Prehospital Emergency Medicine Research Articles

Prehospital emergency medicine research by additional teams on scene – Concepts and lessons learned

While the initial minutes of acute emergencies significantly influence clinical outcomes, prehospital research often receives inadequate attention due to several challenges. Retrospective chart reviews carry the risk of incomplete and inaccurate data. Furthermore, prehospital intervention trials frequently encounter difficulties related to extensive training requirements, even during the planning phase. Consequently, we have implemented prospective research concepts involving additional paramedics and physicians directly at the scene during major emergency calls. Three concepts were used: (I) Paramedic field supervisor units, (II) a paramedic + physician field supervisor unit, (III) a special physician-based research car. This paper provides insights into our historical perspective, the current situation, and the lessons learned while overcoming certain barriers and using existing and novel facilitators. Our objective is to support other research groups with our experiences in their planning of upcoming prehospital trials.

Defining pediatric trauma center resource utilization: Multidisciplinary consensus-based criteria from the Pediatric Trauma Society.

Pediatric trauma triage and transfer decisions should incorporate the likelihood that an injured child will require pediatric trauma center (PTC) resources. Resource utilization may be a better basis than mortality risk when evaluating pediatric injury severity. However, there is currently no consensus definition of PTC resource utilization that encompasses the full scope of PTC services. Consensus criteria were developed in collaboration with the Pediatric Trauma Society (PTS) Research Committee using a modified Delphi approach. An expert panel was recruited representing the following pediatric disciplines: prehospital care, emergency medicine, nursing, general surgery, neurosurgery, orthopedics, anesthesia, radiology, critical care, child abuse, and rehabilitation medicine. Resource utilization criteria were drafted from a comprehensive literature review, seeking to complete the following sentence: "Pediatric patients with traumatic injuries have used PTC resources if they..." Criteria were then refined and underwent three rounds of voting to achieve consensus. Consensus was defined as agreement of 75% or more panelists. Between the second and third voting rounds, broad feedback from attendees of the PTS annual meeting was obtained. The Delphi panel consisted of 18 members from 15 institutions. Twenty initial draft criteria were developed based on literature review. These criteria dealt with airway interventions, vascular access, initial stabilization procedures, fluid resuscitation, blood product transfusion, abdominal trauma/solid organ injury management, intensive care monitoring, anesthesia/sedation, advanced imaging, radiologic interpretation, child abuse evaluation, and rehabilitative services. After refinement and panel voting, 14 criteria achieved the >75% consensus threshold. The final consensus criteria were reviewed and endorsed by the PTS Guidelines Committee. This study defines multidisciplinary consensus-based criteria for PTC resource utilization. These criteria are an important step toward developing a criterion standard, resource-based, pediatric injury severity metric. Such metrics can help optimize system-level pediatric trauma triage based on likelihood of requiring PTC resources. Diagnostic Test/Criteria; Level II.

The Relationship Between Resilience and Conflict Management Styles from the Perspective of the Prehospital Emergency Medicine Operational Staff: A Cross-sectional Descriptive Study

Background: The numerous pre-hospital emergency medicine operational staff interactions with different people cause many conflicts. In addition to affecting their physical and mental health, these conflicts lead to severe problems for the health of society and patients. Objectives: This study aimed to determine the relationship between resilience and conflict management styles from the perspective of pre-hospital emergency medicine operational staff of the Medical Emergency and Accident Management Center in Golestan Province in 2022. Methods: This descriptive correlational study recruited 200 operational staff working in the pre-hospital emergency center in Golestan Province. They were selected using a stratified sampling method with proportional allocation. The data were collected using a demographic questionnaire, the Connor-Davidson Resilience Scale (CD-RISC), and the Rahim Organizational Conflict Inventory-II (ROCI-II). Results: Pearson correlation results demonstrated a direct and significant relationship between resilience and conflict management styles (P = 0.011, r = 0.180); the resilience score increased with an increase in the score of conflict management styles. In addition, resilience was directly associated with compromising (P = 0.012, r = 0.178) and integrating styles (P = 0.001, r = 0.276). Finally, a direct and significant relationship existed between job interest and resilience (P = 0.01). The linear regression analysis showed a significant relationship between the resilience score and the score of conflict management styles (β = 0.17). Conclusions: Resilience can improve the conflict management styles of pre-hospital emergency medicine operational staff. Moreover, job interest can enhance resilience, indirectly affecting conflict management. Pre-hospital emergency managers and officials should hold resilience training courses for pre-hospital emergency operatives.

