Analysis of Web-based learning methods in emergency medicine : randomized controlled trial

Introduction: In medical education, Web-based learning is increasingly used as a complement to practical classes. The objective of the study was to perform a comparative analysis of three different forms of e-learning course on emergency medicine in terms of an indicator of knowledge growth and students’ satisfaction.Material and methods: For the purpose of the study, we developed and im-plemented a tool in the form of an online course: A – non-animated presen-tation, B – video, C – interactive video. The participants were undergraduate students of emergency medicine and nursing (n = 106). A pre-test and a post-test were carried out, and the resulting data were analyzed using parametric tests (t-test, ANOVA, post-hoc). Final questionnaires assessing six parameters of satisfaction were also evaluated.Results: A significant increase in knowledge in the experimental group which used an interactive video was observed (p = 0.04). Moreover, the number of replays of learning material was the highest in group C (2.09 ±2.48). The level of post-course satisfaction turned out to be comparable in all three groups (p = 0.62).Conclusions: The study allowed the interactive course to be identified as the most effective method of distance learning among selected ones. Due to the limitations of the study, we conclude that there is a need for further studies on the effectiveness of e-learning in emergency medicin

The strategy of training staff for a new type of helicopter as an element of raising the security level of flight operations

In 2008, the Polish Medical Air Rescue started replacing its fleet with modern EC135 machines. To ensure the maximum possible safety of the missions performed both in the period of implementing the change and later on, the management prepared a strategy of training its crews to use the new type of helicopter. The analysis of incidents that occurred during 2006–2009 showed that both the human and the technical factors must be carefully considered. Moreover, a risk analysis was conducted to reduce the risk both during general crew training and in the course of particular flight operations. A four-stage strategy of training pilots and crew members was worked out by weighing up all the risks. The analysis of data from 2010 to 2013 confirmed that the risk connected with flying and with all the activities involved in direct support aircraft operations is under control and lowered to an acceptable level

Kardiowersja elektryczna w wykonaniu zespołu ratunkowego bez lekarza w warunkach przedszpitalnych

Tachyarrhythmias are often the cause of hemodynamic instability causing a life-threatening condition. The recommended procedure is to perform urgent electrical cardioversion. Chosen medical emergency systems all over the world make it possible for medical rescuers to perform this procedure in pre-hospital conditions. The analyzed case presents a 75-year-old patient with ventricular tachycardia leading to a cardiogenic shock. The quick recognition and implementation of the proceedings by the rescue team without a doctor turned out to be effective at the place of the event.Tachyarytmie są niejednokrotnie przyczyną niestabilności hemodynamicznej powodującej stan zagrożenia życia. Zalecanym postępowaniem jest wówczas wykonanie pilnej kardiowersji elektrycznej. Wybrane systemy ratownictwa medycznego na świecie umożliwiają wykonanie tego zabiegu ratownikom medycznym w warunkach przedszpitalnych. Analizowany przypadek przedstawia pacjenta lat 75 z częstoskurczem komorowym prowadzącym do wstrząsu kardiogennego. Szybkie rozpoznanie i wdrożone postępowanie przez zespół ratunkowy bez lekarza okazało się skuteczne już na miejscu zdarzenia

Adequacy of placement of EMS units in Central Poland based on an analysis of interventions in road accidents

INTRODUCTION: Road accidents lead to injuries which are one of the most common causes of hospitalisation in trauma centres. Proper placement and number of EMS units determine quick arrival in the scene of accident and need for transport to the adequate healthcare entity. MATERIAL AND METHODS: An analysis was carried out of the profile of the patient, the distance to the scene of accident as well as the allocation of accident casualties to healthcare entities. A statistical analysis was conducted by means of the Chi-Square Test of Independence and the Kruskal-Wallis test by ranks. RESULTS: Distances between the scenes of accidents and places where EMS units were stationed was from 0.5 to 37 kilometres (mean: 9.8 km). 170 patients participated in the accidents. Most frequently, these were males at the age from 21 to 40 (mean: 35.77 ± 15.45). The most common diagnoses according to ICD-10 were injuries to the head (42.7%) and injuries of lower limbs (12%). In most cases, the accident casualties were transported to the Emergency Department in Łuków. 21 patients in total were placed in hospital facilities outside the catchment area. The Polish Medical Air Rescue transported the 10 patients in the most severe condition. CONCLUSIONS: Road accidents are most frequently experienced by middle-aged men. Injuries to the head and of lower limbs are the most common injuries. The placement of EMS units in the area under analysis is optimal, but the mean distance covered by the ambulance to reach to scene of accident is nearly 10 kilometres. Despite the presence of the Emergency Department in Łuków, one in ten injured patient warrants transport outside the catchment area and almost 6% of patients qualify for transport by air

