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Background: Endotracheal intubation is one of the basic methods for airway control during cardiopulmonary resuscitation. In the era of the prevailing pandemic of SARS-CoV-2, medical personnel may face a necessity of resuscitating aninfected patient. Objective: The objective was to compare three intubation methods for suspected/confirmed COVID-19 adult patient resuscitation performed by paramedics wearing personal protective equipment (PPE) for aerosol generating procedures (AGP). Material and Methods: The multicentre, single-blind, prospective, randomized, crossover simulation trial involved 32 paramedics. The participants wearing PPE AGP performed tracheal intubations with the Macintosh, Airtraq, and McGrath MAC laryngoscopes in a patient with suspected COVID-19 in two resuscitation scenarios: scenario A – without chest compressions; scenario B – with continuous chest compressions. The primary outcome was time to intubation. Results: In scenario A, the intubation time for the respective devices equalled 35 s (IQR: 29–46) vs. 44s (IQR: 35–67) vs. 49 (IQR: 34–72) (p = 0.003). The total efficacy of each intubation method was 100%; however, the efficacy of the first intubation attempt was highest for McGrath MAC (90.6%), followed by Macintosh (68.1%) and Airtraq 62.5%) (p

The most acute problem of state health care system is shortage of medical personnel, both physicians and paramedics. The purpose of the study is to assess dynamics of personnel support with otolaryngologists in medical organizations of the Russian Federation for 2018-2023. The retrospective analytical descriptive study was carried out using continuous method based on studying dynamics of personnel support with otolaryngologists in the Russian Federation in general, Federal Okrugs and particular Subjects of the Russian Federation for 2018-2023. The calculation of dynamics of population provision with otolaryngologists per 10 thousand of population and dynamics of the number of otolaryngologists in medical organizations of state and non-state ownership was carried out. In the Russian Federation, level of population provision with otolaryngologists in 2018-2023 decreased from 0.62 to 0.61 per 10 thousand of population/ In some Subjects this indicator increased and in others decreased that testifies existence of internal labor migration of specialists. The largest increase in the number of otolaryngologists was established in Moscow, Moscow Region, St. Petersburg, Kaliningrad Oblast and Sakhalin Oblast and some other Subjects, the most attractive ones in terms of salaries, work conditions, social guarantees and other privileges. Besides, taking into account the number of otolaryngologists working in both state and non-state medical organizations, their number in the Russian Federation in 2018-2023 increased from 13,222 to 14,548 specialists. At the same time, there is significant outflow of otolaryngologists into non-state medical organizations. In 2018, the percentage of otolaryngologists working in non-state medical organizations made up to 20.8% and in 2023 28.3%. The three regions with the lowest level population of provision with otolaryngologists in 2023 were the Jewish Autonomous Region (0.2 per 10 thousand of population), the Republic of Khakassia (0.36 per 10 thousand of population) and the Kurgan Oblast (0.39 per 10 thousand of population). The three Oblasts with highest level of population provision with otolaryngologists are the Republic of North Ossetia-Alania (1.09 per 10 thousand of population), the Chukotka Autonomous Okrug (1.05 per 10 thousand of population) and St. Petersburg (1.03 per 10 thousand of population). It is established that, despite slight decrease in population provision with otolaryngologists in 2018-2023, their labor migration to regions with higher level of social economic development, as well as outflow to non-governmental medical organizations within the region continued to take place. The manpower policy currently implemented in the Russian Federation regarding medical workers brought no expected results. The results demonstrated imbalance in provision with otolaryngologists and different levels of their deficiency in particular regions that emphasizes importance of individualized and comprehensive approach to personnel provision in each region.

Due to staff shortage in the emergency healthcare (EH) system in Bulgaria there was a debate about the introduction of paramedics who are often erroneously identified as the traditionally practicing feldshers/physician assistants (PAs). The purpose of this material is describing the level of competencies of the staff and their applicability in the healthcare structures. The paramedics have professional qualification consisting of competency levels and professional duties to provide EH, comprising of initial assessment and basic life support of patients during their specialized transportation to healthcare facility. As a comparison, the feldshers/PAs are higher education health care professionals, who have been trained in a medical model, and who, to a certain extent, possess rights to diagnose and provide treatment independently. The applicability of health care staff in Bulgaria is directly dependent on the organization of the ambulatory and hospital emergency care and its purpose - providing first aid in the event of a sudden change in the health condition of adults and children due to illness or accident, complications in pregnant and postpartum women, which are threatening the health and life of the mother or fetus in order to prevent death or severe and irreversible disabilities. [ABSTRACT FROM AUTHOR]

