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A Needle in a Haystack: Looking for Gaps in Treatment...
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A Needle in a Haystack: Looking for Gaps in Treatment and Education in Emergency Medicine

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Prehospital Care".

Deadline for manuscript submissions: 31 March 2025 | Viewed by 5048

Special Issue Editors

Prof. Dr. Klaudiusz Nadolny

E-Mail Website
Guest Editor
Department of Emergency Medical Service, Faculty of Medicine, Silesian Academy in Katowice, 40-555 Katowice, Poland
Interests: resuscitation; sudden cardiac arrest; myocardial infarction; pre-hospital care; emergency department organization; intensive care in emergency medicine; emergency medical teams functioning; emergency medical service organization
Dr. Filip Krzysztof Jaśkiewicz

E-Mail Website
Guest Editor Assistant
Emergency Medicine and Disaster Medicine Department, Medical University of Lodz, 90-419 Lodz, Poland
Interests: basic and advanced life support; willingness and barriers to resuscitation; innovations in medical training; hemorrhage control, medical simulation, medical education, emergency medicine and first aid training; the role of the human factor in emergencies

Special Issue Information

Dear Colleagues,

Emergency medicine is a very specific specialization created to meet the needs of patients of all ages, in life-threatening emergencies of any etiology. This makes it stand out from other fields of medicine in terms of the clinical diversity of patients. Emergency care, in many cases, is also characterized by limited time to implement critical life-saving interventions. Noteworthy is the fact that rescue activities have a multi-stage nature, starting with first aid provided by bystanders and ending with multi-specialized care in emergency departments. This, of course, requires effective and safe solutions in the field of logistics, transport and organizational solutions.

This specificity of emergency medicine makes conducting clinical research in this area a great challenge. Despite the continuous development of science, technological progress and the possibilities of research tools, many recommendations and standards of conduct are still based on weak evidence or only the agreed opinion of experts. The thematic breadth of emergency medicine also means that many important research issues are not addressed or are poorly understood, which results in gaps in knowledge and practice.

The purpose of this Special Issue is to encourage researchers to think “outside the box” when planning emergency care research and to fill these gaps. At the same time, this Special Issue aims at drawing attention to the need for high-quality research based on strong and purposeful methodology. The results of this research should have the potential to be translated into patient benefit.

In this Special Issue, high quality and novel original research articles and reviews are welcome. Research areas may include (but are not limited to) the following:

  • Basic and advanced life support;
  • Cardiopulmonary resuscitation;
  • Increasing the effectiveness of emergency medical training;
  • Pre-hospital care;
  • Drug therapies at the pre-hospital stage;
  • Pediatric life-threatening emergencies;
  • Trauma in traffic accidents;
  • Trauma hemorrhage control;
  • Emergency medicine in war-torn areas;
  • Acute internal medicine;
  • Acute cardiac and neurological emergencies;
  • Special patients and special circumstances in emergency medicine;
  • Logistics and transport in rescue operations;
  • Innovations in emergency care;
  • Human factor and psychology in life-threatening conditions.

Prof. Dr. Klaudiusz Nadolny
Dr. Filip Krzysztof Jaśkiewicz
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • emergency medical services
  • pre-hospital care
  • pediatric emergencies
  • acute medicine
  • resuscitation
  • innovations
  • trauma
  • war injuries
  • hemorrhage control
  • medical simulation
  • emergency training

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Further information on MDPI's Special Issue polices can be found here.