Relatives’ influence on the treatment of acutely critically ill patients in prehospital emergency medicine: a qualitative study of healthcare professionals’ experiences and attitudes

BackgroundFamily presence during resuscitation is a growing topic in the field of prehospital emergency medicine. Emergency medicine service (EMS) providers interact with the relatives of acutely critically ill patients daily. Previous studies have found varying preferences towards family presence during resuscitation. Some EMS providers experience family presence affects patient treatment. The study aimed to gain insight into how EMS providers experience relatives of critically ill patients influence patient treatment. MethodsWe used semi-structured individual interviews of specially trained paramedics and anaesthetists specialised in prehospital emergency medicine. A total of 11 interviews were conducted at a University Hospital in Copenhagen. Inductive qualitative contents analysis was used to analyse the data. ResultsRelatives were defined as family, spouses, children, partners, close friends or colleagues, and, for some participants, more peripheral relationships such as schoolmates or acquaintances. We identified four themes, describing how EMS providers experience relatives’ influence on patient treatment: ‘supporting optimal patient treatment’, ‘futile resuscitation’, ‘negative impact on patient treatment’, and ‘the paediatric patient’. ConclusionsOur study illustrates how EMS providers experience that treatment is influenced by relatives of acutely critically ill patients in the prehospital emergency medicine setting. Relatives can help or challenge treatment, and also influence EMS providers’ clinical decision-making. Our findings can guide those working in prehospital emergency medicine towards utilising relatives of critically ill patients and increasing our understanding of how relatives can influence EMS providers’ treatment and their clinical decision-making. Future studies should seek to quantify relatives’ effect on treatment and investigate the clinical and ethical aspects of futile resuscitation.

Comparing effects and application of telemedicine for different specialties in emergency medicine using the Emergency Talk Application (U-Sim ETA Trial)

Telemedicine as a technology can support processes in the field of emergency medicine (EM) including therapies and diagnostics, but technically is often based on hardware solutions for local EM structures, especially when involving the field of pre-hospital EM. By developing an open-source, data protection compliant solution (EU GDPR and HIPAA) as well as using standardized web and open-source based technology the Emergency Talk Application (ETA) can be used as a technology that can connect emergency medical providers and include already available regional structures. By actively involving patients and connecting these with emergency or urgent care physicians ETA can be used not only as a teleconsultation system for paramedics and physicians, but in a wider network. Randomised simulation trial, comparing EM scenarios from the field of internal medicine, trauma and neurology. Participants were qualified as certified paramedics or emergency physicians (EP). Paramedics performed as ambulances crews and involved an EP if needed via ETA as Tele-Emergency Physicians (TEP). EP participated from a device of their choice, while being able to stay within their clinical workspace. From 141 scenarios 129 used ETA. Significant differences were found for the length of scenarios, duration of time the TEP was on scene, TEP arrival after scenario start, duration until TEP was called and the duration until a diagnosis was made. Also a strong positive and significant correlation between duration of the scenario and the time a TEP was bound could be described. Telemedicine is a technology that is increasingly used in the field of EM. Improving the use of telemedicine by using up-to date technology while allowing an integration of available technical and human resources is a challenge in the field of emergency medicine especially with its regional but also broad medical variety. When using one technical solution, understanding that different cases need a different medical and also telemedical approach can help in the understanding and improving therapies, diagnostics but also the involved processes and solutions. Such results are not only relevant for healthcare providers but especially by law and decision makers as to which type of solution could be introduced in each regional setting.

