The clinical relevance assessment of ROSIER scale in emergency care

Stroke incidence and its consequences are nowadays a common cause of death, disability and financial burden for the health system. The scale of this phenomenon is estimated to increase in further years. To ensure the best patients care, therapy should be applied in a dedicated stroke unit as soon as possible. Nevertheless, even 2 out of 3 suspected patients visit the emergency department in the first place. The probable lack of knowledge and experience from the personnel indicates up to a 60% rate of misdiagnosis resulting in delays in treatment administration and consequently a reduction of chance for survival and full recovery. The Recognition of Stroke in the Emergency Room scale has been developed to improve the emergency physicians’ assessment. It evaluates the initial event history and physical examination, which translates into a score from –2 to 5 with a > 0 cut-off point anticipating a high probability of stroke. Simple construction assures easy use and evaluation quality by all emergency staff members. The scale shows satisfactory accuracy, which establishes its superiority over the basic neurological examination, Face Arm Speech Time Test (FAST), and Cincinnati Prehospital Stroke Scale (CPSS) proven in several studies. On the contrary, the application is considerably reduced in cases of hemorrhage stroke, transient ischemic attack (TIA) and posterior circulation infarct in both adult and pediatric patients. Despite those limitations, the Recognition of Stroke in the Emergency Room Scale (ROSIER) scale constitutes a valuable instrument that can improve the insufficient stroke recognition rate and following patients’ prognosis

Analysis of the quality of chest compressions during resuscitation in an understaffed team — randomised crossover manikin study

INTRODUCTION: According to the chain of survival, chest compressions (CCs) are crucial in every cardiac arrest patient. It is very challenging to provide high-quality resuscitation in a two-paramedic team. The task of an automatic chest compression device (ACCD) is to relieve the rescuer and improve the quality of CCs. Its influence on the quality of the whole resuscitation as well as the survival of patients is still subject to discussion worldwide. This study aimed to assess the quality of CCs during resuscitation in a two-paramedic team using ACCD.  MATERIAL AND METHODS: This research was designed as a prospective, randomised, cross-over, high-fidelity simulation study. Fifty-two double paramedic teams took part in the research. The role of the participants was to conduct full advanced resuscitation in a human patient’s simulator. Each team provided resuscitation twice. Once with an ACCD and once using manual compressions. Chest compression quality parameters, as well as chest compression fraction (CCF), were measured.  RESULTS : Statistically significant differences were found between manual and automated compressions in: mean depth (48 ± 4 mm vs. 56 ± 3 mm, p < 0.0001), mean rate (117 ± 9 mm vs. 103 ± 1 mm, p < 0.0001), percentage of CC with correct depth (46 ± 25 vs. 87 ± 13, p < 0.0001), rate (72 ± 22 vs. 96 ± 4, p < 0.0001), and recoil (55 ± 23 vs. 89 ± 13, p < 0.0001). CCF was also higher when the ACCD was used (74 ± 7% vs. 83 ± 2%, p < 0.0001).  CONCLUSIONS: The use of an ACCD increases the quality of compressions by improving CCF, chest recoil, and the percentage of compressions performed with adherence to guidelines.

Assessment of Chest Compression Quality — a systematic review

INTRODUCTION: High-quality chest compression (CC) is a crucial factor that determines the survival of cardiac arrest patients. Adequate quality should be featured by appropriate compression rate and depth, and full chest recoil after each compression. The ranges are strictly determined in Resuscitation Guidelines. All these parameters are interdependent. Currently, there is a need to find or develop a universal index that will enable the definition and determination of the overall quality of CCs.  MATERIAL AND METHODS: A systematic review of the MEDLINE, EMBASE, COCHRANE, and GOOGLE SCHOLAR databases was performed. The authors aimed to find papers in which the quality of CC was assessed. The extracted information included measurement of the CC quality in a direct and objective manner — by analysing the depth, rate, and recoil of CC, position of the hands, duty cycle, and indirectly by evaluating chest compression fraction (CCF). Papers describing the quality of CC based on a combination of various components of the CC quality were selected for analysis.  RESULTS: In total 1604 publications were obtained. Among them, 21 articles satisfied the search criteria. In most of the papers, it was suggested that compressions should have been considered as correct when they met simultaneously all quality criteria. Only three papers presented any mathematical formula that could have been used for further comparisons.  CONCLUSIONS: Although many proposals have been developed, no single, universal, and commonly accepted indicator of resuscitation quality has been so far designed and subsequently applied. Further work on this subject is warranted and strongly recommended.

