COVID-19 in Pediatric Intensive Care Units in Poland, PAPITCO-19 Study (Polish Analysis of PICU Trends during COVID-19).

BACKGROUND: Children suffering from COVID-19 constitute about 10% of the entire population infected with the virus. In most of them, we observe asymptomatic or mild courses; however, about 1% of affected children require a stay in a paediatric intensive care unit (PICU) due to the course of the disease becoming severely life-threatening. The risk of respiratory failure, as with adults, is associated with the coexistence of concomitant diseases. The aim of our study was to analyse patients admitted to PICUs due to the severe course of their SARS-CoV-2 infection. We studied epidemiological and laboratory parameters, as well as the endpoint (survival or death). METHODS: A retrospective multi-centre study, the analysis covered all children with a confirmed diagnosis of SARS-CoV-2 virus infection who were admitted to PICUs in the period from November 2020 to August 2021. We studied epidemiological and laboratory parameters, as well as the endpoint (survival or death). RESULTS: The study analysed 45 patients (0.075% of all children hospitalised in Poland due to COVID-19 at that time). Mortality calculated in the entire study group was 40% (n = 18). Statistically significant differences between the compared groups (survived and died) concerned the parameters of the respiratory system. Lung Injury Score and the Paediatric Sequential Organ Failure Assessment were used. A significant correlation between disease severity and the patient's prognosis was shown by the liver function parameter AST (p = 0.028). During the analysis of patients requiring mechanical ventilation and assuming survival as the primary outcome, a significantly higher oxygen index on the first day of hospitalisation, lower pSOFA scores and lower AST levels (p: 0.007; 0.043; 0.020; 0.005; 0.039, respectively) were found. CONCLUSIONS: As with adults, children with comorbidities are most frequently at risk of severe SARS-CoV-2 infection. Increasing symptoms of respiratory failure, the need for mechanical ventilation and persistently high values of aspartate aminotransferase are indicators of poor prognosis.

Comparison of Professionally and Parentally Administered Analgesia Before Emergency Department Admission.

BACKGROUND: Pediatric patients frequently present to emergency departments in pain. AIM: A cross-sectional prospective study was conducted to investigate the prevalence of acute pain in children attending the ED and arriving by ambulance, as well as the initial ED management of pain. We describe pediatric pain management practices in the pediatric ED, as well as parental pain relief. METHOD: Demographic data, medications, and type of transport to hospital were noted. Pain was assessed upon admission and 30 minutes after administration of analgesia. To standardize pain evaluations, only children aged 4 years or older were included in the study. A numeric rating scale was used to assess pain intensity. RESULTS: The study group consisted of 124 patients. More than 80% of the patients suffered from trauma, injuries to the extremities were the most common cause of admission, and the patient population showed male predominance (62.1%). Over half of the patients (64.51%) were transported by ambulance. Analgesia was administered in 63.5% of the ambulance cases in contrast to only 13.3% of children brought by their parents. Treatment was significantly related to severity of pain. CONCLUSIONS: Both medical emergency teams and parents administered prehospital analgesia insufficiently and without previous assessment. However, medical emergency teams used medications more often than parents. Analgesic therapy used in the emergency department resulted in significant pain reduction.

Neonatal Pictures in a NICU as a Mode of Nursing Intervention to Enhance Parent-Infant Bonding: Parents' Experience during the COVID Pandemic.

INTRODUCTION: Neonatal departments around the world have changed their policies to prevent the spread of infection during the COVID-19 pandemic. The birth of an extremely premature baby can disrupt physical contact between the mother/parent and the baby. This situation affects the bonding process between mother and child. The aim of the study was to investigate the opinions of parents who receive photographs or videos of their children electronically on the usefulness of this intervention, as well as the emotional reaction of parents to the photos or videos received, and potential ways to improve the intervention. METHODS: The study used a qualitative approach and relied on phenomenology, which is a research method used to study experience as experienced from the subjective point of view. Pilot interviews were conducted in January and February 2021, and the final study ran from March to June 2021. RESULTS: The uploaded photographs and videos provided a useful communication tool. The parents' emotions at the proposal to send photographs of the child and while viewing the first photographs were strong and marked by considerable ambivalence. CONCLUSIONS: This study showed how important it is to ensure communication between the parent and the medical staff. Despite the positive reception, in the future obtaining consent from the legal guardian for taking pictures should be considered, whether this form will be accepted, and to ensure the presence of medical staff while the parent is watching the photographs/videos, as this method of communication will not fully ensure direct skin-to-skin contact to build bonds between the parent and the infant. Neonatal intensive care units need to find strategies to mitigate the impact of separation on parental experiences and bonds should a similar situation arise in the future.