Recommendations for Education in Sonography in Prehospital Emergency Medicine (pPOCUS): Consensus paper of DGINA, DGAI, BAND, BV-ÄLRD, DGU, DIVI and DGIIN

Point-of-care sonography is aprecondition in acute and emergency medicine for the diagnosis and initiation of therapy for critically ill and injured patients. While emergency sonography is amandatory part of the training for clinical acute and emergency medicine, it is not everywhere required for prehospital emergency medicine. Although some medical societies in Germany have already established their own learning concepts for emergency ultrasound, auniform national training concept for the use of emergency sonography in the out-of-hospital setting is still lacking. Experts of several professional medical societies have therefore joined forces and developed astructured training concept for emergency sonography in the prehospital setting. The consensus paper serves as quality assurance in prehospital emergency sonography.

Leadership in the multiteam system of prehospital medicine.

Emergency Medicine AustralasiaEarly View Trainee Focus Leadership in the multiteam system of prehospital medicine Natalie Kay PGDipClinEd, MBChB, Corresponding Author Natalie Kay PGDipClinEd, MBChB Emergency Medicine Specialist, Prehospital and Retrieval Medicine Doctor [email protected] Te Whatu Ora Counties Manukau, Middlemore Hospital, Auckland, New Zealand Northern Rescue Helicopter Ltd, Auckland, New Zealand Correspondence: Dr Natalie Kay, Northern Rescue Helicopter Ltd, 440 Harvard Lane, Ardmore, Auckland 2582, New Zealand. Email: [email protected]Search for more papers by this author Natalie Kay PGDipClinEd, MBChB, Corresponding Author Natalie Kay PGDipClinEd, MBChB Emergency Medicine Specialist, Prehospital and Retrieval Medicine Doctor [email protected] Te Whatu Ora Counties Manukau, Middlemore Hospital, Auckland, New Zealand Northern Rescue Helicopter Ltd, Auckland, New Zealand Correspondence: Dr Natalie Kay, Northern Rescue Helicopter Ltd, 440 Harvard Lane, Ardmore, Auckland 2582, New Zealand. Email: [email protected]Search for more papers by this author First published: 21 June 2023 https://doi.org/10.1111/1742-6723.14265Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1Hearns S (ed). Reducing the pressure from frazzle to flow. In: Peak Performance Under Pressure, 1st edn. Bridgwater: Class Professional Publishing, 2019; 233– 47. 2Lauria MJ, Gallo IA, Rush S, Brooks J, Spiegel R, Weingart S. Psychological skills to improve emergency care providers' performance under stress. Ann. Emerg. Med. 2017; 70: 884– 90. 3 New Zealand Government. Coordinated Incident Management System (CIMS), 3rd edn. Wellington: Officials' Committee for Domestic and External Security Coordination, Department of the Prime Minister and Cabinet, 2019. 4Stoate JM. Together or apart: modelling the inter-agency workings of emergency response multiteam systems (PhD thesis). Leeds: Leeds University Business School, 2015. 5 Fire and Emergency New Zealand. What We Do and Why We Do It. Wellington: Fire and Emergency New Zealand, 2023. [Cited Apr 2023.] Available from URL: https://fireandemergency.nz/about-us/what-we-do/ 6 Fire and Emergency New Zealand. Annual Report 2022. Wellington: Fire and Emergency New Zealand, 2023. [Cited Jun 2023.] Available from URL: https://www.fireandemergency.nz/assets/Documents/FENZ_Annual_Report_2022.pdf 7Hylander J, Saveman B, Bjornstig U, Gyllencreutz L. Prehospital management provided by medical on-scene commanders in tunnel incidents in Oslo, Norway – an interview study. Scand. J. Trauma Resusc. Emerg. Med. 2019; 27: 78. 8Calland V, Williams P. Scene safety and assessment. In: T Nutbeam, M Boylan, eds. ABC of Prehospital Emergency Medicine. Chichester: Wiley, 2013; 13. 9Low A, Hulme J. ABC of Transfer and Retrieval Medicine, 1st edn. Chichester: Wiley, 2015. 10Salas E, Granados DD, Klein C et al. Does team training improve team performance? A meta-analysis. Hum. Factors 2008; 50: 903– 33. 11Carson JB, Tesluk PE, Marrone JA. Shared leadership in teams: an investigation of antecedent conditions and performance. Acad. Manag. J. 2007; 50: 1217– 34. 12Diviney R. Why Dynamic Subordination Is Required for High-Functioning Teams. [Updated 2 Aug 2022; cited 28 May 2023.] Available from URL: https://theattributes.com/blog/why-dynamic-subordination-is-required-for-high-performing-teams Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

