of Health, Czech Republic NT 13225-4/2012 and has been registered under ClinicalTrials.gov identifier: NCT01511666.

• MeSH
• indukovaná hypertermie * MeSH
• kardiopulmonální resuscitace přístrojové vybavení   MeSH
• lidé MeSH
• srdeční zástava terapie   MeSH
• urgentní zdravotnické služby organizace a řízení   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Research Support, N.I.H., Extramural MeSH
• srovnávací studie MeSH

INTRODUCTION: Several previous studies have focused on establishing the cause of cardiac arrest (CA) during cardiopulmonary resuscitation (CPR) provided in an out-of-hospital setting. OBJECTIVES: To analyze the ability of professional advanced life support providers to correctly establish the aetiology of cardiac arrest during out-of-hospital CPR. STUDY DESIGN: A retrospective cohort study analysing 211 cases of out-of-hospital cardiac arrest. METHOD: The aetiology assumed by out-of-hospital physicians was compared with the diagnosis that was later established by clinicians or pathologists. RESULTS: Cases were sorted into five diagnostic groups and the overall diagnostic concordance was 74.4% (157 of 211 cases). The cardiac aetiology was presumed in 132 out of 211 patients and confirmed in 135 out of 211 patients. However, an analysis of individual cases of the cardiac causes of cardiac arrest revealed diagnostic matches in only 112 cases. Acute myocardial infarction (AMI) or pulmonary embolism (PE), both of which represent cases that can be potentially influenced by thrombolytic therapy, were presumed in 74 (53+21) and confirmed in 97 (77+20) cases, however with individual diagnostic matches in only 55 cases. CONCLUSION: This study demonstrates the importance of analysing concordance in presumed and definitive diagnosis of individual cases, since an overall comparison in a cohort of cases may be highly misleading. It introduces the method of the crosscheck table for visualization and comparison of presumed and final diagnoses. The two alternative approaches of inclusion rule for applying the thrombolytic therapy in out-of-hospital care were discussed with regard to the recent TROICA study.

• MeSH
• časná diagnóza * MeSH
• diferenciální diagnóza MeSH
• dítě MeSH
• dospělí MeSH
• infarkt myokardu komplikace   diagnóza   MeSH
• kardiopulmonální resuscitace metody   MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• následné studie MeSH
• plicní embolie komplikace   diagnóza   MeSH
• předškolní dítě MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• urgentní zdravotnické služby organizace a řízení   MeSH
• zástava srdce mimo nemocnici MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

AIMS: Percutaneous coronary interventions (PCI) are used to treat acute and chronic forms of coronary artery disease. While in chronic forms the main goal of PCI is to improve the quality of life, in acute coronary syndromes (ACS) timely PCI is a life-saving procedure - especially in the setting of ST-elevation myocardial infarction (STEMI). The aim of this study was to describe the experience of countries with successful nationwide implementation of PCI in STEMI, and to provide general recommendations for other countries. METHODS AND RESULTS: The European Association of Percutaneous Cardiovascular Interventions (EAPCI) recenty launched the Stent For Life Initiative (SFLI). The initial phase of this pan-European project was focused on the positive experience of five countries to provide the best practice examples. The Netherlands, the Czech Republic, Sweden, Denmark and Austria were visited and the logistics of ACS treatment was studied. Public campaigns improved patient access to acute PCI. Regional networks involving emergency medical services (EMS), non-PCI hospitals and PCI centres are useful in providing access to acute PCI for most patients. Direct transfer from the first medical contact site to the cathlab is essential to minimise the time delays. Cathlab staff work is organised to provide acute PCI services 24 hours a day / seven days a week (24/7). Even in those regions where thrombolysis is still used due to long transfer distances to PCI, patients should still be transferred to a PCI centre (after thrombolysis). The highest risk non-ST elevation acute myocardial infarction patients should undergo emergency coronary angiography within two hours of hospital admission, i.e. similar to STEMI patients. CONCLUSIONS: Three realistic goals for other countries were defined based on these experiences: 1) primary PCI should be used for >70% of all STEMI patients, 2) primary PCI rates should reach >600 per million inhabitants per year and 3) existing PCI centres should treat all their STEMI patients by primary PCI, i.e. should offer a 24/7 service.

