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Background: Cardiopulmonary resuscitation with the use of personal protective equipment (PPE) for aerosol generating procedures (AGP) in patients with suspected or confirmed coronavirus disease 2019 (COVID‑19) remains challenging. Aims: The aim of this study was to compare 3 chest compression (CC) methods used by paramedics wearing PPE. Methods: The single‑blinded, multicenter, randomized, crossover simulation study involved 67 paramedics wearing PPE AGP. They performed 2‑minute continuous CCs in an adult with suspected or confirmed COVID‑19 in 3 scenarios: 1) manual CCs; 2) CCs with the TrueCPR feedback device; 3) CCs with the LUCAS 3 mechanical CC device. Results: The depth of CC was more frequently correct when using LUCAS 3 compared with TrueCPR and manual CC (median [IQR] 51 [50–55] mm vs 47 [43–52] mm vs 43 [38–46] mm; P = 0.005). This was also true for the CC rate (median [IQR]102 [100–102] compressions per minute [CPM] vs 105 [98–1114] CPM vs 116 [112–129] CPM; P = 0.027) and chest recoil (median [IQR]100% [98%–100%] vs 83% [60%–92%] vs 39% [25%–50%]; P = 0.001). A detailed analysis of 2‑minute resuscitation with manual CCs showed a decrease in compression depth and full chest recoil after 1 minute of CCs. Conclusion: We demonstrated that during simulated resuscitation with the use of PPE AGP in patients with suspected or confirmed COVID‑19, CC with LUCAS 3 compared with manual CCs as well as the TrueCPR essentially increased the CC quality. In the case of manual CCs by paramedics dressed in PPE AGP, it is advisable to change the person performing resuscitation every minute.

Background: Prehospital emergency care of children is challenging. In the era of the COVID-19 pandemic, when medical personnel should use personal protective equipment against aerosol-generating procedures, the efficiency of medical procedures may decrease. The study objective was to evaluate the effectiveness of different intravascular access methods applied by nurses wearing biosafety Level-2 suits in simulated paediatric COVID-19 resuscitation. Methods: A prospective, randomized, crossover, single-blinded simulation trial was performed. Nursing staff attending Advanced Cardiovascular Life Support courses accredited by the American Heart Association participated in the study. A total of 65 nurses were recruited and randomly assigned to different study groups. They received standard training on intravascular access methods employing distinct devices. The participants wore biosafety Level-2 suits and performed vascular access with the following intraosseous devices: NIO-P, EZ-IO, and Jamshidi needle; intravenous (IV) access was used as a reference method. Both the order of participants and the access methods were random. Each participant performed intravascular access with each of the four methods tested. The effectiveness of the first attempt to obtain intravascular access and the following time parameters were analysed: the time between grasping the intravascular device out of the original packing until infusion line connection. The ease of the procedure was measured with a visual analogue scale (1 – easy; 10 – difficult). Results: The first attempt success rate of intravascular access by using NIO-P and EZ-IO equalled 100% and was statistically significantly higher than that with the Jamshidi needle (80.0%; p = 0.02) and with the IV method (69.2%; p = 0.005). The time required to connect the infusion line varied and amounted to 33 ± 4 s for NIO-P compared to 37 ± 6.7 s for EZ-IO (p < 0.001), 43 ± 7 s for Jamshidi (p < 0.001), and 98.5 ± 10 s for IV access (p < 0.001). The procedure was easiest in the case of NIO-P and EZ-IO (2 ± 1 points; p = 1.0) compared with Jamshidi (5 ± 3 points; p < 0.001) and IV access (7 ± 2 points; p < 0.001). Conclusion: The study provides evidence that nurses wearing biosafety Level-2 suits were able to obtain intraosseous access faster and more effectively as compared with IV access during simulated COVID-19 paediatric resuscitation. The most effective method of intravascular access was the NIO-P intraosseous device. Further clinical trials are necessary to confirm the results.