Pain Evaluation in the Paediatric Emergency Department: Differences in Ratings by Patients, Parents and Nurses.

The pain experienced by paediatric patients is rarely evaluated in emergency departments. The aim of the present study was to compare the degree of conformity in patients' pain severity when assessed by themselves (if possible), their parents and a triage nurse trained in pain evaluation. METHODS: A cross-sectional observational study was conducted at a tertiary paediatric emergency department in Eastern Poland involving children (aged six months to eighteen years), their parents and nurses. The patients had their pain assessed while collecting a medical history. For children ≥ four years of age, the Numerical Rate Scale was used by patients, parents and nurses to evaluate pain. Patients under four years of age were evaluated by parents and nurses using the FLACC scale. RESULTS: Eighty patients and their parents were enrolled in the study. For children ≥ four years, patients rated their pain significantly higher than both their parents (p = 0.03) and nurses (p < 0.001), with the latter group producing the lowest scores. For children under four years of age, parental pain assessments did not significantly differ from those of nurses. CONCLUSION: Compared to the patients themselves and their parents, nurses tended to assign lower pain scores for children. Pain should be assessed on admission to the ED and, whenever possible, by the patients themselves.

Invitation to participate in a multi-center study for validation of cerebral computed tomography angiography and computed tomography perfusion in the determination of cerebral circulatory arrest during brain death/death by neurological criteria diagnosis procedure in paediatric population below 12 years of age.

We would like to invite paediatric intensive care units (PICU) to join our multi-center trial concerning patient population < 12 y/o and aiming at: • validation of computed tomography angiography (CTA)/computed tomography perfusion (CTP) tests for brain death/death by neurological criteria (BD/DNC) diagnosis procedures, • validation of duplex Doppler insonation of extracranial segments of the internal cerebral arteries and the vertebral arteries for choosing an optimal time for CTA/CTP testing.

Air pollution: how many cigarettes does each Pole 'smoke' every year and how does it influence health, with special respect to lung cancer?

INTRODUCTION: Air pollution is one of the most important issues of our times. Air quality assessment is based on the measurement of the concentration of substances formed during the combustion process and micro-particles suspended in the air in the form of an aerosol. Microscopic atmospheric particulate matters (PM) 2.5 and 10 are mixtures of organic and inorganic pollutants smaller than 2.5 and 10 µm, respectively. They are the main cause of negative phenomena in the earth's atmosphere of Earth and human health, especially on the respiratory and cardiovascular systems. Particulates have the ability to cause permanent mutations of tissue, leading to neoplasms and even premature deaths. Nitrogen dioxide (NO2) is one of the main pollutants which arises mainly during the burning of fossil fuels. Based on numerous scientific researches, it has been proved that long-term exposure to NO2 could increase morbidity of cancer due to inflammatory processes increasing abnormal mutations. MATERIAL AND METHODS: Data available in the Polish National Cancer Registry, Chief Inspectorate for Environmental Protection and Map of Health Needs in the Field of Oncology for Poland, WHO Air Quality Guidelines 2005 were analyzed. Air pollution was also evaluated: PM2.5, PM10, NO2, and compared with lung cancer morbidity. RESULTS AND CONCLUSIONS: Based on the available data and literature, it can be concluded that in 2009-2017, on average, each Pole smoked ten cigarettes a day +/- 2. Therefore, it can be estimated that after 60 years everyone had 30 package-years of smoking, leading to a high risk of lung cancer and other smoking related diseases. Additionally air quality in Poland is not satisfactory, exceeding the standards presented in the WHO Guidelines 2005. It can be assumed that this may translate into an additional, independent continuous increase in morbidity and mortality dependent on smoking.

Peritraumatic distress among emergency medical system employees: A proposed cut-off for the Peritraumatic Distress Inventory.