Dzięki wiedzy z zakresu nauk medycznych i zdrowotnych wynikającej z wy-kształcenia i doświadczenia zawodowego ratownicy medyczni mają możliwość angażowania się w działania edukacyjne mające na celu poprawę stanu zdrowia społeczeństwa. Celem pracy była ocena profesjonalnego przygotowania ratowników medycznych pracujących w zespołach ratow-nictwa medycznego do realizacji nowoczesnych założeń edukacji zdrowotnej. Badania skiero-wane były do ratowników medycznych pracujących w zespołach ratownictwa medycznego na terenie Radomia. Zastosowano w nich ankietę diagnostyczną jako metodę badawczą z wykorzy-staniem anonimowego kwestionariusza przygotowanego przez autorów. Badanie ujawniło istot-ne braki i dysproporcje w profesjonalnym przygotowaniu ratowników medycznych pracujących w zespołach ratownictwa medycznego do realizacji edukacji zdrowotnej, zwłaszcza w odnie-sieniu do poziomu wykształcenia. Chociaż edukacja zdrowotna została wymieniona jako jedno z ustawowych zadań zawodowych ratowników medycznych w Polsce, zawodu tego nie można obecnie zdefiniować jako edukatora zdrowia w ścisłym znaczeniu tego terminu. Zwiększenie kompetencji w zakresie edukacji zdrowotnej wśród członków tej grupy zawodowej wymaga podjęcia odpowiednich środków organizacyjnych, przede wszystkim dotyczących modyfikacji programów nauczania w dziedzinie „ratownictwa medycznego”.

Nowadays, there are more and more reports of child abuse. However, this is not due to an increase in violence against minors, but to an increase in public awareness. People have begun to report child abuse. Child Abuse Syndrome affects both physical and psychological violence. There are many risk factors. Correct diagnosis is difficult, especially for children who start walking, running and all kinds of injuries can be the result of their playing. Intelligence, accurate viewing of the child and physical examination has an important role. When discussing the child abuse syndrome, let’s not forget about Munchausen syndrome per procura. Then the child’s testimonies are invented, very often behind the story presented by the young patient there is a family member – mainlythe mother. Since September 2011, all health care workers are subject to the “Blue Card” procedure. [11,27] If child abuse has occurred in the family, or even if there is a suspicion of such abuse, an Interdisciplinary Team is established. The task of this team is to complete the Blue Card procedure and to ensure the safety of a victim of violence. A paramedic plays an important role in this procedure. In most cases it is the person who first comes into contact with a child who is a victim of abuse. The paramedic must ensure that the patient feels safe. Their task is to identify the problem, document the injuries occurring on the child’s body at the time of examination and fill in the appropriate documentation, which will be handed over to the Interdisciplinary Team. This paper presents materials explaining the epidemiology and clinical image of the child abuse syndrome. Social aspects and legal consequences of this issue are also discussed. The “Blue Card” procedure and the “Blue Bear” form are also presented. The paper explains the role of medical personnel in case of violence against children.

The article discusses the issues of paramedic bachelor's degree training in the higher education system. There are no analogues of the paramedic qualification abroad. The significance of the education level for the healthcare quality is shown. The authors demonstrated the key features of the developed educational program of paramedic bachelor's degree training, which includes a large amount of practice.

According to modern healthcare requirements, it is necessary to increase workforce capacity of primary care practice, therefore, improving the specialist training is one of the high-priority problems of medical education. Not enough attention is paid to paramedic education and their role in Russian healthcare. The presented analysis of the paramedic profession history and the current state of high-quality healthcare in Russia shows the need to create a regulatory basis for the training of paramedics in the higher education system — a bachelor’s degree.

