One Year On: Poland's Public Health Initiatives and National Response to Millions of Refugees from Ukraine.

The Russian military invasion of Ukraine on February 24, 2022, resulted in the largest refugee crisis in Europe since World War II. As a neighboring country to Ukraine, Poland was the main country to initially receive refugees. Between February 24, 2022, and February 24, 2023, 10.056 million refugees from Ukraine, mainly women and children, crossed the Polish-Ukrainian border. Up to 2 million of these refugees from Ukraine found shelter in private homes throughout Poland. More than 90% of the resident refugees in Poland were women and children, and approximately 900 000 refugees from Ukraine have sought employment, mainly in the services sector. Since February 2022, there has been rapid development of a national legal framework to ensure access to healthcare, including providing refugees who are healthcare workers with job opportunities. Epidemiological surveillance and prevention programs for infectious diseases and mental health support systems have been implemented. These initiatives have required the use of language translators to ensure that there are no barriers to understanding and implementing public health measures. Hopefully, the lessons learned from Poland and neighboring countries that have hosted millions of Ukrainian refugees can help future preparedness for supporting refugees. This review aims to summarize the lessons learned by the Polish public health services during the past year and outlines the public health initiatives that have been implemented and are still ongoing.

Experience of the Polish Medical Air Rescue Service During the First Year of the COVID-19 Pandemic and Measures Taken to Protect Patients, Medical Staff, and Air Crew from SARS-CoV-2 Infection.

BACKGROUND The emergence of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and the sudden inflow of patients with severe COVID-19 (coronavirus disease 2019) symptoms increased demand for hospital and pre-hospital care, the latter being provided by emergency medical teams. The Polish Medical Air Rescue Services include the Helicopter Emergency Medical Service (HEMS) and the airplane-based Emergency Medical Service (EMS). This study aimed to present the experience of the Polish Medical Air Rescue Service during the first year of the COVID-19 pandemic and measures taken to protect patients, medical staff, and air crew from SARS-CoV-2 infection. MATERIAL AND METHODS We conducted a retrospective analysis of missions completed by the Polish Medical Air Rescue crews with respect to confirmed SARS-CoV-2 cases. We analyzed data from the medical records of the Polish Medical Air Rescue Service, which included flights to accidents and emergencies, and air patient transport missions, where medical assistance was provided to patients with confirmed SARS-CoV-2 infection in the first year of the pandemic in Poland. RESULTS Among the COVID-19 patients, the most common comorbidity was acute respiratory failure (41.58%). Emergency missions more often concerned older patients with sudden cardiac arrest, dyspnea, upper respiratory tract infection, stroke, and acute coronary syndromes. CONCLUSIONS During the first year of the COVID-19 pandemic in Poland, the Polish Medical Air Rescue Service implemented procedures to protect patients, medical staff, and air crew from SARS-CoV-2 infection. This study highlights the importance of using single-patient isolation units for patient transport between hospitals and for emergency hospital admissions when the SARS-CoV-2 status of the patients were unknown.

Use and Effects of Augmentation of Labor with Oxytocin: A Single-Center, Retrospective, Case-Control Study of 4350 Women in Warsaw, Poland, 2015-2020.

BACKGROUND Although there have been some recent clinical trials on the effects of augmentation of labor with oxytocin, or augmentation of labor, there are no clinical guidelines to explain the variations in obstetric practice between countries and within countries. This retrospective case-control study from a single center in Warsaw, Poland aimed to evaluate the use and effects of augmentation of labor with oxytocin in 4350 women between 2015 and 2020. MATERIAL AND METHODS This was a single-center, retrospective, case-control study in which 29 455 cases were qualified for analysis. The study included the analysis of 2 groups: the study group consisted of 4382 patients who underwent stimulation of childbirth, and the control group consisted of 25 073 patients who did not undergo this obstetric procedure. RESULTS Multivariate logistic regression analysis showed that the factors increasing the frequency of augmentation of labor were higher BMI (P<0.05), preinduction (P<0.05), epidural anesthesia (P<0.05), and family present at birth (P<0.05). Factors influencing reduction in the frequency of augmentation of labor were higher number of deliveries (P<0.05), vaginal birth after cesarean (P<0.05), and pre-pregnancy hypertension (P<0.05). CONCLUSIONS This study from a single center in Poland showed that BMI, preinduction, epidural anesthesia, and family present at birth significantly increased the frequency of labor stimulation with oxytocin. However, a history of previous pregnancies, previous cesarean sections, and pre-pregnancy hypertension significantly reduced the frequency of augmentation of labor with oxytocin.

