Sažetak: Teška trauma je vodeći uzrok mortaliteta i teškog stepena invaliditeta. Hitna medicinska pomoć najčešće prva ostvaruje kontakt sa povređenom osobom, tako da od procene težine povrede zavisi dinamika definitivnog zbrinjavanja povređenog. Da bi se procenila težina povrede, neophodna je upotreba adekvatnog Trauma skora (TS). Najčešće korišćeni na prehospitalnom nivou je Revidirani trauma skor (RTS). Pregledom velikih indeksnih baza pronašli smo studije koje se bave upoređivanjem dugo korišćenog RTS skora sa novorazvijenim skorovima MGAP (Mechanism, Glasgow coma scale, Age, and arterial Pressure) i GAP (Glasgow coma scale, Age, and arterial Pressure). Analizom pet pronađenih studija došli smo do zaključka da su novorazvijeni skorovi jednostavniji za upotrebu, a pri tome imaju istu ili bolju trijažnu i prediktivnu vrednost ishoda trauma. Ključne reči: Trauma skor; Revidirani trauma skor; MGAP (Mechanism, Glasgow coma scale, Age, and arterial Pressure) skor; GAP (Glasgow coma scale, Age, and arterial Pressure) skor Summary: Context: Severe trauma is a leading cause of mortality and high-degree invalidity. Emergency Medical Services (EMS) are usually first-line responders to the traumatized persons and the management of traumatism and its dynamics depend on the accurate evaluation by the EMS providers. In order to evaluate the severity of injury, it is necessary to use the adequate trauma score (TS). The aim of this paper is to compare the most common prehospital scoring system RTS (Revised TS) with newly developed MGAP (Mechanism, Glasgow Coma Scale, Age and Arterial Pressure) and GAP (Glasgow Coma Scale, Age and Arterial Pressure), based on the published studies, in order to determine better triage and predictive value, i.e. the highest sensitivity and specificity. Methods: Our search through the large indexical data bases (Web of Science, Scopus, PubMed, Serbian Citation Index), completed on 01 May 2017, discovered numerous articles about trauma scores. Results: Prehospitally, most commonly used score is a RTS. After viewing large indexed data bases, we found studies comparing RTS with newly developed scores, such as MGAP and GAP. MGAP and GAP have better triage and predictive value than RTS. In addition to this, these scores are easier to use and calculate. In most cases, it is possible to calculate them retrospectively, which is not the case with RTS. Its importance is even more prominent in low and middle-income countries, where there are great differences in availability, quality and equipment between medical centres. Conclusions: After analyzing five studies, we concluded that new scores are easier to apply, with equal or improved triage and predictive values regarding the outcome of the trauma.

Background/Aim: Cardiac arrest (CA) is a leading cause of mortality in the last forty years worldwide. Immediately initiated cardiopulmonary resuscitation (CPR) improves chances for survival. Aim of this study was to determine the efficiency of the Emergency medical service (EMS) dispatch centre in the absence of the uniform emergency medical dispatch assessment protocols in the management of cardiac arrest. Methods: The retrospective and observational study was conducted in Institute for Emergency Medical Service Novi Sad (IEMS Novi Sad) Serbia during a one-year follow-up. The study included patients with out-of-hospital cardiac arrests who underwent CPR. Results: EMS teams of the IEMS Novi Sad had 198 CPRs in the follow-up period. In 142 (71.72 %) calls, the EMS dispatcher got information that the patient was unconscious. The reported reaction time I by the dispatchers for the unconscious patients was 1.37 ± 1.27 minutes, actual duration of the conversation between the dispatcher and a caller - was longer: 138.21 ± 103.02 seconds (p < 0.001). The average conversation time with a caller was 61.37 ± 31.13 seconds. In 6 (4.22 %) cases, the EMS team was dispatched to a patient before the phone call was terminated. At the moment of arrival, all patients were unconscious, 194 (94.37 %) were pulseless, while the remaining 8 (5.63 %) experienced cardiac arrest during the examination. The cardiac arrest was witnessed by a layman in 120 (84.51 %) cases and CPR was initiated by bystanders, before the arrival of the EMS team, only in 13 (10.83 %) patients. Twenty-seven (19.01 %) patients arrived in a hospital with vital signs. Conclusion: The absence of the uniform EMS dispatch assessment protocols for the triage of incoming calls and phone assisted CPR for lay rescuers decreases the survival rate of patients with cardiac arrest.

Emergency Medicine does not represent a simple collection of various medical conditions, but rather an urgent approach to life threatening conditions. This urgent approach progresses as fast as the science in medicine does. Modern protocols for treatment of injured and ill patients are introduced, demanding more and more knowledge and skills as well as more modern equipment and wider spectrum of drugs. However, innovations are not followed by changes within the lists of medications set by National Health Insurance Fund of Serbia (NHIFS). Paper describes drugs necessary for adequate pre-hospital treatment that are not available to the physicians due to administrative barriers. On one hand, there are drugs from B list that are necessary for treatment, and are approved for use by NHIFS at hospital level only. The use of any of these drugs at pre-hospital level may lead to severe penalties to the physician in case of complications or adverse reactions in a patient following the treatment. On the other hand, there are drugs from D list which are also necessary for the urgent treatment of patients with life threatening conditions, according to latest recommendations. These drugs may be applied at pre-hospital level, but their procurement is complicated due to NHIFS regulations and that's why some of them may rarely be used (Propafenone and Magnesium sulfate). We particularly emphasize that one of the most effective drugs for the conversion of heart rhythm, Adenosine (6 mg/ml and 10mg/ml ampoule), is not registered in the Republic of Serbia and therefore cannot be used at pre-hospital level. Through these exclusive administrative barriers adequate treatment is rendered impossible while the system of urgent treatment of patients with life threatening conditions at pre-hospital level is degraded.