Publications by authors named "Robert Gałązkowski"

91 Publications

Post-Traumatic Growth among Patients after Living and Cadaveric Donor Kidney Transplantation: The Role of Resilience and Alexithymia.

Int J Environ Res Public Health 2021 02 23;18(4). Epub 2021 Feb 23.

Department of General and Transplant Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland.

The aim of this study was to determine the role of resilience and alexithymia in the post-traumatic growth as a response to extreme stress in patients after kidney transplantation and to determine whether there are differences in the level of posttraumatic growth in patients after living and cadaveric donor kidney transplantation. The relationships between these variables were also evaluated. The questionnaire survey of 91 kidney recipients took place in 2018 and 2019. The following tools were used: authorial post-transplant questionnaire for recipients and validated questionnaires, Post Traumatic Growth Inventory (PTGI-R), Resilience Coping Scale Questionnaire, and Toronto Alexithymia Scale Questionnaire (TAS20). The results obtained showed significant differences between the group of kidney recipients from living donors and recipients from cadaveric donors, in terms of overall post-traumatic growth, as well as changes in self-perception and a greater appreciation for life. Post-traumatic growth in both groups was related to the level of resilience and the level of alexithymia. Resilience is an accurate predictor of posttraumatic growth in general and for each of the groups of recipients separately.
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http://dx.doi.org/10.3390/ijerph18042164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7926671PMC
February 2021

Polycystic Ovary Syndrome and Endometriosis as Reasons for Women's Admission to Outpatient Specialist Care in Poland-A Retrospective Analysis.

Int J Environ Res Public Health 2021 02 4;18(4). Epub 2021 Feb 4.

Department of Emergency Medical Services, Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland.

This study aimed at presenting selected aspects of outpatient specialist care for women diagnosed with polycystic ovary syndrome (PCOS) or endometriosis. The study was carried out using a retrospective analysis of the services provided under Outpatient Specialist Care (AOS) for women, based on data from the National Health Fund (NFZ). The study included data on women with PCOS or endometriosis based on the International Statistical Classification of Diseases and Related Health Problems (ICD-10) in Poland from 2016 to 2018. The average age of women in the study group with PCOS was 25.31 (±7.02) years and, for those with endometriosis, 38.21 (±10.79). AOS patients with diagnosed PCOS most often made 2-3 visits (34.60%) to a specialist doctor, and those with diagnosed endometriosis most often made one visit (39.95%). Significant differences between patients with PCOS and endometriosis using AOS were found concerning the women's age, the year, season, place of treatment, type of clinic, mode of admission, number of visits, and their place of residence or macroregion. With increasing age, women with PCOS made more visits to AOS, and women with endometriosis made fewer visits to the AOS specialist.
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http://dx.doi.org/10.3390/ijerph18041442DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7913858PMC
February 2021

Out-of-hospital cardiac arrest in dialysis patients.

Int Urol Nephrol 2021 Mar 18;53(3):563-569. Epub 2020 Dec 18.

Department of Emergency Medicine, Medical University of Bialystok, Bialystok, Poland.

Purpose: The aim of the study was to assess whether a history of dialysis is related to cardiopulmonary resuscitation (CPR) attempts and survival to hospital admission in patients with out-of-hospital cardiac arrest (OHCA).

Methods: The databases of the POL-OHCA registry and of emergency medical calls in the Command Support System of the State of Emergency Medicine (CSS) were searched to identify patients with OHCA and a history of dialysis. A total of 264 dialysis patient with OHCA were found: 126 were dead on arrival of emergency medical services (EMS), and 138 had OHCA with CPR attempts. Data from the POL-OHCA registry for patients with CPR attempts, including age, sex, place of residence, first recorded rhythm, defibrillation during CPR, and priority dispatch codes, were collected and compared between patients with and without dialysis.

Results: CPR attempts by EMS were undertaken in 138 dialyzed patients (52.3%). The analysis of POL-OHCA data revealed no differences in age, sex, place of residence, first recorded rhythm, and priority dispatch codes between patients with and without dialysis. Defibrillation was less frequent in dialysis patients (P = 0.04). A stepwise logistic regression analysis revealed no association between survival to hospital admission and a history of hemodialysis (odds ratio = 1.12; 95% CI 0.74-1.70, P = 0.60).