Prospective Analysis of the Education System and Evaluation Methods of Medical Rescuers’ Qualifications

The profession of medical rescuer was established in Poland about 20 years ago and now plays a crucial role in the State Emergency Medical Services. Paramedics should be highly qualified in implementing medical rescue activities. This paper presents the educational system of a two-year medical school and three-year first degree studies. First it assesses the unified professional exam for medical rescuers approved by Polish Central Examination Board. Currently, the labor market for rescue units is saturated, and paramedics are trained mainly on the undergraduate level. Under current law there is a lack of standardization of the paramedics’ final exam. The State Emergency Medical Exam project is in the public consultation phase and presents the general propositions for further discussion. Suggested changes in the system for evaluating medical rescuers are based on authors’ own experience and examples from other countries.</p

Lotniczy transport sanitarny z wykorzystaniem ECMO w leczeniu ARDS - opis przypadku

In justified cases, the Polish Medical Air Rescue allows transport of a patient with medical equipment which is not standard medical equipment of the Air Transport Team. In the case at hand, a patient diagnosed with ARDS depended on extracorporeal therapy with an oxygenator. Extracorporeal membrane oxygenation (ECMO) is successfully used in the world and more and more frequently in Poland. It can also be administered using an aircraft of the Polish Medical Air Rescue. Necessity to involve many personnel members and resources indicates the complexity of the described transport of the patient. The authors demonstrate a case of a 22-year-old female patient who one and a half months ago was found unconscious at home following a suicidal attempt (status post aspiration, overdose of the Ketrel drug). Due to the absence of other possible treatments, a decision was made in the hospital to transport the patient to a centre a with higher referral level. Thanks to proper logistics, equipment and protection of the personnel, the Polish Medical Air Rescue transported the patient 260 km in a straight line during ECMO.Lotnicze Pogotowie Ratunkowe dopuszcza w uzasadnionych przypadkach możliwość przewozu chorego z użyciem sprzętu medycznego niebędącego standardowym wyposażeniem medycznym dla Samolotowego Zespołu Transportowego. W opisanym przypadku pacjent ze zdiagnozowanym ARDS zależny był od terapii pozaustrojowej z wykorzystaniem oksygenatora. Terapia pozaustrojowej oksygenacji krwi (ECMO z ang. extracorporeal membrane oxygenation) z powodzeniem stosowana jest na świecie i co raz częściej w Polsce, możliwa jest również z wykorzystaniem samolotu Lotniczego Pogotowia Ratunkowego. Konieczność zaangażowania wielu sił i środków stanowił o złożoności opisanego transportu pacjenta. Autorzy przedstawiają przypadek pacjentki lat 22, która półtora miesiąca wcześniej została znaleziona w domu nieprzytomna po próbie samobójczej (stan po zachłyśnięciu, przedawkowanie leku Ketrel). Z uwagi na brak dalszych możliwości terapeutycznych w szpitalu zdecydowano o transporcie do ośrodka o wyższej referencyjności. Lotnicze Pogotowie Ratunkowe dzięki odpowiedniej logistyce, wyposażeniu i zabezpieczeniu personelu wykonało transport pacjentki na odcinku w linii prostej 260 km w trakcie pozaustrojowej oksygenacji krwi ECMO

Knowledge of CPR and first aid for children among pedagogy students

INTRODUCTION: At home, the parents take care of the child's safety, but when the child is in school or kindergarten, it is the educator that takes care of the child. The awareness of dangers the child is exposed to at every moment of his or her activity during the day obliges educators to have up-to-date knowledge of first aid. The marked differences in anatomy, physiology and mechanisms of life-threatening conditions make the principles of first aid differ from those of an adult. First aid courses organised for both educators and pedagogy students should focus on highlighting these differences and learning how to deal with individuals of all ages. The aim of the study is to assess the level of knowledge and practical skills among pedagogy students and to identify aspects requiring adjustments to the curriculum of future teachers. MATERIALS AND METHODS: The study was conducted in 2022 at the Institute of Pedagogy at the University of Siedlce, Poland. Sixty-three pedagogy students participated in it. For the purpose of the study, a survey questionnaire covering the principles of first aid for children and a practical task evaluation sheet were created. Practical skills were assessed using the Resusci Junior QCPR simulator and a 0-15 point rating scale. RESULTS: The study included as many as 63 students of early childhood and pre-school pedagogy. The mean score achieved on the theory test was M=11.49 out of a possible 14 points (SD±1.24). The highest number of correct answers were given by students for the following questions: actions performed when assessing the child's breathing (n=63; 100%) and placing the child in the safe position (n=61; 96.8%). In contrast, the fewest correct answers were related to the rate of chest compressions (n=27; 42.9%). In the practical task, as many as 15 child CPR activities were considered. The average points scored by students on the practical task was M=6.73 out of a possible 15 points (SD±2.73). The average quality of compressions performed was M=28.59% (SD±30.41), breaths M=17.7% (SD±17.70) and chest compression depth was M=20.29% (SD±27.98). CONCLUSIONS: The level of theoretical knowledge and practical skills of pedagogy students is clearly insufficient to provide effective first aid to children. Significant differences were observed among students taking first aid classes onsite versus remotely. Having theoretical knowledge does not translate into practical skills. It seems that it is necessary to modify the curriculum for training future educators in first aid for children

