Search Results (175)

Background: The COVID-19 pandemic profoundly disrupted healthcare systems worldwide, compelling rapid adaptation of clinical workflows and accelerating the integration of telemedicine. Objective: This study evaluates the implementation of telemedicine in neurosurgical outpatient care at a tertiary referral hospital in Madrid during the first epidemic wave (March–May 2020) and explores its long-term significance five years later. Methods: A retrospective observational analysis including 5175 neurosurgical outpatient consultations was conducted, comparing the first epidemic wave of COVID-19 (2070 teleconsultations) with the equivalent period in 2019 (3105 in-person visits). Demographic, clinical, and procedural data were analyzed, including six-month follow-up outcomes. Univariate and multivariate analyses were performed to identify factors associated with teleconsultation use and follow-up delay. Results: The total number of consultations decreased by 33% compared to the pre-pandemic year. In May 2020, teleconsultations represented more than 70% of all visits. Continuity of care was preserved (follow-up adherence >80%), and missed appointments declined to zero. Cranial and oncological pathologies were prioritized, while degenerative and benign cases were largely deferred. Teleconsultation independently predicted delayed six-month follow-up (aOR 1.9, 95% CI 1.3–2.8, p = 0.002) and a lower likelihood of surgical indication (aOR 0.4, 95% CI 0.2–0.7, p = 0.004). Despite these differences, remote care ensured accessibility, safety, and clinical continuity under extreme healthcare system strain. Five years perspective: In addition to these early outcomes, the study describes the sustained integration of telemedicine during the subsequent five years, illustrating how this model became permanently embedded in routine neurosurgical practice in this center. Conclusions: This study represents one of the earliest structured telemedicine experiences in Spanish neurosurgery. The rapid adaptation of the Hospital General Universitario Gregorio Marañón ensured care continuity during the pandemic and catalyzed the lasting adoption of hybrid models that enhance accessibility, safety, efficiency, and healthcare system resilience. Full article

Background: Delayed graft function (DGF) is a frequent early complication after deceased donor kidney transplantation (DDKT), leading to prolonged hospitalization, increased risk of acute rejection, and reduced graft survival. Reliable and easily measurable preoperative biomarkers for DGF prediction remain limited. This study aimed to evaluate the predictive value of pre-operative Absolute Eosinophil Count (AEC) and Albumin-to-Globulin Ratio (AGR) for DGF in DDKT recipients. Methods: A retrospective analysis was conducted on all DDKT procedures performed at our institution between January 2018 and December 2023. Patients were divided into two groups: Group 1 (DGF) and Group 2 (non-DGF). DGF was defined as the requirement for hemodialysis within the first seven postoperative days. Demographic, clinical, and laboratory data—including pre-operative AEC and AGR—were collected and compared between groups. Statistical analysis was performed using appropriate parametric and nonparametric tests. Receiver operating characteristic (ROC) curves were generated to assess the individual and combined predictive performance of AEC and AGR for DGF. Results: A total of 38 patients underwent DDKT, comprising 27 males (71.05%) and 11 females (28.95%), with a mean age of 43.3 ± 9.41 years. Fifteen patients (39.47%) developed DGF. The mean AEC and AGR were significantly lower in the DGF group compared to the non-DGF group (AEC: 0.20 ± 0.16 vs. 0.40 ± 0.35, p = 0.04; AGR: 1.43 ± 0.22 vs. 1.66 ± 0.39, p = 0.02). ROC analysis demonstrated that both AEC (p = 0.04) and AGR (p = 0.04) were significant predictors of DGF. Combining both parameters resulted in a higher area under the curve (AUC), improved sensitivity, and enhanced negative predictive value (NPV) compared to either marker alone. Conclusions: DGF occurred in nearly two-fifths of DDKT recipients in this cohort. Patients with lower preoperative AEC and AGR were more likely to develop DGF, suggesting that these easily available hematological and biochemical indices can serve as potential preoperative predictors of early graft dysfunction. Future multicentric prospective studies are warranted to validate these findings and explore their integration into DGF risk prediction models. Full article

