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This paper presents an experience of the Educational Centre of EMSC Sarajevo in the postgraduate training of the various profiles of medical personnel (medical doctors and medical technicians) that are employed in the emergency services of the pre-hospital and hospital type in Bosnia and Herzegovina. A period of the last four years (1996-2000) when the Educational Centre was restructured, becoming a one of the most active services in the medical sector of the EMSC Sarajevo has been emphasised in particular. Educational Centre of EMSC was participating in a number of international projects related to the education. Forty-five (45) courses of the various levels and with different programs: BLS, ALS, ACLS, ACLS-instructor course, ATLS, EMT-course, EMT-advanced, EMT-instructor and EMT-dispatcher course were carried out in the mentioned period. Seven thousand eight hundred and twelve (7812) hours of theoretical teaching and practical training were provided for the 570 candidates who successfully completed training in various programs. First aid training for civilian population was also conducted. Twenty one first.aid courses were carried out and successfully achieved by 324 candidates. On this way, 196 hours of theoretical teaching and practical training were realised. In order to make first aid training popular, 160 children from pre-school institutions (kindergartens) of Sarajevo Canton were also introduced to first aid principles. It has been pointed out that well equipped and trained team for the urgent medical intervention with a necessary team work is a crucial factor for the successful treatment of emergency that means a patient in life threatening situation.
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PMID:[Development and organization of the Education Center at the Institute of Emergency Medical Services in Sarajevo]. 1111 30

It must be emphasised that the published International Guidelines 2000 contain an in-depth presentation of the scientific evidence behind advanced life support. The exact interpretation of this evidence, and the algorithms adopted by a national resuscitation council will depend upon various factors such as local interpretation of the evidence, local practice and availability of drugs. The ERC is publishing its own summaries of the guideline changes and the sequences of action for both BLS and ALS and these papers are recommended for further reading.
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PMID:ACLS. 1181 96

The EMS (Emergency Medical Service) system in France is a centrally based, two-tiered, physician-manned system. The first level is composed of BLS (Basic Life Support) fire department ambulances (called "VSAB") based at fire stations. The second level is composed of ALS (Advanced Life Support) physician staffed-ambulances. In France, there are two different levels of emergency department (ED). The first level is called "SAU" and has continuous coverage by surgeons, in Level 2 certain specialities may be available only on an "on-call" basis. Staffing patterns in the ED vary from one hospital to another. In general, EDs in university and major teaching hospitals are staffed by emergency physicians and residents from different specialties. In France medical schools are part of free public universities. The length of medical training varies from 8 to 11 years according to speciality. Emergency Medicine is not recognised as a stand alone specialty.
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PMID:International EMS systems: France. 1545 80

This case study represented a patient with a relatively uncomplicated myocardial infarction that, after prompt prehospital care and transport, was successfully halted in the emergency department with fibrinolytic therapy. This patient was provided excellent care in the prehospital setting because the paramedic and his EMT-B partner worked together effectively as a team. Although ECG monitoring, IV therapy and medication administration are beyond the usual scope of practice of an EMTB, many EMS systems are training their EMT-Bs to assist with these important procedures and interventions. This involves preparing IV equipment and supplies, applying the cardiac monitor, and recognizing and handling the various paramedic medications. This enhanced role of the EMT-B allows the paramedic to perform a more focused and careful patient assessment. A cohesive working relationship between BLS and ALS personnel is absolutely crucial to the outcome of the patient. Although each level of prehospital provider possesses a different knowledge of pathophysiology and patient management, it is the combined contributions and efforts of each provider that will afford patients the high quality of care they deserve.
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PMID:Cardiac case study. 50-year-old male with chest pressure. 1627 74

Emergency medical services are provided by the fire defence headquarters of the local government in Japan. There is a one-tiered EMS system. Ambulances are staffed by three crew members trained in rescue, stabilisation, transport, and advanced care of traumatic and medical emergencies. There are three levels of care provided by ambulance personnel including a basic-level ambulance crew (First Aid Class One, FAC-1), a second level (Standard First Aid Class, SFAC), and the highest level (Emergency Life Saving Technician, ELST). ELSTs are trained in all aspects of BLS and some ALS procedures relevant to pre-hospital emergency care. Further development of an effective medical control system is imperative as the activities of ambulance crews become more sophisticated. A marked recent increase in the volume of emergency calls is another issue of concern. Currently, private services for transportation of non-acute or minor injury/illness have been introduced in some areas, and dispatch protocols to triage 119 calls are being developed.
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PMID:Emergency medical service systems in Japan: past, present, and future. 1674 Mar 55