Retrospective Study to Identify Risk Factors for Severe Disease and Mortality Using the Modified Early Warning Score in 5127 Patients with COVID-19 Admitted to an Emergency Department in Poland Between March 2020 and April 2021.

BACKGROUND COVID-19, a disease caused by SARS-CoV-2, has posed a threat to global public health. This retrospective study of 5127 patients with COVID-19 admitted to an Emergency Department in Poland between March 2020 and April 2021 aimed to identify risk factors for severe disease and mortality using the modified early warning score (MEWS). MATERIAL AND METHODS The study was based on a retrospective analysis of patients with SARS-CoV-2 infection admitted to the Emergency Department between March 2020 and April 2021. A total of 5127 cases were included in the final analysis. Identifying the group of high-risk patients with COVID-19 was determined based on the MEWS score. RESULTS Most of the patients studied were male (53.38%). The in-hospital mortality rate among the patients was 21.53%. The factors associated with the risk of in-hospital mortality from COVID-19 were age (>60 years, hazard ratio [HR]=2.27, P<0.001), comorbidities (cancer, HR=1.39, P=0.005; heart failure, HR=1.31, P=0.009; renal failure, HR=1.37, P=0.004), higher MEWS score (MEWS ≥5, HR=1.43, P<0.001), higher percentage of lung parenchyma affected (>50%, HR=2.10, P=0.001), and higher respiratory rate (>24 breaths per min, HR=2.10, P<0.001). CONCLUSIONS This study produced real-world data of risk factors for mortality from COVID-19 and the use of the MEWS for a faster identification of patients with COVID-19 requiring more intensive medical care.

Polish Medical Air Rescue Interventions Concerning Pregnant Women in Poland: A 10-year Retrospective Analysis.

BACKGROUND Even in the normal course of pregnancy, alarming symptoms and obstetric complications can occur, necessitating appropriate care. Medical rescue and Helicopter Emergency Medical Services (HEMS) teams are responsible for responding to emergencies and performing medical emergency procedures on scene and during patient transport to hospital. The purpose of our study was to present the characteristics of HEMS and Emergency Medical Service (EMS) interventions concerning pregnant women in Poland. MATERIAL AND METHODS The study involved a retrospective analysis of missions by HEMS and EMS crews of the Polish Medical Air Rescue concerning pregnant women in Poland. The analysis included all HEMS and EMS flights to cases of accidents and other emergencies and air transport missions where medical assistance had been provided to pregnant women between January 2011 and December 2020. RESULTS Polish Medical Air Rescue teams were most commonly dispatched to urban areas (79.46%) and for inter-hospital transport (75.85%). The mean patient age was 29.72 years, and the most common diagnosis, in accordance with the International Statistical Classification of Diseases and Related Health Problems (ICD-10), was premature labor (24.38%). CONCLUSIONS Pregnant patients aged 30 and older and those receiving HEMS and EMS assistance in urban areas were found to have a higher odds ratio for premature labor. A correlation was identified between the diagnosis associated with the Polish Medical Air Rescue intervention and the pregnant woman's age and location of call.

The NACA score as a predictor of ventricular cardiac arrhythmias - A retrospective six-year study.

BACKGROUND: Helicopter Emergency Medical Service (HEMS) conducts the evaluation of a patient's condition using NACA score before transporting the patient to hospital. The conditions inside the rescue helicopter limit or even make it impossible to conduct some medical procedures. An appropriate classification of the patient may lead to a lower possibility of occurrence of adverse events during the flight. The aim of the research was to evaluate the correlation of NACA score with the cardiac arrhythmia that may be life threatening. METHODS: A retrospective observational study included a group of 47,131 patients, who were transported by HEMS services between 2012 and 2017. The research was conducted using the analysis of variance ANOVA running a post hoc test. In order to calculate the correlation of variables, Kruskal-Wallis and r-Pearson tests were carried out, interpreting the results according to J. Gilville's scale. The significance level was set at α = 0,05. RESULTS: The average number of points using NACA score for the studied group was 4,06 (SD ±â€¯1,38). Twelve heart rhythms were selected while evaluating correlations using NACA score. There was a significant relation between the ECG variable and NACA score (p = 0,003). There was a very strong correlation between NACA score and the following: VF/pVT (r-Pearson = 0,856; p = 0,006), PEA (r-Pearson = 0,810; p = 0,015) and Asystole (r-Pearson = 0,728; p = 0,026). CONCLUSIONS: NACA score allows to predict the risk of occurrence of ventricular arrhythmia of the myocardium as well as cardiac arrest. The possibility of occurrence of a life-threatening rhythm is significantly higher in patients classified as NACA IV or higher.

