Analysis of Emergency Medical Response Team Performance during the International Winter Championships in Emergency Medicine.

Background and Objectives: Conducting advanced life support (ALS) according to the guidelines of the European Resuscitation Council (ERC) requires medical personnel to implement the appropriate emergency actions. In particular, these actions include chest compressions, airway management, artificial ventilation, defibrillation and the administering of medicines. An appropriate training system enables members of medical response teams (MRT) to acquire the essential knowledge and skills necessary to correctly conduct cardiopulmonary resuscitation (CPR). One way to improve the quality of interventions by MRT personnel is participation in emergency medicine championships. Materials and Methods: The research analysed assessment cards for tasks carried out during the International Winter Championships in Emergency Medicine in the years 2013-2020. The assessed tasks were prepared and led by European Resuscitation Council instructors of advanced life support. During ten-minute scenarios of simulated sudden cardiac arrest (SCA) in adults, the judges assessed the compliance of procedures with current ERC guidelines. This research analysed the performance of 309 teams from Poland made up of paramedics from medical response units from all over the country. Results: In most cases, the study showed significant differences in the percentage of correctly performed procedures between years. Most often, the highest percentage of correctly performed procedures was recorded in 2019 and 2020. The lowest percentage of correctly performed procedures was most often recorded in 2013. In subsequent years, the percentage of use of tracheal intubation decreased (from 54.76% to 31.25%) in favour of an increase in the use of supraglottic airway device SAD (from 35.71% to 59.38%). Conclusions: The research has shown that in subsequent years of the Championships, the quality of the majority of assessed procedures carried out by members of MRT gradually improved. The research authors also observed that in subsequent years, the percentage of intubations decreased in favour of SAD.

Factors which impact the length of hospitalisation and death rate of COVID-19 patients based on initial triage using capillary blood gas tests: a single centre study.

An important element in the effective treatment of patients infected with the SARS-CoV-2 virus during the pandemic is an effective early triage to determine patient allocation and in-patient therapy. This paper assesses the prognostic value of capillary blood gas tests in predicting extended hospitalisation and death due to COVID-19. This retrospective statistical research is based on a group of 200 patients, hospitalised from 15 October 2020 to 08 March 2021. The study utilised the treatment documentation of these patients hospitalised due to COVID-19 at the Pulmonology and Thoracic Surgery Centre in Bystra (Southern Poland) during this period. The hospital has 50 beds with access to oxygen for COVID-19 patients and a five-bed intensive care unit. On the basis of the obtained results, conclusions were drawn that the need for early oxygen therapy with an oxygen mask and low pH values in capillary blood are significant risk factors for prolonging hospitalisation due to COVID-19. Age, the need for early oxygen mask therapy and low oxygen saturation are important risk factors for death from COVID-19. Capillary blood gas analysis is a simple and effective method of early in-patient segregation of COVID-19 patients.

Differences in Perceived Occupational Stress by Demographic Characteristics, of European Emergency Medical Services Personnel during the COVID-19 Virus Pandemic-An International Study.

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.

Thermal Effects of Topical Hyperbaric Oxygen Therapy in Hard-to-Heal Wounds-A Pilot Study.

Clinical studies have been performed to evaluate the thermal response of topical hyperbaric oxygen therapy (THBOT) in patients suffering from hard-to-heal wounds diagnosed as venous leg ulcers located on their lower extremities. It was found that this therapy leads to a temperature decrease in areas around the wound. Moreover, a minor temperature differentiation between all areas was seen in the third period of topical hyperbaric oxygen therapy (THBOT) that may suggest that microcirculation and thermoregulation improvement start the healing process. On the other hand, the results of the conducted studies seem to prove that thermal imaging may provide a safe and effective method of analyzing wound healing of hard-to-heal wounds being treated with THBOT. This is the first study that tries to show the possibilities of a very new method by evaluating treatment of hard-to-heal wounds using thermal imaging, similar to the hyperbaric oxygen therapy effects evaluated by thermal imaging and described previously. However, the first clinical results showed a decrease in temperature due to the THBOT session and some qualitative similarities in the decrease in temperature differentiation between the studied areas and the temperature effects obtained due to hyperbaric oxygen therapy.

