Comparison of the Miller and Macintosh laryngoscopes in simulated pediatric trauma patient: a pilot study

INTRODUCTION: Airway management in pediatric trauma patients is challenging. Direct laryngoscopy is the gold standard for endotracheal intubation in emergency and trauma patients. The aim of the present study was to evaluate the performance of Miller (MIL) and Macintosh (MAC) laryngoscopes when employed in emergency pediatric intubation scenarios. METHODS: This was a prospective, randomized, crossover, single-center study on novice physicians recruited on a voluntary basis. Each participant performer endotracheal intubation using Miller or Macintosh laryn­goscopes during two airway scenarios: Scenario A — normal airway; Scenario B — difficult airway, defined as scenario in which the patient was placed on backboard with neck immobilization performer using rigid cervical collar. The order of use of one or other of the devices was randomized with a ratio of 1:1. The pri­mary endpoint was the first attempt success rate. RESULTS: The effectiveness of the first intubation attempt in Scenario B for MAC was 36.8%, for MIL — 44.7%; while in Scenario A for MAC this was 36.8%, for MIL — 44.7%. During Scenario A, the median duration time of intubation using MIL was 24.5 s [IQR; 21–32.5] and 23 s [IQR; 20.5–31] for MAC. During Scenario B, median intubation time with the MAC laryngoscope was 40.5 [IQR; 36.5–47] s, and with MIL 37.5 [IQR; 33–44.5] seconds. CONCLUSIONS: We concluded that in trauma pediatric patients the Miller laryngoscope is associated with higher first attempt success rates than the Macintosh laryngoscope. These data suggest that for patients with cervical spine immobilization, the Miller laryngoscope should be the preferred method of intubation in emergency medicine conditions

KNOWLEDGE OF MEDICAL RESCUE PERSONNEL REGARDING ADVANCED RESUSCITATION PROCEDURES IN CHILDREN

BACKGROUND: The purpose of this study is to attempt to evaluate the knowledge of medical rescue personnel within the scope of advanced resuscitation procedures in children. MATERIALS AND METHOD: We conducted a quantitative survey. The study included a group of 482 medical per- sonnel. The knowledge of medical staff was assessed by their correct answers to the survey questions. RESULTS: Especially among nurses, there was insuf cient knowledge of the following issues: determination of the child’s body weight (32–62%), the second dose of amiodarone during resuscitation of the child (42–90%), the volume of uids used during uid resuscitation (47–100%). CONCLUSIONS: Among studied groups, nurses are the worst prepared for conducting resuscitation in children. Nurses presented a low level of knowledge within the scope of advanced resuscitation procedures in children

History of the State Medical Rescue Service in Poland

The State Medical Rescue Service in Poland dates back to 1891, when the first ambulance service was established in Cracow. Over 129 years, the system has been fully transformed, starting with medical staff,through numbers, equipment, and modern information and communication systems for emergency callsand assistance during interventions, and medical records. Emergency medical services in Poland had theirbreakthrough when the current Act of 8 September 2006 on the National Medical Rescue Service was introduced, which is the foundation for the modern organisation of medical rescue and emergency medicine inPoland. According to the Ministry of Health, the total number of Emergency Medical Services Teams operatingin 2019 was 1585, including those operating on a seasonal basis

Comparison of two infant chest compression techniques during simulated newborn cardiopulmonary resuscitation performed by a single rescuer: A randomized, crossover multicenter trial

Background: In newborns, ventilation is a key resuscitation element but optimal chest compression(CC) improves resuscitation quality. The study compared two infant CC techniques during simulatednewborn resuscitation performed by nurses.Methods: The randomized crossover manikin, multicenter trial involved 52 nurses. They underwenttraining with two CC techniques: standard two-finger technique (TFT) and novel two-thumb technique(NTTT; two thumbs at 90° to the chest, fingers in a fist). One week later, the participants performedresuscitation with the two techniques. A Tory® S2210 Tetherless and Wireless Full-term Neonatal Simulatorwas applied, with a 3:1 compression to ventilation ratio. CC quality in accordance with the 2015American Heart Association guidelines was assessed during the 2-min resuscitation.Results: Median CC depth was 30 mm for TFT and 37 mm for NTTT (p = 0.002). Correct handplacement reached 98% in both techniques; full chest relaxation was obtained in 97% vs. 94% for TFTand NTTT, respectively. CC fraction was slightly better for NTTT (74% vs. 70% for TFT; p = 0.044),the ventilation volume was comparable for both techniques. On a 100-degree scale (1 — no fatigue;100 — extreme fatigue), the participant tiredness achieved 72 points (IQR 61–77) for TFT vs. 47 points(IQR 40–63) for NTTT (p = 0.034). For real resuscitation, 86.5% would choose NTTT and13.5% TFT.Conclusions: The NTTT technique proved superior to TFT. Evidence suggests that NTTT offersbetter CC depth in various medical personnel groups. One-rescuer TFT quality is not consistent withresuscitation guidelines

INTENSITY OF STRESS AND SYMPTOMS OF JOB EXHAUSTION AMONG PARAMEDICS IN POLAND

BACKGROUND: The aim of this article is to show how the features of job exhaustion depend of the amount of work-related stress. MATERIALS AND METHODS: This research included a randomly selected group of 456 paramedics, aged between 21 and 51, working at hospital emergency departments and in mobile emergency teams. The authors used the Maslach Burnout Inventory Form and Perceived Job Stress Questionnaire Form. RESULTS: The most important factors in uencing general amount of stress in a paramedic’s job include as follows: the sense of responsibility; the sense of insecurity impacted with the system of work; and the sense of psychic workload. However, less important factors in uencing stress include: unpleasant work conditions; a lack of support; a lack of control; a sense of threat. CONCLUSIONS: Paramedics are exposed to job exhaustion syndrome which causes a lessening of feeling safe in their work place. The risk factors in uencing job exhaustion syndrome include as follows: uncertainty of work system; sense of psychic workload caused by work; poor social contacts causing a lack of assistance from others; a lack of positive motivators in one’s job, such as various rewards