Prognostic Factors for Nonasphyxia-Related Cardiac Arrest Patients Undergoing Extracorporeal Rewarming - HELP Registry Study.

OBJECTIVE: Extracorporeal rewarming is the treatment of choice for patients who had hypothermic cardiac arrest, allowing for best neurologic outcome. The authors' goal was to identify factors associated with survival in nonasphyxia-related hypothermic cardiac arrest patients undergoing extracorporeal rewarming. DESIGN: All 38 cardiac surgery departments in Poland were encouraged to report consecutive hypothermic cardiac arrest patients treated with extracorporeal life support. All variables collected were analyzed in order to compare survivor and nonsurvivor groups. The parameters available at the initiation of extracorporeal rewarming were considered as potential predictors of survival in a logistic regression model. The primary outcome was survival to discharge from the intensive care unit. The secondary outcome was neurologic status. SETTING: Multicenter retrospective study. PARTICIPANTS: Ninety-eight cases in the final analysis. INTERVENTIONS: All patients in nonasphyxia-related hypothermic cardiac arrest rewarmed with extracorporeal life support. MEASUREMENTS AND MAIN RESULTS: The survival rate was 53.1%, and 94.2% of survivors had favorable neurologic outcome. The lowest reported core temperature with cerebral performance category scale 1 was 11.8°C. A univariate analysis identified 3 variables associated with survival, namely: age, initial arterial pH, and lactate concentration. In a multivariate analysis, 2 independent predictors of survival were age (0.957; 95% confidence interval [CI] 0.924-0.991) and lactates (0.871; 95% CI 0.789-0.961). The area under the receiver operating characteristics curve for this fitted model was 0.71; 95% CI 0.602-0.817. CONCLUSIONS: Favorable survival with good neurologic outcome in nonasphyxiated hypothermic patients treated with extracorporeal life support was reported. Age and initial lactate level are independently associated with survival.

RETROSPECTIVE ANALYSIS OF INTERVENTIONS PERFORMED BY EMERGENCY MEDICAL TEAMS IN POLAND BEFORE AND DURING THE SARS COV-2 PANDEMIC.

OBJECTIVE: Introduction: The SARS-CoV-2 virus was recognized in December 2019 in China. From that moment it has quickly spread around the whole world. It causes COVID-19 disease manifested by breathlessness, coughing and high temperature. The COVID-19 pandemic has become a great challenge for humanity. The aim: To analyze interventions of emergency medical teams during the SAR-CoV-2 pandemic, and to compare obtained data with the same periods in 2018-2019. PATIENTS AND METHODS: Material and methods: The study retrospectively analyzed interventions of emergency medical teams in the period from 15.03 to 15.05 in 2018 - 2020. 1,479,530 interventions of emergency medical teams were included in the study. The number of interventions, reasons for calls, and diagnoses made by heads of the emergency medical teams during the SARS-CoV-2 pandemic were compared to the same period in 2018-2019. RESULTS: Results: Authors observed the decline in the number of interventions performed by emergency medical teams during the pandemic in relation to earlier years by approximately 25%. The big decline concerned interventions that were the reason for calls to public places, such as "traffic accident" and "collapse". In the case of diagnoses made by the head of the emergency medical team, the diagnoses regarding stroke or sudden cardiac arrest remained at the similar level. Others showed a marked decline. CONCLUSION: Conclusions: Reduced social activity contributed to a reduced number of interventions by emergency medical teams in public places. The societal fear of the unknown also contributed to the decrease in the number of interventions performed by emergency medical teams. People began to avoid contact with other people.

Polish Helicopter Emergency Medical Service (HEMS) Response to Stroke: A Five-Year Retrospective Study.