Background/Objectives: Out-of-hospital cardiac arrest (OHCA) has persistently low survival rates. While advanced airway management (AAM) is crucial during cardiopulmonary resuscitation, optimal timing remains unclear. This study examined the association between early AAM and clinical outcomes in adult OHCA patients. Methods: This retrospective study analyzed Korean nationwide OHCA registry data (August 2019–December 2022). Adult patients with emergency medical service-treated OHCA of presumed medical origin receiving AAM were included. Early AAM was defined as airway placement within 5 min of CPR initiation. Time-dependent propensity score matching controlled for selection bias and time-related confounding. Structural equation modeling examined associations between AAM timing and other prehospital interventions. Primary outcome was survival to hospital discharge with good neurological recovery (cerebral performance category 1–2). Results: Among 51,869 patients receiving AAM, 27,591 received early AAM and 24,278 received delayed AAM. After propensity score matching, 12,014 patients were included per group with balanced characteristics. Early AAM was associated with higher prehospital return of spontaneous circulation (11.8% vs. 10.5%; adjusted RR 1.21, 95% CI 1.12–1.29) and favorable neurological recovery (5.8% vs. 5.1%; adjusted RR 1.12, 95% CI 1.01–1.23). AAM timing correlated with timing of other critical interventions, including rhythm analysis and epinephrine administration. Conclusions: Early AAM within 5 min of CPR initiation was associated with improved neurological outcomes and increased prehospital ROSC in OHCA. Airway timing may indicate overall resuscitation quality, emphasizing the importance of coordinated, timely prehospital interventions. Full article

Timely reporting of microbiological results is critical for clinical decision-making, particularly in pediatric hospitals where delays can significantly impact outcomes. Despite advances in laboratory automation, workflow inefficiencies and resistance to change remain barriers to improvement in Latin America. This study aimed to evaluate the effect of implementing a Kaizen-based change management strategy on reducing turnaround time (TAT) in the microbiology laboratory of Hospital Roberto del Río, Santiago, Chile. We conducted a prospective, pre–post intervention study focusing on blood culture processing. The baseline period (July 2022) included 961 cultures processed with the BacT/ALERT^® 3D system. A Kaizen/LEAN intervention was designed, comprising workflow redesign, staff training, and installation of the BACT/ALERT^® Virtuo^® (bioMerieux, Marcy l’Etoile, France) continuous-loading blood culture system. The intervention engaged all technical and professional staff in a five-day Kaizen immersion, followed by eight months of monitoring. Outcomes were assessed by comparing TAT for positive blood cultures before and after implementation (June 2023, 496 samples). Statistical analysis was performed using the Mann–Whitney U test, with p < 0.05 considered significant. The intervention achieved a median reduction in TAT from 68.22 h (IQR 56.14–88.59) pre-intervention to 51.52 h (IQR 41.17–66.57) post-intervention, corresponding to a 24.48% improvement (p < 0.001), surpassing the 20% target. Time to preliminary Gram reporting also decreased, and workflow standardization enhanced staff productivity and culture validation frequency. Implementation of Kaizen principles in a pediatric microbiology laboratory significantly reduced blood culture TAT and improved workflow efficiency. Beyond technological upgrades, active staff engagement and structured change management were key to success. These findings support the applicability of Kaizen-based interventions to optimize laboratory performance in resource-constrained public healthcare systems. Full article

Introduction: Timely detection of clinical deterioration in hospitalized patients remains a challenge, often limited by intermittent vital signs (VS) monitoring and delayed escalation. Remote patient monitoring (RPM) offers a medium of high-frequency surveillance of patient VS and may facilitate earlier recognition of deterioration. This study evaluated whether RPM integration into rapid response workflows improves clinical outcomes among patients requiring clinical emergency response team (CERT) activation and subsequent intensive care unit (ICU) transfer. Methods: A retrospective study was conducted to assess the impact of RPM implementation on severity of illness and mortality in adult patients who experienced CERT activation followed by ICU transfer. The primary outcomes were severity of illness at ICU admission and in-hospital mortality. We hypothesized that patients in the post-intervention group would demonstrate better outcomes compared to pre-intervention. Results: A total of 1120 patients were included (PRE: n = 656; POST: n = 464). The POST group, which received continuous monitoring via the BioButton^® device and augmented workflows, demonstrated a lower mean APACHE-IV score at ICU transfer (83.96 vs. 90.01; p = 0.0016 and reduced in-hospital mortality (7.75% vs. 11.48%; p = 0.084). Median ICU stay in the PRE group was 5.85 (3.00–11.58) and 5.07 (2.59–9.22) in the POST group (p: 0.0565). Total LOS was 11.95 (6.57–20.40) and 10.50 (6.01–18.17), respectively [p = 0.0278]. Conclusions: Integration of RPM into hospital care pathways was associated with earlier recognition of clinical deterioration, reduced illness severity at ICU admission, and lower in-hospital mortality. These findings may support the utility of RPM as part of a comprehensive, multicomponent, rapid response model to recognize early physiological deterioration and may improve patient safety and outcomes in acute care settings. Full article

