Mission & Aims
The Czech Republic (78,866 km2, 10.5 mil. inhabit.) is divided into 14 administrative regions, incl. the Capital City of Prague. In each region pre-hospital care is organized by its Regional Emergency Medical Service (EMS) established by the regional government and financed jointly from the regional government and health insurance companies, and helicopter operations also directly from the Ministry of Health.
The EMS of the Hradec Kralove Region is one of the 14 EMS systems in the country. Its catchment area for ground ambulances is 4,700 km2 with 550,000 inhabitants. The Emergency Medical Dispatch (EMD) centre is an integral part of each EMS, and always staffed by qualified medical personnel. Medical dispatchers process all medical emergency calls coming to the national number 155, or calls reconnected via 112 call-takers. Since 2007, EMDs are nationwide responsible for dispatcher-assisted cardiopulmonary resuscitation (DA-CPR). EMS is closely co-operating with the University Hospital Hradec Kralove serving as a Level I trauma centre, a post-cardiac arrest centre, and a stroke centre. There are 85,000 incoming emergency calls annually, of which 40,000 result into 49,000 EMS responses (some cases are responded by 2 or more ambulance teams).
There are approx. 430 CPRs started by EMS every year (1.1% of all responses). The incidence of started CPRs for non-traumatic OHCA is 67–84 cases per 100,000 inhabitants, the mean age of resuscitated patients was 68 years, mean response time for cardiac arrest 8 min 55 sec, incl. urban, rural, and mountain areas. The initial shockable rhythm was present in 24.7% of patients. There were 11.3 % patients discharged from hospital after CPR from any cardiac arrest (incl. all rhythms, and traumatic arrests) in 2014. However, traumatic cardiac arrest had very poor prognosis: there was only 1 (0.7%) survivor (CPC 1-2) of 129 cases in a 4-year period (2011-2014). On the other hand, in the subgroup of shockable rhythms (VF/pVT), the primary outcome was 65-75%, and discharge from hospital (CPC 1-2) was achieved in 33-40%. There were found differences between survival rates in urban and rural areas. In the city of Hradec Kralove (95,000 inhabit.) with mean EMS response time 5.5 min discharge from hospital (CPC 1-2) was achieved in 15.2% of all rhythms, and in 47.5% of VF/pVT. The first responder (FR) project introducing mobile AEDs into selected police cars, and EMS guided training to police officers was started in 2016.
Subsequently, a first responder app for mobile phones was introduced. Both ambulance personnel out-of-duty and trained lay rescuers could be alerted for OHCA automatically. Mobile app should reduce time to defibrillation and/or high-quality CPR initiation in areas with longer EMS response times.
Our aim in the ESCAPE-NET project is detection of areas where the Chain of Survival can be strengthened and survival from OHCA further improved.
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