Published Papers (5 papers)

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Research

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10 pages, 983 KiB  
Article
What Mistakes Can Be Made When Performing the Electrical Cardioversion Procedure?—Analysis of Emergency Medical Team Performance during the Championships in Emergency Medicine
by Michał Ćwiertnia, Mieczysław Dutka, Piotr Białoń, Michał Szlagor, Arkadiusz Stasicki, Monika Mikulska, Maciej B. Hajduga, Rafał Bobiński, Marek Kawecki and Tomasz Ilczak
Healthcare 2024, 12(17), 1724; https://doi.org/10.3390/healthcare12171724 - 29 Aug 2024
Viewed by 588
Abstract
Background: Medical personnel carrying out electrical cardioversion (EC) procedures must remember to have the R-wave sync mode switched on, use the correct energy and maintain personal safety. The defibrillators used by medical response teams most often switch out of cardioversion mode once a [...] Read more.
Background: Medical personnel carrying out electrical cardioversion (EC) procedures must remember to have the R-wave sync mode switched on, use the correct energy and maintain personal safety. The defibrillators used by medical response teams most often switch out of cardioversion mode once a shock is delivered. Therefore, this mode must be switched on again before subsequent shocks are delivered. The main aim of the study was to assess the ability of emergency medical teams participating in emergency medicine championships to perform EC. Methods: The research was a retrospective observational study and was based on an analysis of the evaluation sheets from two tasks simulating the management of a patient with unstable tachycardia conducted during the International Winter Emergency Medicine Championships. Three-person teams consisting of paramedics and representing the Polish emergency services were included in the study. The team representing the championship organiser and the few foreign teams participating in the competition were excluded from the study. Results: The decision to conduct EC was taken by 36 teams (83.72%) in 2015 and 27 teams (87.10%) in 2019. In both editions of the championships, during consecutive shocks, the percentage of actions performed correctly decreased significantly—switching on synchronisation mode in 2015 (94.4%, 83.33%, 72.22%) and in 2019 (100%, 88.89%, 81.48%); correct energies in 2015 (91.67%, 80.56%, 77.78%) and in 2019 (92.59%, 85.19%, 81.48%); shocks in a safe manner in 2015 (94.44%, 94.44%, 91.67%) and in 2019 (100%, 96.30%, 96.30%). Conclusions: Teams participating in the assessed tasks in a significant majority of cases correctly qualified the patient for EC, and correctly carried out the actions required for this procedure. It is of particular note that with every subsequent shock, the percentage of shocks carried out without the sync mode increased significantly. Full article
(This article belongs to the Special Issue A Needle in a Haystack: Looking for Gaps in Treatment and Education in Emergency Medicine)
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10 pages, 242 KiB  
Article
Assessment of the Severity of COVID-19 on the Basis of Examination and Laboratory Diagnostics in Relation to Computed Tomography Imagery of Patients Hospitalised Due to COVID-19—Single-Centre Study
by Tomasz Ilczak, Szymon Skoczynski, Ewa Oclon, Mirosław Kucharski, Tomasz Strejczyk, Marta Jagosz, Antonina Jedynak, Michał Wita, Michał Ćwiertnia, Marek Jędrzejek, Mieczysław Dutka, Wioletta Waksmańska, Rafał Bobiński, Roch Pakuła, Marek Kawecki, Paweł Kukla and Szymon Białka
Healthcare 2024, 12(14), 1436; https://doi.org/10.3390/healthcare12141436 - 18 Jul 2024
Viewed by 920
Abstract
From the moment the SARS-CoV-2 virus was identified in December 2019, the COVID-19 disease spread around the world, causing an increase in hospitalisations and deaths. From the beginning of the pandemic, scientists tried to determine the major cause that led to patient deaths. [...] Read more.
From the moment the SARS-CoV-2 virus was identified in December 2019, the COVID-19 disease spread around the world, causing an increase in hospitalisations and deaths. From the beginning of the pandemic, scientists tried to determine the major cause that led to patient deaths. In this paper, the background to creating a research model was diagnostic problems related to early assessment of the degree of damage to the lungs in patients with COVID-19. The study group comprised patients hospitalised in one of the temporary COVID hospitals. Patients admitted to the hospital had confirmed infection with SARS-CoV-2. At the moment of admittance, arterial blood was taken and the relevant parameters noted. The results of physical examinations, the use of oxygen therapy and later test results were compared with the condition of the patients in later computed tomography images and descriptions. The point of reference for determining the severity of the patient’s condition in the computer imagery was set for a mild condition as consisting of a percentage of total lung parenchyma surface area affected no greater than 30%, an average condition of between 30% and 70%, and a severe condition as greater than 70% of the lung parenchyma surface area affected. Patients in a mild clinical condition most frequently had mild lung damage on the CT image, similarly to patients in an average clinical condition. Patients in a serious clinical condition most often had average levels of damage on the CT image. On the basis of the collected data, it can be said that at the moment of admittance, BNP, PE and HCO3− levels, selected due to the form of lung damage, on computed tomography differed from one another in a statistically significant manner (p < 0.05). Patients can qualify for an appropriate group according to the severity of COVID-19 on the basis of a physical examination and applied oxygen therapy. Patients can qualify for an appropriate group according to the severity of COVID-19 on the basis of BNP, HCO3 and BE parameters obtained from arterial blood. Full article
(This article belongs to the Special Issue A Needle in a Haystack: Looking for Gaps in Treatment and Education in Emergency Medicine)

