| Abstract |
Background
'Emergency' means any life-threatening emergency; for one or more organs or for one or more limbs of the patient. "Emergency" is characterized by a variety of gravity - complexity and requires immediate, multimodal and structural treatment. Early on it was realized that the level of knowledge of medical staff is directly related to the quality of health services in emergency reception areas. Thus, an effort has been made to quantify and ensure the necessary training by organizing appropriate basic and specialized life support seminars. Studies have also highlighted the importance of lifelong ongoing training of medical and nursing staff in skill stations, current algorithms and scenarios for children and adults and in the structured approach of patients with cardiac arrest, severe disease or serious trauma.
Objective
The evaluation of the knowledge of the staff of the Emergency Departments (ED) of tertiary Hospitals, the National Ambulance Service (EKAB), Health Centers (HC) and Primary Health-Care Structures (TOMY) in the prefecture of Heraklion on the structured approach to emergencies of severe disease, serious trauma and cardiac arrest in both adults and children. In addition, self-assessment of knowledge and recording of the views of the participants in the research related to the education in emergency medicine was made.
Methods
This is a 6-month cross sectional study using an improvised questionnaire based on the latest ALS, APS, BLS, PLS and APLS to the Medical Staff of ED, EKAB, HC, and TOMY. The statistical analysis was done using the SPSS 26 statistical package.
Results
Of the survey participants, 48.3% were doctors, 39.6% were nurses and 12.1% were EKAB rescuers. Education in specialized adult life support had 65.1% of participants, with superiority of employees in the ED or EKAB (two seminars 42.5%), compared to HC or TOMY (p=0.019), while the corresponding rates in children's life support (PLS) were12.1% and those trained in the advanced pediatric life support (APLS) were only 6%. Last training in BLS is recorded 11.5±7.9 years ago, specialized support 4.7±6 years ago, while 8.1% have not attended any emergency seminar (TOMY 25%, HC 10%, p=0.046). More frequent repetitive seminars are recorded among rescuers (77.8%) compared to doctors (38.1%) or nurses (39.7%, p=0.003). In everyday practice, significantly differed the cases in which workers had to apply CPR (p<.002), administer oxygen (p<0.001), resuscitation drugs (p<0.005), or attach the defibrillator (p<0.001) among the different centers. Only 3.4% (ED 5.5%) had inserted an intraosseous needle, while foreign body removal procedures have been more frequently applied by EKAB rescuers (17%). Of all the questions, the average percentage of correct answers per group per question was for EKAB 49.25%, ED 55.96%, HC 50.67%, and TOMY 43.99%. More than half of respondents were unaware of the initial approach to a victim of loss of consciousness or sepsis, while low rates of participants were aware of the initial treatment of convulsions (56.4%), burn (42.3%), drowning (25.5%) and supraventricular tachycardia (35.6%). The CPR rate for children was known to 55.7% while the danger of non-recognized esophageal intubation was best recognized by those working in HC (70%) and the capnometry usefulness by the ED (68%) and EKAB (58%) personnel (p<0.001). More than 70% did not recognize SaO2 as the most reliable indicator of assessment of severe asthma and 66% did not identify intravenous administration of adrenaline in anaphylaxis as an error. 14.8% of respondents are unaware that automatic defibrillators with whatever electrodes they have are suitable for use in children of all ages while only 26.2% would rate 15 GCS in quadriplegic without injury. Survey participants characterized their basic knowledge in BLS and PLS as moderate or below average, while high rates of demand for continuing lifelong education were recorded, particularly among physicians (98.6%) compared to nurses (96.6%) and rescuers (83.3%, p=0.012).
Conclusions
The results of this study highlight for the first time in our country the low level of training of medical, nursing staff, and rescuers working in any emergency reception structure, with characteristic ignorance of a number of specific simple algorithms. There is a lack of experience of simple interventions and the staff confidence is low, especially in regard to their knowledge of pediatric emergencies. Employees characterize their knowledge as moderate and express a universal desire for education in basic and advanced life support seminars for both adults and children. In conclusion, the need to train and retrain the staff of ED, EKAB, HC and TOMY not only in BLS-ALS, but also in PLS-APLS seminars in a systematic way, is necessary and imperative.
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Τρέχουσες γνώσεις και προσεγγίσεις του προσωπικού των ΤΕΠ, ΕΚΑΒ και ΤΟΜΥ σε θέματα βασικής και εξειδικευμένης υποστήριξης της ζωής σε παιδιά και ενήλικες στην Κρήτη