Conclusions: A history of dialysis in patients with OHCA does not affect the rate of CPR attempts by EMS or a short-term outcome in comparison with patients without dialysis. Defibrillation during CPR is less common in patients on dialysis than in those without.
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http://dx.doi.org/10.1007/s11255-020-02694-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907018PMC
March 2021

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

Wiad Lek 2020 ;73(8):1659-1662

MINISTRY OF HEALTH, WARSAW, POLAND.

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.
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October 2020

Analysis of out-of-hospital cardiac arrest in Poland in a 1-year period: data from the POL-OHCA registry.

Kardiol Pol 2020 05 19;78(5):404-411. Epub 2020 Mar 19.

Department of Emergency Medical Service, Medical University of Warsaw, Warsaw, Poland

Background: Out‑of‑hospital cardiac arrest (OHCA) is a severe medical condition. Prehospital care plays an essential role in patient survival.

Aims: First, the study aimed to evaluate cases of OHCA managed by cardiopulmonary resuscitation (CPR) attempts in Poland in 2018, including their frequency and patient outcomes in terms of survival until hospital admission or transport to the hospital by helicopter emergency medical service (HEMS). Second, the study was performed to identify the predictors of patient survival until hospital admission or transport by HEMS.

Methods: It was a case‑control study based on medical records. In 2018, 3 400 000 emergency visits were registered. Patients who were treated by emergency medical service (EMS) ambulance staff using defibrillation and / or administering at least 1 dose of 1 mg of epinephrine were considered to have OHCA managed by CPR attempts.

Results: A total of 26 783 CPR attempts were reported by EMS in Poland in 2018. The incidence of OHCA with CPR attempts in 2018 was 69.7 per 100 000 inhabitants and it varied from 58.9 per 100 000 to 84.5 per 100 000 inhabitants in 16 Polish provinces. The mean survival rate until hospital admission or transport by HEMS was 36.3% and it ranged from 34.5% to 38.3%. Patient survival until hospital admission or transport by HEMS was related to age, sex, emergency site, defibrillation during CPR, the first recorded rhythm, and procedures performed by the EMS personnel.

Conclusions: The rate of OHCA with CPR attempts was similar to that reported in other European countries. Patient survival until hospital admission or transport by HEMS was associated with many well‑‑known, identified nonmodifiable and modifiable factors.
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http://dx.doi.org/10.33963/KP.15241DOI Listing
May 2020

Medical emergency team interventions in patients with ST-segment elevation myocardial infarction in Poland in 2018.

Kardiol Pol 2020 04 2;78(4):292-299. Epub 2020 Mar 2.

Department of Cardiology, Centre for Heart Diseases, 4th Military Hospital, Wrocław, Poland; Department of Heart Diseases, Wroclaw Medical University, Wrocław, Poland

Background: The National Emergency Medical Services Management Support System, a unique information and communication technology system, was developed to reduce the burden of ST-segment elevation myocardial infarction (STEMI) in Poland. According to the European Society of Cardiology guidelines, medical emergency teams (METs) should diagnose STEMI using electrocardiogram (ECG) transmission and apply dual antiplatelet therapy (DAPT) as a pivotal treatment.

Aims: This study aimed to analyze MET interventions in patients with STEMI and assess regional differences in the management in Poland.

Methods: Using ambulance call reports, we retrospectively analyzed MET interventions due to conditions classified as I21 (acute myocardial infarction; according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision), which were performed in Poland between January 1, 2018 and December 31, 2018.

Results: In 2018, METs conducted 16 807 interventions classified as I21, which accounted for 0.5% of all MET interventions in Poland in that year. Most interventions were conducted in the Mazovia Province (13.4%; P <0.001), and the lowest number was reported in the Podlasie Province (2.5%). A 12‑lead ECG was performed during 98.6% of interventions, and ECG transmission in 37.49%: most often in the Mazovia Province (59.62%; P <0.001), and least often in the Lublin Province (13.8%). In 72.12% of interventions, DAPT was applied: clopidogrel was the P2Y12 inhibitor used in 49.68% of interventions, and ticagrelor in 25.14% (P <0.001). A P2Y12 inhibitor was most often used in the Wielkopolska Province (98.4%), and least often in the Silesia Province (40.34%).