INTRODUCTION: Emergency medical system (EMS) workers are exposed to traumatic events that may lead to posttraumatic stress disorder (PTSD). OBJECTIVES: The purpose of this study was to explore and discuss the relationship between peritraumatic distress (PD) and elevated posttraumatic stress symptoms (PTSS) in EMS employees. MATERIAL AND METHODS: A cross-sectional study including 100 EMS employees was conducted. Demographic and occupational data were collected for each subject. The Polish version of the Impact of Event Scale-Revised (IES-R) was used to evaluate PTSS and the Polish version of the Peritraumatic Distress Inventory (PDI) was used to determine the level of PD experienced during and immediately after a traumatic event. RESULTS: The highest scores indicative of distress were obtained on the negative emotions subscale, and the lowest on the loss of control and arousal (LCA) subscales. A strong positive correlation was found between the severity of PD and PTSS. Among the PDI subscales, the severity of PTSS was most strongly correlated with LCA, and had the weakest correlation with sense of threat. The optimal PDI cut-off score for predicting elevated PTSS was 19. CONCLUSIONS: PD is strongly related to elevated PTSS and serves as a useful tool for screening EMS workers at risk of developing PTSD. Individuals with PDI scores of 19 or higher are good candidates for specialist consultations aimed at detecting and treating elevated PTSS.

Polish version of the Parental Stressor Scale: Neonatal Intensive Care Unit.

INTRODUCTION: Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) by M. Miles et al. has been developed in order to assess the stress experienced by parents of infants being treated in Intensive Care Units. The measurement of parental stress enables the evaluation of nursing care effectiveness, as well as facilitating the determination of the level of progress made by parents in coping with the difficult situation they face. OBJECTIVES: The aims of the research include: (1) validation of the Parental Stressor Scale: Neonatal Intensive Care Unit into Polish and (2) initial assessment of perceptions of parental stress in a group of 151 parents of infants treated in four NICUs in Poland. MATERIAL AND METHODS: This quantitative cross-sectional study was performed among 151 parents (129 mothers and 22 fathers) of infants treated in four NICUs in central and eastern Poland. The respondents were asked to complete forms following the Parental Stressor Scale: Neonatal Intensive Care Unit, the Impact Event Scale - Revised (IES-R),and their demographics, which combined basic medical data along with socio-emographic data of both parents and children. RESULTS: The three sub-scales distinguished on the basis of the factor analysis (Infant Appearance, Parental Role Alteration, Sights and Sounds) can explain in total 54.89% of variances. Cronbach's alpha for the entire scale equals 0.92, while as follows for the particular sub-scales: Infant Appearance -.92; Parental Role Alteration -.86, and Sights and Sounds - 0.78. CONCLUSIONS: The Polish version of PSS:NICU is an accurate and reliable tool for the assessment of stress experienced by parents whose infants require treatment in NICUs.

Validity, reliability and factor analysis of the Polish version of the Peritraumatic Distress Inventory. / Trafnosc, rzetelnosc i analiza czynnikowa polskiej wersji Skali Dystresu Okolotraumatycznego.

OBJECTIVES: Evaluation of validity and reliability of the Polish version of the Peritraumatic Distress Inventory (PDI) and conducting factor analysis of the tool. METHODS: Cross-sectional study involved 100 employees of the Polish emergency medical system. They completed author's questionnaire, the Polish version of the Impact Event Scale-Revised and the 13-item PDI, validated in this study. RESULTS: Cronbach's alpha coefficient for the entire scale, finally including 12 items, is 0.77. A three-factor structure of the tool has been demonstrated, explaining 60.04% of the variance. This analysis revealed moderate to high values of the factor loadings of all items which form subscales with the exception of the fifth subject. On this basis it was decided to reject the fifth item. Cronbach's alpha for factor 1 (Loss of control and arousal) is 0.75, for factor 2 (Negative emotions) - 0.77 and for factor 3 (Feeling of threat) - 0.68. A strong positive correlation between distress and severity of symptoms of posttraumatic stress disorder (r = 0.70, p < 0.01) was shown. Additionally, distress strongly and positively correlated with the various symptoms of PTSD: intrusion, arousal and avoidance. CONCLUSIONS: Polish version of the PDI is a relevant and reliable distress assessment tool.

Factor analysis and validity of the Polish version of the Peritraumatic Distress Inventory in mothers of seriously ill children.

