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.

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.

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.

Purpose: The aim of the study is to make a quantitative and qualitative assessment of selected parameters connected with a patient's ventilation using a self-inflating bag during simulated 'head-first' or ‘legs-first' directions of patient transport. Methods: Seventeen people participated in the conducted study. Their task included conducting alternative ventilation during the transport of the patient (Airway Management Simulator BT Inc.) by using the head or the legs technique: in the transport trolley's movement direction. At all times during the transport, video recording was carried out non–stop, and the spectrum of generated vibrations was recorded using the SVAN 958 vibration spectrum analyser, with a three-direction SVANTEK SV 39A disc for measuring whole body vibrations. Additionally, a survey was carried out. The task of the research participants was to indicate the degree of performer comfort related to the ventilation and the transport process. The assessment of the results was then subjected to statistical analysis. Results: The duration of the patient transport by using the legs-first technique was shorter (57.5 s on average) in comparison with the head-first one (62.5 s on average). The subjective assessment of performer comfort on the transport and ventilation process with the legs-first technique was perceived as higher compared to the head-first one. During the patient transport, the highest a RMS acceleration values in the vertical direction were obtained for frequencies 8-25 [Hz], corresponding to the resonance frequencies of the head (17-25 Hz), trachea and bronchi (12-16 Hz), lungs (4-11 Hz) and the spine (8-12 Hz). According to other authors, vibrations with a frequency of 8-10 Hz lead to a decrease in blood pressure, bradycardia and bradypnoe; vibrations at a frequency of 11-12 Hz cause increased heart rate, peripheral vasoconstriction, fatigue, abnormal temperature, nausea, abdominal and chest pain, while vibrations above 12 Hz cause dangerous arrhythmia, muscle tremors, pain and bleeding. Conclusions: The recommended position of intra-hospital patient transport is the legs-first technique. At the stage of preparation for transport, it is necessary to keep in mind the ergonomic aspects of carrying out possible rescue procedures, e.g. artificial ventilation, the effectiveness of which depends on the height of the patient’s trolley, the elbow-shoulder angle of the paramedic, and their back inclination in the thoracolumbar section. The training of medical staff should include conducting high fidelity simulation of activities connected with e.g. transport, enabling future paramedics to acquaint themselves with the working conditions in terms of the effectiveness of actions and ensuring adequate work ergonomics.