Rola Lotniczego Pogotowia Ratunkowego jako wsparcia dla naziemnych zespołów ratownictwa medycznego

INTRODUCTION: An essential link in the rescue system is the Polish Medical Air Rescue (PMAR). In Poland, PMAR helicopters are stationed at 21 permanent bases. Air teams are available directly to the place of the incident and as inter-hospital transport. They also play a significant role when they reach the patient first before the arrival of the ground emergency medical services (EMS). MATERIAL AND METHODS: The study was conducted based on data from 2017-2018 covering 687 missions of "Rescuer 19" - a helicopter stationed in Sokołów Podlaski (eastern region of central Poland). The results of own research were expressed in the form of arithmetic means and average standard errors. To determine the relationship between variables, the Chi-square, and r-Pearson test was used. All results were considered significant at p <0.05. RESULTS: In 2017, the PMAR team performed 250 missions, and in 2018 - 437. "Rescuer 19" in 71.9% of cases was available to support ground EMS, and only 17.8% was available alone. The average time of arrival to call in 2017-2018 was M=20 [min] (SD=8.86), from the start M=17 [min] (SD=7.32), duration of the mission since the call M=114 [min] (SD=49.33), from the start M=108 [min] (SD=50.71), and the distance M=40.4 [km] (SD=25.16). CONCLUSIONS: The vast majority of PMAR missions are HEMS flights. An air ambulance team is available in most cases as support for ground EMS. Only every fifth HEMS mission is carried out by PMAR alone, without ground EMS.WSTĘP: Istotnym ogniwem w systemie ratownictwa jest Lotnicze Pogotowie Ratunkowe. W Polsce śmigłowce LPR stacjonują w 21 stałych bazach. Zespoły lotnicze dysponowane są bezpośrednio na miejsce zdarzenia oraz jako transport międzyszpitalny. Pełnią także znaczącą rolę w przypadku, gdy docierają do pacjenta jako pierwsze, jeszcze przed przybyciem ambulansu naziemnego. MATERIAŁ I METODY: Badania zostały przeprowadzone na podstawie danych z lat 2017-2018 obejmujących 687 misji „Ratownika 19” – śmigłowca stacjonującego w Sokołowie Podlaskim (wschodni region centralnej Polski). Wyniki badań własnych zostały wyrażone w postaci średnich arytmetycznych i średnich błędów standardowych. W celu określenia zależności między zmiennymi zastosowano Test chi-kwadrat oraz r-Pearson’a. Wszystkie wyniki uznano za istotne przy p < 0,05. WYNIKI: W roku 2017 zespół LPR wykonał 250 misji, a w 2018 – 437. „Ratownik 19” w 71,9% przypadków był dysponowany jako wsparcie dla zespołów naziemnych, a tylko w 17,8% był dysponowany samodzielnie. Średni czas dolotu do wezwania w latach 2017-2018 wyniósł M = 20 [min] (SD = 8,86), od startu M = 17 [min] (SD = 7,32), czas trwania misji od wezwania M = 114 [min] (SD = 49,33), od startu M= 108 [min] (SD = 50,71), a odległość M=40,4 [km] (SD = 25,16). WNIOSKI: Zdecydowana większość misji LPR to loty HEMS. Zespół lotniczego pogotowia ratunkowego zostaje dysponowany w większości przypadków jako wsparcie dla naziemnych zespołów ratownictwa. Jedynie co piąta misja HEMS jest realizowana przez LPR samodzielnie, bez udziału ambulansu naziemnego

Prospektywna ocena projektu interaktywnego egzaminu ratownictwa medycznego z wykorzystaniem multimedialnych urządzeń komputerowych