INTRODUCTION: Injury-related interventions currently place a heavy workload on emergency medical teams in both adults and paediatric patients. One of the most common types of injuries are limb injuries caused by physical activity, falls or traffic accidents. It is extremely important to provide adequate protection for the paediatric patient in case of injury, as homeostasis disorders can occur very quickly in this age group. The aim of the study was to obtain data on the type and frequency of limb injuries in the group of paediatric patients who received medical rescue services interventions. An attempt was also made to specify the most frequent causes of limb injuries. MATERIAL AND MeTHODS: The study was based on a retrospective analysis of medical records of emergency rescue teams in the period from November 2017 to October 2018. The study included an analysis of interventions to patients under 18 years of age to whom EMS teams intervened due to limb injury. The analysis included sociodemographic data such as age, gender, time and place of the injury, as well as the type of injury based on the ICD-10 classification. RESULTS: In the studied period, 289 interventions in paediatric patients with limb injuries were recorded, which constituted 9.8% of all interventions in paediatric patients. The main site of the injury was a school. Upper limb injuries were reported in 123 cases, which constituted 42.6% of the intervention to the studied group of patients. The upper limb injuries were predominantly caused by forearm fractures (n = 33; Tab. 3), while the lower limb — by knee joint injuries. CONCLUSIONS: Limb injuries account for nearly 10% of all EMS interventions in paediatric patients. The main site of the injury was a school and the most frequent were upper limb injuries including forearm fractures, while for the lower limb — knee joint injuries. Further action should be taken to reduce the number of limb injuries in children.

Background: The prevailing COVID-19 pandemic forces paramedics to take medical rescue operations using personal protective equipment (PPE) for aerosol-generating procedures (AGP). The use of PPE-AGP may reduce the effectiveness of the procedures performed, including airway management, intravascular access, or chest compression. The goal of the current study was to compare the quality by which a chest compression during simulated COVID-19 resuscitation while wearing PPE-AGP. A secondary goal was to assess provider preferences with standard versus OHD chest compression methods while wearing PPE-AGP. Methods: This is a randomized cross-over single-blinded study involving 37 paramedics performing 2-min continuous chest compression using two methods: the standard chest compression (CC) method during which the rescuer takes a position to the side of the victim (STD) and over-the-head position (OHD). During cardiopulmonary resuscitation, study participants wore Class C PPE-AGP. Both the order of study participants and compression methods were random. The results were blinded before statistical analysis. The compression rate per minute (CPM), CC depth as well as full chest recoil were measured. The analysis was undertaken using STATISTICA (V13.3EN). Results : Mean chest compression depth using distinct CC methods varied and amounted to 42 ± 2mm for STD vs. 46 ± 4mm for OHD (p < 0.001). Chest compressions based on the OHD method were associated with a lower frequency of chest compressions (107 ± 7CPM) compared with STD (114.5 ± 8; p< 0.001). A higher percentage of full chest recoil was observed in the case of STD (42 ± 6%) than in the case of OHD (34 ± 10%). Conclusions: Based on the current simulation trial, it is impossible to clearly determine which method (STD vs. OHD) is more effective in resuscitation with PPE-AGP. Paramedics wearing PPE-AGP achieved better chest compression depth for OHD compared to the STD, however, OHD resuscitation causes a lower degree of full chest relaxation. A further well-designed clinical study looking at efficacy, safety, and outcomes is needed to confirm current results.

Background: Pre-filled syringes are increasingly popular in medicine, especially in emergency medicine, where fast intervention is crucial. Additionally, as indicated by numerous studies, the use of drugs in prefilled syringes reduces the risk of medical errors associated with inadequate preparation of the drug and reduces the risk of contamination as a result of tissue injury due to rupture of a standard ampoule with the drug. The aim of the study was to compare the use of pre-filled syringes with adrenaline and standard adrenaline in ampoules during simulated CPR during simulated cardiopulmonary resuscitation in non-shockable rhythms performed by two-person teams. Methods: The study was a randomised cross-over study and was based on medical simulation. The study involved 40 paramedics assigned randomly to 20 two-person rescue teams. These teams were to perform 10-minute cardiopulmonary resuscitation in three research scenarios: Scenario A — During CPR, access to the median basilic vein and preparation and administration of adrenaline infusions from generally available ampoules at concentration 1:1000 were required (Adrenaline WZF 0.1%; Polfa, Warsaw, Poland) with a standard syringe; Scenario B — During resuscitation, the median basilic vein was accessed and adrenaline was to be administered from an adrenaline pre-filled syringe (Aguettant Sante, Lyon, France); Scenario C — During CPR, intraosseous tibial vascular access was obtained using a NIO Adult kit, and adrenaline was administered using a pre-filled syringe with adrenaline (Aguettant Sante, Lyon, France). Both the order of resuscitation and medication administration as well as the order of participants were random. Results : The time to obtain vascular access in the examined scenarios varied and was 240 sec [IQR; 220–265] for Scenario A, 236 sec [IQR; 210–270] for Scenario B, and 165 sec [IQR; 90–180] for Scenario C; A vs. C, (p < 0.001), B vs. C (p < 0.001). In scenarios A, B, and C, the duration of adrenaline administration varied and was 55 sec [IQR; 50–85] vs. 20 sec [IQR; 18–35] vs. 20 sec [IQR; 20–30] (A vs. B, and A vs. C, p < 0.001). Conclusion: A simulation study has shown that paramedics in two-person teams are unable to deliver adrenaline at the time recommended by CPR guidelines. The delay of CPM adrenaline supply compared to PFS adrenaline is statistically significant. In the opinion of paramedics participating in the study, adrenaline during resuscitation should be administered by means of pre-filled syringes, which eliminates the delays in rescue operations resulting from the time needed to prepare drugs as well as limited human resources in rescue teams.