REBOA in Bleeding and Cardiac Arrest in Pre-Hospital Care by Helicopter Emergency Medical Service: The RIBCAP-HEMS Project

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) plays an important role in the most severe trauma and medical patients with cardiac arrest. Its use in pre-hospital emergency medicine in Germany does not yet regularly occur, and the vast majority of rapid response vehicles are not equipped with REBOA devices. In this article we will describe the introduction of REBOA for bleeding patients, as well as an adjunct for refractory out-of-hospital cardiac arrest (OHCA), in a German helicopter emergency medical service (HEMS).Methods: The DRF-Luftrettung HEMS base in Halle (Saale) Germany has incorporated REBOA in pre-hospital emergency medicine and will accompany this introduction with a feasibility study. We will describe the implementation of REBOA and the results of the training course. The training consists of theoretical and practical issues within different case scenarios. This was carried out before introducing REBOA into pre-hospital emergency medicine. Using a pre- and post-course exam and a self-assessment questionnaire the theoretical and practical knowledge and the performance of the critical care teams were determined.Results: The results of the pre-course exam in comparison with the post-course exam improved from 82% to 96%. Based on the self-assessment questionnaires, all participants felt a relevant improvement of their theoretical and practical knowledge. All physicians successfully performed REBOA under ongoing cardiopulmonary resuscitation in manikin simulators.Conclusions: The results from the training course indicate that there was a significant improvement of the theoretical and practical knowledge, as well as the performance of REBOA. The on-going feasibility study will show if it is worth introducing REBOA in a civilian HEMS for the patients in extremis.

Training of Icelandic rural doctors in managing trauma and acute illness

Rural medicine is in many ways different from urban primary care. In addition to providing primary care for a population, the rural doctor is tasked with the initial evaluation and stabilization of all emergencies usually managed by an Emergency Department in urban areas. The goal of this study was to assess rural doctors' in Iceland attendance of courses in Emergency Medicine (EM), how rural doctors grade their own ability to respond to emergencies and evaluate their Continuous Medical Education (CME) within the field of EM. In this descriptive cross-sectional study, all rural general practitioners (GP) in Iceland with at least two years of experience post foundation training and who practiced at least a quarter of every year outside the capital area were surveyed using an electronic questionnaire. T-test and qi-square test were used for analysis and significance determined if p<0.05. The survey was sent to 84 doctors with 47 (56%) completing the survey. Over 90% of the participants reported having completed a course in Advanced Life Support (ALS) but only 18% had completed a course in prehospital EM specifically designed for this group of doctors. Over half of the participants considered themselves to have good training to perform 7 out of 11 surveyed emergency procedures. Over 40% of participants considered it necessary to improve their CME in 7 out of 10 categories of EM. The majority of rural GPs considered shortage of doctors in the rural environment a significant factor limiting their CME. The majority of rural doctors in Iceland consider themselves to have a good training to provide initial EM care in their community. Efforts to improve their training in this field of medicine should focus on scene safety and working in the prehospital setting, pediatrics, labor and deliveries and gynecological emergencies. Rural doctors need to have access to appropriate EM training courses.