BACKGROUND A stroke is a serious life-threatening emergency that requires immediate intervention in an appropriate therapeutic center. The aim of this study was to analyze the time of medical procedures at the scene and changes in the state of stroke patients during transport by HEMS in Poland. The presented research is the first nationwide study covering such a large group of stroke patients, for whom aerial support was used in the therapeutic process. MATERIAL AND METHODS A retrospective cross-sectional study of 48553 missions performed by Polish Medical Air Rescue (PMAR) during the 5-year study period resulted in 3906 stroke patients who, after medical rescue operations by HEMS crew, were transported by helicopters to hospitals. RESULTS Helicopters in 3475 (88.97%) cases were utilized as a support for Ground Emergency Medical Service (GEMS). The maximum duration of HEMS operation from activation to patient transfer to the hospital did not exceed 108 min and the median was 60 min. Over 87% of patients with HEMS reported stroke symptoms and arrived at the medical center with the possibility of implementing thrombolytic therapy. The factor that affected the deterioration of patients' condition was the drawing out of the extent of time spent by the crew at the scene. CONCLUSIONS The use of HEMS in Poland in the case of patients with stroke symptoms ensures fast and professional assistance at the site of the medical emergency as well as safe transport to specialized centers, shortening the time of proper treatment implementation.

Body temperature measurement in ambulance: a challenge of 21-st century?

BACKGROUND: Some crucial decisions in treatment of hypothermic patients are closely linked to core body temperature. They concern modification of resuscitation algorithms and choosing the target hospital. Under- as well as over-estimation of a patient's temperature may limit his chances for survival. Only thermometers designed for core temperature measurement can serve as a guide in such decision making. The aim of the study was to assess whether ambulance teams are equipped properly to measure core temperature. METHODS: A survey study was conducted in collaboration with the Health Ministry in April 2018. Questionnaires regarding the model, number, and year of production of thermometers were sent to each pre-hospital unit of the National Emergency Medical System in Poland. RESULTS: A total of 1523 ground ambulances are equipped with 1582 thermometers. 53.57% are infrared-based ear thermometers, 23.02% are infrared-based surface thermometers, and 20.13% are conventional medical thermometers. Only 3.28% of devices are able to measure core body temperature. Most of analyzed thermometers (91.4%) are not allowed to operate in ambient temperature below 10 °C. CONCLUSIONS: There are only 3.28% of ground ambulances that are able to follow precisely international guidelines regarding a patient's core body temperature. A light, reliable thermometer designed to measure core temperature in pre-hospital conditions is needed.

[Analysis of medical rescue operations performed by medical rescue teams from all over poland in patients with burn wounds].

OBJECTIVE: Introduction: A burn is a superficial or deep tissue damage caused by the action of: heat (high temperature), chemicals, electric current, solar rays and ionizing radiation. The aim: To analyze the trips of emergency medical teams in the period from November 1, 2017 to April 30, 2018 to patients diagnosed with burns throughout the country. PATIENTS AND METHODS: Materials and methods: The analysis covers the whole of Poland, all medical rescue teams. The obtained data comes from the System of Supporting the State Medical Rescue System. The analysis includes the characteristics of the population studied and the medicines used. The study included those that ended with the diagnosis of burns (T-20 to T-32). Taking into account the above criteria, 547 cases were obtained. RESULTS: Results: In 321 cases, there were women and 226 cases of men (58.68% vs 41.32%, p<0.001). More often, it referred to patients over 18 (317 cases vs. 193 below 18 years of age, p<0.001) in 37 cases no data. Most events were recorded in the Masovian and Silesian voivodships (12.97% and 11.33%) and the least in Podlasin (2.92%). In 20.47% of cases, pain treatment was applied, of which in the group of adults in 25.23% vs. 1658% in children, p<0.001. CONCLUSION: Conclusions: The above results of medical emergency teams' activities indicate insufficient pharmacological treatment, which requires rapid improvement.

Is an emergency department a safer place for hypothermic victims than an ambulance? A comparison of the knowledge of medical personnel concerning hypothermia.

OBJECTIVE: Introduction: Improper initial management of a victim in severe hypothermia is associated with a risk of cardiac arrest. At the same time, an uncontrolled drop in core body temperature in trauma victims is an independent risk factor for mortality. Medical personnel require a thorough understanding of the pathophysiology and treatment of hypothermia. Gaps in this understanding can lead to serious complications for patients. The aim: To compare knowledge concerning hypothermia between medical personnel working in emergency departments (ED) and emergency medical services (EMS). PATIENTS AND METHODS: Materials and methods: A total of 5,362 participants were included in the study. In this study, EMS and ED personnel were encouraged to participate in an e-learning course on hypothermia. Subsequently, the scores of a pre-test, lesson tests and post-test completed by participants of this course were compared. RESULTS: Results: Pre-test scores were significantly higher among personnel working in EMS compared with those working in EDs. Nurses employed in EDs had significantly more failures in completing the course than EMS nurses. The most difficult topics for all practitioners were post-traumatic hypothermia and hypothermia-related clotting disorders. CONCLUSION: Conclusions: EMS personnel have a higher level of knowledge of hypothermia than ED personnel. Moreover, an e-learning course is an effective tool for improving medical personnel's knowledge of hypothermia.