Background: Emergency airway management is a crucial and complex procedure frequently performed in the emergency department (ED). Airway contamination usually caused by blood, secretions, and emesis impairs ventilation, reduces successful intubation, and increases the complication rates, leading to difficult laryngoscopy, delayed intubation, and increased mortality rates. One technique employed to decontaminate these airways when standard approaches fail is Suction-Assisted Laryngoscopy and Airway Decontamination (SALAD). Methods: A comprehensive literature search was conducted across PubMed, Cochrane, and Science direct databases following a specific search strategy. All search results were screened in a two-stage process (title–abstract and full-text screening) in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. Data from finalized articles were extracted using a standardized excel file developed a priori. Lastly, quality and risk of bias were assessed using appropriate tools according to respective study designs, and data were narratively synthesized. Results: A total of 224 records were identified. Upon screening, seven studies were included consisting of five simulation-based studies and two clinical case reports. Simulation studies reported that SALAD training significantly improved first-pass intubation success (53.7–90.2%), reduced time to intubation (up to 30 s), and enhanced airway visualization. Clinical cases further reported successful first-pass intubation in patients with massive airway contamination without complications. Overall, across both study types, the SALAD technique improved airway management performance, provider confidence, and airway contamination control compared to standard suction techniques. Conclusions: This systematic review highlights the benefits of the SALAD technique by enhancing airway visualization, reinforcing it as a significant tool for contaminated airway management. Trainees who underwent SALAD training demonstrated improved first-pass intubation success, reduced intubation time, and increased operator confidence. While data from the included studies seems promising, most studies are small simulation-based studies with limited clinical outcome data. Given its clinical relevance and educational value, future studies must prioritize high-quality research in clinical environments to establish SALAD’s efficacy and to define its role in integration into prehospital protocols. Full article

Background: Variceal upper gastrointestinal bleeding (VUGIB) remains a major cause of short-term mortality in cirrhosis despite advances in endoscopic and pharmacological therapy. Prognostic factors and outcomes were evaluated in a historical cohort, and a guideline-aligned management algorithm is proposed. Methods: We conducted a retrospective study of 98 consecutive adults admitted with VUGIB to a tertiary surgical center in Romania (2009–2014). Demographics, etiology, admission hemoglobin (Hb), timing of presentation, endoscopic and surgical management, and outcomes were recorded. Survival was analyzed using Kaplan–Meier with log-rank tests; associations were tested with chi-square and t-tests; predictors of mortality were assessed with logistic regression. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminatory ability of hemoglobin for in-hospital mortality. Results: Mean age was 57.8 ± 11.7 years; 60.2% were male. Cirrhosis etiology was alcoholic in 73%, viral in 18%, and metabolic in 9%. Endoscopy occurred within 48 h in 62% of patients, but only 4% underwent the procedure within 8 h. Overall mortality was 17.3%. Kaplan–Meier analysis showed no survival difference between alcoholic and viral cirrhosis (log-rank p = 0.39), but survival was markedly lower with Hb < 8 g/dL (p < 0.001). Admission delay was prognostic: >24 h was associated with worse survival (p < 0.05). On multivariable analysis (reference 1–2 days), admission at 3–4 days (OR 35.3, 95% CI 1.6–786, p = 0.024), >4 days (OR 71.0, 95% CI 2.16–2337, p = 0.017), and <6 h (OR 22.4, 95% CI 1.25–399.7, p = 0.035) independently predicted death. Admission Hb predicted mortality with an AUC of 0.79; the optimal cut-off was 4.3 g/dL (sensitivity 57%, specificity 95%). Limited use of pre-emptive TIPS likely contributed to outcomes. Conclusions: In this historical cohort, mortality from VUGIB was driven mainly by bleeding severity and admission delay, rather than by cirrhosis etiology. The study provides a historical benchmark for Eastern Europe, highlights gaps in adherence to contemporary standards, and supports restrictive transfusion, early vasoactive therapy, antibiotics, urgent endoscopy, and pre-emptive TIPS. The retrospective single-center design and limited therapies available during the study period remain important limitations. Full article