It's 2000 HRS on a Friday evening. You're assigned to an ALS engine company, and you're just settling down after a busy day when you're dispatched along with a BLS ambulance to a report of a sick person outside a local club where they're holding a concert. During your response, dispatch advises that they're receiving multiple calls on the incident and are dispatching a second BLS ambulance to the call. * As you turn the corner and approach the scene, you notice a haze in the air coming from an industrial site on the same side of the street and see approximately 200 people exiting the club in haste. Several dozen patrons line the street between the club and the subway station. They're coughing and crying, and several are vomiting. * The driver stops the engine in front of the subway entrance, which is located approximately 500 feet from the club and uphill and upwind from the haze. The scene is overwhelming, even to the captain, who turns to you-as the paramedic on the crew-and asks what you want done first. Your first thought is, Triage. But you know that triaging these patients is more complicated than your everyday two-car collision.
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PMID:Medical triage for WMD incidents incidents: an adaptation of daily triage. 1848 52

As an EMT-B, there will be times when your assessment and treatment skills will be put to the test as you find yourself on scene with a critical patient and no ALS backup. Your ability to recognize patients with critical symptoms and do the most good for them within the EMT-B scope of practice could have a tremendous impact on patient survival. The importance of rapid but accurate assessment of both the clinical presentation and the patient's history cannot be overemphasized. This article will review BLS assessment and care of the congestive heart failure (CHF) patient.
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PMID:Skills review: the CHF patient. A review of BLS ssessment and care of the congestive heart failure patient. 1971 72

Cardio-pulmonary resuscitation is a life-saving technique that should be familiar to all people, even those without medical education. There are two basic life-saving levels: BLS (Basic Life Support) and ALS (Advanced Life Support). ALS a medical procedure that is restricted to medical practitioners. Cessation of circulation may happen to anyone. Cardiac arrest in case of pregnant women is a very specific state. The cause of life-threatening states during pregnancy can be connected with new infections, exacerbation of chronic diseases, as well as changes connected with the pregnancy itself. In those situations, due to physiological and anatomical changes which occur during pregnancy some modifications in the procedure of resuscitation are necessary
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PMID:[Cardiopulmonary resuscitation in pregnancy--European Resuscitation Council guidelines]. 2087 23

Key changes in Guideline 2010 by Japanese Resuscitation Council were described and the reasons of the change were explained based on 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care with Treatment Recommendations. In BLS, the value of chest compression was further emphasized and it became an initial skill of CPR In ALS, post resuscitation care was systemized by incorporating hypothermia, PCI, and other diagnostic and therapeutic modalities. Indication of hypothermia was further expanded to non-VF categories. Use of AED was expanded to infant. Education, Implementation and Teams were newly included as a chapter to promote the knowledge and skill of resuscitation science into the society.
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PMID:[New evidences in the 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care with Treatment Recommendations]. 2159 11

The past 40-50 years of research and experience have given us improved knowledge of the pathophysiology and treatment of drowning injuries. Still, an all-too-common event, the morbidity and mortality of drowning can be mitigated by prevention, recognition and target treatment. Old terms, such as "near drowning" and "secondary drowning," are confusing and misleading, and use of these terms should be abandoned. Most importantly, EMS personnel should understand that drowning is a hypoxic event resulting from submersion in a liquid. Most BLS and ALS strategies are designed to treat cardiac causes of respiratory and cardiac arrests (with recent change to a CAB algorithm). Drowning, however, is initially a purely hypoxic event and should be treated as such with ventilation and oxygenation (with an ABC algorithm). EMS and the fire service, because of their presence in the community, are uniquely positioned to play a major role in drowning prevention and treatment.
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PMID:Silent struggle. 2299 68


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