Other

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9 pages, 412 KiB  
Protocol
CALL TO ECLS—Acronym for Reporting Patients for Extracorporeal Cardiopulmonary Resuscitation Procedure from Prehospital Setting to Destination Centers
by Tomasz Sanak, Mateusz Putowski, Marek Dąbrowski, Anna Kwinta, Katarzyna Zawisza, Andrzej Morajda and Mateusz Puślecki
Healthcare 2024, 12(16), 1613; https://doi.org/10.3390/healthcare12161613 - 13 Aug 2024
Viewed by 896
Abstract
The acronym CALL TO ECLS has been proposed as a potential tool to support decision-making in critical communication moments when qualifying a patient for the ECPR procedure. The aim of this study is to assess the accuracy of the acronym and validate its [...] Read more.
The acronym CALL TO ECLS has been proposed as a potential tool to support decision-making in critical communication moments when qualifying a patient for the ECPR procedure. The aim of this study is to assess the accuracy of the acronym and validate its content. Validation is crucial to ensure that the acronym is theoretically correct and includes the necessary information that must be conveyed by EMS during the qualification of a patient with out-of-hospital cardiac arrest for ECMO. A survey was conducted using the LimeSurvey platform through the Survey Research System of the Jagiellonian University Medical College over a 6-month period (from December 2022 to May 2023). Usefulness, importance, clarity, and unambiguity were rated on a 4-point Likert scale, from 1 (not useful, not important, unclear, ambiguous) to 4 (useful, important, clear, unambiguous). On the 4-point scale, the Content Validity Index (I-CVI) was calculated as the percentage of subject matter experts who rated the criterion as having a level of importance/clarity/validity/uniqueness of 3 or 4. The Scale-level Content Validity Index (S-CVI) based on the average method was computed as the average of I-CVI scores (S-CVI-AVE) for all considered criteria (protocol). The number of fully completed surveys by experts was 35, and partial completion was obtained in 63 cases. All criteria were deemed significant/useful, with I-CVI coefficients ranging from 0.87 to 0.97. Similarly, the importance of all criteria was confirmed, as all I-CVI coefficients were greater than 0.78 (ranging from 0.83 to 0.97). The average I-CVI score for the ten considered criteria in terms of usefulness/significance and importance exceeded 0.9, indicating high validity of the tool/protocol/acronym. Based on the survey results and analysis of responses provided by experts, a second version was created, incorporating additional explanations. In Criterion 10, an explanation was added—“Signs of life”—during conventional cardiopulmonary resuscitation (ROSC, motor response during CPR). It has been shown that the acronym CALL TO ECLS, according to experts, is accurate and contains the necessary content, and can serve as a system to facilitate communication between the pre-hospital environment and specialized units responsible for qualifying patients for the ECPR. Full article
(This article belongs to the Special Issue A Needle in a Haystack: Looking for Gaps in Treatment and Education in Emergency Medicine)
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7 pages, 1755 KiB  
Case Report
Successful Intraosseous (IO) Adenosine Administration for the Termination of Supraventricular Tachycardia (SVT) in a 3.5-Year-Old Child—Case Report and Literature Review
by Jakub Zachaj, Łukasz Kręglicki, Tomasz Sikora, Katarzyna Moorthi, Filip Jaśkiewicz, Klaudiusz Nadolny and Robert Gałązkowski
Healthcare 2024, 12(15), 1509; https://doi.org/10.3390/healthcare12151509 - 30 Jul 2024
Viewed by 929
Abstract