Conclusions: Significant differences in the implementation of the European Society of Cardiology guidelines regarding ECG transmission and DAPT were observed between particular provinces in Poland.
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http://dx.doi.org/10.33963/KP.15222DOI Listing
April 2020

Characteristics of urban versus rural utilization of the Polish Helicopter Emergency Medical Service in patients with ST-segment elevation myocardial infarction.

Kardiol Pol 2020 04 14;78(4):284-291. Epub 2020 Feb 14.

Polish Medical Air Rescue, Warsaw, Poland; Department of Emergency Medicine,Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland

Background: In patients with acute phase of ST‑segment elevation myocardial infarction (STEMI), quick transportation to a specialist therapeutic center is of utmost importance to increase the chances of surviving.

Aims: The objective of this study was to characterize the missions of the Polish Helicopter Emergency Medical Service (HEMS) to patients with STEMI in urban and rural areas and to assess the utilization of air ambulance support as part of an early stage of the therapeutic process.

Methods: This retrospective analysis included 6099 patients with STEMI treated by the Polish HEMS crews from January 2011 to December 2018.

Results: The study group included mainly men (68.9%) and persons aged 60 to 79 years (53.9%). The mean (SD) age of the entire group was 64.8 (11.9) years. The level of consciousness measured by the Glasgow Coma Scale score ranged from 13 to 15 (84.8% of patients), the mean (SD) Revised Trauma Score was 11.4 (1.9) points, and the mean (SD) number of points on the National Advisory Committee for Aeronautics scale was 4 (1). In rural areas, the Polish HEMS crews were more frequently dispatched to medical emergencies (99.3% vs 59.6%). Sudden cardiac arrest occurred more often in those areas (6% vs 3.8%), which resulted in the death of the patient (2.4% vs 0.4%; P <0.05 for both).

Conclusions: There were differences in utilization of the Polish HEMS in patients with STEMI in urban and rural areas. The results demonstrated a positive impact of the utilization of HEMS in the early stages of the therapeutic process of these patients.
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http://dx.doi.org/10.33963/KP.15190DOI Listing
April 2020

Maladaptive perfectionism and authentic leadership skills in emergency medicine students

Wiad Lek 2019 Aug;72(8):1453-1459

Zakład Edukacji i Badań w Naukach o Zdrowiu, Wydział Nauki o Zdrowiu, Warszawski Uniwersytet Medyczny, Warszawa, Polska

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.
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August 2019

Neonatal Transport in the Practice of the Crews of the Polish Medical Air Rescue: A Retrospective Analysis.

Int J Environ Res Public Health 2020 01 22;17(3). Epub 2020 Jan 22.

Department of Emergency Medicine, Faculty of Health Sciences, Medical University of Lublin, 4-6 Staszica St., 20-081 Lublin, Poland.

The aim of the study was to present characteristics of patients transported in incubators by crews of Helicopter Emergency Medical Service (HEMS) and Emergency Medical Service (EMS) of the Polish Medical Air Rescue as well as the character of their missions. The study was based on the method of retrospective analysis of neonatal transports with the use of transport incubators by the crews of HEMS and EMS of the Polish Medical Air Rescue. The study covered 436 medical and rescue transports of premature babies and full-term newborns in the period between January 2012 and December 2018. The study group consisted mainly of male patients (55.05%) who, on the basis of the date of delivery, were qualified as full-term newborns (54.59%). During the transport their average age was 37.53 (standard deviation, SD 43.53) days, and their average body weight was 3121.18 (SD 802.64) grams. A vast majority of neonatal transports were provided with the use of a plane (84.63%), and these were medical transports (79.36%). The average transport time was 49.92 (SD 27.70) minutes with the average distance of 304.27 km (SD 93.05). Significant differences between premature babies and full-term newborns were noticed in terms of age and body weight at the moment of transport, diagnosis based on the International Statistical Classification of Diseases and Related Health Problems (ICD-10), the most commonly used medications (prostaglandin E1, glucose, furosemide, vitamins), National Advisory Committee for Aeronautics (NACA) scale rate as well as the mission type and the presence of an accompanying person.
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http://dx.doi.org/10.3390/ijerph17030705DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7037463PMC
January 2020

Road ambulances: working conditions of paramedics - pilot studies.