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.

INTRODUCTION: Head injuries in children pose a serious challenge both in terms of the management and di- agnostics. Due to technological progress and thus the development of motorization, despite the decreasing overall injury rate, the incidence of high-energy injuries increases. The aim of the study was to assess the frequency of intervention of emergency medical teams to paediatric patients due to head injuries. METHODS: The study was a retrospective study. The material consisted of medical interventions of medical rescue teams from the regions of Piaseczno and Pruszkow from the period 11.2016–10.2017. 422 medical emergency records were analyzed. RESULTS: Median age of study group was 7.7 years (IQR; 3–12) — females 7.6 years (IQR; 2–13) and males 7.9 years (IQR; 4–12). The injuries occurred most frequently in March (n = 43; 11.8%), and least frequently in February (n = 22; 5.2%). The above relation occurred regardless of gender. Injuries occur most frequently in spring (n = 132; 31.3%), and least frequently in summer (n=88; 20.8%; Tab. 1). In the afternoon an increase in the incidence of injuries was observed. Differences in the incidence of injuries in the group of males and females depending on the time of day were not significantly statistical (p = 0.206). Superficial head injury was the most common injury (n = 122; 28.9%) followed by open head wounds in both males and females. CONCLUSIONS: The most frequent head injuries were superficial head injuries followed by open head inju- ries. Injuries occurred more often on weekdays, less frequently at weekends. In the afternoon an increase in the incidence of injuries was observed. Injuries occur most frequently in spring and least frequently in summer on a monthly basis they occurred most frequently in March, and least frequently in February re- gardless of gender.

BACKGROUND: Traumatic brain injury (TBI) is a leading cause of death and disability. In many cases of TBI-related intracranial hemorrhage (ICH) is associated with a high risk of coagulopathy and may lead to an increased risk of hemorrhage growth. Therefore, tranexamic acid (TXA), which is known as an antifibrinolytic agent that reduces bleeding by inhibiting the breakdown of blood clots, might limit ICH expansion. MATERIAL AND METHODS: We aimed to quantify the effects of TXA in brain injury and thus performed a literature search using PubMed, Web of Science, Scopus, EMBASE, and Cochrane Center Register of Controlled Trials (CENTRAL) for studies that were published between the respective database inception, and April 10, 2021. RESULTS: A total of nine studies were identified; these included 5845 patients treated with, and 5380 treated without TXA. The 28-day or in-hospital mortality was 17.8% for the TXA group, compared with 19.3% for the no-TXA group (OR = 0.92; 95% CI: 0.83, 1.01; p = 0.08). At 6-months follow-up, mortality was 18.3% vs 19.9% (OR = 0.91; 95% CI: 0.63–1.31; p = 0.60), with and without TXA, respectively. A Glasgow Outcome Scale less than 4 points at 28-days follow-up was reported in 3 studies and was 29.8% vs 34.8% (OR = 0.91; 95% CI: 0.45, 1.82; p = 0.78), with and without TXA, respectively. No differences were found in adverse events between TXA and non-TXA groups. CONCLUSION: Our analysis found showed no statistical significance between TXA and non-TXA treatment of TBI patients, however, in the TXA group a trend to decrease 28-day mortality compared to non-TXA treatment was observed. More high-quality studies are needed to show the significant benefit of using TXA, especially in moderate and severe TBI patient groups.