Second Victims among German Emergency Medical Services Physicians (SeViD-III-Study)

Patient care in the prehospital emergency setting is error-prone. Wu's publications on the second victim syndrome made very clear that medical errors may lead to severe emotional injury on the caregiver's part. So far, little is known about the extent of the problem within the field of prehospital emergency care. Our study aimed at identifying the prevalence of the Second Victim Phenomenon among Emergency Medical Services (EMS) physicians in Germany. Web-based distribution of the SeViD questionnaire among n = 12.000 members of the German Prehospital Emergency Physician Association (BAND) to assess general experience, symptoms and support strategies associated with the Second Victim Phenomenon. In total, 401 participants fully completed the survey, 69.1% were male and the majority (91.2%) were board-certified in prehospital emergency medicine. The median length of experience in this field of medicine was 11 years. Out of 401 participants, 213 (53.1%) had experienced at least one second victim incident. Self-perceived time to full recovery was up to one month according to 57.7% (123) and more than one month to 31.0% (66) of the participants. A total of 11.3% (24) had not fully recovered by the time of the survey. Overall, 12-month prevalence was 13.7% (55/401). The COVID-19 pandemic had little effect on SVP prevalence within this specific sample. Our data indicate that the Second Victim Phenomenon is very frequent among prehospital emergency physicians in Germany. However, four out of ten caregivers affected did not seek or receive any assistance in coping with this stressful situation. One out of nine respondents had not yet fully recovered by the time of the survey. Effective support networks, e.g., easy access to psychological and legal counseling as well as the opportunity to discuss ethical issues, are urgently required in order to prevent employees from further harm, to keep healthcare professionals from leaving this field of medical care and to maintain a high level of system safety and well-being of subsequent patients.

Construction of a 5G-based, three-dimensional, and efficiently connected emergency medical management system

BackgroundShenzhen is unique in its need for ad hoc responses to emergencies. The need for emergency medicine also demonstrates a trend of sustained growth. ObjectiveA three-dimensional and efficiently connected emergency medical management model using fifth generation mobile communication technology (5G) was established to improve the efficiency and level of management in emergency medicine. MethodA mixed-frequency band private network collaborative emergency treatment mode was built under daily emergency scenarios using 5G. The efficiency of a three-dimensional telemedicine treatment mode was tested using prehospital emergency medicine. Also, the feasibility of quickly establishing a temporary network information system using unmanned aerial vehicle (UAV) and/or high-throughput communication satellites under disaster-caused power outages and network interruptions was examined. A monitoring system was constructed for suspected cases using 5G amid public health emergencies, which raised the Emergency Department’s efficiency and security in responding to the pandemic. ResultsThe three-dimensional rescue system supported by 5G showed that the radius of the emergency medical rescue services expanded from 5 to 60 km, and the cross-district emergency reaction time reduced from 1 h to <20 min. Thus, it was feasible to construct a communication network expeditiously with devices carried by UAV under disastrous scenarios. The system developed based on 5G could be used in managing suspected cases of public emergencies. Among the 134 suspected cases in the early stage of the pandemic, no nosocomial infection was detected. ConclusionA three-dimensional, efficiently connected emergency medical management system based on 5G was constructed, following which the emergency rescue radius quickly expanded and the emergency response time reduced. Thus, with the aid of new technology, an emergency information network system was built expeditiously under specific scenarios, such as a natural disaster, and the level of management under public health emergencies advances. The confidentiality of patient information is a critical issue regarding the application of new technology.

Prehospital emergency medicine for children receiving palliative home care in Germany-a cross-sectional, exploratory study of EMS providers.