Int J Occup Med Environ Health 2020 Jan 13;33(1):91-105. Epub 2019 Dec 13.

Medical University of Warsaw, Warsaw, Poland (Department of Emergency Medical Services).

Objectives: The article presents the results of selected pilot studies conducted in medical ambulances. Their aim was to determine the working conditions and identify troublesome factors accompanying the performance of basic medical procedures by rescue teams.

Material And Methods: The study of working conditions was carried out in Mercedes-Benz ambulances, type S and P. Fifty-one paramedics of the Emergency Medical Rescue Service in Siedlce took part in the research. The questionnaire expert survey method and the direct observation method were used.

Results: As a result of the applied research methods, knowledge was gained on the irregularities and difficulties that occur at the workplace of a paramedic, i.e., in an ambulance, including the lack of access to essential elements of medical equipment and their different location inside the vehicle, and the diversity of solutions for the spatial structure of ambulances, which all cause difficulties at work. Research has shown that paramedics take, on average, 33 min to familiarize themselves with the location of equipment in an ambulance other than the one in which they are usually on duty. There was no correlation between the lifeguard's length of service and the time necessary for getting acquainted with the equipment, which was studied using Pearson's correlation coefficient. In the study, rescuers also pointed to musculoskeletal ailments, mainly spinal pains resulting from taking forced positions during medical activities in an ambulance.

Conclusions: The results obtained constitute the basis for the author's methodology of complex research aimed at defining the ergonomic recommendations necessary in the modification process of the operated medical fleet. The next step will be to formulate uniform guidelines for the construction of medical compartments of ambulances, the application of which will lead to the unification of their spatial structure regardless of the vehicle brand. Int J Occup Med Environ Health. 2020;33(1):91-105.
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http://dx.doi.org/10.13075/ijomeh.1896.01479DOI Listing
January 2020

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

J Cardiothorac Vasc Anesth 2020 Feb 5;34(2):365-371. Epub 2019 Aug 5.

Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland.

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.
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http://dx.doi.org/10.1053/j.jvca.2019.07.152DOI Listing
February 2020

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

Am J Emerg Med 2020 11 26;38(11):2249-2253. Epub 2019 Dec 26.

Siedlce University of Natural Sciences and Humanities, Faculty of Medical Sciences and Health Sciences, Siedlce, Poland.

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 ± 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.
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http://dx.doi.org/10.1016/j.ajem.2019.12.044DOI Listing
November 2020

Stress at work: The case of municipal police officers.

Work 2020 ;65(1):145-152

Andrzej Frycz Modrzewski Krakow University, Kraków, Poland.

Introduction And Objective: Occupational stress-related factors among working municipal police officers in Poland have not been examined in the literature. The purpose of the paper was to evaluate the impact of selected work-related factors on occupational stress in active municipal police officers in Warsaw by using configural frequency analysis (CFA).

Materials And Methods: A cross-sectional study was conducted among 578 participants, which accounted for 55.1% of all municipal police officers in Warsaw. The majority of study participants were men (72%) (mean age 43 years old). Two groups of workplace-related stress factors were analysed in the study: physical conditions and organisational working conditions causing stress. The study was carried out using the PAPI method (Paper-and-Pencil Interviewing), based on a proprietary questionnaire developed for the study. CFA searches for templates and patterns in contingency tables.

Results: Municipal police officers who claimed that stress did not affect health, took advantage of psychological/psychiatric advice less often than those who thought so (1.7% vs 10.1%; χ2 = 20.152, df = 2, P = 0.000). Those who declared that they often experienced stress at work were also more prone to claiming that one or two factors affected their level of stress: physical abuse, contact with infectious materials, working at uncomfortable temperatures or working in a noisy environment. In the opinion of the study population, there were some factors which contributed to the occurrence of stress at work, and these factors included: working in a hurry, lack of necessary resources, devices and materials at work, the need to be available at all times and the unpredictability of the work. The municipal police officers from the study population combined two or three methods to cope with stress, such as watching TV, surfing the Internet and talking with their families.

