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The use of ultrasonic waves dates back to the forties of the last century. Due to easy portability, ease of use, as well as diagnosing life-threatening conditions such as cardiac arrest, aortic dissection, myocardial infarction, cardiac tamponade, pericardial effusion, etc., ultrasound is recognized as a perfect diagnostic instrument at the prehospital level. Case report 1: The Emergency medical services (EMS) team received a first line emergency call for a 79-year-old female patient. After arriving at the scene, all measures of cardiopulmonary cerebral resuscitation (CPR) were started according to the protocol for shockable rhythms. During the rhythm check, the presence of cardiac activity was confirmed by ultrasound. Case report 2: A 59-year-old female patient called 194 due to a feeling of suffocation that has lasted all day and is intensifying. Ultrasound diagnostics in the form of urgent echocardiography were applied, where a decrease in systolic function was registered, which until then did not exist in the available medical documentation of the patient, who states in her anamnestic that she is not being treated for anything. In addition to the urgent echocardiography, the doctor on the field also performed an ultrasound of the lungs, where the pathological findings and the presence of B lines as part of the alveolar syndrome are registered. Alveolar syndrome and reduction of systolic function are sufficient pre-hospital diagnostic data that differentially indicated alveolar fluid overflow and consequent cardiac decompensation. Case report 3: A 71-year-old patient experiences cardiac arrest in the outpatient department of the Institute for Emergency Medical Assistance in Novi Sad, and all CPR measures are started. After 20 minutes of CPR closure, the doctor decides for an urgent echocardiography, as a result of which he observes the presence of cardiac activity in the patient. Urgent echocardiography registered a pathological finding in the form of akinesia of the lower wall of the heart, and a rupture of the papillary muscle was suspected, which was later confirmed at the emergency admission of the Institute for Cardiovascular Diseases of Vojvodina. Case report 4: A 48-year-old man calls 911 because of what he describes as stomach discomfort and sweating. Upon arrival of the team, patient states that his complaints have passed and refuses to see a doctor. The doctor still insists on the examination. The electrocardiographic findings at the time of examination are comparatively stationary compared to all previous ones. Using urgent echocardiography, the doctor finds a pathological finding in the form of hypokinesia to septo-apical akinesia, and the patient, accompanied by medical team, is referred to the Institute for Cardiovascular Diseases under the differential diagnosis of acute myocardial infarction. Conclusion: In addition to facilitating the doctor in the field in making a differential diagnosis of the patient, errors in therapeutic procedures can be significantly reduced, as shown by previous studies.

Sudden cardiac arrest is the leading cause of death in the world, accounting for 15-20% of all deaths. One of the biggest challenges when maintaining the stability of the patient's condition until hospital conditions is the occurrence of hypotension immediately after the return of spontaneous circulation (ROSC). In case of hypotension, the drugs of choice are vasopressors and inotropes. The Department of Emergency Medicine Belgrade has at its disposal Dopamine, a vasoactive, inotropic drug whose importance and use during hypotension after the establishment of spontaneous circulation (ROSC) in a patient who experienced cardiac arrest are described through a case report. Case report: a 78-year-old man, after severe abdominal pain and black copious stools followed by hemodynamic instability, experiences cardiac arrest. After all measures of cardiocerebral pulmonary resuscitation (CPR) have been taken, cardiac function is restored, but hemodynamic instability persists. The application of Dopamine infusion leads to hemodynamic optimization of the patient and transport to the on-call health facility, where the patient is placed alive, hemodynamically stable, in the intensive care unit. Conclusion: Given that the occurrence of hypotension after ROSC is frequent (it occurs in as many as 47% of cases), while on the other hand, the availability of vasopressors and inotropes at the pre-hospital level, which would treat this hypotension, is limited, it is necessary to note the importance of the use of these drugs and increase the availability of them to doctors in emergency medical services. Applying vasoactive support pre-hospital would lead to easier hemodynamic optimization of already vitally endangered and unstable patients for transport to health institutions.

Mass accidents do not happen often, but when they do, they cause a significant disruption in the functioning of a society with a large number of casualties and an increased percentage of deaths among the injured. The aim of the work is to present the way of organization within the emergency medical aid service in the event of a mass accident. Numerous services are involved in caring for the injured, so their mutual cooperation is important, as is the functioning within each service. Depending on the type of event, the leader of the intervention should be from the service that is responsible for the nature of the event. He is in charge of organizing the entire intervention. All the services that participate in care have their own leader who communicates with the leader of the intervention. Within the Emergency Medical Service, the triage leader and the transport leader play an important role. The triage leader is in charge of primary triage. It uses simple triage algorithms to triage the injured according to the urgency of care in four categories in the shortest possible time. After primary triage, secondary triage and treatment of the injured is in process. Only necessary measures to stabilize the injured are taken during this phase. The transport of the injured takes place based on the priority and the type of transport that is needed. During the whole treatment process, the injured must be marked with triage cards. Based on them,we can later conduct the documentation: total number of injured, number of injured by triage categories, care measures taken, method and time of transport. In order for the services to provide the best care for injured in a mass accident, the existence of unique protocols at the level of one country is necessary. In addition to protocols, education and training of employees are necessary, not only in the emergency medical service, but in all services that participate in caring for the injured. Best way to do this is shared training of employees from several departments. Only in this way can the available resources be used in the most optimal way to take care of the largest number of injured people in the best possible way and in the shortest possible time.

Introduction: Early recognition and calling for help, early cardiopulmonary resuscitation (CPR), early defibrillation, and post-resuscitation care are the four links in the chain of survival in cases of sudden cardiac arrest. Objective: To determine the incidence of Basic Life Support (BLS) measures being implemented by the eyewitnesses in cases of out-of-hospital cardiac arrest before the arrival of the ambulance, as well as telephone-assisted CPR, and whether the measures taken affected the rate of achieving the return of spontaneous circulation (ROSC). Material and Methods: The study is retrospective and observational. It was conducted for a year at the Institute for Emergency Medical Assistance Novi Sad. The study included patients with sudden cardiac arrest who were resuscitated by ambulance teams. Results: There were 148 patients enrolled in the study. In the group of patients who survived, there were fewer unrecognized cardiac arrests by the dispatcher, more telephone-assisted CPRs and fewer cases of no CPR measures undertaken by the eyewitnesses before the arrival of the ambulance. In the group of patients who survived, the only statistically significant event was cardiac arrest in the presence of the ambulance team. Conclusion: The implementation of telephone-assisted CPR protocol in dispatch centres would increase the number of cases in which bystanders could implement BLS measures before the arrival of the medical team.