The prevalence of children with life-limiting conditions is rising, and since the amendment of the social insurance code in Germany, palliative home care teams have treated an increasing number of children. These teams provide 24/7 readiness, yet some parents still call the general emergency medical service (EMS) for various reasons. EMS is exposed to complex medical problems in rare diseases. Questions arose about the experiences of EMS and whether they felt prepared for emergencies involving children treated by a palliative care team. This study used a mixed methods approach to focus on the interface between palliative care and EMS. First, open interviews were conducted, and a questionnaire was developed based on the results. The variables included demographic items and individual experiences with patients. Second, a case report of a child with respiratory insufficiency was presented to assess the spontaneous treatment intentions of EMS providers. Finally, the need, relevant topics, and duration of specific training in palliative care for EMS providers were evaluated. In total, 1,005 EMS providers responded to the questionnaire. The average age was 34.5 years (±10.94SD), 74.6% were male. The average work experience was 11.8 years (±9.7), 21.4% were medical doctors. Experience with a call of a life-threatening emergency involving a child was reported by 61.5% and severe psychological distress during such a call was reported by 60.4%. The equivalent distress frequency for adult patient calls was 38.3%. (p < 0.001). After review of the case report, the EMS respondents suggested invasive treatment options and rapid transport to the hospital. Most (93.7%) respondents welcomed the consideration of special training in pediatric palliative care. This training should include basic information about palliative care, an analysis of cases involving palliatively treated children, an ethical perspective, practical recommendations, and available (24/7) local contact for further guidance and support. Emergencies in pediatric palliatively treated patients were more common than expected. EMS providers perceived the situations as stressful, and there is a need for specific training with practical aspects.

Abdominal Trauma by Impalement. Clinical case.

Introduction: Impalement injury is one of the most spectacular and potentially dramatic rare forms of penetrating trauma. [2,3] In many cases, the impaled patient dies at the scene.[3] The patient who manages to reach the hospital alive and is hemodynamically stable has a good chance of overcoming a traumatic event. However, the non-removal of a foreign object represents the cornerstone of initial treatment, as possible vascular lesions remain compressed by the object in situ, thus avoiding irrepressible hemorrhages. Clinical case: A 32-year-old male was brought in by a paramedic after suffering electrical burns to the right thoracic limb and right pelvic limb that caused a fall from a power pole with subsequent penetrating abdominal trauma due to impalement. He denies antecedents of importance for the current condition. Upon arrival, he was hemodynamically stable, with the presence of a first-degree electrical burn in the right hand and forearm and the right thigh, as well as a metallic rod passing through the abdomen from the left groin to the right flank, for which it was decided to perform Exploratory Laparotomy who reported the following findings: Intestinal perforation of more than 50% of the lumen at jejunum level, side-to-side anastomosis was performed. During his stay on the floor of General Surgery, he had a torpid post-surgical evolution, intolerance to the oral route, abdominal distension, absence of gas channeling, and symptoms of intestinal obstruction, for which it was decided to perform a new Exploratory Laparotomy, finding intestinal stenosis at the level of the previous anastomosis was dismantled and reconstructed in side by side, on this occasion with favorable evolution and he was discharged due to improvement after 14 days of hospital stay. Discussion: Prehospital emergency medicine (PHEM) offers unique and challenging perspectives to orthodox emergency medicine. Impalements are extremely rare and often require a multidisciplinary team approach in the prehospital setting. Most cases of impalements are fatal at the scene. Patients surviving the initial trauma and arriving at the hospital alive, usually make a good recovery with multidisciplinary team management underpinning the importance of meticulous prehospital care in transporting patients with impalements safely. This case highlights the role of PHEM clinicians as experts in clinical knowledge, decision-making, leadership, team working skills, and improvisations.

A Study on the Ethical Aspects of Witnessed Resuscitation from the Perspective of Prehospital Emergency Caregivers

Aim: Patients' relatives are routinely removed from the emergency department resuscitation room. One can attribute this practice primarily to reasons such as safeguarding patient welfare, protecting medical personnel and patient's relatives from potential risks. In prehospital emergency medicine, it is often not possible to prevent witnessed resuscitation efforts. Prehospital emergency caregivers responding to cardiopulmonary arrest must focus only on the patient. It is aimed to investigate the ethical perspectives of prehospital emergency caregivers on witnessed resuscitation and to make policy recommendations according to the results of the research.Methods: The study was designed as a prospective, descriptive survey. Between February 18, 2022 and March 18, 2022, the survey prepared for EMTs, paramedics, health officers, nurses, and physicians working in the ambulance service of Kırşehir Provincial Health Directorate was applied face-to-face.Results: The majority of the participants were women, associate degree graduates, EMT, and paramedics, and their career duration was between 6-10 years. When comparing paramedic and EMT responses to the questions, a statistically significant difference was only found in the response to question “Does witnessing the resuscitation you perform in the prehospital area cause a situation that may harm the patient?”. Additionally, the ethical aspects of witnessed resuscitation in the prehospital setting were examined under the headings such as the witness of the family and nonfamily individuals, professionalism, patient privacy and confidentiality, the grieving process, medical staff safety, and nonmaleficence.Conclusions: Witnessed resuscitation in the prehospital setting has many controversial ethical aspects and needs regulations and training in this regard.

