Objectives: The COVID-19 pandemic has forced emergency services to implement new standards of practice around the world. The dynamic and unpredictable nature of many clinical situations has placed emergency service personnel in direct danger of contracting the disease. This work uses a validated survey developed for the study to assess the predictors of stress that paramedics, nurses and doctors experience in the face of the COVID-19 pandemic. Material and Methods: The study group included 955 medical staff, and the level of significance adopted for statistical analysis was p = 0.05. Non-parametric Mann-Whitney and Kruskal-Wallis tests were used to analyze the qualitative variables divided into groups. The selection of tests was carried out based on the distribution of variables, verified using the Shapiro-Wilk test. In order to determine the predictors that caused the feelings of stress, it was necessary to use the linear regression model. Results: During the COVID-19 pandemic, stress among emergency medical personnel has increased considerably due to new factors that did not previously exist. The predictors of stress in the professional environment include the fear of contracting COVID-19, a decrease in the level of safety while conducting emergency medical procedures, and the marginalization of treatment for patients not suffering from COVID-19. Additional socio-demographic factors that increase stress among emergency medical personnel are being female and working in the nursing profession. Appropriate training, the supply of personal protective equipment and opinions on the preparedness of the system to deal with the outbreak of the pandemic did not affect the level of stress among health service personnel. Conclusions: The factors that can be considered to act as predictors of occupational stress include the fear of contracting COVID-19, a decrease in the level of safety and security while conducting emergency medical procedures, and the marginalization of patients not suffering from COVID-19. Int J Occup Med Environ Health. 2021;34(2)

Objectives:The variety of clinical presentation on the topic of carbon monoxide (CO) intoxication ranges from slight headache to coma or death. YouTube allows patients to search not only for entertainment but also medical advice. Therefore, the aim of this study was to evaluate the content and quality of YouTube videos concerning CO poisoning as a source of knowledge for non-medical audience. Material and Methods: On the December 8, 2020 a YouTube search was conducted for the following phrases: "carbon monoxide poisoning, " "carbon monoxide symptoms, " "CO poisoning, " "carbon monoxide asphyxiation, " "carbon monoxide intoxication" using the "incognito mode" and without attachment to Google Account. The search results were set as: "default" in the YouTube browser. The first 50 results were taken into consideration. Two raters, a specialist in emergency medicine and a specialist in clinical toxicology rated videos with Quality Criteria for Consumer Health Information (DISCERN), Global Quality Score (GQS) and Journal of the American Medical Association (JAMA). "VidIQ Vision for YouTube" plug-in was used. Results: Ninety-five videos were included. The interclass coefficient for DISCERN, GQS and JAMA scores were: 0.8, 0.74 and 0.62 reaching good and moderate reliability. The mean DISCERN/GQS/JAMA was 28.1 (SD 7.9), 2.5 (SD 0.8) and 1.1 (SD 0.7) respectively. Higher DISCERN/GQS/JAMA had videos providing information on: exposure time, treatment options, hyperbaric chamber indications as well as physician speaker (p < 0.05). Video Power Index was higher when the video contained animations and presented patients own history of CO exposure but not influenced the DISCERN/ GQS/JAMA scores. Videos providing misleading information had a higher like ratio. Conclusions: The overall video quality was poor indicating inappropriate educational and informative value for patients who search information about carbon monoxide poisoning. Int J Occup Med Environ Health. 2022;35(3)

Objectives: The outbreak of the COVID-19 pandemic has brought commercial, social, and economic consequences in every country that has experienced substantial SARS-CoV-2 infection rates. The complete change in the environment that took place due to the outbreak of the pandemic can lead to stressful situations, especially among healthcare personnel. Material and methods: The research were conducted during the COVID-19 pandemic between the 27 March 2020 and the 20 April 2020. The research included 1984 employees of emergency medical systems in seven European countries. An internet-based questionnaire format was adopted for the study (ΩMc-Donald > 0.7). Results: The highest level of stress was experienced by personnel in the United Kingdom M = 4.03, and the lowest by Norwegian employees M = 2.89. High levels of stress were also experienced by nurses from Spain and Poland. Women actively working in the healthcare system during the pandemic experienced higher stress levels than men. Conclusions: Women working in European emergency medical systems are more vulnerable to work-related stress, while carrying out emergency medical procedures during the pandemic. Differences in the level of stress experienced while carrying out duties in pre-hospital conditions were only found among Spanish emergency medical system personnel.

Background: Identifying predictive factors based on procedures carried out by emergency medical teams may speed up the diagnosis of AMI. By shortening the time between the onset of the pain and the initiation of coronary reperfusion, patient prognosis can be improved Methods: The study was conducted on residents of the Bielsko-Biała district, served by state ambulance service Medical Response Teams (MRT). The patients were assigned to the following groups: Group A (n = 338) - patients with chest pain in whom infarction with elevation of the ST segment (ST-ACS) was diagnosed on the basis of an ECG, Group B (n=300) - patients with chest pain in whom an infarction was not diagnosed. A factor structural test for the studied parameters was used to determine their significance. An odds ratio (OR) was established for statistically significant parameters, and multi-dimensional logistic regression analysis was conducted. The significance of the odds ratios (OR) was estimated for individual risk factors based on 95% confidence intervals (CI). Results: It can be stated with 95% probability that the significant parameters: Male (p=0.00001), Age 51-70(p=0.00307), Breathing rate less than 12/min(p=0.02711), Pulse below 60 min (p=0.00165), Edemas (p=0.00075), Moist skin(p<0.01), Sinus rhythm (p=0.00004), Additional ventricular beats(p=0.00133) increase the risk of myocardial infraction. Conclusion: Identifying the predictors of myocardial infarction specific to pre-hospital emergency care is essential for improving the detection of AMI and shortening the time between calls to the MRT and the initiation of coronary reperfusion.