Conclusion: Due to the specificity of a municipal police officer's occupation, special attention should be paid to the occupational stress risk factors characteristic for this group of professionals, and measures should be taken to reduce the number of stressors. It is important to organise training events devoted to effective methods of coping with stress. There is need to carry out more in-depth studies of occupational stress among municipal police officers.
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http://dx.doi.org/10.3233/WOR-193067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7029323PMC
August 2020

Characteristics of aeromedical transport, both interhospital and directly from the scene of the incident, in patients with acute myocardial infarction or acute trauma between 2011-2016 in Poland: A case-control study.

Adv Clin Exp Med 2019 Nov;28(11):1495-1505

Department of Emergency Medical Services, Faculty of Health Science, Medical University of Warsaw, Poland.

Background: Patients with acute myocardial infarction (AMI) or acute trauma (AT) are transported by air to save time. Helicopter Emergency Medical Service (HEMS) provides both flights to and from the emergency scene, as well as interhospital transport (interHtransport).

Objectives: The objective of this study was to compare aeromedical transport and HEMS missions of AMI and AT patients regarding safety, medical procedures and the length of flights.

Material And Methods: This is a case-control study analyzing the medical history records of AMI and AT patients transported between hospitals and from the scene identified using ICD-10 codes. Research of customary data (age, sex and general health status measured with Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS)) was performed.

Results: There were 48,555 flights in the years 2011-2016, of which 7,645 (15.7%) were interhospital (19% AMI and 12% AT). Out of these, 40,910 (84.3%) HEMS missions were to patients on the scene (10% AMI and 13% AT). No fatalities were noted. The AMI GCS score was higher than in AT patients: 15.0 vs 14.0, respectively. The medical procedures during transport of AMI patients between hospitals and from the scene were the following: cardiopulmonary resuscitation (CPR): 6 vs 73 cases (p < 0.001); oxygen therapy: 41.1% vs 50.2%, respectively. The median distance was 59.4 km vs 52.1 km (p < 0.001), while median flight time was 45.0 min vs 38.0 min (p < 0.001), respectively. Regarding AT patients, the procedures performed (during interhospital and from the scene transport) were the following: CPR: 5 vs 244 cases (p < 0.001); intubation: 10.7% vs 17.3% (p < 0.001); sedation: 50.1% vs 24.3% (p < 0.001); oxygen therapy: 17.6% vs 36.6% (p < 0.001); spinal board: 17.1% vs 66% (p < 0.001); cervical collar: 15.9% vs 63.4% (p < 0.001), respectively. Interhospital transport and HEMS mission median flight distance was 135.9 km vs 56.3 km (p < 0.001), while median flight time was 66.0 min vs 45.0 min (p < 0.001), respectively.

Conclusions: Aeromedical transport is safe and very rarely requires resuscitation during the flight. The long distances of flights and time required can reflect the scarcity of trauma centers (TCs) compared to cardiovascular wards. The location of hemodynamic centers in Poland is optimal.
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http://dx.doi.org/10.17219/acem/109456DOI Listing
November 2019

Breast self-examination among nurses in Poland and their reparation in this regard.

Ann Agric Environ Med 2019 Sep 4;26(3):450-455. Epub 2019 Mar 4.

Medical University, Warsaw, Poland.

Introduction And Objective: Working at night and in shifts, as well as an unhealthy lifestyle, may increase the risk of breast cancer in nurses who therefore should frequently perform breast self-examination (BSE). The aim of the study was to investigate the performance of BSE among Polish nurses, its accuracy, sources of knowledge and skills, self-assessment of own competences and preparation to educate women about BSE.

Material And Methods: A descriptive, cross-sectional study was conducted in a group of female nurses (N=1,242). An anonymous, self-administrated questionnaire was used for data collection. To properly assess the BSE a four-item scale was made of the type single best answer multiple choice question. Each item referred to one agreed principle of performing BSE.

Results: Regularly BSE was performed by 56.1% nurses, 67.3% pre-menopause nurses 2-3 days after cessation of menstruation and 30.4% post-menopause women on a chosen day of the month. About 98% examined visually and by palpation; 58.9% did so in two positions. In the accuracy scale of BSE, the average number of points was 2.8 out of 4. All (4 points) or almost all (3 points) recommendations of accurate BSE were met by 61.4% of the nurses. Self-assessment of knowledge and BSE practical skills were considered as good or very good by 93.5% and 88.8% nurses, respectively. The self-evaluation of nurses' knowledge and BSE skills was significantly correlated with the result on the accuracy scale or this BSE.