Two case reports of sudden cardiac arrest with unsuccessful resuscitation: is there a role for postmortem investigation and targeted next generation sequencing?

Background: Sudden unexpected cardiac arrest is one of the life-threatening interventions of the pre hospital emergency medicine teams. Globally sudden cardiac death (SCD) accounts for 4-5 million deaths per year and is in most cases linked to coronary artery disease. Other causes include cardiomyopathies and channelopathies, but these are not always clear to the physician. Case Presentation: We present two unconscious patients with life-threatening cardiac arrests who were unsuccessfully resuscitated by the emergency team. As the cause of the sudden cardiac arrest was unclear an autopsy was performed. Conclusion: SCD can be the final stage of several pathologies. In acute myocardial infarction due to coronary artery disease, the underlying cause is clear. The situation is however more complex in drug abuse where the physician should be aware that underlying pathologies can be masked. If the cause of sudden cardiac arrest is unclear, a &amp;quot;molecular&amp;quot; autopsy is recommended to detect genetic susceptibility to dysrhythmias( long QT syndrome, Brugada syndrome), cardiomyopathies, thoracic aortic aneurysm, and dissection. Correlating significant clinical information, postmortem findings and genetic analysis can be used to detect underlying pathologies and to decide whether genetic screening and clinical follow up of relatives should be carried out.

IS CARDIOPULMONARY RESUSCITATION OUTCOME IN PRE-HOSPITAL EMERGENCY MEDICINE RELATED TO AIRWAY MANAGEMENT TECHNIQUE?

According to current European Resuscitation Council guidelines, priorities in advanced life support in adult are chest compression with minimal interruption and early defibrillation. Endotracheal intubation is still considered the gold standard in airway management, but guidelines suggest that securing the airway be incremental, ranging from basic techniques to more complex ones. Doctors who work in pre-hospital emergency medicine teams (EMT) in Croatia usually lack sufficient education and expertise. The aim of this study was to determine whether there was a significant difference in recovery of spontaneous circulation during cardiopulmonary resuscitation (CPR) in out-of-hospital setting depending on the EMT airway management technique of choice. This retrospective analysis included data collected during a 10-year period at the Krapina-Zagorje County Emergency Medicine Institute on all patients with CPR performed by EMTs 20 minutes from initial emergency call. The airway management groups included oropharyngeal tube, i-gel supraglottic device, and endotracheal tube. There were 968 patients, mean age 70. In 74.61% of patients, the cause of arrest was of cardiac etiology. Our study did not find a statistically significant in difference of CPR success among the three groups analyzed according to the airway management technique of choice (p=0.74, χ2-test).

Tranexamic acid in polish pre-hospital emergency medicine and the competencies of medical rescue teams

INTRODUCTION: Medical rescue teams (MRTs) are the basic components of the Polish Emergency Medicine System (PEMS) that provide pre-hospital emergency medical services. However, despite the possibility for paramedics to use 47 drugs and many complicated medical procedures, tranexamic acid was not found there. Efficacy of pre-hospital emergency medical services could be improved by using tranexamic acid (TXA) in the management of traumatic hemorrhage and traumatic brain injury (TBI). The aim of this study was to demonstrate that the competencies of MRTs should be expanded and that Polish paramedics should be authorized to independently administer TXA to TBI patients. MATERIAL AND METHODS: The main research method was an analysis of the literature, including studies focusing on TXA administration and the associated risks. The article was written in the last two years. RESULTS: The study demonstrated that TXA contributes to the effective management of selected types of hemorrhage and TBI and that the risk of adverse effects associated with TXA administration is minimal. CONCLUSIONS: The gathered evidence suggests that paramedics should be authorized to independently administer TXA in pre-hospital care to maximize the efficacy of emergency medical services provided to patients in the PEMS.

