Introduction: Trauma scoring systems in prehospital settings are supposed to ensure the most appropriate in-hospital treatment of the injured. Aim of the study: To determine the sensitivity and specificity of the CRAMS scale (circulation, respiration, abdomen, motor and speech), RTS score (revised trauma score), MGAP (mechanism, Glasgow Coma Scale, age, arterial pressure) and GAP (Glasgow Coma Scale, age, arterial pressure) scoring systems in prehospital settings in order to evaluate trauma severity and to predict the outcome. Materials and Methods: A prospective, observational study was conducted. For every trauma patient, a questionnaire was initially filled in by a prehospital doctor and these data were subsequently collected by the hospital. Results: The study included 307 trauma patients with an average age of 51.7 ± 20.9. Based on the ISS (injury severity score), severe trauma was diagnosed in 50 (16.3%) patients. MGAP had the best sensitivity/specificity ratio when the obtained values indicated severe trauma. The sensitivity and specificity were 93.4 and 62.0%, respectively, for an MGAP value of 22. MGAP and GAP were strongly correlated with each other and were statistically significant in predicting the outcome of treatment (OR 2.23; 95% Cl 1.06–4.70; p = 0.035). With a rise of one in the MGAP score value, the probability of survival increases 2.2 times. Conclusion: MGAP and GAP, in prehospital settings, had higher sensitivity and specificity when identifying patients with a severe trauma and predicting an unfavorable outcome than other scoring systems.

The relationship between coronavirus disease 2019 (COVID-19) and myocardial injury was established at the onset of the COVID-19 pandemic. An increase in the incidence of out-of-hospital cardiac arrest was also observed. This case report aims to point to the prothrombotic and proinflammatory nature of coronavirus infection, leading to simultaneous coronary vessel thrombosis and subsequently to out-of-hospital cardiac arrest. During the COVID-19 pandemic, a 46-year-old male patient with no comorbidities suffered out-of-hospital cardiac arrest (OHCA) with ventricular fibrillation as the first recorded rhythm. The applied cardiopulmonary resuscitation (CPR) measures initiated by bystanders and continued by emergency medical service (EMS) resulted in the return of spontaneous circulation. The stabilized patient was transferred to the tertiary university center. Electrocardiogram (ECG) revealed “lambda-like” ST-segment elevation in DI and aVL leads, necessitating an immediate coronary angiography, which demonstrated simultaneous occlusion of the left anterior descending (LAD) and right coronary artery (RCA). Primary percutaneous coronary intervention (PCI) with the implantation of one drug-eluting stent (DES) in LAD and two DES in RCA was done. Due to the presence of cardiogenic shock (SCAI C), an intra-aortic balloon pump (IABP) was implanted during the procedure, and due to the comatose state and shockable cardiac arrest, targeted temperature management was initiated. The baseline chest X-ray revealed bilateral interstitial infiltrates, followed by increased proinflammatory markers and a positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) demasking underlying COVID-19-related pneumonia. Within the following 48 h, the patient was hemodynamically stable, which enabled weaning from IABP and vasopressor discontinuation. However, due to the worsening of COVID-19 pneumonia, prolonged mechanical ventilation, together with antibiotics and other supportive measures, was needed. The applied therapy resulted in clinical improvement, and the patient was extubated and finally discharged on Day 26, with no neurological sequelae and with mildly reduced left ventricle ejection fraction.

Introduction: Early recognition and calling for help, early cardiopulmonary resuscitation (CPR), early defibrillation, and post-resuscitation care are the four links in the chain of survival in cases of sudden cardiac arrest. Objective: To determine the incidence of Basic Life Support (BLS) measures being implemented by the eyewitnesses in cases of out-of-hospital cardiac arrest before the arrival of the ambulance, as well as telephone-assisted CPR, and whether the measures taken affected the rate of achieving the return of spontaneous circulation (ROSC). Material and Methods: The study is retrospective and observational. It was conducted for a year at the Institute for Emergency Medical Assistance Novi Sad. The study included patients with sudden cardiac arrest who were resuscitated by ambulance teams. Results: There were 148 patients enrolled in the study. In the group of patients who survived, there were fewer unrecognized cardiac arrests by the dispatcher, more telephone-assisted CPRs and fewer cases of no CPR measures undertaken by the eyewitnesses before the arrival of the ambulance. In the group of patients who survived, the only statistically significant event was cardiac arrest in the presence of the ambulance team. Conclusion: The implementation of telephone-assisted CPR protocol in dispatch centres would increase the number of cases in which bystanders could implement BLS measures before the arrival of the medical team.

