Organization of trauma centres in Poland

The organization of the medical emergency system in Poland assumes assistance to persons in danger of life and health at various stages, starting with the onset of their first symptoms. The witnesses of the event who undertake rescue operations — begin first aid and inform the emergency medical team — play a key role. The management of the trauma patient by staff requires knowledge of the patient’s assessment, as well as the ability to qualify the patient to the trauma centre according to criteria and age group, as there are two types of trauma centres: for adults and for people under 18 years of age, called a traumatic centre for 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

Medical emergency and battlefield medicine

A victim in a life-threatening situation is a big challenge for rescue services around the world. Especially in a situation where assistance is to be provided in conditions that also threaten rescuers. Such an event may occur, for example, in the conditions of the battlefield. In order to provide effective assistance, separate rescue systems had to be implemented, which on the one hand included effective assistance to the victim, and on the other, they adapted it to the battlefield. These systems allow limited exposure to the risk of health or life-threatening situations to the rescuers. The paramedic operating in the emergency medical system operates in the safe zone with the equipment in emergency backpacks, along with an ambulance and entities supporting the State Medical Rescue system. The victim is to receive full assistance according to current standards. The patient is to have all the tests done to confirm or rule out life-threatening inju- ries. Evacuation to the hospital takes place, if the situation requires, using equipment to fully immobilize the spine. Acting in combat conditions, a paramedic in a dangerous zone provides assistance to an injured person in the field of authorship or performs only simple activities to protect the basic life functions of the victim. It is only in a potentially safe zone that he uses emergency equipment stored in a rescue pack or a personal first aid kit. Evacuation of the victim takes place on a stretcher, which does not fully protect the victim with a spinal injury.

Irritable bowel syndrome dietary modifications - what to forbid and what to recommend?

Irritable bowel syndrom is a gastrointestinal disorder, that affects about 10 % of worlds population. The etiology remains unclear, however studies show, that bad dietary habits may aggravate the symptoms. The most frequent signs of IBS are: abdominal pain, bloating, constipation, diarrhea and change in bowel habits. The aim of this study was to describe dietary modifications that can alleviate the symptoms and improve patients quality of life. The study material consisted of publications, that we’ve found on databases as PubMed, ResearchGate and Google Scholar. Patients find out, that certain food aggravate the symptoms. The most frequent triggering factors are: coffee, diary products, alcohol, spicy foods and lipids. Our review shows, there are some recommendations that help patients in their everyday diet change. For example drinking at least 3 cups of coffee per day can reduce bloating and diarrhea, while drinking more than 1,5 L of other fluids per day can alleviate symptoms as constipation. According to studies, following a IBS diet can minimize the signs. Moreover, recently developed  „IBS food pyramid” is based on actual recommendations and knowledge a visual and user-friendly tool helping patients in everyday diet changes.Unfortunately, still there is insufficient evidence of studies about dietary approaches. Well designed and randomized control trials are needed to improve efficacy, safety and knowledge about dietary modifications

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

Effectiveness and safety of hypotension fluid resuscitation in traumatic hemorrhagic shock: a systematic review and meta-analysis of randomized controlled trials

Background: Although the resuscitation of an adult trauma patient has been researched and written about for the past century, the ideal fluid strategy to infuse during the initial resuscitation period remains unresolved. This work was aimed at assessing the effect of hypotensive versus conventional resuscitation strategies in traumatic hemorrhagic shock patients on mortality, and the need for blood transfusions  including adverse events. Methods: This systematic review and meta-analysis were performed following the PRISMA guidelines. Electronic databases were searched for randomized controlled trials (RCT) comparing the effect of hypotension versus conventional fluid resuscitation for traumatic hemorrhagic shock patients. Two reviewers independently performed the screening, data extraction, and bias assessment. The data analysis was completed using the Cochrane Collaboration's software RevMan 5.4. Results: Data from 28 RCTs on 4503 patients were included in the final meta-analysis. Patients receiving hypotension fluid resuscitation compared with conventional fluid resuscitation experienced less mortality (12.5% vs. 21.4%; RR = 0.58; 95% CI: 0.51–0.66; p < 0.001), fewer adverse events (10.8% vs. 13.4%; RR = 0.70; 95% CI: 0.59–0.83; p < 0.001), including fever acute respiratory distress syndrome (7.8% vs. 16.8%) or multiple organ dysfunction syndrome (8.6% vs. 21.6%). Conclusions: This meta-analysis showed that hypotensive fluid resuscitation significantly reduced the mortality of hypovolemic shock patients. Findings are low in certainty and should be interpreted with caution. Therefore, there is an urgent need for larger, multicenter, randomized trials to confirm these findings