INTRODUCTION: Digitisation and implementation of IT solutions is contemporarily an intrinsic element while carrying out emergency medical activities. However, the system of education and evaluation of paramedics is conducted in a traditional way in Poland. The aim of the paper was to implement and critically evaluate the project of Emergency Medicine Exam conducted with the use of multimedia computer devices. MATERIAL AND METHODS: The undergraduates took part in a test consisting of fifteen questions concerning medical emergency activities conducted in a traditional (written) and interactive (computer) form. An original tool was developed and it enabled us to apply interactive tasks and centralize statistics. The achieved results underwent parametric tests (T-Student test, T – test for dependent samples with Pearson’s Correlation Coefficient) at significance coefficient of p<0,05. RESULTS: Average percentage results of both forms of the test including all the question categories indicated a statistically significant difference in the test with both samples for averages , where p=0,001 (59,09 % ± 12,16 vs 49,36 % ± 17,61). The number of people who did not succeed in passing the test at 51% passing point was 6 in the traditional test and 10 in the interactive one. Satisfaction analysis indicated the highest mark for detailed feedback (Me=5,95; from 1 to 6 scale). CONCLUSIONS: Multimedia computer devices may be efficiently used while implementing Emergency Medicine Exam. The evaluation of non-technical skills, thanks to the introduction of interactive tasks, enables a more detailed assessment of the competence of candidates for paramedics.WSTĘP: Cyfryzacja i informatyzacja jest współcześnie nieodłącznym elementem podczas wykonywania medycznych czynności ratunkowych. Jednak system edukacji i ewaluacji ratowników medycznych w Polsce realizowany jest przeważnie w formie tradycyjnej. Celem pracy była implementacja i krytyczna ocena projektu Państwowego Egzaminu Ratownictwa Medycznego, prowadzonego przy użyciu multimedialnych urządzeń komputerowych. Dokonano analizy porównawczej dwóch form egzaminu: tradycyjnej (papierowej) oraz interaktywnej (komputerowej), pod względem satysfakcji uczestników oraz uzyskanych wyników. MATERIAŁ I METODY: TBadani uczestniczyli w teście złożonym z piętnastu zagadnień z zakresu medycznych czynności ratunkowych realizowanym w formie tradycyjnej (pisemnej) oraz interaktywnej (komputerowej). Opracowano autorskie narzędzie umożliwiające aplikację zadań interaktywnych oraz scentralizowaną statystykę. Uzyskane wyniki poddano testom parametrycznym (Test T-Studenta, TEST-T dla prób zależnych ze współczynnikiem Korelacji Pearsona), przy współczynniku istotności p<0,05. WYNIKI: Średnie procentowe wyniki obu form testów wykazały istotną statystycznie różnicę w teście z dwiema próbami dla średnich, gdzie p=0,001 (59,09 % ± 12,16 vs 49,36 % ± 17,61). Liczba osób, które nie zaliczyły egzaminu wg przyjętego progu 51% wyniosła 6 - test tradycyjny, vs. 10 – test interaktywny. W analizie satysfakcji najwyższą notę przyznano za dokładność informacji zwrotnej (Me=5,95; w skali od 1 do 6) WNIOSKI: Multimedialne urządzenia komputerowe mogą być skutecznie zastosowane przy wdrożeniu Państwowego Egzaminu Ratownictwa Medycznego. Ocena umiejętności nietechnicznych, dzięki implementacji zadań interaktywnych, umożliwia bardziej szczegółową ocenę kompetencji kandydatów na ratowników medycznych

The influence of the pre-hospital application of non-invasive measurements of carboxyhemoglobin in the practice of emergency medical services in multiple and mass casualty incidents (MCI) – A case report

In 2013 a fire broke out in the Nursing Home (NH) in the Henryszew village 5 km away from the district hospital in Żyrardów. At the time of the incident 52 residents and 16 staff members were present in the building. Due to a large number of casualties, the occurrence was classified as a potentially mass casualty incident (MCI). Troops of the State Fire Brigade, Paramedic Rescue Squads, choppers of the Helicopter Emergency Medical Service, the Police, and the NH staff took part in the rescue operation. The priority was given to the evacuation of the NH residents carried out by the NH staff and firefighters, extinguishing the fire, as well as to primary and secondary survey triage. Due to the pre-accident health state of the victims, the latter posed a considerable difficulty. A decisive role was played by the need to conduct non-invasive measurements of carboxyhemoglobin in all the casualties, which then made it possible to adequately diagnose the patients and implement proper procedures. The rescue operation was correctly followed although it proved to be a serious logistical and technical undertaking for the participating emergency services. The residents were not found to be suffering from carbon monoxide poisoning, therefore 46 of the residents safely returned to the building. The fact that all the Paramedic Rescue Squads were equipped with medical triage sets and were able to conduct non-invasive measurements of carboxyhemoglobin made it possible to introduce effective procedures in the cases of suspected carbon monoxide poisoning and abandon costly and complicated organisational procedures when they proved to be unnecessary. Med Pr 2014;65(2):289–29