Rescue Blankets as Multifunctional Rescue Equipment in Alpine and Wilderness Emergencies-A Narrative Review and Clinical Implications.

The utilization of rescue blankets in pre-hospital emergency medicine exceeds protection from hypothermia and enhanced visibility by far. In this narrative review, we focus on emphasizing the alternative applications of these fascinating multifunctional tools in the pre-hospital setting. A literature search in PubMed® and Web of ScienceTM yielded 100 results (last update was on 8 July 2022), a total number of 26 of which were included in this narrative review. Nine articles assessing alternative functions of rescue blanket were further evaluated and described in more detail. In addition, we performed various experimental and observational trials to test the functionality of rescue practice in mountain emergency medicine. Newly fabricated rescue blankets proved to possess impressive robustness. We evaluated rescue blankets in their applicability to not only protect from hypothermia, but also as practical tools to treat catastrophic hemorrhage and bleeding limbs, to perform open pneumothorax chest seals in sucking chest wounds, to prevent damage to unprotected eyes on the glacier and as alternative instruments for transportation in the inaccessible areas. Rescue blankets are important rescue equipment in alpine and wilderness emergencies with multifunctional applications, and must be part of every personal medical kit.

Case Report: The Value of Vigilance and Iterative Evaluations with an Uncooperative Patient in the Emergency Department

A patient in the sixth decade of life presented to the Emergency Department (ED) with an apparent suicide attempt as well as with abdominal pain. The patient appeared to be inebriated. The prehospital emergency medicine service (EMS) providers suggested that the presentation may have been due to diabetic ketoacidosis. A chest x-ray finding showed possible pneumoperitoneum, but was read by radiology has having been seen on a chest x-ray from a year prior. Repeat physical examination continued to show abdominal tenderness, leading to a CT scan of the abdomen that demonstrated a large pneumo-peritoneum with a mild ileus and chronic surgical findings. The patient was transferred to a tertiary level of care for exploratory laparotomy after broad spectrum antibiotics and additional pain medication given. A bowel perforation was identified and was repaired. He had an uncomplicated clinical course and was discharged from the hospital 8 days later. The critical thinking skill of iterative reconsideration of a diagnosis along with iterative testing can avoid the pitfalls that can attend to such biases of cognition as anchoring and premature closure of thinking.

The Correlation Between Mental Health and Corona Anxiety Among Pre-hospital Emergency Medicine Clinicians Abstract

Background: According to the literature, pre-hospital emergency medicine clinicians’ mental health has most likely been ignored during the COVID-19 outbreak. Objectives: This study aimed to investigate the correlation between mental health and corona anxiety among pre-hospital emergency medicine clinicians during the COVID-19 outbreak in Isfahan, Iran. Methods: A cross-sectional study was conducted in Isfahan, Iran, from May to July 2020. All participants voluntarily participated in this study, and an informed consent was obtained. Data collection was done through completing two questionnaires, including the Corona Disease Anxiety Scale (CDAS) and the General Health Questionnaire (GHQ). Data were analyzed with SPSS version 18 using the Pearson correlation test and multivariate linear regression. Results: A preliminary data analysis of CDAS and GHQ showed a significant correlation between the total score of COVID-19 anxiety and general health (r = 0.6, P &lt; 0.001). Also, multivariate analysis showed that field of study (B = 0.13; P-value = 0.005) and COVID-19 anxiety were significant predictors for general health (B = 0.6; P-value &lt; 0.001). Conclusions: According to the findings, the higher the anxiety score, the poorer one’s general health and the more likely they are to have mental disorders. Therefore, it is recommended to provide mental health services for pre-hospital emergency medicine clinicians during the COVID-19 pandemic.