Endotracheal Tube Cuff Pressure - Comparison of the Two Filling Methods - Simulated Test.

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.

Orbital reconstruction - applied materials, therapeutic agents and clinical problems of restoration of defects.

Reconstruction of large cavities in the skull and facial regions is important not only to restore health but also for the correction of facial distortions. Every visible deformity in the facial region of the patient affects their mental wellness and perception by society, entailing both, deterioration of health, but also a decrease in the performance in society, which translates into its productivity. With the progressive degradation of the natural environment, cancer, in the coming years, will be on the leading causes of morbidity and mortality. The review focuses on two main aspects: (i) the causes of injuries leading to the necessity of removal of orbital cavities occupied by the tumor and then their reconstruction, with the focus on the anatomical structure of the orbital cavity, (ii) the materials used to reconstruct the orbital cavities and analyze their advantages and disadvantages. The manuscript also underlines the not yet fully met challenges in the area of facial- and craniofacial reconstruction in people affected by cancer.

Predictors of stress among emergency medical personnel during the COVID-19 pandemic.

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):139-49.

Porcine Transgenic, Acellular Material as an Alternative for Human Skin.

Although new therapeutic approaches for burn treatment have made progress, there is still need for efficient coverage of donor fields. Promising dressing for skin graft donor site should be biocompatible, attach easily to the wound bed, remain in place until donor site has renewed, and decrease morbidity at the site. Porcine skin may be applied as a dressing for severe burns. Therefore pig skin xenografts can be used also as donor field coverage. In the Burn Treatment Centre, we used gauze soaked in Vaseline to secure donor fields. The aim of the study was to check if transgenic porcine skin is better than standard in donor site coverage used in our center. We showed that dressing reduces pain experienced by patients. The dressing leads to a reduction of hospitalization time by an average of 8 days. The dressing is as safe as the gold standard. Securing the donor field reduces the risk of colonization of the wound in the second smear after application by 60%. The disadvantage of the dressing is the inability to absorb blood; the use of hemostatic ointments in combination with the skin of transgenic pigs should be considered in the future.

Amniotic Stem Cells Cultured on Thermoresponsive Polymers Allow Obtaining a Full Cell Sheet.

Amniotic stem cells promote adhesion and migration of epithelial cells. Obtaining a full sheet containing amniotic stem cells seems to be the best solution for the treatment of burn wounds. The main advantage of this method is obtaining a full sheet of cells by lowering the temperature below the transition temperature, which does not affect extracellular matrix. The purpose of this work was to produce a skin substitute-a full sheet consisting of amniotic mesenchymal stem cells-and compare with well-known fibroblast sheet. Amniotic membrane cells revealed better tendency to full sheet detachment than fibroblasts. Confluence after 24 hours was always higher on polymer-coated dishes than on normal polypropylene dishes. Also viability was higher than on the control culture dish, while the number of apoptotic cells was always highest on polypropylene (control). Ile-Lys-Val-ala-Val (IKVAV) 0.28 addition to poly (poly [ethylene glycol] ethyl methacrylate) (PTEGMA) caused best cell confluence and highest percentage of cells in mitosis phase of cell cycle, but also worst cell detachment was observed in both cell types on PTEGMA IKVAV 0.28. Viability of cells transferred in cell sheet form onto a new culture dish was higher than when detached as suspension enzymatically. Additionally, percentage of apoptotic cells transferred in cell sheet form onto a new culture dish was always lower than when detached as suspension enzymatically. Culturing of PTEGMA, PTEGMA IKVAV 0.28 and PTEGMA IKVAV 0.14 have a stimulating effect on number of cells in mitosis in amniotic cell culture even after cell sheet transfer onto a new dish, whereas such effect with fibroblast was not observed.

Amniotic and Umbilical Cord of Transgenic Pigs as an Alternative Source of Stem Cells.