AIMS AND OBJECTIVES: The purpose of this study was to evaluate and validate the Peritraumatic Distress Inventory (PDI) in mothers of severely ill children hospitalised currently or in the past within a paediatric hospital setting. BACKGROUND: Serious illness in a child causes a sense of fear in her parents, which may occur in variously manifested stress. METHODS/SETTING/PARTICIPANTS: The participants were 135 mothers of children treated in the Intensive Care Unit (ICU), Hematology & Oncology Department, and with perinatal history, who filled out Authors' Questionnaire and the Polish version of the Peritraumatic Distress Inventory. Mothers of all children except those hospitalised in the Intensive Care Unit, additionally filled out the Hospital Anxiety and Depression Scale-Modified (HADS-M) and Impact of Event Scale-Revised (IES-R). RESULTS: Statistical analyses demonstrated a bifactor structure explaining 49.28% of the total variance. The first factor refers to the distress associated with the feeling of threat and somatic reactions, explaining 34.99% of the variance. The second factor, describing negative emotions, explains 14.99% of the variance. Cronbach's α coefficient for the whole scale, eventually consisting of 11 items, is 0.80; for the subscale Feeling of Threat and Somatic Reactions is 0.75, and Negative Emotions is 0.72. The general severity of peritraumatic distress correlates positively with the level of anxiety (ρ = 0.50; p < 0.01) and depression (ρ = 0.49; p < 0.01). CONCLUSIONS: Polish adaptation of the PDI appears to be a valuable tool for studying distress in parents of seriously ill children. RELEVANCE TO CLINICAL PRACTICE: All parents of hospitalised children are at risk of distress so personnel should pay attention to that and report to a clinical psychologist.

Plasma magnesium concentration in patients undergoing coronary artery bypass grafting.

[b]Introduction[/b]. Magnesium (Mg) plays a crucial role in cell physiology and its deficiency may cause many disorders which often require intensive treatment. The aim of this study was to analyse some factors affecting preoperative plasma Mg concentration in patients undergoing coronary artery bypass grafting (CABG). [b]Materials and method[/b]. Adult patients scheduled for elective CABG with cardio-pulmonary bypass (CPB) under general anaesthesia were studied. Plasma Mg concentration was analysed before surgery in accordance with age, domicile, profession, tobacco smoking and preoperative Mg supplementation. Blood samples were obtained from the radial artery just before the administration of anaesthesia. [b]Results. [/b]150 patients were studied. Mean preoperative plasma Mg concentration was 0.93 ± 0.17 mmol/L; mean concentration in patients - 1.02 ± 0.16; preoperative Mg supplementation was significantly higher than in patients without such supplementation. Moreover, intellectual workers supplemented Mg more frequently and had higher plasma Mg concentration than physical workers. Plasma Mg concentration decreases in elderly patients. Patients living in cities, on average, had the highest plasma Mg concentration. Smokers had significantly lower plasma Mg concentration than non-smokers. [b]Conclusions. [/b]1. Preoperative magnesium supplementation increases its plasma concentration. 2. Intellectual workers frequently supplement magnesium. 3. Smoking cigarettes decreases plasma magnesium concentration.

Risk factors for the development of post-traumatic stress disorder and coping strategies in mothers and fathers following infant hospitalisation in the neonatal intensive care unit.

AIMS AND OBJECTIVES: The aim of this study was to identify the potential risk factors for the development of post-traumatic stress disorder in mothers and fathers following infant hospitalisation in the neonatal intensive care unit. BACKGROUND: The development of neonatal intensive care units has increased the survival rate of infants. However, one of the major parental problems is post-traumatic stress disorder. DESIGN: An observational study covered 125 parents (72 mothers and 53 fathers) of infants aged 3-12 months who were hospitalised in the neonatal intensive care unit during the neonatal period. SETTING: Third-referral neonatal intensive care unit. Several standardised and self-reported research tools were used to estimate the level of post-traumatic stress symptoms (Impact Event Scale-Revised), perceived stress (Perceived Stress Scale) and coping strategies (COPE Inventory). The respondents also completed a Parent and Infant Characteristic Questionnaire. RESULTS: The mothers and fathers did not differ in their parental and infant characteristics. Post-traumatic stress disorder was present in 60% of the mothers and 47% of the fathers. Compared to the fathers, the mothers felt greater stress (p = .020) and presented a higher severity of post-traumatic stress disorder (p < .001). Previous miscarriages (p = .023) and the presence of chronic diseases (p = .032) were risk factors for post-traumatic stress disorder in the mothers. In the fathers, an Apgar test at 1 min after birth (p = .030) and a partner's post-traumatic stress disorder (p = .038) were related to post-traumatic stress disorder. The mothers compared to the fathers were more likely to use strategies such as: positive reinterpretation and growth, focusing on and venting of emotions, instrumental social support, religious coping and acceptance. In the fathers, the predictors included an Apgar score at 1 min after birth, a lack of congenital anomalies in the child and mental disengagement. CONCLUSION: Risk factors for post-traumatic stress disorder, as well as coping strategies, differ in women compare to men. RELEVANCE TO CLINICAL PRACTICE: Knowledge of risk factors for post-traumatic stress disorder, specific to men and women, may help identify the parents in whom probability of the occurrence of this disorder is increased.