Sepsis is a life-threatening dysfunction of the body that causes a host to respond incorrectly to an infection. Sepsis and septic shock are a major health issue affecting millions of people each year worldwide. Every fourth person with sepsis dies. Multi-organ trauma, acute myocardial infarction or stroke, early diagnosis and management in the first hours after the onset of sepsis improve survival rate. The Sequential Organ Failure Assessment (SOFA) scale is mainly used to assess sepsis. SOFA helps medical staff to assess the risk of morbidity and mortality due to sepsis. The basic parameters of SOFA are: assessment of the respiratory system based on partial oxygen pressure in the blood (PaO2), assessment of the nervous system based on the Glasgow Coma scale (GCS), assessment of the cardiovascular system based on the average blood pressure or after vasopressor administration (any dose), assessment of liver function based on the level of bilirubin in the blood, assessment of kidney function based on the level of creatinine in the urine, assessment of blood clotting based on the amount of thrombocytes contained in the plasma. This scale is used in hospital settings. qSOFA (Quick Sequential Organ Failure Assessment score) is a simplified version of the SOFA score as the first way to identify high-risk patients due to poor results associated with infection. qSOFA simplifies the SOFA score drastically, taking into account only three clinical criteria and introducing "any change" instead of requiring GCS ≤13. It uses three criteria, assigning one point for low blood pressure (SBP ≤100 mmHg), high respiratory rate (≥ 22 breaths per minute) or changed mentation (GCS

Capnometry is an increasingly used element of patient monitoring in emergency medicine, also in pre-hospital area. The increasing availability of compact devices for measuring the end-expiratory concentration of carbon dioxide (EtCO2) offers great opportunities to improve the quality of treatments, as well as giving rescuers feedback on the effectiveness of life-saving procedures. However, the capnometer is just another device and without the proper substantive preparation of the person who uses it, its usefulness will be negligible. Aim of this study, is to assess paramedics knowledge about capnometry and capnography. The study group consisted of 102 paramedics who are actively working in ambulance service, aged 30.5 ± 5.7 years including 7% of women and 93% of men. Results were collected with the author’s questionnaire. Most of participants (91%) confirmed that in their ambulance was available device to measure end-expiratory carbon dioxide (EtCO2). The most commonly available device was capnometry (72%), followed by the capnography (19%). Moreover, the analysis shows that the rescuers who declared participation in the training of monitoring and analysis end-expiratory value of carbon dioxide concentration in the last 12 months obtained significantly higher correct answers than the staff who did not have such training (6.5 ± 2.0 vs. 5.4 ± 1.7). However, only 35% of participants took part in such training in last year. Study shown a lack of knowledge and experience in use of devices to measure end-expiratory carbon dioxide concentration (EtCO2) by Emergency Medical Service providers.

Mikos Marcin, Juszczyk Grzegorz, Czerw Aleksandra. Odpowiedzialność cywilna ratownika medycznego za błąd medyczny = Civil liability of a paramedic in case of a medical error. Journal of Education, Health and Sport. 2016;6(11):221-224. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.166268 http://ojs.ukw.edu.pl/index.php/johs/article/view/3988 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 755 (23.12.2015). 755 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Author (s) 2016; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 22.10.2016. Revised 30.10.2016. Accepted: 11.11.2016. Odpowiedzialność cywilna ratownika medycznego za błąd medyczny Civil liability of a paramedic in case of a medical error Marcin Mikos (1), Grzegorz Juszczyk (2), Aleksandra Czerw(2) (1) Polskie Towarzystwo Prawa Medycznego (2) Warszawski Uniwersytet Medyczny, Zakład Zdrowia Publicznego Streszczenie: Ratownik medyczny podobnie jak inni profesjonaliści medyczni może zostać pociągnięty do odpowiedzialności cywilnej za zawinione postępowanie niezgodne ze stanem aktualnej wiedzy medycznej, w wyniku którego pacjent doznał szkody na zdrowiu. Ocena zgodności postępowania ratownika medycznego ze stanem aktualnej wiedzy medycznej jest przedmiotem oceny biegłych sądowych. Za powstałe szkody o charakterze majątkowym i niemajątkowym ratownik medyczny może zostać zobowiązany do wypłaty odszkodowania i zadośćuczynienia. Abstract Paramedics, similar to other medical professionals may a subject of civil liability litigation in case of at fault actions which has been inconsistent with current medical knowledge followed by a loss in health experienced by a patient. The evaluation of accordance of medical activities with current medical knowledge is performed by an expert witness. A paramedic may be obliged to pay a compensation if a financial or nonfinancial loss is proven. Słowa kluczowe: ratownik medyczny, odpowiedzialność prawna, błąd medyczny. Key words: paramedic, legal liablility, medical error.