BACKGROUND: The placenta is worthy of consideration as a source of tissues for transplantation. Porcine material preparation allows significantly more grafts to be obtained than human material. Amniotic cells are a very practicable stem cell type and easy to obtain with great potential, compared with, for instance, adipose-derived stem cells. The aim of this paper was to verify if porcine transgenic amnion and umbilical cord could be as effective for xenotransplantation of stem cells as human material. METHODS: Oxytocin was administered to the sows on the day the material was obtained. The obtained material was divided by weight into 4 relatively equal parts, which were transferred into 1 of 4 containers. The containers had different transport media and a concentration of antibiotics. After cell isolation by homogenization, the number of live, dead, and apoptotic cells was assessed. RESULTS: Maintaining the sterility when obtaining material from breeding pigs was the biggest problem. Transport medium, despite the addition of antibiotics, was in most cases infected. Tests revealed that porcine cells have a tendency to leave tissue material and adhere to plastic as human cells do. Porcine cells are also fibroblast like, which can suggest that these cells might be tested for the presence of mesenchymal stem cells. However, some differences are visible in all parameters, which can result from contamination of material or improper transport medium. There were significant differences between viability and apoptotic cell number in human and transgenic pig cells isolated from both sources---amniotic membrane and umbilical cord.

The Causes for the Loss of Cellular Material at the Qualification Stage and the Influence of the Patient's Flora on Culture Infection.

There are several causes leading to the loss of cellular material earmarked for transplantation. This paper aims to evaluate the number of lost donors and lost cells in the culture by means of verifying both the results of the qualification tests and the presence of microorganisms in the cellular material. The analysis involved 86 donors hospitalized for thermal burns, from whom cells were harvested for keratinocyte and fibroblast cultures in the years 2011 to 2015. All potential donors underwent qualification tests: Anti-HIV-1,2; HBsAg; Anti-HCV-Ab; HBc, and a specific test for syphilis. In the case of skin fragments collected for culturing, the microbiological tests included the carrying fluid, the medium after 1 change, and the medium during culturing and before transplantation. Skin donors for cell cultures were assigned to the groups based on if the skin was collected up to 7 days following the burn or later. On average, 12% of the disqualifications were reported among donors for cell culturing. The most frequent cause of donor disqualification (54% of all disqualifications) was a positive HBc(+). The occurrence of fungal infections detected in the cellular material was over 30%. Establishing the culture after day 7 following the injury immediately increases the risk of infection by 25% in comparison to those cultures established before or on day 7 following the injury. Proper disinfection of donor place is crucial, but sometimes insufficient for maintenance sterility in cell culture. The risk of infection increases 25% after 7 following the injury.

The Effect of Lauric Acid on Pathogens Colonizing the Burn Wound: A Pilot Study.

OBJECTIVE: Some of the most serious complications of burns include septic infections. Instead of fulfilling the function of a protective barrier, tissues damaged by high temperature create a niche that serves as an environment and source of nourishment for pathogens. An accepted practice is to use antibiotics to inhibit development of pathogens. Taking into consideration the characteristics of the burn wound and increasing antibiotic resistance, the search for new substances that have both antimicrobial and regenerative effects seems justified. The aim of the study was to determine the influence of lauric acid on bacteria-colonizing tissue samples taken during surgical treatment of burns. METHODS: Lauric acid was combined with 5 different ointment bases: Anhydrous Eucerin DAB, Anhydrous Eucerin II, Hydrophilic Vaseline, White Vaseline, and Lekobaza. The content of lauric acid in the ointment bases was 10% to 20% w/w. The preparations were applied onto samples of burnt skin collected during surgery. The samples were subsequently subjected to a microbiological test with the use of model strains of Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli. RESULTS: With one exception (White Vaseline), lauric acid showed a more pronounced effect on bacteria in 20% w/w concentration. In a 10% lauric acid concentration, no effect on bacteria was observed on the Hydrophilic Vaseline ointment base. Lauric acid had the strongest inhibiting effect on microbial growth of Gram-positive Staphylococcus aureus. Satisfactory zones of inhibition were also observed in the case of Escherichia coli. Growth inhibition of Pseudomonas aeruginosa was observed only when pure lauric acid was used. CONCLUSIONS: Due to its aseptic and regenerative effect on chemically damaged tissues, lauric acid can be a promising modifier of the burn healing process.