Traumatic brain injury (TBI) remains a critical public health issue worldwide, with significant morbidity, mortality, and long-term disability. Timely transfer to a specialized trauma unit is crucial to improving outcomes, yet in resource-limited settings, delays often exceed recommended time frames. This study evaluates the impact of arrival time on mortality, disability, and clinical outcomes in Ecuadorian patients with TBI. A cross-sectional and observational study was conducted, analyzing 383 adult patients diagnosed with TBI. Patients were categorized into two cohorts: those who arrived at a specialized trauma unit within five hours post-injury and those who arrived between five and 24 h. Demographic, clinical, and radiological characteristics were analyzed, including Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Marshall Scale classification, and presence of subarachnoid hemorrhage (SAH). Logistic regression models were used to identify predictors of mortality and disability. Longer transfer times were associated with increased mortality (3.34 times higher for ≥5 h, p < 0.05) and disability (2.92 times higher for ≥5 h, p < 0.05). Patients with Marshall Diffuse Injury III and IV had an 8.80- and 9.05-fold increased risk of mortality, respectively. SAH was an independent predictor of mortality (4.53 times higher), and GCS between 9–13 increased the likelihood of death by 6.49 times. Delayed transfers were associated with lower GCS at admission, longer ICU stays, and increased surgical complications. Although some survivors experienced improvement over time, disability in TBI can persist for many years or even lifelong, underscoring the burden of delayed trauma care. Despite delays, overall survival remained higher than reported in high-income countries, suggesting compensatory factors in hospital-based management. Delayed hospital arrival in TBI patients significantly increases mortality and disability. Early transfer within five hours is essential to reduce secondary brain injury and improve functional outcomes. Findings suggest that in resource-limited settings, optimizing pre-hospital care and transport efficiency is crucial to minimizing long-term disability. Full article

Methods: Using the most recent pre-COVID National Inpatient Sample (2016–2019), we evaluated inpatient mortality and economic impact after elective primary total hip arthroplasty (THA) across 327,123 cases (1,635,615 weighted discharges).Results: Overall inpatient mortality was 0.04%, but was higher in patients ≥ 80 years (0.15%), with weekend admissions (0.10%), and with surgical delay ≥ 1 day (0.17%). Comorbidities with the greatest mortality association included congestive heart failure and chronic kidney disease (both with markedly elevated odds), and acute in-hospital complications (e.g., pulmonary embolism) carried substantial risk. Complications also increased resource use; for example, heart failure, pulmonary edema, and acute coronary artery disease were each associated with significantly higher costs and prolonged length of stay. Conclusion: These findings provide a contemporary, pre-pandemic national baseline that quantifies high-risk subgroups and the economic footprint of adverse events, supporting targeted perioperative strategies and hospital planning for elective THA. Full article

Background/Objectives: Patients with advanced ovarian cancer with a high tumor burden typically undergo neoadjuvant chemotherapy (NACT) followed by interval debulking surgery. The optimal number of NACT cycles remains undefined: although three to four cycles are considered gold-standard, in real-world practice, five or more cycles are frequently administrated. This study aims to evaluate the impact of delayed interval debulking surgery (DIDS) after ≥5 cycles of NACT on the survival rates. Methods: We conducted a retrospective analysis of women with advanced ovarian cancer that underwent surgery in the 1st Department of Obstetrics–Gynecology Clinic from 2012 to 2022. Patient characteristics, oncological, and follow-up information were collected. Results: A total of 125 patients met the inclusion criteria and were divided into two groups: Group A (77 patients) received 3–4 of NACT cycles, and Group B (48 patients) ≥5 cycles. No statistically significant difference was observed between the groups concerning age, BMI, comorbidities, Aletti score, FIGO stage, pre-operative CA-125 values, surgery duration, rate of postoperative complications, hospital stay, ICU admittance, and complete gross resection (RD = 0). However, patients undergoing DIDS experienced significantly greater intraoperative blood loss. Progression-free survival did not differ between groups (IDS: 17 vs. DIDS: 18 months, p = 0.561), whereas overall survival was significantly lower in the DIDS group (IDS: 52 vs. DIDS: 36 months, p = 0.00873). This statistical significance persisted after controlling for residual disease, but was lost after adjusting for FIGO stage. Conclusions: DIDS may be considered for advanced ovarian cancer patients with a high tumor burden, when complete gross resection (RD = 0) cannot be achieved during IDS. Further prospective randomized trials are necessary to evaluate its oncological safety and morbidity. Full article