Conclusions: Many deficiencies concerning frequency, times and BSE techniques were revealed among Polish nurses. There is a discrepancy between the high self-assessment of competences and the accurate practice of BSE. Nurses' preparation in Poland in BSE is insufficient and requires improvement.
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http://dx.doi.org/10.26444/aaem/102762DOI Listing
September 2019

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

Med Sci Monit 2019 Sep 1;25:6547-6553. Epub 2019 Sep 1.

Department of Emergency Medical Services, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland.

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.
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http://dx.doi.org/10.12659/MSM.915759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738001PMC
September 2019

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

BMC Emerg Med 2019 08 8;19(1):44. Epub 2019 Aug 8.

Department of Emergency Medical Services, Medical University of Warsaw, Żwirki i Wigury 81a, Warsaw, Poland.

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.
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http://dx.doi.org/10.1186/s12873-019-0261-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686239PMC
August 2019

Missions of the Helicopter Emergency Medical Service in rural and urban areas in Poland - A comparative retrospective analysis.

Ann Agric Environ Med 2019 Jun 19;26(2):355-360. Epub 2019 Apr 19.

Medical University, Warsaw, Poland.

Introduction: Mortality due to various causes, despite continuous efforts to improve the quality of medical services, is a serious problem for modern healthcare systems. Ischaemic heart disease and stroke are the cause of over 15 million deaths annually, and are therefore known as the world's number one killer.

Objective: The aim of this study is to characterise the missions and the most common reasons for dispatching Helicopter Emergency Medical Service (HEMS) crews, with special emphasis on the differences between urban and rural areas.

Material And Methods: The study was conducted using a retrospective analysis of HEMS missions, including flights to accidents and diseases carried out by HEMS crews in Poland from January 2014 - December 2018. The final analysis included 35,213 cases of HEMS missions.

Results: The study group consisted mainly of male patients (66.40%), aged 50-64 (22.06%), mean age of the entire analysed group - 47.71 (SD: 25.96). The main reason for HEMS missions were strokes (21.63%). Analysis of patients' clinical status revealed that the clinical status of patients treated in rural areas was more severe, which was indicated by the Glasgow Coma Scale - GCS (12.03 vs 12.35) and the Revised Trauma Scale - RTS (10.14 vs 10.60) scores. When assessed by the National Advisory Committee for Aeronautics (NACA) score, body injuries and fatal diseases were observed more often in patients in rural areas (NACA 7 6.12% vs 3.46%) (p<0.05).

Conclusions: Multi-organ injuries, head traumas, sudden cardiac arrest, traumatic brain injuries, collapse and epilepsy, were more frequent reasons for HEMS missions in rural areas than in urban areas.
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http://dx.doi.org/10.26444/aaem/106223DOI Listing
June 2019

Prehospital emergency thoracotomy performed by helicopter emergency medical service team: A case report.

Ulus Travma Acil Cerrahi Derg 2019 May;25(3):303-306

Department of Emergency Medical Services, Medical University of Warsaw, Zwirki i Wigury 61, Warsaw, Poland.

Emergency thoracotomy can be a life-saving procedure in critically injured patients who present with chest injuries. Currently, the indications for an on-the-scene thoracotomy are penetrating trauma of the chest or upper abdomen with cardiac arrest that has occurred in the presence of an emergency team or within 10 minutes prior to their arrival. The indications for an emergency thoracotomy in blunt chest trauma are less clearly defined. In the present case, a helicopter emergency medical service (HEMS) team performed an emergency thoracotomy at the scene. To the best of our knowledge, it is the first description of such a procedure in Poland. A 41-year-old male was crushed in a tractor accident. Though all available measures were taken, a sudden cardiac arrest occurred. The HEMS team performed an emergency thoracotomy at the scene as an integral part of prehospital cardiopulmonary arrest management. The patient survived, and was later discharged from the hospital in good physical condition. No neurological deficit was identified (cerebral performance category 1). The patient returned to his previous activities with no complications or deficits. The presence of a fully trained crew allows for the performance of a potentially critical on-the-scene emergency thoracotomy. In a well-selected group of patients with blunt thoracic injury, a prehospital emergency thoracotomy may be a significant and life-saving procedure.
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http://dx.doi.org/10.5505/tjtes.2018.50284DOI Listing
May 2019

Helicopter Emergency Medical Service (HEMS) Response in Rural Areas in Poland: Retrospective Study.