Comparison of standard and over-the-head method of chest compressions during cardiopulmonary resuscitation - a simulation study.

BACKGROUND: Maintaining highly effective cardiopulmonary resuscitation (CPR) can be particularly difficult when artificial ventilation using a bag-valve-mask device, combined with chest compression have to be carried out by one person. The aim of the study is to compare the quality of CPR conducted by one paramedic using chest compression from the patient's side with compression conducted from the 'over-the-head' position. METHODS: The subject of the study were two methods of CPR - 'standard' (STD) and 'over-the-head' (OTH). The STD method consisted of cycles of 30 chest compressions from the patient's side, and two attempts at artificial ventilation after moving round to behind the patient's head. In the OTH method, both compressions and ventilations were conducted from behind the patient's head. RESULTS: Both CPR methods were conducted by 38 paramedics working in medical response teams. Statistical analysis was conducted on the data collected, giving the following results: the average time of the interruptions between compression cycles (STD 9.184 s, OTH 7.316 s, p < 0.001); the depth of compression 50-60 mm (STD 50.65%, OTH 60.22%, p < 0.001); the rate of compression 100-120/min. (STD 46.39%, OTH 53.78%, p < 0.001); complete chest wall recoil (STD 84.54%, OTH 91.46%, p < 0.001); correct hand position (STD 99.32%, OTH method 99.66%, p < 0.001). A statistically significant difference was demonstrated in the results to the benefit of the OTH method in the above parameters. The remaining parameters showed no significant differences in comparison to reference values. CONCLUSIONS: The higher quality of CPR in the simulated research using the OTH method by a single person justifies the use of this method in a wider range of emergency interventions.

A Histologic Perspective on Electrical and Thermal Burn-Injured Human Skin.

OBJECTIVE: To analyze specific spectroscopic (FT-Raman) and thermal (limiting oxygen index) aspects of skin samples exposed to electrical injury compared with thermal injury. METHODS: An observational case-control study was conducted at the Dr Stanislaw Sakiel Center for Burns Treatment in Siemianowice, Silesia, Poland. A scanning electron microscope was used to diagnose and illustrate the topography of skin samples from electrical and thermal burns and the morphologic effects on damaged versus undamaged skin surfaces. In particular, researchers attempted to detect spectroscopic and thermal changes at the molecular level, namely, specific biomarkers of tissue degeneration and their regeneration under the influence of the applied modifiers (antioxidants and orthosilicic acid solutions). RESULTS: Modification with L-ascorbic acid and hydrogel of orthosilicic acid caused an increase in the intensity of the amide I Raman peaks, whereas modification with sodium ascorbate and orthosilicic acid resulted in the separation of the band protein side chains (1,440-1,448 cm), which is a part of tissue regeneration. The best result was obtained when the skin was treated with 7% orthosilicic acid (limiting oxygen index, 26%). CONCLUSIONS: Antioxidant treatment may be advantageous in minimizing injury in patients with thermal burns but not always in electrical burns.

Fibroblast and keratinocyte crosstalk: the effect of a poly(tri[ethylene glycol] ethyl ether methacrylate) thermoresponsive surface on short-term co-culture.

The treatment of difficult-to-treat wounds can be challenging. Although a number of approaches have been investigated, the healing process may be slow and unsatisfactory. An alternative approach is the use of a continuous sheet of skin cells applied over a wound which may improve cell implantation and patient recovery. To analyse the gene expression profile of fibroblast/keratinocyte co-culture on poly(tri[ethylene glycol] ethyl ether methacrylate) (P[TEGMA-EE]), a thermoresponsive biocompatible surface. Cultures were grown for 72 hours as a continuous layer on P(TEGMA-EE). Assays for genotoxicity, cell morphology, and fluorescence-assisted flow cytometry were performed to exclude adverse effects. A gene expression profile related to the extracellular matrix was investigated by microarray analysis. For fibroblast monocultures and fibroblast/keratinocyte co-cultures maintained for 72 hours on P(TEGMA-EE), no change in morphology or specific surface markers, or DNA damage (comet assay) was observed, relative to control surface. Moreover, no detrimental impact was ascertained based on microarray analysis. In response to lowered temperature, the detachment of a continuous cell layer sheet from the thermoresponsive surface was observed. When gene expression was compared between fibroblasts cultured alone and co-cultured with keratinocytes on P(TEGMA-EE), 10 genes were shown to be differentially expressed. Of these genes, six were significantly differentially expressed between cultures grown on P(TEGMA-EE) and human skin samples. Our results indicate that P(TEGMA-EE) is fully biocompatible and is therefore a suitable surface for successful preparation and recovery of two-layered fibroblast/keratinocyte co-culture as a continuous sheet of cells.