Introduction: Tracheal intubation is the optimal method for opening up airways. Performed correctly, it prevents stomach contents from entering the respiratory tract and allows asynchronous cardiopulmonary resuscitation (CPR) to be conducted during sudden cardiac arrest. An important element of correct intubation is proper inflation of the endotracheal tube cuff. Research has shown that when medical personnel use the palpation technique, the cuff is usually inflated incorrectly. This can result in numerous health complications for the patient. Methods: This research was conducted in 2020 on a group of paramedics participating in the 15th International Winter Championship of Medical Rescuers in Bielsko-Biala (Poland). The aim of the research was to assess two methods of inflating the endotracheal tube cuff. Method A involved inflating the cuff using a syringe and assessing the pressure in the control cuff using the palpation technique. Method B involved inflating the cuff using a manometer. During the inflation, both the cuff inflation pressure and the time required to complete the procedure were recorded. Analysis was also conducted on whether completion of certified Advanced Life Support (ALS) and Advanced Cardiovascular Life Support (ACLS) training had any influence on the effectiveness of the inflation procedure. Results: The research showed that paramedics using Method B significantly more often inflated the endotracheal tube cuff to the correct pressure than those using Method A. However, when Method B was used, the procedure took longer to conduct. The study also showed that completion of certified ALS or ACLS training did not have a significant influence on proper inflation of the cuff. Those who had completed certified training courses took significantly longer to inflate the endotracheal tube cuff when using Method A. Conclusions: Inflation of the endotracheal tube cuff by use of a syringe, followed by the palpation technique for assessing the inflation of the cuff balloon, is ineffective. Paramedic teams should be equipped with manometers to be used for inflating the endotracheal tube cuff.

Respiratory tract burns are among the most serious injuries. Complications include rapid swelling of the respiratory tract, which is the cause of high mortality rates. Such injuries require appropriate specialist treatment. The priority in emergency medical care is to ensure the airways remain unobstructed. If symptoms appear that suggest rapidly increasing swelling of the respiratory tract, intubation becomes essential to ensure the airways remain open. The aim of this article is to discuss the issue of the necessity to develop guidelines for emergency medical personnel attending patients with respiratory tract burns. Currently, according to the State Emergency Medical Care statute, paramedics may carry out intubation on patients suffering from sudden cardiac arrest. According to the Regulation of the Minister of Health of the 20th April 2016, the list of actions that a paramedic may freely undertake does not include intubation of patients with rapidly increasing swelling of the respiratory tract caused by burns. Taking into consideration the decrease in the number of specialist teams, recommendations should be developed as quickly as possible on indications for prompt intubation of patients with inhalation injuries. The scope of emergency medical treatment carried out independently by paramedics should also be expanded.

Aim: To determine the importance of electrocardiogram (ECG) teletransmission on the time required for decisions on diagnosis and treatment and the transport of patients with myocardial infarction. Material and methods: This study is retrospective in character and concerns the regional activities of the Bielsko Emergency Medical Services and the possibility of sending medical data electronically from a patient’s location to the clinic of interventional cardiology (CIC). Group A (n=237) included patients in whom the Medical Response Team (MRT) confirmed ST-Elevation Myocardial Infarction (STEMI) and carried out an ECG with data teletransmission to the CIC. Group B (n=101) included patients in whom the MRT confirmed STEMI and carried out an ECG without teletransmission. For both groups, the MRT recorded the time of arrival at the patient’s location and the time when the patient was handed over to the CIC. Results: A group of 638 patients were identified in whom the chest pain was of cardiac origin. Of these patients, 338 were identified as patients with diagnosed STEMI. A significant dependence was demonstrated of the time t [mins] of teletransmission (p=0.00308). A significant dependence was demonstrated of the effect of distance s [kms] (p=0.00000). A significant dependence was demonstrated of the time t from the place of residence, taking into account the distance s (p=0.00929). Conclusions: Using ECG teletransmission in pre-hospital procedures shortens the time for diagnosis and transport of patients with STEMI, and thus improves the results of treatment.

The aim: Methemoglobina is an oxidized form of hemoglobin, which normally doesn`t exceed 1%. It is stated that the amount of methemoglobin over 70% is fatal. The etiology vary, it might for instance be idiopathic, congenital or caused by toxic compounds. Material and methods: We analyzed the case of patient who had exceeded the fatal level of methemoglobin in a blood. Case report: Medical Air Rescue Team was dispatched to an 80-year-old patient who suddenly lost consciousness at home. Methemoglobin level was measured using Cobas b221 system and amounted to 75%. Given the patient’s advanced age, congenital causes of methemoglobinemia, such as deficiency of cytochrome-b5 reductase or nicotinamide adenine dinucleotide reductase (NADPH-MHb reductase) were excluded a priori. It seems that the only reason for the observed methemoglobinemia in the case of the examined patient was the acquired methemoglobinemia. The patient was treated with methylene blue with good results, her state improved soon. Despite a detailed interview, it was impossible to establish the etiological factor of methemoglobinemia. None of the household members exhibited clinical symptoms of poisoning with methemoglobinogenic substance. Although the methemoglobin level was potentially deadly, the patients survived. Conclusion: It should be stressed that it is not always possible to determine the etiological factor of the discussed disorders. Knowledge of the clinical picture of poisoning, as well as of the changes characteristic for poisoning and observable in laboratory, is extremely important, especially when it is not possible to determine the etiological factor of poisoning.