Role of Polish Medical Air Rescue in national medical rescue system

Great technological progression, as well as the development of motorization in the past decades, has caused an intensification of danger to health and life for contemporary societies. The increasing amount of HEMS (Helicopter Emergency Medical Service) units interventions underline that the significance of the Polish Med­ical Air Rescue service within the structures of National Medical Rescue System is increasing. Polish Medical Air Rescue is the one and only organization in Poland which uses helicopters while performing emergency medical services and conducting the transport of patients. The history of medical aviation, and later the Polish Medical Air Rescue service shows the great work and effort that has been put into the development and functioning of this organization

Members of the emergency medical team may have difficulty diagnosing rapid atrial fibrillation in Wolff-Parkinson-White syndrome

Background: Atrial fibrillation (AF) in patients with Wolff-Parkinson-White (WPW) syndrome is potentially life-threatening as it may deteriorate into ventricular fibrillation. The aim of this study was to assess whether the emergency medical team members are able to diagnose AF with a rapid ventricular response due to the presence of atrioventricular bypass tract in WPW syndrome. Methods: The study group consisted of 316 participants attending a national congress of emergency medicine. A total of 196 questionnaires regarding recognition and management of cardiac arrhythmias were distributed. The assessed part presented a clinical scenario with a young hemodynamically stable man who had a 12-lead electrocardiogram performed in the past with signs of pre-excitation, and who presented to the emergency team with an irregular broad QRS-complex tachycardia. Results: A total of 71 questionnaires were filled in. Only one responder recognized AF due to WPW syndrome, while 5 other responders recognized WPW syndrome and paroxysmal supraventricular tachycardia or broad QRS-complex tachycardia. About 20% of participants did not select any diagnosis, pointing out a method of treatment only. The most common diagnosis found in the survey was ventricular tachycardia/broad QRS-complex tachycardia marked by approximately a half of the participants. Nearly 18% of participants recognized WPW syndrome, whereas AF was recognized by less than 10% of participants. Conclusions: Members of emergency medical teams have limited skills for recognizing WPW syndrome with rapid AF, and ventricular tachycardia is the most frequent incorrect diagnosis

Wpływ zastosowania monitora CPRMeter na jakość uciśnięć: prospektywne badanie randomizowane, krzyżowe, symulacyjne