Maladaptive perfectionism and authentic leadership skills in emergency medicine students

Introduction: Leadership skills can be critical in emergency medicine. However, there are no works that analyze this issue in much more details. The aim: To analyze the level of leadership skills in emergency medicine students, and also checking if despondency perfectionism is a variable that reduce the correlation between self-efficacy and leadership skills. Material and methods: The analyzed group consisted of 75.76% of all emergency medicine students taking up education at the Medical University of Warsaw in 2018 (n = 150, W = 74, M = 71). The average age was 23 years (SD = 1.7). All students were divided into two groups: Group 0 - without maladaptive perfectionism (n = 64), and group 1- with maladaptive perfectionism (n = 79). In the cross-sectional study, three standardized research tools were used: Authentic Leadership Questionnaire, Almost Perfect Scale-Revised (APS-R), and General Self-Efficacy Scale (GSES). ANCOVA analysis was used. Results: The linear regression coefficients for both comparison groups were significantly different (interaction of variables: "maladaptive perfectionism * self-efficacy": F = 4.841, p = .029). Comparing adjusted mean values for both groups (0 vs 1), it can be stated that students from group 0 had a significantly higher level of authentic leadership skills compared to group 1 (F = 4.432, p = .037). Conclusions: Studies to determine the mechanisms of a positive relationship between the self-efficacy and leadership skills in emergency medicine students with high maladaptive perfectionism are required. This will allow the development of effective programs to strengthen the leadership skills of these students.

Polish Helicopter Emergency Medical Service (HEMS) Response to Out-of-Hospital Cardiac Arrest (OHCA): A Retrospective Study.

BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a significant clinical challenge for emergency medical systems worldwide. The first step towards ensuring patient survival is achieving return of spontaneous circulation (ROSC). The purpose of the study was to analyze the cases of OHCA to which HEMS teams were dispatched. MATERIAL AND METHODS We performed a retrospective analysis of all HEMS calls in Poland for cases of OHCA between 1 January 2011 and 31 December 2016. Data were obtained from medical records maintained by the Polish HEMS. RESULTS The total number of responses to cases of OHCA was 2447. Of this total, 308 cases were excluded from the study as the patient was found not to have cardiac arrest or was confirmed dead. ROSC was achieved in 1119 cases, including 335 cases where ROSC occurred before the arrival of the HEMS team. In the group studied, ROSC was achieved more commonly in women, in patients younger than age 40 years, in CA cases of cardiac origin, and in cases with shockable rhythms (p<0.05). CONCLUSIONS The study results are consistent with global trends in terms of OHCA incidence and the effectiveness of CPR performed on scene. The study also demonstrates that HEMS dispatch to OHCA cases is justified both as a means of providing assistance to EMS teams on scene and as the first choice.

[1,4-diaminobenzene and diphenylamine-induced severe methemoglobinaemia treated by hyperbaric oxygen therapy - Case report]. / Zastosowanie tlenoterapii hiperbarycznej w ciezkiej methemoglobinemii wywolanej zatruciem 1,4-diaminobenzenem i difenyloamina ­ opis przypadku.

Methemoglobin is an oxidized form of hemoglobin that is not capable of carrying oxygen. Exposure to exogenous oxidizing agents can cause severe methemoglobinemia and subsequent hypoxia. This article presents the rare case of a 23-year old patient with methemoglobinemia of 54.2% of total hemoglobin, induced by workplace exposure to 1,4-diaminobenzene and diphenylamine. Following the hyperbaric oxygen therapy the patient was discharged in good general condition and referred to a district hospital for observation. Med Pr 2018;69(3):345-350.

[Sudden cardiac arrests in years 2013-2016 within operation area of siedlce emergency ambulance service].