Organization of technical rescue operations in the national rescue system

The organization of technical rescue is crucial to carry out an effective rescue operation. Often, this field of rescue is an inseparable element when conducting medical rescue operations, where it is necessary to use highly specialized equipment that is designed to provide access to the injured person and enable members of the Emergency Medical Teams to conduct medical rescue operations, as well as to provide them with qualified first aid by firefighters

PERFORMANCE OF CHEST COMPRESSIONS WITH THE USE OF THE NEW MECHANICAL CHEST COMPRESSION MACHINE LIFELINE ARM: A RANDOMIZED CROSSOVER MANIKIN STUDY IN NOVICE PHYSICIANS

BACKGROUND: The Lifeline ARM (ARM; De btech, Guilford, USA) is a new mechanical chest compression device. The aim of the current study was to compare the quality of single rescuer cardiopulmonary resuscitation (CPR) with and without ARM device. METHODS: In this randomized crossover manikin trial forty-four novice physicians participated. Thirty minutes of training was allotted for manual CPR and then for the ARM. The following day, every participant performed a 2-min CPR single rescuer scenario, once with manual CPR and once with the ARM. The primary outcome measure of the study is effective compression; de ned as compressions performed with the correct of depth of 50–60 mm, complete decompressions, and the correct pressure point of CC. RESULTS: The ARM, compared with manual CPR, carried out more effective compressions (96 [interquartile range, IQR; 94–98] vs. 36 [IQR; 33–41]%, p < 0.001). The compressions preformed with the use of the ARM, furthermore, were with a correct CC rate (100 [IQR; 99–101] vs. 130 [IQR; 124–140] min-1; p<0.001) and a correct depth (97 [IQR; 96–98] vs. 37 [IQR; 31–39]%; p<0.001). The result of resuscitation with ARM was signi cantly better than manual CPR (p<0.05) for all of the analyzed chest compression parameters (percentage of CC too deep, percentage of CC too shallow, percentage of correct pressure points and percentage of correct pressure releases), as well as for the ventilation parameters (tidal volume, ventilation rate, minute-volume, gastric in ations). CONCLUSION: During this simulated trial, when CPR was performed by novice physicians, the ARM signi cantly improved the quality of CPR. Further clinical trials should provide motivation to con rm the potential bene ts of ARM use during CPR

How should we teach cardiopulmonary resuscitation? Randomized multi-center study

Background: A 2017 update of the resuscitation guideline indicated the use of cardiopulmonary resuscitation (CPR) feedback devices as a resuscitation teaching method. The aim of the study was to compare the influence of two techniques of CPR teaching on the quality of resuscitation performed by medical students. Methods: The study was designed as a prospective, randomized, simulation study and involved 115 first year students of medicine. The participants underwent a basic life support (BLS) course based on the American Heart Association guidelines, with the first group (experimental group) performing chest compressions to observe, in real-time, chest compression parameters indicated by software included in the simulator, and the second group (control group) performing compressions without this possibility. After a 10-minute resuscitation, the participants had a 30-minute break and then a 2-minute cycle of CPR. One month after the training, study participants performed CPR, without the possibility of observing real-time measurements regarding quality of chest compression. Results: One month after the training, depth of chest compressions in the experimental and control group was 50 mm (IQR 46–54) vs. 39 mm (IQR 35–42; p = 0.001), compression rate 116 CPM (IQR 102–125) vs. 124 CPM (IQR 116–134; p = 0.034), chest relaxation 86% (IQR 68–89) vs. 74% (IQR 47–80; p = 0.031) respectively. Conclusions: Observing real-time chest compression quality parameters during BLS training may improve the quality of chest compression one month after the training including correct hand positioning, compressions depth and rate compliance

EMPATHY AND BURNOUT SYNDROME IN THE PRACTICE OF EMERGENCY SERVICES — PILOT STUDY

  INTRODUCTION: The burnout syndrome is a result of stress on the work situation and most often concerns pro­fessions requiring emotional and direct contact with another human being. The level of empathy is closely related to the phenomenon of occupational burnout. The aim of the study was to determine the impact of socio-demo­graphic factors of emergency services employees on the level of empathy. METHOD: In the period January–March 2018, a survey was conducted using a questionnaire — Emphatic Sensi­tiveness Scale (ESC) and an anonymous author’s questionnaire containing questions regarding sex, age, length of employment, occupation, marital status and number of hours worked per month. The survey was addressed to 81 employees of emergency services: paramedics (n = 17) and firefighters (n = 23). The control group consisted of 16 nurses and 25 people performing non–medical professions. RESULTS: The average number of hours worked per month by the respondents was 189 ± 49. There were 50 fe­males (62%) and 31 males (38%). The questionnaire showed statistically significant differences in perspective taking domain between the control group composed of people working in non-medical professions (25.6 ± 4.3) and emergency services professionals: firefighter (28.7 ± 3.6) vs. paramedic (29.9 ± 3.5) vs. nurse (31.2 ± 3.0), p < 0.001. It has been shown a statistically significant effect of sex on personal distress domain: male (21.4 ± 4.2) vs. female (24.3 ± 4.7), p = 0.005. CONCLUSIONS: In conclusion, our data indicates that: (1) Nurses were characterised by the highest level of empathy amongst the surveyed professional groups; (2) Females were characterised by a higher level of personal distress; (3) Variables such as sex, age, and length of employment did not affect the level of empathy