ems1cover300 Dear Colleagues

Welcome to the new scientific journal Emergency Medical Service. Ratownictwo Medyczne (EMS, RM). The initiative to create this journal has been received very well. The prehospital and hospital emergency care is a field undergoing dynamic changes and those changes need to be communicated to the medical community to broaden their knowledge and exchange opinions. It is my firm belief that EMS,RM will become a place to present new research and case reports and the spread of knowledge will support us in our work. I wish to encourage you to publish your scientific papers in our quarterly journal. The first issue is planned for publication in October 2014. You are warmly invited to join us.

Best regards
Robert Gałązkowski, PhD
Editor-in-Chief

Evaluation and comparison of paramedical (P) and specialist (S) emergency medical teams in the field of physical examination

Abstract
Background: The ability to perform clinical interview is one of the basic diagnostic methods in emergency medical teams. 
Aim: Evaluation and comparison of paramedical (P) and specialist (S) emergency medical teams in the field of clinical interview as an element of diagnostic process among patients with cardiovascular problems.
Material and method: 1560 documents issued by EMS teams have been examined. These document the work of 5 emergency medical teams in Kraków, Poland in 2012. The following aspects of clinical examination were analyzed: chief complains, time from the onset of symptoms to decision to call for EMS and past medical history and medication.
Results: Main symptoms manifested by patients treated by both types of emergency medical teams were similar; they are present in 98% of documents issued by specialist and on 95% by paramedical EMS teams. Time of symptom occurrence has been stated by 71% of paramedical teams and by 66% of specialist teams. Past medical history has been examined by 71% and 69% teams respectively.
Conclusion: Paramedical and specialist teams undertake clinical interview on similar level.

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Sudden threat to human health and life. Legal analysis and its socio-medical context.

Abstract
While the concept of life-threatening is understood intuitively much more difficult to define the concept of health risks. Precise definitions of the two concepts are fundamental to the broad sense of security. The article examines both the legal terms on the basis of existing legislation as well as court rulings. We discuss both aspects of civil and criminal problems, while stressing the need for up In conclusion, made considerations, to endanger the health or life status should be adopted involving sudden or anticipated in the short term onset of symptoms worsening health, the direct consequence may be severe damage to the functions of the body, injury or loss of life. Thus, the threat to life and health occurs when there is a failure to postpone medical care, which could, to the knowledge and experience of the medical prevent the patient’s adverse effects. The obligation to provide assistance in such cases is absolute and ahead of limitations arising from contracts of health benefits. Health care facility, in the event of refusal of health care services to the patient in a situation of danger to health or life runs the risk of liability, and its employees to criminal liability and disciplinary due without aid.to a broad perspective on the issues and the simultaneous application of different legal acts.

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INITIAL INTENSIVE CARE IN THE EMERGENCY DEPARTMENT

Abstract
In this article, the authors discuss the basics of intensive care in the emergency department settings. Attention was drawn to the basic techniques of monitoring and treatment of critically ill patients. This article discusses the typical trauma and non-trauma cases including proper diagnosis and treatment. The authors analyze the basic methods of monitoring of cardiovascular and respiratory systems typically used in the emergency department. This article discusses the role of the early warning scales/scores (NEWS) in the emergency department, as well as airway insufficiency, mechanical ventilation including non-invasive ventilation, central vein cannulation, ultrasound and capnography in cardiac arrest and the initial treatment in the increased intracranial pressure cases.

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Hungarian Air Ambulance aka HEMS in Hungary

Abstract
Hungarian Air Ambulance Nonprofit Ltd. is a government-owned, not-for-profit organization covering the whole country as the sole provider of HEMS in Hungary. This article gives an introduction to Hungarian HEMS, its organizational structure, missions and history.

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Pain management at the scene

Summary
The pain accompanying each injury is a phenomenon that affects the function of all organs and systems very negatively. Its effective alleviation is essential for the treatment of post-traumatic patients. The following article presents the definition of pain, its pathomechanisms and methods of its evaluation. It also discusses pharmacotherapy options differentiating between pain management at the scene or during transportation and at patient’s home during the recovery period.

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THE USAGE OF MORPHINE IN DAILY PRACTICE BY EMERGENCY MEDICAL SERVICES (EMS). A PILOT STUDY

Abstract
Introduction: For a long time within the paramedic community, there has been an ongoing discussion about increasing nurses’ and paramedics’ rights who are employed in the EMS.
The aim: To assess morphine use in pre-hospital EMS settings.
Materials and methods: Paramedics were surveyed using a questionnaire made by the authors of this article. EMS supervisors were invited to take the survey, which was conducted in two ambulance stations between October and December 2016. The survey responses (36) should be interpreted as a preliminary result regarding this issue.
Result: 86% of paramedics surveyed use morphine for all patients, 14% use it only in adults and 58% do not feel the need to administer opioids, other than morphine. Morphine was given in fractionated doses by 63% of responders, while 8% use a single dose of 2 to 3 mg iv. In addition to opioids and once any contraindications were ruled out, 69% of responders gave an analgesic, most commonly ketoprofen.
Conclusions: Paramedics use morphine in their daily practice. Most paramedics do not want any additional privileges regarding opioid use in pain relief. Pain intensity scales were used. Fractionated morphine doses were most commonly administered. A substantial portion of the study group dreads side effects. Metoclopramide is not routinely used in combination with morphine. Morphine is most commonly administered in emergency situations, such as acute coronary syndrome (ACS) and trauma.

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Pharmacological treatment and electrotherapy: paramedics’ opinions and knowledge. New qualifications and challenges

Abstract
Introduction: New qualifications given to paramedics caused many questions about the reasons for the decision on introducing the changes. There are also some questions related to the paramedics’ readiness for those changes. Being aware of different ways of development, training and acquiring experience motivated us to run a survey and check the paramedics’ knowledge of the emergency treatment that can be provided by them.

Aim: The aim of the work is to collect paramedics’ opinions on given qualifications (a regulation of the Minister of Health of 20 April 2016) and check their knowledge of those new issues.

Material and methods: The questionnaire form for the survey was made by the authors of this article. The survey was conducted during the 3rd Paramedic Summer Conference in Grudziądz. The interviewees answered 25 single choice questions related to the introduced changes.

Results: Paramedics’ independence in using fentanyl is considered to be a right decision by 74% of the interviewees. 92% support using hydroxyzine, 34% urapidil, 90% metamizole, 57% metoprolol, 81% paracetamol, 65% ibuprofen and 62% adenosine. 69% of the interviewed paramedics think it is right to use external cardiac electrostimulation on their own. 63% consider cardioversion as a right procedure to be provided by paramedics independently.

Conclusions: The interviewed paramedics approve of reforms being made. Only one-third of the answerers hold with putting urapidil on the list of medicines used by paramedics independently. Two-thirds consider changes in providing electrostimulation to be a right step. Most of the interviewees have basic knowledge on the use of fentanyl, metoprolol, paracetamol and ibuprofen. The answerers do not have adequate knowledge of the properties of hydroxyzine and urapidil. Only 50% of the interviewed paramedics know how to classify a patient as hemodynamically unstable.

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