   Background: Drowning is a common issue at many pools and beaches, and in seas all over the world. Lifeguards often act as bystanders, and therefore adequate training in high-quality cardiopulmonary resuscitation (CPR) and use of adequate equip­ment by lifeguards is essential. Aim: The aim of this study was to evaluate the impact of the recently introduced CPRMeter (Laerdal, Stavanger, Norway) on quality of CPR, if used by moderately experienced CPR providers. In particular, we tested the hypothesis that using the CPRMeter improves quality of chest compression by lifeguards compared to standard non-feedback CPR. Methods: The study was designed as prospective, randomised, cross-over manikin trial. Fifty lifeguards of the Volunteer Water Rescue Service (WOPR), a Polish nationwide association specialised in water rescue, participated in this study. Participants were randomly assigned 1:1 to one of two groups: a feedback group and a non-feedback group. Participants swim a distance of 25 m in the pool, and then they were asked to haul a manikin for the second 25 m, simulating rescuing a drowning victim. Once participants finished the second 25-m distance, participants were asked to initiate 2-min basic life support according to the randomisation. Results: The median quality of CPR score for the 2-min CPR session without feedback was 69 (33–77) compared to 84 (55–93) in the feedback group (p &lt; 0.001). Compression score, mean depth, rate of adequate chest compressions/min, and overall mean rate during the CPR session improved significantly in the feedback group, compared to the non-feedback group. Conclusions: Using the visual real-time feedback device significantly improved quality of CPR in our relatively unexperienced CPR providers. Better quality of bystander CPR is essential for clinical outcomes, and therefore feedback devices should be considered. Further clinical studies are needed to assess the effect of real-time visual devices, especially in bystander-CPR.Wstęp: Tonięcie jest problemem mogącym powszechnie wystąpić na wielu basenach, plażach i terenach nadmorskich na całym świecie. Ratownicy wodni często podejmują działania jako przypadkowi świadkowie zdarzenia, dlatego też istotne znaczenie ma odpowiednie wyszkolenie w zakresie prowadzenia wysokiej jakości resuscytacji krążeniowo-oddechowej (RKO) i stosowania odpowiedniego sprzętu. Cel: Celem badania była ocena wpływu wprowadzonego ostatnio urządzenia CPRMeter2 (Laerdal, Stavanger, Norwegia) na jakość RKO w sytuacji używania przez ratowników ze średnim doświadczeniem. W szczególności badano hipotezę, iż stosowanie CPRMeter2 poprawia jakość uciskania klatki piersiowej przez ratowników wodnych w porównaniu ze standardową RKO bez informacji zwrotnej. Metody: Badania miało charakter prospektywny, randomizowany, krzyżowy i objęło 50 ratowników Wodnego Ochotniczego Pogotowia Ratunkowego (WOPR). Uczestnicy badania zostali losowo przydzieleni w proporcji 1:1 do jednej z dwóch grup — grupy z informacją zwrotną oraz bez informacji zwrotnej. Uczestnicy mieli za zadanie przepłynąć dystans 25 m w basenie, następnie holować manekina przez kolejne 25 m, symulując działania podejmowane u osoby topiącej się. Po ukończeniu drugiego dystansu 25 m uczestnicy byli proszeni o przeprowadzenie 2-minutowej resuscytacji (BLS) zgodnie z losowym przydziałem do grupy badanej. Wyniki: Średni wynik QCPR dla 2-minutowej RKO bez informacji zwrotnej wyniósł 69 (33–77) w porównaniu z 84 (55–93) w grupie z informacją zwrotną (p < 0,001). Jakość uciśnięć, średnia głębokość uciśnięć, częstość prawidłowych uciśnięć w ciągu minuty, całkowita średnia częstość uciśnięć podczas RKO uległy znacznej poprawie w grupie z zastosowaniem urządzenia zapewniającego informację zwrotną w porównaniu z grupą bez jego stosowania. Wnioski: Stosowanie urządzeń zapewniających wizualną ocenę zwrotną w czasie rzeczywistym w badanej grupie ratowników ze średnim doświadczeniem znacząco poprawiało jakość RKO. Lepsza jakość RKO prowadzonej przez przypadkowych ratowników ma kluczowe znaczenie dla wyników postępowania ratunkowego, dlatego też należy rozważyć stosowanie urządzeń zapewniających informację zwrotną. W celu oceny wpływu urządzeń zapewniających informację zwrotną w czasie rzeczywistym, szczególnie w grupie ratowników przypadkowych prowadzących RKO, konieczne są dalsze badania kliniczne

Cardiopulmonary resuscitation in adults over 80 : outcome and the perception of appropriateness by clinicians

OBJECTIVES: To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out‐of‐hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome. DESIGN: Subanalysis of an international multicenter cross‐sectional survey (REAPPROPRIATE). SETTING: Out‐of‐hospital CPR attempts registered in Europe, Israel, Japan, and the United States in adults 80 years or older. PARTICIPANTS: A total of 611 clinicians of whom 176 (28.8%) were doctors, 123 (20.1%) were nurses, and 312 (51.1%) were emergency medical technicians/paramedics. RESULTS AND MEASUREMENTS: The last CPR attempt among patients 80 years or older was perceived as appropriate by 320 (52.4%) of the clinicians; 178 (29.1%) were uncertain about the appropriateness, and 113 (18.5%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the “appropriate” subgroup was 8 of 265 (3.0%), 1 of 164 (.6%) in the “uncertain” subgroup, and 2 of 107 (1.9%) in the “inappropriate” subgroup (P = .23); 503 of 564 (89.2%) CPR attempts involved non‐shockable rhythms. CPR attempts in nursing homes accounted for 124 of 590 (21.0%) of the patients and were perceived as appropriate by 44 (35.5%) of the clinicians; 45 (36.3%) were uncertain about the appropriateness; and 35 (28.2%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the nursing home patients was 0 of 107 (0%); 104 of 111 (93.7%) CPR attempts involved non‐shockable rhythms. Overall, 36 of 543 (6.6%) CPR attempts were undertaken despite a known written do not attempt resuscitation decision; 14 of 36 (38.9%) clinicians considered this appropriate, 9 of 36 (25.0%) were uncertain about its appropriateness, and 13 of 36 (36.1%) considered this inappropriate. CONCLUSION: Our findings show that despite generally poor outcomes for older patients undergoing CPR, many emergency clinicians do not consider these attempts at resuscitation to be inappropriate. A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts. J Am Geriatr Soc 68:39–45, 201