Background/Objectives: The COVID-19 pandemic disrupted healthcare systems globally, with dental services significantly limited due to infection control measures. This study investigates the impact of the pandemic on the clinical presentation, management, and outcomes of odontogenic abscesses over three distinct periods. Methods: A retrospective study was conducted at University Clinical Hospital (Poznan, Poland), which included adult patients hospitalised for odontogenic infections between March 2019 and February 2022. The cohort comprised 101 patients (median age: 33 years; 59.41% male), with admissions distributed across pre-pandemic (37.62%), pandemic (19.80%), and post-pandemic (42.57%) periods. Clinical, biochemical, and radiographic data were analysed. Results: No statistically significant differences were found between periods for abscess severity, hospitalisation length, or inflammatory marker levels. Elevated procalcitonin (Rs = 0.289, p = 0.005), C-reactive protein (Rs = 0.385, p < 0.001), and body mass index (Rs = 0.253, p = 0.011) independently predicted longer hospital stays. In regression modelling, procalcitonin (β = 0.464, p = 0.001) and prior outpatient antibiotic use (β = 0.281, p = 0.038) were mainly associated with larger abscess volumes, while comorbidities (β = 0.262, p = 0.025), longer hospitalisation (β = 0.594, p = 0.001) and abscess volume (β = −0.294, p = 0.040) increased the risk of reoperation. Conclusions: The study highlights clinically important findings linked to delayed dental care and increased systemic inflammation related to the pandemic. Elevated procalcitonin and CRP levels provide prognostic information that can guide early triage, risk stratification, and decisions regarding surgical versus outpatient management. These findings emphasise the importance of maintaining essential dental services, implementing preventive strategies, and optimising management protocols to reduce the risk of severe infections and improve patient outcomes during healthcare disruptions. Full article

Background: Emergency laparotomy (EL) carries high morbidity and mortality relative to elective abdominal surgery. While Enhanced Recovery After Surgery (ERAS) principles improve outcomes in elective care, their translation to emergencies is inconsistent. The emergency department (ED) provides a window for rapid risk stratification and pre-optimization, provided that interventions do not delay definitive surgery. Methods: We conducted a PRISMA-ScR–conformant scoping review to map ED-initiated, ERAS-aligned strategies for EL. PubMed, Scopus, and Cochrane were searched in February 2025. Eligible sources comprised ERAS guidelines, systematic reviews, cohort studies, consensus statements, and programmatic reports. Evidence was charted across five a priori domains: (i) ERAS standards, (ii) comparative effectiveness, (iii) ED-feasible pre-optimization, (iv) risk stratification (Emergency Surgery Score [ESS], frailty, sarcopenia), and (v) oncological emergencies. Results: Thirty-four sources met inclusion. ERAS guidelines codify rapid assessment, multimodal intraoperative care, and early postoperative rehabilitation under a strict no-delay rule. Meta-analysis and cohort data suggest ERAS-aligned pathways reduce complications and length of stay, though heterogeneity persists. ED-feasible measures include multimodal analgesia, goal-directed fluids, early safe nutrition, respiratory preparation, and anemia/micronutrient optimization (IV iron, vitamin B12, folate, vitamin D). Sarcopenia, frailty, and ESS consistently predicted adverse outcomes, supporting targeted bundle activation. Evidence from oncological emergencies indicates feasibility under no-delay governance. Conclusions: A minimal, ED-initiated, ERAS-aligned bundle is feasible, guideline-concordant, and may shorten hospitalization and reduce complications in EL. We propose a practical framework that links rapid risk stratification, opportunistic pre-optimization, and explicit continuity into intra- and postoperative care; future studies should test fidelity, costs, and outcome impact in pragmatic emergency pathways. Full article

