Streptokinase and enoxaparin in the pre-hospital management of the ST-segment elevation acute myocardial infarction.

UNLABELLED: In a pilot study, safety and efficacy of an accelerated Streptokinase (SK) regimen (0.75 MU/10 min. repeated after 50 min. if no signs of coronary reperfusion were detected) in combination with enoxaparin was evaluated in the prehospital (preASENOX regimen) and in the in-hospital (in ASENOX regimen) phase of the ST segment elevation acute myocardial infarction (STAMI) and compared to the in-hospital standard SK plus Heparin (the StSK regimen). METHODS: A group of 262 consecutive patients (age 34-74 years) thrombolised within the first 6 hours after the onset of STAMI was divided in three subgroups according to the mentioned regimens: preASENOX (64 patients); in ASENOX (69 patients) and StSK (129 patients). Enoxaparin was administered i.v. 40 mg before the first dose of 0.75 MU of SK and 1 mg/kg every 12 hours for 5-7 days. Heparin was infused 1000 i.u./h 48-96 hrs. Three noninvasive reperfusion criteria were used: 1) Rapid cessation of the chest pain; 2) Rapid decreasing of the ST segment elevations by more than 50% from the initial value; 3) Rapid increasing of the CK and CK-MB with a peak within the first 12 hrs. RESULTS: The chest pain-thrombolysis time was 145 +/- 52 min in the preASENOX subgroup, significantly shorter as that in the ASENOX subgroup (172 +/- 73 min, p = 0.016) and the StSK one (168 +/- 80 min, p = 0.038). The ratios of the CR were 81.2%, 78.2% and 62.0%, respectively (preASENOX vs StSK p = 0.025; in ASENOX vs StSK p = 0.030). The inhospital mortalities were: 3.12% (preASENOX); 5.8% (inASENOX) and 10.8% (StSK)(non-significant differences). Only one case of ischemic stroke was registered (in the inASENOX subgroup). Symptomatic hypotension appeared more frequent in the preASENOX (39.06%), and inASENOX (43.47%) subgroups as compared to the SSK one (20.15%). CONCLUSIONS: 1) The preASENOX and inASENOX regimens are safe, and lead toward a significant higher ratios of coronary reperfusion as compared to StSK regimen; 2) Our data suggest a very low mortality in patients treated with the preASENOX regimen. Further investigations (randomized studies) are needed for a definite conclusion.

Evaluation of the computer-based dispatching system for emergency medical dispatch.

The work makes an evaluation of the benefits brought by the system to the Ambulance Service of the City of Bucharest (ASCB) as well as to those who are using it, and of the conditions that permitted the bringing into operation of the system and made possible work with this system 7 days per week, 24 hours out of 24 for over 4 years. Also, the problems are presented that appeared with this system during exploitation--hardware, software, in the work with people.

Emergency Health Care Information System for Bucharest-Romania.

The Emergency Health Care Information System (EHCIS) in Bucharest provides information about the whole activity of Dispatch Emergency Ambulance Service and Emergency Receiving Room of the 7 Hospitals, providing emergency health care in Bucharest over a MAN (Metropolitan Area Network). In each of these places a local network is located, containing a database server ORACLE. The link among LANs is made via switched lines. The Hospitals collect information only about emergency cases. The microstation represents station for emergency teams of Emergency Ambulance Service of Bucharest (EASB), distributed in all 6 districts of Bucharest. The system is structured accordingly with the working-groups existing in Dispatch, microstations and hospitals: registration operators (phone-operators) for administer the emergency requests/calls; a location for the medical coordinator which must to choose, in few seconds, the emergency team, accordingly with the case emergency degree; radio-operators which communicate with the teams in the field; a location for the manager of Dispatch, in order to provide a full-set of real-time medical and resources information; a registration operator at each microstation; a registration operator at each hospital. The data are registered in the ORACLE database on the central server. The client/server architecture assures the real time communication among all these locations. The system works 7 days/week, 24 hours/day.

A new approach for assessment of IT programs in health care.

The efficiency of health care programs, on the level of a community, results not only from reducing hospitalization or drugs costs but also from the number of days of health and life gained. This gain can be estimated in monetary terms if we accept that, at least partially, the Gross Domestic Product results from the human activity. In the Center for Health Information and Statistics, Ministry of Health Bucharest. Romania, a methodology based on these premises was developed and non-officially used in assessment of several health programs. In this paper, the core of this methodology, as well as some applications are shown.