Arrhythmias Occurring in Children during HEMS Intervention: A Retrospective Cohort Study.

Background: Arrhythmias in patients during medical transport remain a challenge for medical personnel. Helicopter emergency medical service (HEMS) crews, as the only medical rescue teams in Poland to conduct rescue flights, keep detailed documentation of monitoring vital functions over short time intervals during the flight. Aims: The aim of this study was to determine the characteristics of cardiac arrhythmia in pediatric patients (up to 12 years of age) transported by HEMS operatives, considering life-threatening rhythms and those that occur during out-of-hospital cardiac arrest (OHCA). Methods: The analysis of HEMS medical documentation covered 90345 missions carried out from 2011 to 2020. Among all activations, 820 cases of arrhythmias in pediatric patients up to 12 years of age were extracted. Results: Missions for males accounted for 60% of all activations (n = 492), while flights for females accounted for 40% (n = 328). A statistically significant relationship between the number of HEMS flights and the season was demonstrated (p = 0.015). During the study period, pediatric patients mostly experienced cardiac arrhythmias in the form of supraventricular tachycardia (sVT) (n = 504). Asystole (n = 178) and pulseless electrical activity (PEA) (n = 52) ranked second and third in terms of occurrence, respectively. A statistically significant relationship between the type of heart rhythm disorder and age was demonstrated (p < 0.05). Conclusions: Heart rhythm disorders most often affected children between 0 and 3 years of age. As the patient's age increased, the incidence of arrhythmias decreased. Among pediatric patients, supraventricular tachycardia proved to be the predominant arrhythmia during the study period.

Injuries to Users of Single-Track Vehicles.

INTRODUCTION: Single-track vehicles (including, among others, scooters, bicycles, mopeds, and motorcycles) are becoming increasingly popular means of transport, especially in large cities. A significant disadvantage of single-track vehicles is the low level of protection of users' bodies during road accidents, which causes life-threatening injuries. The aim of this study is to characterize the injuries of users of single-track vehicles. MATERIAL AND METHODS: An analysis of medical documentation of the ambulance service in the region of central Poland covered cases in 2019-2020. Out of 17,446 interventions, a group of 248 road incidents involving single-track vehicles was selected. The data included the scene of the event, the sociodemographic data of the casualties, the injuries suffered, and the clinical diagnoses. Analyses of the correlation of variables with the chi-squared and Spearman's Rho tests were applied. All results were considered significant at p < 0.05. RESULTS: In the analyzed period, trips of men accounted for 83.5% of all of the interventions (n = 207), while trips of women accounted for 16.5% (n = 41). The mean age of the victims was 45.66 years (SD ± 20.45). Taking into account the division of single-track vehicles, individual cases were recorded with the participation of bicycles (n = 183), motorcycles (n = 61), and scooters (n = 4). Taking into account the type of event, the following were distinguished: deductions (n = 62), falls (n = 179), and sickness (n = 7). The most common injuries were to the heads of cyclists (n = 101, which constitutes 55.19% of all injuries), lower limb injuries in motorcyclists (n = 35; 57.38%), and head injuries in scooter users (n = 3; 75%). The locations of sustained injuries significantly correlated with the type of vehicle in the cases of head injuries (p = 0.046), spine/back injuries (p = 0.001), pelvis injuries (p = 0.021), and lower limb injuries (p = 0.001). CONCLUSIONS: The users of single-track vehicles injured in road accidents were more often men than women. The characteristics of the injuries depended on the type of vehicle. The lack of adequate body protection significantly increases the likelihood of death or damage to health. It is advisable to promote safety rules among users of single-track vehicles, with a particular emphasis on the protection of individual parts of the body.

The use of analgesics in pediatric patients with body injuries in pre-hospital conditions.

BACKGROUND: Despite the positive dynamic changes in medicine and science, injuries continue to be the dominant cause of death among people under 45 years of age. Children's injuries are particularly dangerous as they can lead to hypovolemic shock, disability or even death. EMS uses opioid and nonopioid analgesics in order to provide relief to patients suffering from pain. The aim of this work is to analyze the types of pharmacological substances used in children in pre-hospital conditions. METHODS: The research tools included medical documentation of the emergency medical services in Poland. The analysis included 68,441 medical emergency treatment forms from 2016-2017, from which 464 interventions for children after trauma were selected. The general patient profile, characteristics of the event site, type of injuries suffered, type of intervening EMS, pharmacotherapy being used, as well as vital signs (GCS, RTS, HR, NiBP) were subject to assessment. The χ2 independence tests were performed, considering the results as statistically significant for p<0.05. RESULTS: There were 354 instances of BEMS (Basic Emergency Medical Services - without a doctor) and 110 instances of SEMS (Specialist Emergency Medical Services - with a doctor) sent to the emergency site. The mean age was 10.8 (SD ± 4.84) years. Boys were subject to intervention more often than girls (n=283 vs. n=181). Analgesics were administered in case of 49 (10.56%) patients only. NSAIDs (Nonsteroidal Anti-Inflummatory Drugs) were the analgesics of choice, which were used in 25 patients (50%), while opioid analgesics were used in 10 patients (20.40%). Analgesia was mostly used in patients with lower limb (34.69%) and upper limb (30.61%) injuries. The lowest percentage of analgesic use was observed in patients with head and neck injuries (3.06%). There was a significant relationship demonstrated between the type of EMS and the use of analgesics (χ2=6.330; p=0.012). CONCLUSIONS: Analgesia with EMS in children with injuries is critically insufficient. NSAIDs are the most commonly administered drugs in pre-hospital conditions. Head and torso injuries reduce the percentage of drugs administered by EMS. The EMS teams with no doctors (BEMS) are significantly more likely to use anesthetics, compared to SEMS.