OBJECTIVE: Introduction: SCA is an unexpected, and potentially of reversible effect, in which occurs a cessation of hemodynamically heart beat as a pump, and cessation of cardiovascular circulation. PATIENTS AND METHODS: Materials and methods: Our analysis is based on 1032 SCA occurrences where cardiopulmonary resuscitation have been applied. The analysis covers operating region of Siedlce Emergency Medical Services in years 2013-2016. The study is of retrospective nature. The analysis has been based on all cases of cardiac arrests. Successful rate of medical assistance at patients with SCA have been assessed. RESULTS: Results: CPR have been applied 1032 times, out of which 45,3& of cases have resulted in spontaneous recovery of circulation, and in 54,7& such action have failed. however the efficiency of CPR applied K-2 call-outs was higher (p=0.016). It was noted that there was significantly higher (p = 0,010) number of interventions due to SCA with males (n = 744) than females (n = 288). Also, there was higher successful rate for SCA treatment with females than males. It was proven that the number of SCA have grown in line with an age, however successful rate of SCA treatment have been comparable among all age groups (p = 0,553). Most numerous group of patients with SCA have been 75 year old and above (n = 281). It was noted that significant factor in SCA and CPR successful treatment was the time of the day (p = 0,021). There was more SCA as well as successful CPRs before afternoon and afternoon in comparison with evening and night time. The time of arrival for Ambulance crews for patients with spontaneous was significantly shorter (p = 0,000) in comparison with patients who have failed to recover (on average 7,3± 5,96 vs. 9,8± 6,42 min). In rhythm to defibrilation or PEA, ROSC took place significantly more often than at patients with asystole (p = 0,000). CONCLUSION: Conclusions: A successful resuscitation depends on the quality of emergency medical procedures performed at the place of incident. The highest probability of ROSC is related with defibrillation, intubation, the application of a respirator and performing mechanical ventilation, as well as shorter time from dispatch to arrival.

[An assessment of medical rescue actions performed by the students in the sixth year of medicine at the national medical universities in Lviv and ivano-frankivsk in an out-of-hospital cardiac arrest (ohca) patient. a simulation study].

OBJECTIVE: Introduction: Sudden cardiac arrest is a condition that requires the implementation of advanced emergency medical procedures. It constitutes a significant medical, economic and social issue. The aim: To assess the medical rescue actions performed by the students in the sixth year of medicine at the National Medical Universities in Lviv and Ivano-Frankivsk in an out-of-hospital cardiac arrest (OHCA) patient. PATIENTS AND METHODS: Material and methods: The research involved students in the sixth year of medicine at the National Medical Universities in Lviv and Ivano-Frankivsk. Participation was voluntary and all students were adult. Consequently, no written parental consent was required. The number of participating students amounted to 17 in Lviv and 16 in Ivano-Frankivsk. There were two stages of the study. The research was conducted in compliance with the 2015 guidelines formulated by the European Resuscitation Council. The adopted level of statistical significance was p<0.05. RESULTS: Results: The pre-test percent average amounted to 60.27% whereas the final test average values were 82.39% in the first stage and 77.96% in the second stage. Higher scores were reported in the case of Lviv students which especially refers to the final tests (p< 0.001). The most important element influencing the effectiveness of the procedures is chest compression (compression location, depth, frequency and relaxation). A higher chest compression effectiveness was reported in each subsequent stage of the research. A higher effectiveness rate was observed in students in Ivano-Frankivsk (p<0.028). The other element with a significant impact on the effectiveness of procedures is ventilation. A higher rate of successful ventilation (breath frequency, volume and strength) was noted in Ivano-Frankivsk, especially as far as the first stage after training was concerned (p<0.038). CONCLUSION: Conclusion: The education of students of medicine in Ukraine is insufficient. The results of the effectiveness of resuscitation are not satisfactory and do not prepare future doctors to perform high quality resuscitation procedures.

[Hypothermia - e-learning course dedicated to lifeguards, border guards and policemen].