• MeSH
• akutní koronární syndrom komplikace   diagnostické zobrazování   terapie   MeSH
• balónková koronární angioplastika * MeSH
• benchmarking MeSH
• časové faktory MeSH
• chronická nemoc MeSH
• cíle organizace MeSH
• dostupnost zdravotnických služeb organizace a řízení   MeSH
• infarkt myokardu diagnostické zobrazování   etiologie   terapie   MeSH
• koronární angiografie MeSH
• lidé MeSH
• nemoci koronárních tepen komplikace   diagnostické zobrazování   terapie   MeSH
• nemocnice MeSH
• pohotovostní zdravotnická služba organizace a řízení   MeSH
• přemístění pacientů organizace a řízení   MeSH
• programy národního zdraví organizace a řízení   MeSH
• regionální zdravotnické plánování organizace a řízení   MeSH
• rozvoj plánování MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• trombolytická terapie MeSH
• urgentní zdravotnické služby organizace a řízení   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

• MeSH
• kritický stav * MeSH
• lidé MeSH
• třídění pacientů organizace a řízení   MeSH
• urgentní lékařství * MeSH
• urgentní služby nemocnice MeSH
• urgentní zdravotnické služby organizace a řízení   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH
• komentáře MeSH
• Geografické názvy
• Česká republika MeSH

The article focuses on the question of reorganisation of Emergency Medical Service in Poland. First part of the paper contains a short description of a project of the Integrated Rescue System, which have been included in the National Emergency Medical Service Act enacted by Parliament in 2001. Considering to the fact, that implementation of this reform has been stopped after general elections in autumn 2001, in the second part of the paper some arguments supporting the postulate of urgent realisation of this project are discussed. The arguments refer to five spheres: epidemiological, social, political, legal and economical. The conclusions of the discussion are, that in every of those spheres negative consequences of blocking the reform may be observed. The final conclusion is, that reorganisation of ineffective Emergency Medical Service in Poland is still a challenge, which public authorities have to manage.

• MeSH
• lidé MeSH
• reforma zdravotní péče * MeSH
• urgentní zdravotnické služby organizace a řízení   MeSH
• zdravotnické služby - potřeby a požadavky * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Polsko MeSH

Emergency Medicine (EM) has evolved since 1950s--in the Czech Republic as well as abroad--from Anaesthesiology and Resuscitation in parallel with the Burn Medicine which has separated from Plastic Surgery. EM creates a link between the laymen first aid and the specialized hospital care, which is realized by the Emergency Medical Service (EMS). The EMS interventions for serious burn patients comprise the early professional prehospital medical care: establishing free airway and breathing, establishing intravenous/intraosseous access into the blood circulation, early shock therapy, early pharmacotherapy and analgesia, aseptic covering of damaged body surface, releasing escharotomies of circumferential burns of the chest and neck and optimal transport of patients into burn centres.

• MeSH
• lidé MeSH
• popálení terapie   MeSH
• urgentní zdravotnické služby organizace a řízení   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

• MeSH
• lidé MeSH
• plánování postupu v případě katastrof * MeSH
• terorismus * MeSH
• urgentní zdravotnické služby organizace a řízení   MeSH
• záchranná práce organizace a řízení   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• kongresy MeSH
• Geografické názvy
• City of New York MeSH
• Evropa MeSH

• MeSH
• katastrofy * MeSH
• lidé MeSH
• urgentní zdravotnické služby zákonodárství a právo   organizace a řízení   MeSH
• záchranná práce zákonodárství a právo   organizace a řízení   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH