Aim:The purpose of the study is to work out a new emergency medical service (EMS) tactic to be employed in CBRNE/HAZMAT incidents, which would allow performing emergency medical procedures in the area so far inaccessible to the State Emergency Medical System (Polish abbreviation: PRM). Project and methods: Incidents involving new hazardous materials, especially terrorist ones, demand emergency services to be well prepared in order to respond accordingly. Latest technological advances regarding both personal protective equipment (PPE) for preventing contamination and respiratory protection equipment bring effective and safe methods of medical professionals' protection at every stage of rescue operations being performed. The research study was conducted in 2016-2018 and its main focus was on providing medical care at all stages of rescue operations. The CBRNE/HAZMAT incident procedures of the State Emergency Medical System (PRM), the National Firefighting and Rescue System (KSRG), the Bureau of Anti-Terrorist Operations of the National Police Headquarters (BOA KGP) and the Epidemiological Response Centre of the Polish Armed Forces (CRESZ) were thoroughly analysed. An analysis of procedural shortcomings within rescue operations of all services was also conducted. In addition, the PPE for preventing contamination and the respiratory protection equipment that is used by various emergency services and may also be applied within PRM operations was thoroughly examined. Results: Based on the study, a new EMS tactic was developed using the available PPE, a management system of rescue operations and a model of organisation of any operations. The in-depth analysis of PPE for preventing contamination and respiratory protection equipment indicated new solutions and methods for protecting professionals of the State Emergency Medical System (PRM) while providing pre-hospital and hospital care (in Hospital Emergency Departments). A set of training drills employing new tactics and PPE indicated real possibilities to transfer new solutions to EMS that would compensate the shortcomings identified within the procedures of responses at the subsequent stages of CBRNE/HAZMAT incidents. Conclusions: The suggested tactic of emergency medical services shall enhance the effectiveness of the emergency rescue system in CBRNE/HAZMAT incidents as it enables emergency medical procedures (Polish abbreviation: MCR) to be more promptly performed in patients with life-threatening conditions, along with providing medical care at all stages of rescue operations.

Study/Objective: To estimate the early prognosis and evaluate the need of intensive medical resources of patients with multiple injuries. Background: A large amount of research and clinical practice indicates that the multiple injuries are urgent and the illness change of a patient's condition is rapid, which leads to the a high mortality rate. We can take some early and effective methods of triage to make patients receive timely, effective treatment, thus to reduce the mortality rate. In that case, we need some early and effective indicators of triage. Methods: We recruited 115 patients with multiple injuries admitted to emergency department of West China Hospital, Sichuan University between March 2016 and May 2016 and collected 19 clinical indicators from each patient. The indicators included gender, age, temperature, heart rate, respiratory rate, peripheral oxygen saturation, systolic pressure, diastolic pressure, power of hydrogen (PH), hemoglobin, base excess (BE), serum potassium, serum sodium, serum calcium, lactic acid, glucose, partial pressure of oxygen (PO2), carbon dioxide partial pressure (PCO2), and peritoneal effusion. We analyzed the correlation of these indicators with deaths within the first 24 hours, emergency surgery, admissions to intensive care unit (ICU), and length of ICU stay through the method of a rank sum test and logistic regression with SPSS 19.0. Results: The results showed that the possibility of death (A) could be expressed as: A =-0.276*BE(mmol),-3.005*T(°C)-0.073*PO2 (mmHg) 110.843 and the need of admissions to intensive care unit (B) as: B = 1.007* peritoneal effusion + 0.140* glucose (mmol/L)-3.224. Conclusion: BE, T, PO2 may be useful in early forecasting the prognosis of patients with multiple injuries; glucose and peritoneal effusion can evaluate if the patient needs the intensive medical resources.

Introduction: Medical personnel of the state Emergency Medical Services (EMS) will be the first element involved in providing assistance to victims of radiation incidents. Triage, initial diagnosis and further patient medical management will depend on their actions. In many radiation incidents, initial radiation triage and early diagnostics will be carried out in the emergency department (ED) or trauma center (TC). Extended triage, diagnosis of ARS and proper treatment will be continued in specialist centers. The aim: To present a model of patient medical management including initial triage and early diagnosis of ARS that can be carried out at the ED and TC. Material and methods: The initial medical procedures prepared by expert groups were presented. The choice of procedures was made in terms of the possibility of their application by the EMS teams in Poland. Particular attention was paid to the method of initial triage, based on the clinical condition and laboratory diagnostics. Results: Based on the material collected, the path of the initial medical procedure was presented. Variants of the radiation triage, interpretation of clinical parameters and results of laboratory tests are presented. The methods of initial treatment and the method of qualification for specialist treatment, and new methods of treating patients were also described. Conclusions: An adequate evaluation of radiation incidents, determining the absorbed dose of ionising radiation and ARS, as well as initial triage seem to be crucial skills of the EMS workers.

Purpose:The effects of ionising radiation on the human body has been discussed. The authors believe that the understanding of the radiation incidents from the perspective of its effects is crucial for better preparation, and therefore safer and more effective responses to incidents involving such threats. Introduction: The increasing use of radioactive materials and radiation producing devices in many areas of our lives carries the risk of exposure to high doses of radiation being hazardous to our health due to possible damage to radiation sources or improper handling. Exposure resulting from the intentional use of radioactive materials for criminal or terrorist purposes cannot be excluded, either. Exposure to ionising radiation may cause adverse health effects both to victims of a radiation incident and for rescuers providing emergency care. Such threats require the proper preparation of emergency medical services (EMS). Part of these preparations is to examine the specifics of radiation hazards, including radiation sources, the mechanism of injury of ionising radiation and the type of radiation damage. Methodology: The publication presents the properties of ionising, corpuscular and electromagnetic types of radiation, which are the most important from EMS's perspective. The dangers of contact with a radiation source, the problem of external and internal contamination, the estimation of the amount of absorbed radiation were discussed, and the interrelationships between them were presented. The mechanism of direct and indirect action of ionising radiation on cell structures (DNA, mRNA, cytoplasmic membranes) and intracellular enzymes was thoroughly discussed. The authors presented health consequences of radiation for the body in the form of acute (deterministic) lesions and late (stochastic) lesions. Conclusions: Particular attention was paid to acute radiation syndrome (ARS). The dependence of ARS on the amount of absorbed radiation was discussed in detail. Four stages of ARS were presented: initial, latent, manifest illness and recovery (or death) as well as the time of their onset, duration and end. The mechanism of damage to individual organs and systems was also analysed. The most common symptoms, their severity, and causes of life-threatening conditions, resulting from radiation damage in particular syndromes of ARS, were indicated. In addition to systemic effects, local changes in the form of Cutaneous Radiation Syndrome (CSR) were discussed.

Introduction: The use of radiation sources in various areas of life generates the risk of accidents and radiation disasters. The increase in terrorist threats as well as the risk of an outbreak of new armed conflicts carries the risk of using radioactive materials by terrorist groups and the military. Exposure to high doses of radiation and absorbing above-threshold doses by victims may cause acute radiation syndrome (ARS), as well as some distant effects. Personnel of the State Emergency Medical System (EMS) will be the first professional medical team in the process of providing assistance to such victims. The effects of further medical treatment in the hospital will depend on EMS’s first response, radiological triage and initial interventions taken. The aim: To present pathophysiology and clinical symptoms of acute radiation syndrome in the context of the medical practice of the EMS. Material and methods: For the purpose of this publication, an analysis of literature on the subject of the mechanism of ionizing radiation and its effects on the human body was performed. The work is focused on the interpretation of research results and their presentation from the EMS’s perspective. Results: The publication presents the impact of ionizing radiation on the body, the mechanism of damage to cellular structures and its consequences for individual organs and systems. ARS’s clinical (hematopoietic, intestinal, cerebrovascular) syndromes were discussed in detail, paying attention to radiation doses, the sensitivity of individual systems and organs, the dynamics of individual phases, as well as the ability to recognize and assess the severity of their progression by EMS personnel. Conclusions: The knowledge of pathophysiology, and ARS’s symptoms and dynamics is important to respond correctly to radiation incidents. This knowledge allows for efficient organization and emergency management during rescue operations. The increase in the risk of radiation incidents and radiation disasters generates the need for appropriate preparation of emergency rescuers, in particular, of the medical personnel of the State Emergency Medical Services.