Int J Environ Res Public Health 2019 04 30;16(9). Epub 2019 Apr 30.

Department of Emergency Medical Services, Faculty of Health Science, Medical University of Warsaw, 81 Żwirki i Wigury St., 02-091 Warsaw, Poland.

The aim of the study was to identify the characteristics of missions performed by HEMS (Helicopter Emergency Medical Service) crews and the analysis of health problems, which are the most common cause of intervention in rural areas in Poland. The study was conducted using a retrospective analysis based on the medical records of patients provided by the HEMS crew, who were present for the emergencies in rural areas in the period from January 2011 to December 2018. The final analysis included 37,085 cases of intervention by HEMS crews, which accounted for 54.91% of all the missions carried out in the study period. The majority (67.4%) of patients rescued were male, and just under a quarter of those rescued were aged between 50-64 years. Injuries (51.04%) and cardiovascular diseases (36.49%) were the main diagnoses found in the study group. Whereas injuries were significantly higher in the male group and patients below 64 years of age, cardiovascular diseases were higher in women and elderly patients ( < 0.001). Moreover, in the group of women myocardial infarction was significantly more frequent (30.95%) than men, while in the group of men head injuries (27.10%), multiple and multi-organ injuries (25.93%), sudden cardiac arrest (14.52%), stroke (12.19%), and epilepsy (4.95%) was significantly higher. Factors that are associated with the most common health problems of rural patients are: gender and age, as well as the seasons of the year and the values of the Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and National Advisory Committee for Aeronautics (NACA) used to assess the clinical status of patients.
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http://dx.doi.org/10.3390/ijerph16091532DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6539897PMC
April 2019

Determinants of occupational burnout among employees of the Emergency Medical Services in Poland.

Ann Agric Environ Med 2019 Mar 3;26(1):114-119. Epub 2018 Sep 3.

Medical University, Warsaw, Poland.

Introduction: Occupational burnout is a multifaceted phenomenon and a problem often encountered among medical personnel. An example of such a group are workers of the Emergency Medical Services (EMS). The aim of the present study was to make an attempt to assess the level of job burnout among professionally active employees of the EMS and to compare the different occupational groups (paramedics, nurses of the system, doctors of the system) according to four analyzed factors.

Material And Methods: A cross-sectional study was performed using an on-line questionnaire. Four factors impacting the level of burnout were analyzed: 1) attitude to work; 2) workload; 3) contact with the patient; 4) attitude to stress). The minimum possible result on the scale is 36 points and the maximum - 252. Data were analysed by means of the Cronbach's alpha coefficient, the Spearman correlation, the Ramsey RESET test, the Chow test, VIF statistics.

Results: The average score for occupational burnout was 131.0 points (SD ± 31.47). The tool's reliability measured by means of Cronbach's alpha was 0.910). Both nurses and doctors obtained higher results throughout the scale (βstand.0.147 and 0.215). Significant differences were shown between the group working only in the Helicopter Emergency Medical Service (HEMS) teams and the other services (land EMS, emergency rooms, etc.) at the level of p < 0.000.

Conclusions: EMS employees encounter varying degrees of threat by occupational burnout. Doctors working in the system are shown to have the highest level of burnout, while paramedics the lowest. Among all the jobs analyzed, the lowest level of occupational burnout has been demonstrated by employees of HEMS.
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http://dx.doi.org/10.26444/aaem/94294DOI Listing
March 2019

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

Wiad Lek 2019;72(2):209-215

Polish Medical Air Rescue, Warsaw, Poland, Department of Anaesthesiology And Intensive Care, Medical University of Silesia, Katowice, Poland.

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.
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August 2019

Extracorporeal membrane oxygenation for accidental deep hypothermia-current challenges and future perspectives.

Ann Cardiothorac Surg 2019 Jan;8(1):137-142

Department of Anesthesiology and Intensive Care Medicine, Medical University of Silesia, Katowice, Poland.