Post-traumatic growth in parents after infants' neonatal intensive care unit hospitalisation.

AIMS AND OBJECTIVES: To determine the incidence and severity of post-traumatic growth in a group of parents of children hospitalised in the intensive care unit in the past. BACKGROUND: A premature birth or a birth with life-threatening conditions is a traumatic event for the parents and may lead to a number of changes, some of which are positive, known as post-traumatic growth. METHOD: The survey covered 106 parents of 67 infants aged 3-12 months. An original questionnaire and standardised research tools were used in the study: Impact Event Scale - Revised, Perceived Stress Scale, COPE Inventory: Positive Reinterpretation and Growth, Coping Inventory for Stressful Situations, Post-traumatic Growth Inventory and Parent and Infant Characteristic Questionnaire. RESULTS: Due to a stepwise backward variables selection, we found three main factors that explain post-traumatic growth: post-traumatic stress symptoms, positive reinterpretation and growth and dichotomic variable infants' survival. This model explained 29% of the post-traumatic growth variation. Similar models that were considered separately for mothers and fathers showed no significantly better properties. CONCLUSION: Post-traumatic growth was related to a lesser extent to sociodemographic variables or the stressor itself, and related to a far greater extent to psychological factors. RELEVANCE TO CLINICAL PRACTICE: Our study highlights the fact that post-traumatic growth in the parents of neonates hospitalised in the neonatal intensive care units remains under-evaluated.

Pediatric pain management - what are we able to do in Polish emergency medical services?

Pain management in emergency medical care remains underestimated, especially in pediatric patients. This is due to neglecting the issue, lack of knowledge in the appropriate use of analgesics and finally- the fear of being criticized by physicians in hospital departments. Moreover, it is difficult to objectively assess a child with acute pain. Even experienced "adult" anesthesiologists wonder how to recognize if a child suffers strong pain or is just anxious. Many different pain scales are available and some of them may be used in emergency medical care.. The administration of analgesia used in children depends on the patient's age and competencies of the providers of medical emergency teams. Proper pain control and treatment brings immeasurable benefits to the psyche of the child and his guardian. The purpose of this review is to draw attention to the existing problem, present pain scales most suitable for specific groups of children as well as analgesia methods and to propose a simple pain management algorithm based on competencies of the various emergency medical services professional groups in Poland.

Nursing Activities in the Prevention and Treatment of Perioperative Complications After Airway Foreign Body Removal in Pediatric Patients.

PURPOSE: 1) To evaluate postanesthesia complications after bronchoscopy performed for a suspected foreign body (FB) in the pediatric population and 2) To propose an algorithm of nursing activities for management of this problem. DESIGN: A retrospective descriptive design was used. METHODS: A chart review of 155 children who underwent rigid bronchoscopy for FB removal was conducted. FINDING: Complications occurred in 78% of children: 43% of them experienced desaturation below 90% requiring oxygen therapy. Therapy ranged from oxygen administration via blow-by nasal cannula or face mask (89%) to positive pressure ventilation via bag-mask (23%). Seven percent of the population required intubation and admission to intensive care unit (all were less than 2 years of age). CONCLUSIONS: Our results suggest special attention to the children less than 2 years of age as serious respiratory failure may occur after FB removal. The algorithm for nurses was created to manage children after bronchoscopy.

Pediatric pain management - what are we able to do in Polish emergency medical services?