Does the transplantation of keratinocytes really reduce the risk of death? Survival analysis of patients hospitalized at the Dr Stanislaw Sakiel Centre for Burns Treatment in 2008-2015.

BACKGROUND: Keratinocyte transplantation is an adjuvant procedure in the extensive burn therapy method. However, it must be taken into consideration that clinical results of keratinocyte transplantation are ambiguous and progress achieved in this method is still being verified, especially due to the high cost of cultured epithelial autograft (CEA) transplants. OBJECTIVES: The aim of this study was to verify the impact of cultured keratinocyte application on patients' survival. This study included a group of patients with the highest chance for a successful outcome of the therapy and excluded patients with no compelling reason to apply for such an expensive therapy. MATERIAL AND METHODS: This study included all the patients with burns diagnosed between January 1, 2008 and January 1, 2016, who were treated with cultured skin cells. Patients' age and gender, percentage of total body surface area (TBSA) affected, percentage of burn depth of the 3rd/4th degree, number of days between admission and surgery, and need for rehabilitation were analyzed. RESULTS: The cultured cell application did not significantly affect the risk of death (p > 0.05). CONCLUSIONS: Keratinocytes should be applied as an adjunctive method for the treatment of burns with at least 40% TBSA affected, but with a maximal burn depth of the 2nd degree. In the group of patients below 50 years of age, a higher number of transplants with a cell population above 20 million/mL and a significantly lower mortality rate were observed, which means that in the mentioned age group, this graft was more effective. It has been suggested that patients older than 50 years of age with burns deeper than of the 2nd degree should be treated with more advanced methods like, e.g., the application of stem cells.

Thermal imaging and planimetry evaluation of the results of chronic wounds treatment with hyperbaric oxygen therapy.

BACKGROUND: One of the methods to treat chronic wounds is the use of hyperbaric oxygen (HBO). Objective measurement of the wound surface is an important element in the process of monitoring and predicting the progress of treatment. OBJECTIVES: The aim of the study was to evaluate the effect of hyperbaric oxygen therapy (HBOT) on ulcer wound healing in patients with chronic venous insufficiency ulcers and diabetic foot syndrome using thermal imaging and computerized planimetry. MATERIAL AND METHODS: During a 3-year period, 284 digital computer planimetry measurements were gathered from 142 patients treated for leg ulcers caused by chronic venous insufficiency and ulcers from diabetic foot syndrome at HBOT Unit of the Dr Stanislaw Sakiel Centre for Burns Treatment in Siemianowice Slaskie (Poland). Each patient took 30 HBOT sessions using a Haux multiplace HBO chamber at a pressure of 2.5 atmospheres absolute (ATA). The results of the treatment were monitored by thermovision and computerassisted planimetry measurements performed before and after HBOT. RESULTS: Both groups of patients exhibited a reduction in the surface and perimeter of the wound after HBOT. The treatment effects were also confirmed by thermal imaging. The areas calculated from thermal imaging and planimetry are different but correlated. CONCLUSIONS: It seems that a combination of thermal imaging and planimetry may enhance the diagnosis as well as provide the physician with more information about therapy effects.

Isolation, culturing and preparation for transplantation of amniotic mesenchymal stem cells Repetitive and reproducible laboratory, technical protocol.