The incidence of accidental hypothermia (core temperature ≤35 °C) is difficult to estimate, as the affected population is heterogeneous. Both temperature and clinical presentation should be considered while determining severity, which is difficult in a prehospital setting. Extracorporeal rewarming is advocated for all Swiss Staging System class IV (hypothermic cardiac arrest) and class III (hypothermic cardiac instability) patients. Veno-arterial extracorporeal membrane oxygenation (ECMO) is the method of choice, as it not only allows a gradual, controlled increase of core body temperature, but also provides respiratory and hemodynamic support during the unstable period of rewarming and reperfusion. This poses difficulties with the coordination of patient management, as usually only cardiac referral centers can deliver such advanced treatment. Further special considerations apply to subgroups of patients, including drowning or avalanche victims. The principle of ECMO implantation in severely hypothermic patients is no different from any other indication, although establishing vascular access in a timely manner during ongoing resuscitation and maintaining adequate flow may require modification of the operating technique, as well as aggressive fluid resuscitation. Further studies are needed in order to determine the optimal rewarming rate and flow that would favor brain and lung protection. Recent analysis shows an overall survival rate of 40.3%, while additional prognostic factors are being sought for determining those patients in whom the treatment is futile. New cannulas, along with ready-to-use ECMO sets, are being developed that would enable easy, safe and efficient out-reach ECMO implantation, thus shortening resuscitation times. Moreover, national guidelines for the management of accidental hypothermia are needed in order that all patients that would benefit from extracorporeal rewarming would be provided with such treatment. In this perspective article, we discuss burning problems in ECMO therapy in hypothermic patients, outlining the important research goals to improve the outcomes.
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http://dx.doi.org/10.21037/acs.2018.10.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6379186PMC
January 2019

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

Wiad Lek 2019;72(1):26-30

Lotnicze Pogotowie Ratunkowe, Warszawa, Polska, Zakład Ratownictwa Medycznego, Wydział Nauk o Zdrowiu, Warszawski Uniwersytet Medyczny, Warszawa, Polska.

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.
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August 2019

The Effect of the Treatment at a Pain Clinic on the Patients' Assessment of Their Pain Intensity and the Incidence of Mental Disorders in the form of Anxiety, Depression, and Aggression.

Int J Environ Res Public Health 2019 02 18;16(4). Epub 2019 Feb 18.

Department of Anesthesiology and Intensive Care, John Paul II Western Hospital in Grodzisk Mazowiecki, 11 Daleka St., 05-825 Grodzisk Mazowiecki, Poland.

The aim of the study was to analyze the effect of the treatment given to patients in a pain clinic on their assessment of pain intensity and the incidence of emotional disturbances in the form of anxiety, depression, and aggression. The study was conducted from January 2014 to April 2018 among patients under the care of two Warsaw pain clinics. The study tools were the Hospital Anxiety and Depression Scale-Modified Version (HADS-M) and the Numerical Rating Scale (NRS). The project enrolled 325 patients, with women comprising 60.62% of patients, and the age bracked of 65⁻79 years comprising 39.38% of patient. The major reasons for attending the pain clinic were osteoarticular pain (44.92%) and neuropathic pain (42.77%). The therapy applied lowered the patients' pain intensity (4.98 vs. 3.83), anxiety (8.71 vs. 8.12), aggression (3.30 vs. 3.08), and the overall HADS-M score (18.93 vs. 17.90), which shows that the treatment of both the pain symptoms and the associated emotional disturbances in the form of anxiety and aggression was effective. Sex is a factor affecting pain intensity. The level of mental disorders was influenced by the sex and age of the patients and how long they had been treated in the pain clinics.
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http://dx.doi.org/10.3390/ijerph16040586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406293PMC
February 2019

The role of extracorporeal life support in patients with hypothermic cardiac arrest.

Resuscitation 2019 01;134:157-158

Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Medyków 16, Katowice, Poland. Electronic address:

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http://dx.doi.org/10.1016/j.resuscitation.2018.10.015DOI Listing
January 2019

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

Wiad Lek 2018;71(9):1729-1737

Zakład Ratownictwa Medycznego, Warszawski Uniwersytet Medyczny, Warszawa, Polska.

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.
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June 2019

In Response to Cold Card by Giesbrecht.

Wilderness Environ Med 2019 03 4;30(1):105-106. Epub 2019 Jan 4.

Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland.

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http://dx.doi.org/10.1016/j.wem.2018.10.007DOI Listing
March 2019