Resuscitation of the patient with suspected/confirmed COVID-19 when wearing personal protective equipment: A randomized multicenter crossover simulation trial

Background: The aim of the study was to evaluate various methods of chest compressions in patients with suspected/confirmed SARS-CoV-2 infection conducted by medical students wearing full personal protective equipment (PPE) for aerosol generating procedures (AGP).Methods: This was prospective, randomized, multicenter, single-blinded, crossover simulation trial. Thirty-five medical students after an advanced cardiovascular life support course, which included performing 2-min continuous chest compression scenarios using three methods: (A) manual chest compression (CC), (B) compression with CPRMeter, (C) compression with LifeLine ARM device. During resuscitation they are wearing full personal protective equipment for aerosol generating procedures.Results: The median chest compression depth using manual CC, CPRMeter and LifeLine ARM varied and amounted to 40 (38–45) vs. 45 (40–50) vs. 51 (50–52) mm, respectively (p = 0.002). The median chest compression rate was 109 (IQR; 102–131) compressions per minute (CPM) for manual CC, 107 (105–127) CPM for CPRMeter, and 102 (101–102) CPM for LifeLine ARM (p = 0.027). The percentage of correct chest recoil was the highest for LifeLine ARM — 100% (95–100), 80% (60–90) in CPRMeter group, and the lowest for manual CC — 29% (26–48).Conclusions: According to the results of this simulation trial, automated chest compression devices (ACCD) should be used for chest compression of patients with suspected/confirmed COVID-19. In the absence of ACCD, it seems reasonable to change the cardiopulmonary resuscitation algorithm (in the context of patients with suspected/confirmed COVID-19) by reducing the duration of the cardiopulmonary resuscitation cycle from the current 2-min to 1-min cycles due to a statistically significant reduction in the quality of chest compressions among rescuers wearing PPE AGP

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

CAN THE FACE-TO-FACE INTUBATION TECHNIQUE BE USED DURING CARDIOPULMONARY RESUSCITATION? A PROSPECTIVE, RANDOMIZED, CROSSOVER MANIKIN TRIAL

   BACKGROUND: Endotracheal intubation in cardiopulmonary resuscitation conditions is the gold standard for the protection of airway patency, allowing for both ventilation with positive pressures and continuous moni­toring of carbon dioxide concentration in the exhaled air, as well as enabling continuous chest compressions. AIM: The aim of the study was to compare the effectiveness of endotracheal intubation performed with the usage of Macintosh laryngoscope in two positions: behind the patient’s head and in the face-to-face position. METHODS: We included 54 students during their final year of medicine in the study. All of participants declared the ability to perform endotracheal intubation based on direct laryngoscopy. Prior to the study, all participants took part in the training in laryngoscopy and cardiopulmonary resuscitation. During the study, the participants performed intubation in the simulated resuscitation environment in two scenarios: Scenario A — intubation from behind the patient;s head, Scenario B — face-to-face intubation. Participants had a maximum of three intubation attempts. The chest compressions were paused during the procedure. RESULTS: The effectiveness of the first intubation attempt in the case of scenario A was 44.4%, while in the case of scenario B — 24.1%. The overall success ratios of intubation for scenarios A and B were 88.9% vs. 53.7%, respectively. The median intubation time during scenario A was 43.5 [IQR; 34–53.5] seconds, and 54.5 [IQR; 38.5–59.5] seconds for scenario B. CONCLUSIONS: In the study, intubation performed by final-year medical students while taking a position behind the head of the victim was of a higher efficiency when compared to the face-to-face position