To date, different methods of isolation of amniotic stem cells have been developed. Our previous studies have demonstrated that there are significant differences in viability and efficiency of the isolation and culture process depending on the enzyme and medium used. The aim of this study was to present efficient protocol, which can be used within good manufacturing practise conditions. Amniotic membranes were obtained from ten woman 31-39 years old who signed informed constent. GMP regulations are applicable. The described protocol aims to obtain a clinically significant cell yield (>1*108). The cells may be maintained in the growth phase even for 2 months. The mesenchymal cells constitute about 75-95% of the cells in primary culture. Supervisory authorities require repetitive and reproducible laboratory protocol for stem cells culture. Presented protocol allow achieving clinically significant cell yield (>1*108) in 4-5 weeks. Cells can be transplanted as suspension or cell sheet.

A New Triage Method for Burn Disasters: Fast Triage in Burns (FTB).

BACKGROUND There are few triage methods based on patient age and extent of burn. However, in case of mass casualties, age might be hard to define. Burn segregation in mass-casualty accidents requires an easy, fast, and effective method. Triage in burns should also segregate casualties requiring treatment in burn centers. The aim of this study was to create a proprietary segregation algorithm dedicated to mass-casualty incidents. MATERIAL AND METHODS A retrospective analysis of 939 burned patients admitted to the Clinical Department of Burns, Plastic and Reconstructive Surgery, Military Institute of Medicine (MIM) in Warsaw and to the Center for the Treatment of Burns (CTB) in Siemianowice Slaskie in 2012 and 2013 was performed. The aim was to reveal which early factors could be used during segregation of burn victims in mass-casualty incidents on the battlefield and in civilian circumstances. Only easy and quick-to-evaluate factors that can be examined without medical equipment and laboratory tests were used in creating the proprietary triage algorithm. RESULTS As a result of our study, we created an algorithm for fast triage in mass-casualty situations. The algorithm is based on parameters that can be easily evaluated without additional equipment. To create the algorithm, we used factors that had the strongest impact on mortality prediction in severely burned patients, in multifactor analysis: advanced age (p<0.001. OR=1.04), extent of the deep burn (p<0.001. OR=1.1), and low systolic arterial pressure (p<0.001. OR=0.96). CONCLUSIONS The FTB (Fast Triage in Burns) algorithm is a new triage method dedicated for massive burn events in civilian circumstances. The FTB algorithm is a simple, quick, and credible means of segregating burn victims. The algorithm is dedicated to use in pre-hospital care, during mass-casualty events both in civilian and battlefield circumstances. The aim is to be able to evaluate burn victims immediately, without access to medical equipment or additional tests and to evaluate indications for burn center care. It is a unique method designed to be used during segregation in isolated burn mass-casualty incidents.

Computerized planimetry evaluation of hyperbaric oxygen therapy in the treatment of diabetic foot.

BACKGROUND: Diabetic foot ulcer is one of the major complications of diabetes mellitus in adults. OBJECTIVES: The aim of the study was to conduct a planimetry evaluation of the effectiveness of hyperbaric oxygen therapy (HBOT) in the treatment of patients with vascular disorders caused by diabetic foot. MATERIAL AND METHODS: The study included 94 patients, 30 females (32%) and 64 males (68%), aged 33-76 years, with diabetes lasting 1.5-32 years, who underwent HBOT due to diabetic foot. All patients from that group underwent vascular procedures prior to HBOT. In qualifying patients for hyperbaric oxygen therapy, transcutaneous oximetry method was applied (30-60 exposures in hyperbaric oxygen at pressure of 2.5 ATA). Progress in wound healing was evaluated by computerized planimetry system IRIS 4. RESULTS: In 26 patients the wounds were completely closed and in 37 patients the topical state was significantly improved - the wound surface decreased by 34% in average. During the treatment, in 11 patients amputation of fingers and metatarsal necrotic bones was performed, while in 9 patients amputation was prevented. CONCLUSIONS: A planimetry evaluation showed that the application of HBOT in the treatment of diabetic foot enhances foot ulcer healing, reduces tissue damage, contributes to the reduction of complications related to soft tissue and bone infections.