Differences in symptoms and utility of MEWS score in geriatric patients with COVID-19

Introduction: Rational resource management was key to avoiding overcrowding in Coronavirus Infectious Disease 2019 (COVID-19) dedicated wards. The study aimed to identify specific symptoms for aged patients with COVID-19 and assess the utility of the Modified Early Warning Score (MEWS) as a tool that may support decisions within an emergency department (ED). Material and methods: This was a retrospective analysis of medical records. ED patients with positive antigen tests for COVID-19 infection were identified. Patients’ history, length of stay (LOS) and vital signs were collected. MEWS score was calculated. Age groups were divided as follows: non-geriatric (NG) — aged under 60; geriatric groups (G): G1 — aged 60–74; G2 — aged 75–89; G3 — aged 90 and over. Results: There were 777 individuals (261 NG and 510 G patients). Symptoms related to pain as well as anosmia and ageusia occurred more often in NG patients. The longest LOS was in G2 — 182 [101–295] minutes. A significantly shorter LOS (51 [24–156] minutes) was recorded in NG (NG vs. G1 p < 0.0001; NG vs. G2 p < 0.0001; NG vs. G3 p = 0.0007). Admission rate was as follow: NG: 17.24%, G1: 50.97%, G2: 61.43%, G3: 54.17. Accuracy parameters for MEWS score (NG vs G, [%]) were as follow: sensitivity (93.18 vs. 91.04), specificity (13.04 vs. 11.79), positive predictive value (18.55 vs. 52.88), negative predictive value (90.00 vs. 54.76). Conclusions: Geriatric patients spent more time in ED and were admitted more often. Seniors were less likely to experience pain. MEWS is not a valuable tool for supporting decisions concerning the admission or discharge of geriatric patients with COVID-19

The level of knowledge of healthcare professionals about child restraint systems

Introduction: Knowledge of how to correctly use the safety car seat is important to ensure that children are properly protected during their journey. European child transportation standards apply in Poland, which also indicate the type of car seat appropriate for the youngest children. The purpose of this survey is to assess the healthcare professionals knowledge in this field and estimate the percentage of children transported in rearward facing car seats. Currently, in Poland, there is a lack of collected data about the direction of the car seats in which the child traveled. This deficit is being initially supplemented by the results of the conducted study. Material and methods: 105 healthcare professionals participated in the study. They filled in questionnaires consisting of 29 questions that assess their level of knowledge about child restraint systems. Results: More than half of the respondents (n = 63; 61.76%) were convinced that a 2-year-old child traveling in a rearward facing car seat (RWF) is safer than if it traveled in a forward-facing car seat (FWF). Despite this, most of the healthcare professionals transported children over 1 year of age in FWF. In addition, not all healthcare workers are aware that the airbag should be deactivated when the child is transported in RWF in the front passenger seat. Conclusions: Healthcare professionals have insufficient knowledge about the safest way of how to transport children in their safety seat. This indicates a need to implement appropriate means to raise their awareness of this subject

Emergency healthcare providers perception of workplace dangers in the polish Emergency Medical Service: a multi-centre survey study