OBJECTIVE: Introduction: The paper covers the problem of pre-hospital hypothermia recognition and management among lifeguards, board guards and policemen, who took part in e-learning course Academy of Hypothermia. PATIENTS AND METHODS: Materials and methods: The subject of analysis were the results of pre-test, post-test and lesson revision tests of Academy of Hypothermia e-learning course, taken by lifeguards (WOPR), board guards (SG) and policemen (POL). RESULTS: Results: 221 participants were enrolled in a study. Lifeguards were significantly younger than other groups (mean age respectively: 34,13 years SG; 32,95 years POL and 23,31 years WOPR; p< 0,001) and median work experience (respectively: 10 years SG, 8 years POL and 2 years WOPR; p< 0,001). Pre-test analysis showed significant difference in results of board guards and lifeguards (median and q1-q3 values respectively: 61%; 43%-92% for SG and 53%; 46%-69% for WOPR, p = 0,02). Post-test analysis proved significantly better results of board guards (median and q1-q3 values: 92%; 77%-100%) in comparison to policemen (median and q1-q3 values: 85%; 69%-92%) and lifeguards (median and q1-q3 values: 85%; 69%-92%). Extra analysis was performed for lesson revision tests. The least correct answers were noted in lessons covering the topic of post trauma hypothermia and the algorithm of hypothermia casualty management. CONCLUSION: Conclusions: Lifeguards have least knowledge on accidental hypothermia than board guards and policemen. E-learning course is an effective tool for improving knowledge of hypothermia recognition and treatment.

[The epidemiology of sudden cardiac arrest in prehospital care in the area of the silesian voivodeship].

OBJECTIVE: Introduction: Sudden cardiac arrest (SCA) is a serious medical and social issue. The incidence of SCA varies depending on the location and the circumstances. The aim: A retrospective analysis of non-hospital SCA cases from an epidemiological perspective. The research involved the population monitored by the Voivodeship Rescue Service (VRS) in Katowice. PATIENTS AND METHODS: Material and methods The analysis covered dispatch order forms and emergency medical procedure forms of the VRS in Katowice in 2016 (n = 249 872). The retrospective analysis involved cases of non-hospital SCA in adults (n = 1603). Quantitative parameters have been presented as average values with standard deviation. Non-metric variables have been described by means of structure indicators. A comparative analysis was conducted by means of the Student's T-test for the quantitative variables and the Pearson's chisquared test for the non-metric variables. The statistical significance adopted for the purpose of all analyses was 0.05. RESULTS: Results: There were 1005 men (62.7%), 566 women (35.3%) and 32 cases (2.0%) where gender identification was not reported. Female individuals were generally older than male individuals (p = 0.000). Patients' average age was 65.7 years. The SCA attack rate was 59.37/100 000. SCA cases were usually reported in domestic conditions (71.1%, p = 0.000). In a majority of cases, the incident was witnessed by a third person (about 70.0% of cases, p= 0.000). Most of the SCA cases were reported in the first quarter of the year whereas the lowest number of cases was noticed in the third quarter (28.4 % vs 22.5 %). SCA was most frequent during the day. Restoration of spontaneous circulation was reported in 33.4% of the cases. CONCLUSION: Conclusions: The incidence of SCA is occasional in the context of all analyzed emergency cases in the period under research. However, SCA cases are related with a high risk of failure. Acting according to the currently available knowledge will probably cause an increase of the restoration of spontaneous circulation (ROSC) rate.

ASIT as the component of bronchial asthma's therapy can improve the adherence to the treatment.

OBJECTIVE: The aim: To compare the treatment adherence of patients with Bronchial Asthma (BA) receiving basic treatment and its combination with allergen-specific immunotherapy. PATIENTS AND METHODS: Materials and methods: The study included 104 patients aged from 18 to 50 with BA. All patients were divided into two groups. The main group (MG) consisted of 51 patients receiving basic medical treatment and ASIT. 38 of them received subcutaneous ASIT and 13 patients received sublingual ASIT. The comparative group (CG) consisted of 53 patients who received only basic therapy. The patients' observation duration was for a year. RESULTS: Results: All patients were done the computer spirometry with a bronchodilation test, determination of the total IgE level, questionnaires (quality of life, control of asthma, adherence to treatment). Also the major and minor component of allergy house dust mites and specific IgG4 were determined in patients of main groups. After 12 months of observation in both groups the spirometry rates improved (the main group result was 16.9%, the control group - was 12.8%). The indicators of asthma's control also increased (MG by 28%, in CG - 21%, (p <0,05)). After individual conversations and training the patients improved and adherence to the treatment too. In the beginning of our research the mean level in MG was 3.2 ± 0.3 points, in - CG-3.3 ± 0.2 points (p> 0.05), after 12 months it increased to 6.3 ± 0.2 points in MG vs 5. 8 ± 0.1 points in CG (p <0.05). CONCLUSION: Conclusion: Patients' combining basic therapy with SIT had significantly better results of the overall BA's controllability compared to the patients' receiving only basic therapy.