LABOR PRODUCTIVITY WITHIN THE EMERGENCY MEDICAL SERVICE IN THE CZECH REPUBLIC

In the frame of health care facilities effectiveness is very important to observe and regularly evaluate not only medical, but also economic indicators for assuming the highest possible accessibility of the healthcare for most of population. The aim of this paper is to describe and evaluate the Emergency Medical Service labor productivity as the important indicator of the economic effectiveness. For objective measurement were chosen significant economic and performance indicators. For the purpose of the presumptive measurement of the pre hospital emergency care effectiveness was propose the structure of applicable indicators

PRE-HOSPITAL EMERGENCY CARE ("PEC") IN THE CZECH REPUBLIC, CHANGES IN THE PEC ORGANIZATION – PERSONNEL AND ECONOMIC CONNECTIONS

In past 25 years PEC in the Czech Republic has gone through the development when the common denominator was a lack of funds and a lack of doctors. We describe the changes in the organization of these services that are based on the reduction of so called urgent care service and strengthening of the emergency medical service ("EMS") with even increasing availability of the quality medical first aid in the pre-hospital phase without a need of a step increase of the funds. It was succeeded in solving a lack of doctors and funds by means of involving so called Rendez-Vous system. EMS in the Kralovehradecký Region succeeded in satisfying the limits for overtime work of doctors according to opinions of the EU. We present particular figures on the development of the number of patients treated and basic economic parameters in the Královéhradecký Region, one of 14 regions in the Czech Republic, comparing the years 2003-2013

Abstract 324: Effect of Prehospital Use of Plasma and Erythrocytes on Crystalloid and Blood Product Requirements in Trauma

Introduction: Recent studies demonstrated positive effects of blood products (BP) administration by helicopter emergency medical services (HEMS) to trauma patients but most of them were limited to specific cohorts (e.g. mixture of primary and secondary transports, long prehospital times, high prevalence of penetrating injuries, military use). This study aimed to assess implementation of prehospital use of BP into a regional trauma system treating predominantly blunt injuries (&gt;95 %) and achieving short prehospital times (first emergency call to handover at trauma center ~60 min). Methods: A prospective observational study in patients treated with prehospital plasma (1 unit) followed by erythrocytes (1 unit) during the initial 7 months of the RABBIT trial (Rapid Administration of Blood by HEMS in Trauma, ClinicalTrials NCT03522636). The treatment group was compared to a historical cohort treated with massive transfusion protocol but no BP available prehospitally. It was hypothesized that early transfusion was associated with lower severity of coagulopathy and lower requirements for crystalloids and BP within 24 hours. Data analysis was performed using Prism 6.0 (GraphPad, La Jolla, USA). Results: Twenty patients treated with prehospital BP (Jun-Dec 2018) were compared to 24 patients in a control group (Jun-Dec 2017). There were no secondary transports. No differences were found between groups in age (47.0 ± 4.1 vs. 46.1 ± 3.7 years, p=0.87), ISS (33.5 ± 3.7 vs. 35.8 ± 3.4, p=0.65), prehospital time (60.9 ± 3.8 vs. 63.8 ± 3.6 min, p=0.59), fibrinogen (2.6 ± 0.2 vs. 2.5 ± 0.2 g/L, p=0.74) and lactate on admission to trauma center (4.5 ± 0.7 vs. 4.4 ± 0.7 mmol/L, p=0.94). The treated patients had better INR (1.1 ± 0.1 vs. 1.4 ± 0.1, p=0.028), and required 14.5 ± 1.7 units of BP in 24 hours compared to 21.42 ± 4.0 units in a control group (p=0,15). Prehospital and emergency department (ED) dose of crystalloids was reduced from 1696 ± 161 mL to 1088 ± 137 mL (p=0.006). No colloids were given at any time. There were no transfusion related complications. Conclusion: Prehospital use of plasma and erythrocytes in a setting with short prehospital times was associated with lower need for crystalloids, better INR at admission, and a trend towards lower consumption of BP in a trauma center. </jats:p