ORGANIZATION OF PROVISION OF EMERGENCY MEDICAL CARE TO PATIENTS WITH STEMI AT THE PREHOSPITAL STAGE

Potiaghenko M. M., Ischeykin K. E., Nikitina I. V., Lavrenko O. S., Tkach L. I., Nastroga T. V.

SOCIAL MEDICINE AND ORGANIZATION OF HEALTHCARE PROTECTION

Scentific article

The main strategy in treatment patients with STEMI is reperfusion therapy. It helps to improve the quality of life and decrease mortality. Purpose. To analyze the results of emergency medical care (EMC) at the pre-hospital stage to patients with STEMI by teams of ME “Poltava Regional Center of Emergency Medical Care and Disaster Medicine” for 2015-2019 that received reperfusion therapy. Object and methods of research. It was performed retrospective analysis of 489 EMC teams departure cards (F № 110/0), accompanying letters (F № 114/0) and ECG of patients with STEMI that received reperfusion therapy in 2015-2018. Results. ME “Poltava Regional Center of Emergency Medical Care and Disaster Medicine” was created in 2013 after reorganisation of emergency medical care station. There were formed 4 territorial medical districts. Due to applying modern telemetrical technologies in EMC working, quality of diagnosing and providing medical care to cardiac patients at pre-hospital stage is at the high level. Usage of telemetrical technologies in work of EMC was started in 1994, when distance cardiological centre (DCC) was created on basis of Poltava municipal emergency medical care station. Every year the load on DCC is increasing, Compared to 2012, the amount of distance ECG in 2018 has increased almost by 6 times. Since 2014 usage of consultative abilities of DCC specialists allows large parts of cardiological calls provide most of urgent medical and organizational measures by paramedic and general medical teams, includes pre-hospital thrombolysis to patients with STEMI. Besides, paramedic teams that work with cardiological calls within the district stations, provided 56% of the total amount of thrombolysis. Since 2015 in Poltava Sklifosovsky regional clinical hospital the specialized department of interventional radiology, successfully works, where urgent coronary angiography and primary stenting can be performed. Since 2018 in Poltava Regional Clinical Cardiology Dispensary works an intervention department. According to the requirements of the order of the healthcare department of Poltava region № 121 “About the interaction of medical institutions in the Poltava region in providing urgent cardiac care in acute coronary syndromes” from 16.02.2017, patients with STEMI before 24 hours should be transported to the specialized department of interventional radiology in Poltava Sklifosovsky regional clinical hospital or to the intervention department in Poltava Regional Clinical Cardiology Dispensary. In every case hospitalisation route solves due to remote transmission ECG that allows to reduce “first medical contact – stenting” time by 2 times. Due to it, amount of pre-hospital thrombolysis has been decreased. In 2016 in Poltava region were performed 876 coronary angiography, including urgent – 320. In 2018 were performed 1767, which means that the amount of angiography has increased by 2 times. The analysis of the results show that the number of hospitalisations in the DIR is progressively increasing. So, in 2015 in the DIR 51 patients were hospitalised, in 2016 – 129 patients, in 2017 – 148, in 2018 were hospitalized 157 patients, which means that the amount of patients has increased by 3 times. Mortality patients with STEMI after primary coronary intervention was in 2015 – 6.3%, in 2016 – 5.5%, in 2017 – 7.0, in 2018 – 7,6%, while average mortality from STEMI in the region – 11.6%, in Ukraine – 12,3%. The results demonstrate the effectiveness of timely early reperfusion. Conclusions. The organization of the regional territorial telemetry network of EMC on the basis of the ME “Poltava Regional Center of Emergency Medical Services and Disaster Medicine” helps to improve the quality of EMC at the pre-hospital stage to patients with STEMI.

acute coronary syndrome with ST segment elevation (STEMI).

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«Bulletin of problems biology and medicine» Issue 4 Part 2 (154), 2019 year, 356-360 pages, index UDK 616.127 – 005.8 – 039.74 – 073.7 – 08

10.29254/2077-4214-2019-4-2-154-356-360