The use of e-learning in medical education for mountain rescuers concerning hypothermia

Objective: Victims of mountain accidents are often exposed to wet and cold environments which may increase the risk of hypothermia. Mountain rescuers should be able to recognize and manage hypothermia. We aimed to assess relevant knowledge in professional and volunteer mountain rescuers, as well as to evaluate the efficacy of an e-learning platform for continuing medical education. Methods: An e-learning platform was developed to provide access to updated information about hypothermia. Volunteer and professional mountain rescuers participated in an e-learning course. Pretest, post-test, and specific lesson test scores were compared. After 1 year, a follow-up course was performed. Results: In total, 187 rescuers, comprising 136 (72.7%) volunteers and 51 (27.3%) professionals, were enrolled. Ahead of the course, no difference in knowledge was found between professionals and volunteers. After the course, one's knowledge of hypothermia increased significantly (p < 0.001). The scores achieved in the field management of hypothermia were better among professional rescuers than among volunteer rescuers (p = 0.003), whereas in post-traumatic hypothermia half of the results were insufficient in both groups. Moreover, 57 rescuers repeated the course after 12 months. While professionals partially retained the achieved level of knowledge, the volunteers had dropped back to their initial level. Conclusions: The e-learning course increased the knowledge of hypothermia among mountain rescuers. The poor retention after 1 year indicates that the interval between lectures should be reduced. An e-learning platform is an effective tool for the medical education of mountain rescuers

Artifacts in fluoroscopy and changes in radiation dose caused by heating blankets and insulating covers during simulated endovascular treatment

Purpose We aimed to assess whether insulating covers and warming systems cause artifacts in fluoroscopy, and whether they alter the radiation dose. Methods Eight insulating and warming systems were wrapped around the phantom in order to obtain images in fluoroscopy, and to measure the absorbed and scattered radiation dose. A dosimeter, endovascular catheters, and stents were placed into a phantom. The other dosimeter was placed outside of a C-arm table, at the operator’s and anesthesiologist’s locations. Results Most of the insulating covers did not cause artifacts in the fluoroscopy and led to a significant decrease in both the absorbed and scattered radiation dose. The highest decrease in the absorbed dose was observed with metalized foil (− 2.09%; p = 0.001) and in the scattered dose with Helios cover (− 55%; p < 0.001). Only one heating system (Ready Heat combined with Hypothermia Prevention and Management Kit cover) caused significant artifacts and increased radiation up to 99% (p < 0.001). Conclusion Thermal insulation may be maintained during X-ray-guided emergency endovascular procedures in trauma victims. Self-heating blankets should be replaced with another warming system

Ostra utrata krwi : co możemy zrobić w warunkach przedszpitalnych? Doświadczenia pola walki

Autorzy przedstawili praktyczne wnioski i zalecenia postępowania w przypadku wystąpienia krwotoków w warunkach pola walki. Ich stosowanie ma kluczowe znaczenie dla osiągnięcia sukcesu i przeżycia rannych w niesprzyjających warunkach środowiska taktycznego. Doświadczenia medycyny wojskowej i praktyczne rozwiązania w celu zapewnienia skutecznej hemostazy lub zachowania restrykcyjnej płynoterapii w przypadku krwotoków wewnętrznych mogą znaleźć zastosowanie również w cywilnej opiece przedszpitalnej.The authors presented the practical conclusions and therapeutic recommendations for the heavily bleeding patients, managed under combat conditions. Such therapy is vital for the wounded in the hostile tactical environment. The military medical solutions for assuring the effective hemostasis or applying the restrictive fluid therapy in internal bleeding cases may be useful also in civilian medicine

Severe hypothermia management in mountain rescue : a survey study

Introduction: Severe hypothermia is a rare but demanding medical emergency. Although mortality is high, if well managed, the neurological outcome of survivors can be excellent. The aim of the study was to assess whether mountain rescue teams (MRTs) are able to meet the guidelines in the management of severe hypothermia, regarding their equipment and procedures. Methods: Between August and December 2016, an online questionnaire, with 24 questions to be completed using Google Forms, was sent to 123 MRTs in 27 countries. Results: Twenty-eight MRTs from 10 countries returned the completed questionnaire. Seventy-five percent of MRTs reportedly provide advanced life support (ALS) on-site and 89% are regularly trained in hypothermia management. Thirty-two percent of MRTs transport hypothermic patients in cardiac arrest to the nearest hospital instead of an Extracorporeal Life Support facility; 39% are equipped with mechanical chest compression devices; 36% measure core body temperature on-site and no MRT is equipped with a device to measure serum potassium concentration on-site in avalanche victims. Conclusions: Most MRTs are regularly trained in the treatment of severe hypothermia and provide ALS. The majority are not equipped to follow standard procedural guidelines for the treatment of severely hypothermic patients, especially with cardiac arrest. However, the low response rate—23% (28/123)—could have induced a bias

Techniki ewakuacji poszkodowanego w poszczególnych fazach prowadzenia działań w środowisku taktycznym

Działanie w warunkach bojowych i realizacja zadań związanych z dużym ryzykiem może prowadzić do dużych strat sanitarnych. Priorytetem jest podjęcie czynności mających na celu wykonanie zadania bojowego przy jednoczesnym zminimalizowaniu strat własnych. Ewakuacja poszkodowanych z pola walki jest uzależniona od aktualnej sytuacji taktycznej, zmieniającego się środowiska oraz dostępnych sił i środków. Przemieszczanie rannego ze strefy CUF (care under fire) do TFC [tactical field care) odbywa się na różnych poziomach zaawansowania, wynikających z wiedzy i taktycznego wyszkolenia żołnierzy oraz dostępności sprzętu ewakuacyjnego. Szybka i bezpieczna ewakuacja poszkodowanego ze strefy zagrożenia do strefy opieki medycznej umożliwia zastosowanie procedur zwiększających prawdopodobieństwo przeżycia na polu walki.Combat operations and the implementation of high-risk tasks can generate a high number of dead and wounded soldiers. Taking steps to minimize losses during combat tasks is treated as a priority. The evacuation of casualties from the battlefield depends on the current tactical situation, the changing environment, and the available forces and means. Moving the wounded from the CUF (Care Under Fire) area to TFC (Tactical Field Care) takes place at various levels, resulting from the knowledge and tactical training of the soldiers and the availability of emergency equipment. Rapid and safe evacuation of casualties from the danger zone to the medical care zone enables the use of procedures that significantly increase the battlefield survival rate

Active shooters — how close are they?

Recent terrorist attacks in the United States, Canada and Western Europe have shown an increase in the incidence of “Active Shooters” [1]. These ruthless and desperate assassins usually attack urban and poorly protected areas (lack of armed protection) that are densely populated [2]. Utilizing their strength, they realize that their plan is to maximize the number of casualties, without counting on the consequences of their actions. The basis of their action may be based on extremely radical views. Frequent outcomes for active shooters include suicide during an attack (90%) or the resolution of the threat by the authorities [3]. In response to the ever-increasing number of assassinations and the risk of such incidents in one’s immediate surroundings, comprehensive education should be widely spread. Thus, it is important to promote appropriate behaviour, rules of reaction during an attack by an armed assailant, as well as cooperation with incoming service personnel. Such actions will not only help one prevent, but also allow one to prepare for such incidences