INTRODUCTION: There are many risk factors that account for hazards in paramedics’ and ambulance nurses’ profession. Driving a vehicle, having contact with patients, making difficult medical decisions, doing night shifts and working in a stressful environment, all of those features negatively affect their health. The aim of the study was to evaluate paramedics’ and ambulance nurses attitude towards personal safety, to assess their subjective feeling of danger, as well as identify types of hazards they experience. MATERIAL AND METHODS: The study was carried out via a diagnostic survey method, an anonymous questionnaire. Among 572 responders there were nurses and paramedics, who work in non-physician medical rescue teams in Poland. RESULTS: Most of the surveyed medics (40.5%) have rated the level of danger of their occupation to 4 on a scale from 1 to 5, with the greatest hazard being posed by patients under the influence of designer drugs. As many as 43% of medics have had back-related problems and 41% have suffered injuries at work. Notwithstanding, a majority of respondents have admitted that if they could plan their career again, they would choose the same profession. CONCLUSIONS: Prehospital healthcare providers have generally rated their work as dangerous. More attention should be paid to teach first responders how to deal with aggression and how to handle stress. Efforts should be made to increase paramedics’ and nurses’ awareness about health problems related to shift work

The impact of the COVID-19 pandemic on alcohol-related emergency department visits in a large European city

Introduction: The COVID-19 (Coronavirus infectious disease 2019) pandemic has caused global behavioural changes due to the need to remain in quarantine by large groups of the population. Earlier work on the effects of other epidemics on the human psyche has revealed a possible increase in the number of people who abuse alcohol as a method of coping with mental stress. Despite this, the studies on the COVID-19 pandemic have not shown a clear correlation between lockdowns and quarantines and an increase in alcohol consumption. This study focused on examining the impact of the pandemic on the number of alcohol-related attendances in the Emergency Department in Poznan (Poland). Material and methods: The periods of one year before the pandemic (control trial) and the first year of the COVID-19 pandemic (study group) were analysed retrospectively using the data of ED patients who were under the documented influence of alcohol. Total number, alcohol concentration, waiting time for a medical examination, the patient’s aggressive behaviour, length of stay in the ED, the need for additional examinations, suturing wounds or endotracheal intubation were analysed. Results: 954 patients were identified, which constituted 2.9% of all patients admitted to the ED during this period (the total number of patients admitted was 33510). During the control period, the total number of ED admissions was 30388 and 794 (2.6%) of them were in the control group. The median body alcohol concentration was 2.6%%. It has been shown that during the pandemic more women and fewer men under the influence of alcohol were admitted to the ED (212 (22.2%) females and 742 (77.8%) males) than in the pre-pandemic period [135 (17.0%) females and 659 (83.0%) males]. Additional examinations were performed less frequently (84.1% vs. 73.9%; p = 0.00000) and patients were admitted to other departments more often (25.7% vs. 40.9%; p = 0.00000). Other examined parameters did not change significantly. Conclusions: The study shows an increase in the number of patients under the influence of alcohol during the pandemic presenting to the ED and a noticeable change in management patterns’ variables such as shorter LOW, fewer performed laboratory tests and more admissions to wards. However, this data requires further analysis and comparison with studies from other centres to draw more general conclusions

Dynamics of the Third Wave of COVID-19 from the Perspective of the Emergency Department in a Large Regional Hospital—Single Center Observational Study

Background: The outbreak of the Coronavirus Disease 2019 (COVID-19) pandemic has caused many significant social and economic changes. The consecutive waves of the epidemic in various countries have had dissimilar courses depending on the methods used to combat it. The aim of this study was to determine the dynamics of the third wave of COVID-19 from the perspective of emergency departments (ED). Methods: This was a retrospective review of medical records from ED. The authors have identified the most frequent symptoms. Prognostic factors have been chosen—prognostic scales, length of stay (LOS)—and a number of resources required have been calculated. Results: As the time passed, there were fewer patients and they presented mild symptoms. A statistically significant difference was observed in the median of blood oxygenation measurement (p = 0.00009), CRP level (p = 0.0016), and admission rate. Patients admitted to the hospital required more resources at ED. LOS was shorter in patients discharged home (p < 0.0001). Conclusions: The blood oxygen saturation (SPO2) and CPR levels can be helpful in decision-making regarding medical treatment. The fast-track for patients in good clinical condition may shorten the duration of stay in ED, and reduce the number of required resources

Czas reakcji służb ratownictwa medycznego nie wpływa na częstość przywrócenia spontanicznego krążenia u osób po resuscytacji w warunkach przedszpitalnych w milionowej środkowoeuropejskiej aglomeracji