Pain management in emergency medical care remains underestimated, especially in pediatric patients. This is due to neglecting the issue, lack of knowledge in the appropriate use of analgesics and finally- the fear of being criticized by physicians in hospital departments. Moreover, it is difficult to objectively assess a child with acute pain. Even experienced "adult" anesthesiologists wonder how to recognize if a child suffers strong pain or is just anxious. Many different pain scales are available and some of them may be used in emergency medical care.. The administration of analgesia used in children depends on the patient's age and competencies of the providers of medical emergency teams. Proper pain control and treatment brings immeasurable benefits to the psyche of the child and his guardian. The purpose of this review is to draw attention to the existing problem, present pain scales most suitable for specific groups of children as well as analgesia methods and to propose a simple pain management algorithm based on competencies of the various emergency medical services professional groups in Poland.

Risk Factors for Posttraumatic Stress Disorder in Polish Paramedics: A Pilot Study.

BACKGROUND: Working as a paramedic carries the risk of witnessing events and personal experiences associated with emergency life-threatening circumstances that may result in symptoms associated with posttraumatic stress. This problem is well known but still underestimated. OBJECTIVES: The specific study objectives were to 1) assess the influence of sociodemographic and occupational factors on posttraumatic stress disorder (PTSD) among paramedics, and 2) suggest preventive strategies in this population. METHODS: This prospective, descriptive study examined a sample of 100 paramedics who agreed to complete the Author Questionnaire comprising demographic questions and the Impact of Event Scale-Revised. RESULTS: The total prevalence of PTSD in the examined group was 40.0% (women = 64.3%, men = 36.1%). It was more frequently reported in paramedics working under an employer's contract than among those who were self-employed. It occurred less frequently in persons with more education. Other sociodemographic factors studied showed no significant impact. A statistically significant effect of exposure to certain types of traumatic events on the incidence of PTSD was found. There was no significant correlation between the prevalence of PTSD and the occurrence of problem situations in respondents' workplaces. CONCLUSIONS: Polish paramedics who agreed to take part in the survey were shown to have a high rate of PTSD. Multi-center screening and early supportive management is recommended.

Post-traumatic stress disorder in parents of children hospitalized in the neonatal intensive care unit (NICU): medical and demographic risk factors.

BACKGROUND: Post-traumatic stress disorder (PTSD) among parents of neonates hospitalized in the Neonatal Intensive Care Units (NICU) stays an underestimated problem. We determined the incidence of PTSD in parents and pointed out medical and demographic risk factors for PTSD in neonates hospitalized in the NICU. SUBJECT AND METHODS: The study involved 39 mothers and 27 fathers of 42 infants aged 1 to 16 months who were hospitalized in the NICU of a Children's University Hospital during the neonatal period. As a measure of PTSD we used the Polish version of the Impact of Event Scale-Revised (IES-R). The current level of stress was measured using the Perceived Stress Scale (PSS-10). The author's questionnaire contained demographic and medical information on the infants hospitalized in the NICU and their parents. Data were statistically analyzed. RESULTS: The incidence of PTSD and levels of stress did not differ in the group of mothers and fathers. There was a statistically significant difference in the severity of PTSD symptoms in general (p=0.006) and the severity of symptoms of intrusion (p=0.009) and arousal (p=0.015), which were more pronounced in mothers of children hospitalized in the NICU than in their fathers. In the multivariate models perceived stress was the only predictor that significantly affected the rate of PTSD symptoms in parents. CONCLUSIONS: Since PTSD is a very common problem in parents of children hospitalized in the NICU and estimating the risk of its occurrence on the basis of collected data is not possible, the parents of all those children should be considered at high risk.

Are there any differences in medical emergency team interventions between rural and urban areas? A single-centre cohort study.

OBJECTIVE: To compare interventions of medical emergency teams in urban and rural areas with particular emphasis on response time and on-site medical rescue activities. DESIGN: A retrospective analysis of ambulance call reports from two emergency medical service substations: one in the city and the other in a rural area. SETTING: Two emergency medical service substations: one in the city and the other in a rural area. PARTICIPANTS: Medical emergency teams. RESULTS: Interventions in the city were associated with a substantially shorter response time in comparison to rural areas. In the city, the distances were generally less than 10 km. In the rural area, however, such short distances accounted for only 7.2% of events, while 33.8% were over 30 km. Medical emergency teams more often acted exclusively on-site or ceased any interventions in rural areas. Compared with the city, actions in the rural setting were associated with significantly increased use of cervical collars and decreased use of intravenous access. The presence of a physician in the team raised the probability of pharmacotherapy. CONCLUSION: The relationship between medical emergency teams activities and the location of intervention shows the real diversity of the functioning of emergency medical service within a city and rural areas. Further research should aim to improve the generalisability of these findings.