Żurowska-Wolak Magdalena, Wolak Bartłomiej, Mikos Marcin, Juszczyk Grzegorz, Czerw Aleksandra. Stres i wypalenie zawodowe w pracy ratowników medycznych = Stress and a burn-out syndrome at work among paramedics. Journal of Education, Health and Sport. 2015;5(7):43-50. ISSN 2391-8306. DOI 10.5281/zenodo.19112 http://ojs.ukw.edu.pl/index.php/johs/article/view/2015%3B5%287%29%3A43-50 https://pbn.nauka.gov.pl/works/575047 http://dx.doi.org/10.5281/zenodo.19112 Formerly Journal of Health Sciences. ISSN 1429-9623 / 2300-665X. Archives 2011 – 2014 http://journal.rsw.edu.pl/index.php/JHS/issue/archive Deklaracja. Specyfika i zawartość merytoryczna czasopisma nie ulega zmianie. Zgodnie z informacją MNiSW z dnia 2 czerwca 2014 r., że w roku 2014 nie będzie przeprowadzana ocena czasopism naukowych; czasopismo o zmienionym tytule otrzymuje tyle samo punktów co na wykazie czasopism naukowych z dnia 31 grudnia 2014 r. The journal has had 5 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 1089. (31.12.2014). © The Author (s) 2015; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland and Radom University in Radom, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 21.04.2015. Revised 28.05.2015. Accepted: 24.06.2015. Stres i wypalenie zawodowe w pracy ratowników medycznych Stress and a burn-out syndrome at work among paramedics Magdalena Żurowska-Wolak (1), Bartłomiej Wolak (2), Marcin Mikos (3), Grzegorz Juszczyk (4), Aleksandra Czerw (4) 1. Wydział Nauk o Zdrowiu, Uniwersytet Jagielloński – Collegium Medicum, Kraków 2. Krakowskie Pogotowie Ratunkowe; Kraków 3. Instytut Zdrowia Publicznego, Uniwersytet Jagielloński – Collegium Medicum, Kraków 4. Zakład Zdrowia Publicznego, Warszawski Uniwersytet Medyczny, Warszawa Adres do korespondencji: Magdalena Żurowska-Wolak tel: 503 196 836; e- mail: m_zurowska@vp.pl Streszczenie: Zawód ratownika medycznego jest jednym zawodów, w których narażenie na stres jest wysokie oraz istnieje ryzyko wystąpienia zespołu wypalenia zawodowego. Celem badania było poznanie sposobów radzenia sobie ze stresem, stosowanych przez ratowników medycznych oraz występowania wśród nich objawów wypalenia zawodowego. Najczęstszym z nich było występowanie dużego zmęczenia po pracy. Większość badanych (64%) potwierdziła wykorzystywanie konstruktywnych sposobów radzenia sobie ze stresem, jak również niekonstruktywne stosowanie używek, w szczególności kofeiny i nikotyny, których spożycie wzrastało w sytuacjach trudnych. Na podstawie badań można wnioskować, że wśród ratowników medycznych, pracujących w Krakowie i okolicach, występuje niebezpiecznie dużo objawów wypalenia zawodowego. Świadczy to o potrzebie stworzenia i realizacji przez ich pracodawców działań, obniżających poziom stresu wśród pracowników oraz zapobiegających wystąpieniu wypalenia zawodowego – jak debriefing, trenieng technik radzenia sobie ze stresem czy wspierania aktywności fizycznej. Jest to o tyle istotne, iż skutki stresu oraz wypalenia odczuwają nie tylko sami ratownicy. Skutki te są dolegliwe także dla pracodawców, którzy zatrudniają gorzej funkcjonujących pracowników oraz pacjentów, otrzymujących usługi o niższej jakości. Abstract: Paramedics are one of the professions where the risk of exposure to stress is high as well as the risk of occurrence of the burnout syndrome. The aim of the study was to analyze methods of stress reduction and symptoms of the burnout syndrome among 122 paramedics from Kraków and surrounding area. The most prevalent symptom was severe tiredness after working hours. The majority of respondents (64%) confirmed using constructive methods of stress reduction, however potentially dangerous use of alcohol, cigarettes was also observed especially in difficult situations. The results showed that in the research group the occurrence of alarming symptoms of the burnout syndrome was numerous. Therefore there is a need to define and implement appropriate activities aiming at stress reduction training – like debriefing, training on resilience or support of physical activity. It is highly important since the outcomes of burnout will affect not only paramedics themselves, but also their employers and patients. Słowa kluczowe: ratownik medyczny, stres, wypalenie zawodowe. Key words: paramedic, stress, burnout syndrome.