Paediatric supraventricular tachycardia (SVT) is a common arrhythmia of great clinical significance. If not treated promptly, it can cause heart failure and cardiogenic shock. Depending on the patient’s condition, SVT treatment involves vagal manoeuvres, pharmacological, or direct current cardioversion. The goal of acute [...] Read more.
Paediatric supraventricular tachycardia (SVT) is a common arrhythmia of great clinical significance. If not treated promptly, it can cause heart failure and cardiogenic shock. Depending on the patient’s condition, SVT treatment involves vagal manoeuvres, pharmacological, or direct current cardioversion. The goal of acute SVT management is to immediately convert SVT to a normal sinus rhythm (NSR) and prevent its recurrence. Adenosine is recommended as the first-line treatment for stable SVT by the European Resuscitation Council (ERC) and American Heart Association (AHA) guidelines, when vagal manoeuvres have proven ineffective. The ERC and AHA guidelines recommend the intravenous route of administration. The intraosseous (IO) administration technique is also possible, but still relatively unknown. The aim of this paper is to describe a 3.5-year-old child with SVT that was converted to NSR following IO administration of adenosine. Successful conversion was achieved after the second attempt with the adenosine dose. In the described case, there was no recurrence of SVT. Full article
(This article belongs to the Special Issue A Needle in a Haystack: Looking for Gaps in Treatment and Education in Emergency Medicine)
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7 pages, 216 KiB  
Perspective
“Even Though the System Had Failed Him His Entire Life, We Were Failing Him Yet Again”: How Clinical, Welfare, and Penal Medicine Interact to Drive Health Inequities and Medical Moral Injury
by Siddhi S. Ganesh, Kyle B. Joyner, Shamsher Samra, Ricky N. Bluthenthal and Todd W. Schneberk
Healthcare 2024, 12(13), 1354; https://doi.org/10.3390/healthcare12131354 - 7 Jul 2024
Viewed by 1097
Abstract
Adam, a justice-involved young man, was brought into the emergency department at the county hospital in cardiogenic shock due to a recurring episode of injection-drug-use-related infective endocarditis (IDU-IE). Adam had initiated injection opioid use in prison. He was surgically treated for the previous [...] Read more.
Adam, a justice-involved young man, was brought into the emergency department at the county hospital in cardiogenic shock due to a recurring episode of injection-drug-use-related infective endocarditis (IDU-IE). Adam had initiated injection opioid use in prison. He was surgically treated for the previous episodes of IDU-IE but was unable to fully recover due to limitations in care within penal medicine. This case report explores the prison as a determinant of health, interactions between clinical, welfare, and penal medicine, to produce and maintain health inequities, and structural drivers of physician moral injury through an interview with Adam and reflexive writings from emergency medicine physicians. This case demonstrates the need for three types of structural health interventions: (1) restorative justice, community-based reentry programs, and housing as welfare medicine, (2) increased harm reduction services across healthcare, especially penal medicine, and (3) equitable institutional protocols (contrary to ambiguous guidelines) to treat clinical conditions like IDU-IE that disproportionately impact structurally vulnerable patients. Full article
(This article belongs to the Special Issue A Needle in a Haystack: Looking for Gaps in Treatment and Education in Emergency Medicine)
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