Major travmalı hastalara hastane öncesi yaklaşımda acil hekimliği sertifika programı temel eğitim modülünün etkisi
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Date
2008
Authors
Turan, Mustafa
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Bu araştırma, Acil Hekimliği Sertifika Programı Temel Eğitim Modülü'ne katılan Acil Sağlık Hizmetleri (ASH) ekiplerinin major travmalı hastalara hastane öncesi yaklaşımında eğitim öncesi ve sonrasında farklılık olup olmadığını saptamak amacıyla yapıldı.1 Ocak 2005- 30 Haziran 2005 (6 ay) ile 1 Kasım 2005- 30 Nisan 2006 (6 ay) tarihleri arasında ASH ekiplerinin hastane öncesi dönemde müdahale ettikleri 18 yaş ve üstü yetişkin, Hastane öncesi indeks (PHI) skoru 4 ve üstünde olan major travmalı hastalar çalışmaya alındı. Hastaların sosyodemografik özellikleri, travma mekanizması, yaralanma bölgeleri, Glasgow Koma Skoru (GKS), Düzeltilmiş Travma Skoru (RTS), Yaralanma Şiddet Skoru (ISS) ve PHI skorları, yapılan müdahaleler ve sonuçlanma durumları kaydedildi.Toplam 163 hastanın (Eğitim öncesi: 93, eğitim sonrası: 70) 130'u erkek olup ortalama yaş 37.63±18.42 yıl idi. Eğitim öncesi hastaların % 80.6'sı künt travma olup, eğitim sonrası bu oran %67.1 idi. Her iki grupta en fazla görülen yaralanma bölgesi baş (sırasıyla %63.4, %54.2) ve torakstı (%23.7, %28.6). Travma skorları açısından iki grup arasında anlamlı bir farklılık saptanmadı. Eğitim sonrası vakaya varış süresi, müdahale süresi ve nakil süresi eğitim öncesine göre daha kısa idi, ancak istatistiksel olarak anlamlı bir farklılık yoktu. Eğitim sonrası servikal ve torakal immobilizasyon, oksijen tedavisi uygulama ve damar yolu açma oranlarında istatistiksel olarak anlamlı bir farklılık saptanmaz iken sadece entübasyon uygulama oranında (%12.5'tan %35'e) anlamlı bir değişiklik tespit edildi. Eğitim sonrası (%25.7) ve eğitim öncesi (%28) mortalite oranları arasında anlamlı bir değişiklik yoktu.Sonuç olarak, Temel Eğitim Modülü hastane öncesi major travmalı hastaya yaklaşım açısından yetersiz olup, güncel bilgiler doğrultusunda yeniden gözden geçirilmeli ve hastane öncesi teorik ve pratik uygulamalarla desteklenmelidir.
This Study was performed to find out differences at prehospital approach for major trauma patients, before and after training at the Basic Training Modules in Emergence Medical Science Certificate Program participated by Emergency Medical Service (EMS) teams. Major traumatic patients, age of 18 and older, PHI (Prehospital Index) 4 and above, manipulated by EMS teams at prehospital period between 1 January 2005-30 June 2005 (pretraining) and 1 November 2005-30 April 2006 (posttraining), were evaluated as participants. The sociodemographic properties, trauma mechanisms, injured area, Glasgow Coma Score (GCS), Revised Trauma Score (RTS) , Injury Severity Score (ISS) and Prehospital index (PHI), all interventions and their results were recorded. 130 participants were male among total 163 patient (pretraining:93; posttraining:70) and their average age was 37.63±18.42. 80.6% of pretraining patients and 67.1% of posttraining patients were blunt trauma. For these two groups, the most seen injured areas were head (respectively 63.4% and 54.2%) and thorax ( 23.7%, 28.6%). There were no significant differences between two groups in terms of trauma scores. The arrival time, intervention time, and transporting time in post training was shorter than in pretraining, however it was not statistically significant. Although there were no significant differences in servical and thoracal immobilization, oxygen treatment application and intravenous line emplacement, there was significant difference in intubation applications (pretraining group 12.5%, posttraining group 35%). There was no significant difference in mortality rates between posttraining (25.7%) and pretraining groups (28%). v In conclusion, Basic Training Modules is not sufficient for the approach of prehospital major traumatic patients; it should be revised according to contemporary knowledge and supported with prehospital theoric and practice applications.
This Study was performed to find out differences at prehospital approach for major trauma patients, before and after training at the Basic Training Modules in Emergence Medical Science Certificate Program participated by Emergency Medical Service (EMS) teams. Major traumatic patients, age of 18 and older, PHI (Prehospital Index) 4 and above, manipulated by EMS teams at prehospital period between 1 January 2005-30 June 2005 (pretraining) and 1 November 2005-30 April 2006 (posttraining), were evaluated as participants. The sociodemographic properties, trauma mechanisms, injured area, Glasgow Coma Score (GCS), Revised Trauma Score (RTS) , Injury Severity Score (ISS) and Prehospital index (PHI), all interventions and their results were recorded. 130 participants were male among total 163 patient (pretraining:93; posttraining:70) and their average age was 37.63±18.42. 80.6% of pretraining patients and 67.1% of posttraining patients were blunt trauma. For these two groups, the most seen injured areas were head (respectively 63.4% and 54.2%) and thorax ( 23.7%, 28.6%). There were no significant differences between two groups in terms of trauma scores. The arrival time, intervention time, and transporting time in post training was shorter than in pretraining, however it was not statistically significant. Although there were no significant differences in servical and thoracal immobilization, oxygen treatment application and intravenous line emplacement, there was significant difference in intubation applications (pretraining group 12.5%, posttraining group 35%). There was no significant difference in mortality rates between posttraining (25.7%) and pretraining groups (28%). v In conclusion, Basic Training Modules is not sufficient for the approach of prehospital major traumatic patients; it should be revised according to contemporary knowledge and supported with prehospital theoric and practice applications.
Description
Keywords
Major travma, Hastane öncesi dönem, Temel eğitim modülü, Mortalite, Major trauma, Prehospital period, Basic training module, Mortality
Citation
Turan, M. (2008). Major travmalı hastalara hastane öncesi yaklaşımda acil hekimliği sertifika programı temel eğitim modülünün etkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.