Background: Optic nerve sheath diameter (ONSD) and its ratio to eyeball transverse diameter (ETD; ONSD/ETD) are potential markers for elevated intracranial pressure in comatose survivors of out-of-hospital cardiac arrest (OHCA). However, their prognostic accuracy remains uncertain. We compared their predictive value via compted tomography (CT)and magnetic resonance imaging (MRI) before and after targeted temperature management (TTM) in OHCA survivors. Methods: This retrospective study included adult comatose OHCA survivors who underwent TTM and serial brain imaging. ONSD and ONSD/ETD ratios were measured on brain CT and MRI at two predefined time-points: within 6 h (pre-TTM) and at 72–96 h (post-TTM) after return of spontaneous circulation. Intra-rater reliability was assessed using intraclass correlation coefficients (ICC). Poor neurological outcome was defined as a Cerebral Performance Category score of 3–5 at 6 months. Prognostic performance was evaluated using area under the receiver operating characteristic curve (AUC). Results: Among 136 patients, 78 (57%) had poor neurological outcomes. Only ONSD (5.12 vs. 5.37 mm) and ONSD/ETD ratio (0.22 vs. 0.23) measured on post-TTM MRI were significantly higher in the poor outcome group. These results depicted modest predictive performance (AUC, 0.67 and 0.65, respectively), whereas all CT-based and early MRI measurements had AUC < 0.60. Intra-rater reliability for ONSD and ETD was higher on CT (ICC: up to 0.93) than on MRI (ICC: 0.73–0.80). Conclusions: Delayed MRI-based ONSD and ONSD/ETD showed statistically significant but modest prognostic value, with limited clinical applicability as a stand-alone tool. These findings underscore the relevance of measurement timing, supporting ONSD as an adjunctive, rather than definitive, tool in multimodal prognostication. Full article

Background: Appropriate medication management before surgery is essential to minimise perioperative risk. Patient adherence to preoperative medication advice demonstrates considerable variability and is influenced by multiple interacting factors. This study assessed patient understanding and adherence to preoperative medication advice provided in the Pre-Admission Clinic (PAC) and identified factors contributing to non-adherence. Methods: A cross-sectional survey study was conducted over 12 weeks in 2022 at a tertiary hospital. Adult patients scheduled for elective surgery who received preoperative medication advice in PAC were surveyed on the day of surgery. Data collected included demographics, clinical characteristics, adherence, reasons for non-adherence, and communication preferences. Descriptive and inferential statistics were used for analysis. Results: Of 156 participants, 91 (58.3%) adhered to medication advice, while 65 (41.7%) did not. Common reasons for non-adherence included forgotten advice (35.4%), misunderstood advice (33.8%), and intentional deviation due to surgery (18.5%). Non-adherence rates were highest for NSAIDs (50.0%) and P2Y12 inhibitors (45.5%). Two surgeries were cancelled due to the delayed cessation of anticoagulants. Non-adherence was significantly associated with a greater number of medications requiring perioperative management (p = 0.004) and a longer duration between PAC and surgery (p = 0.010). Most non-adherent patients (64.7%) preferred a combination of verbal and written advice. Conclusions: A substantial proportion of patients were non-adherent to preoperative medication advice, often due to unclear communication or a lack of understanding of the clinical rationale for the advice. Multimodal strategies, including written or digital reinforcement of verbal advice, multidisciplinary collaboration, and patient-centred education, may improve adherence and reduce preventable cancellations. Future studies should evaluate the impact of these interventions. Full article

Objectives: The primary objective was to compare the usage of Hazardous Materials (HazMat) Protective Personal Equipment (PPE) and ordinary PPE when performing basic and advanced health care support maneuvers in a prehospital setting, evaluating the effectiveness of several procedures, defined as the mean success rate of each. The secondary objective was to evaluate the presence of a learning effect, with improvements in the success rate and/or procedure timing. Methods: This was a prospective within-subjects (repeated-measures) study conducted on Emergency Medical Services (EMS) responders within their Chemical-Biological-Radiological-Nuclear-Explosive (CBRNe) training institutional programme. Volunteers performed a trial sequence of eight lifesaving procedures four times. During the first trial sequence, they wore standard clothing; during the three successive trials, they wore full HazMat PPE equipment. The primary outcomes were changes in success rate and time interval across the four trials. Results: A total of 146 EMS responders volunteered for the experiment. Procedure success rates remained high overall, with the most notable initial drop observed for video-assisted intubation (≈−10%). The only statistically significant delay in the first HazMat trial compared with baseline was for intravenous access (median +30 s; p < 0.001). In the two successive HazMat trials, success rates and timings improved, with median values coming close to baseline. However, only 61% of participants completed the entire drill due to tolerance limits of the equipment. Conclusions: HazMat PPE, while physically and ergonomically demanding, has minimal impact on most lifesaving procedures, though it may reduce intubation success and delay intravenous access. Tolerance to prolonged use is a key limitation, but dexterity improves rapidly with brief practice. EMS responders can benefit from continuous training practice, while manufacturers could explore ergonomic and tolerance improvements in their PPE equipment. Full article