Background/Aim: Cardiac arrest (CA) is a leading cause of mortality in the last forty years worldwide. Immediately initiated cardiopulmonary resuscitation (CPR) improves chances for survival. Aim of this study was to determine the efficiency of the Emergency medical service (EMS) dispatch centre in the absence of the uniform emergency medical dispatch assessment protocols in the management of cardiac arrest. Methods: The retrospective and observational study was conducted in Institute for Emergency Medical Service Novi Sad (IEMS Novi Sad) Serbia during a one-year follow-up. The study included patients with out-of-hospital cardiac arrests who underwent CPR. Results: EMS teams of the IEMS Novi Sad had 198 CPRs in the follow-up period. In 142 (71.72 %) calls, the EMS dispatcher got information that the patient was unconscious. The reported reaction time I by the dispatchers for the unconscious patients was 1.37 ± 1.27 minutes, actual duration of the conversation between the dispatcher and a caller - was longer: 138.21 ± 103.02 seconds (p < 0.001). The average conversation time with a caller was 61.37 ± 31.13 seconds. In 6 (4.22 %) cases, the EMS team was dispatched to a patient before the phone call was terminated. At the moment of arrival, all patients were unconscious, 194 (94.37 %) were pulseless, while the remaining 8 (5.63 %) experienced cardiac arrest during the examination. The cardiac arrest was witnessed by a layman in 120 (84.51 %) cases and CPR was initiated by bystanders, before the arrival of the EMS team, only in 13 (10.83 %) patients. Twenty-seven (19.01 %) patients arrived in a hospital with vital signs. Conclusion: The absence of the uniform EMS dispatch assessment protocols for the triage of incoming calls and phone assisted CPR for lay rescuers decreases the survival rate of patients with cardiac arrest.

Mass accidents do not happen often, but when they do, they cause a significant disruption in the functioning of a society with a large number of casualties and an increased percentage of deaths among the injured. The aim of the work is to present the way of organization within the emergency medical aid service in the event of a mass accident. Numerous services are involved in caring for the injured, so their mutual cooperation is important, as is the functioning within each service. Depending on the type of event, the leader of the intervention should be from the service that is responsible for the nature of the event. He is in charge of organizing the entire intervention. All the services that participate in care have their own leader who communicates with the leader of the intervention. Within the Emergency Medical Service, the triage leader and the transport leader play an important role. The triage leader is in charge of primary triage. It uses simple triage algorithms to triage the injured according to the urgency of care in four categories in the shortest possible time. After primary triage, secondary triage and treatment of the injured is in process. Only necessary measures to stabilize the injured are taken during this phase. The transport of the injured takes place based on the priority and the type of transport that is needed. During the whole treatment process, the injured must be marked with triage cards. Based on them,we can later conduct the documentation: total number of injured, number of injured by triage categories, care measures taken, method and time of transport. In order for the services to provide the best care for injured in a mass accident, the existence of unique protocols at the level of one country is necessary. In addition to protocols, education and training of employees are necessary, not only in the emergency medical service, but in all services that participate in caring for the injured. Best way to do this is shared training of employees from several departments. Only in this way can the available resources be used in the most optimal way to take care of the largest number of injured people in the best possible way and in the shortest possible time.

Background/Objectives: Pain is the most frequently reported symptom in over 90% of patients presenting with traumatic injuries, and three-quarters of patients are discharged from emergency departments experiencing moderate to severe pain. The objective of this study was to compare the frequency of analgesic administration between patients with chest pain presumed to be of cardiac origin and those with suspected bone fractures as well as to assess whether significant differences exist between these two groups. Methods: A retrospective, observational study was conducted. Patients were categorized into two groups: Group 1—patients with angina pectoris, acute myocardial infarction, or non-specific chest pain; and Group 2—patients with a preliminary diagnosis of bone fracture made by the attending physician at the scene. Results: A total of 1189 patients were included in this study, with 503 (42.3%) in Group 1 and 686 (57.7%) in Group 2 (χ² = 28.166; p < 0.001). Analgesic administration was significantly more frequent among patients in Group 1 than in Group 2 (χ² = 23.187; p < 0.001). Within Group 1, the highest rate of analgesic use was recorded in patients diagnosed with acute myocardial infarction. In Group 2, analgesics were administered to 36.4% of patients with suspected trunk bone fractures, while only 7.1% of patients with suspected cranial fractures received analgesic therapy. Pain intensity scores were not available for either group. Conclusions: The administration of analgesic treatment was significantly more common among patients presenting with chest pain of presumed cardiac origin than among those with suspected bone fractures, including fractures involving multiple body regions.