Background: The survival of out-of-hospital sudden cardiac arrest (OHSCA) in Europe still remains low. The State Medical Rescue System is composed of several elements. The efficacy of each of these elements may have an influence on the victim’s survival. Until now, the incidence of return of spontaneous circulation (ROSC) and its correlation with rescue services time in the city of Poznan has not been determined. Aim: The main purpose of this study was to assess incidents of OHSCA and prehospital frequency of ROSC after OHSCA in Poznan city and district. We also wanted to analyse whether ROSC depends on Emergency Medical System (EMS) reaction time. Methods: Retrospective analysis based on medical documentation conducted in 2015 in Poznan EMS. Results: Return of spontaneous circulation was achieved in 68.88% of cases. It was most frequent when OHSCA occurred in public places (p = 0.000, contingency factor = 0.233) and victims were younger (p = 0.042, contingency factor = 0.129). 63.17% of patients were male, but sex did not affect the incidence of ROSC. The median time of system response was 8.53 min, while time from ambulance departure to arrival was 5.42 min. We did not find any statistically significant difference between the number of deaths and those parameters (p = 0.723, p = 0.891). However, longer team response time correlated with the highest mortality (p = 0.042, contingency factor = 0.126). In the group where ROSC was achieved the median time of EMS response was 8.18 min, while among the group of deceased the median was 8.63 min. Conclusions: The incidence of OHSCA in our region is similar to other Polish and European cities. EMS response time does not affect the frequency of ROSC. ROSC was achieved more often if OHSCA occurred in public and the victim was younger.Wstęp: Przeżycie pozaszpitalnego nagłego zatrzymania krążenia (OHSCA) w Europie wciąż pozostaje na niskim poziomie. System Państwowego Ratownictwa Medycznego składa się z kilku elementów. Sprawność działania każdego z tych ogniw może wpływać na szanse przeżycia nagłego zatrzymania krążenia. Dotychczas liczba przypadków przywrócenia spontanicznego krążenia (ROSC) po resuscytacji prowadzonej w warunkach przedszpitalnych oraz jej korelacja z czasem reakcji służb ratownictwa medycznego na terenie Poznania nie została określona. Cel: Głównym celem pracy była ocena występowania OHSCA i częstość przypadków ROSC u jego ofiar w mieście oraz powiecie poznańskim. Drugim celem pracy było określenie zależności występowania ROSC od czasu reakcji poszczególnych ogniw systemu ratownictwa medycznego. Metody: Przeprowadzono retrospektywną analizę opartą na elektronicznej dokumentacji medycznej prowadzonej w Rejonowej Stacji Pogotowia Ratunkowego w Poznaniu w 2015 r. Wyniki: Przywrócenie spontanicznego krążenia uzyskano w 68,88% przypadków. Zjawisko to było częściej obserwowane, gdy do nagłego zatrzymania krążenia dochodziło w miejscu publicznym (p = 0,000; wsp. kontyngencji = 0,233) oraz u młodszych pacjentów (p = 0,042, wsp. kontyngencji = 0,129). 63,17% pacjentów stanowili mężczyźni, jednak płeć nie wpływała na liczbę ROSC. Mediana czasu reakcji systemu wyniosła 8,53 min, z kolei mediana czasu od wyjazdu karetki do przybycia na miejsce zdarzenia — 5,42 min. Nie wykazano różnicy istotnej statystycznie między liczbą zgonów a tymi parametrami (p = 0,723; p = 0,891). Jednak dłuższy czas reakcji zespołu ratownictwa medycznego wiązał się z wyższą śmiertelnością (p = 0,042, wsp. kontyngencji = 0,126). W grupie, w której uzyskano ROSC, mediana czasu reakcji systemu wyniosła 8,18 min, natomiast w grupie osób zmarłych — 8,63 min. Wnioski: Występowanie OHSCA w mieście i powiecie poznańskim jest podobna do innych polskich i europejskich miast. Czas reakcji systemu ratownictwa medycznego nie wpływa na częstość występowania ROSC. Większą liczbę przypadków ROSC uzyskiwano, gdy do OHSCA dochodziło w miejscu publicznym, a jego ofiara była młodsza