Background Emergency service personnel work under substantial physical and psychological strain. Heart rate variability (HRV) reflects autonomic reactivity and may serve as a non invasive indicator of occupational load. This study assessed heart rate (HR) and ultra short term HRV responses during simulated cardiopulmonary resuscitation (CPR). Material/Methods A total of 110 participants were enrolled (mean age 25.7 +/- 7.9 years; BMI 23.8 +/- 3.2 kg/m(2)): 84 emergency healthcare workers (43 women, 41 men) and 26 male firefighters, recruited from two sites (Poland n = 34; Hungary n = 76). The protocol consisted of three consecutive 120 second phases: Pre (rest), During (continuous chest compressions on a Rescue Anne QCPR manikin), and Post (rest). RR intervals were recorded using a Polar H10 sensor (1000 Hz). The primary outcome was RMSSD (ms), with mean HR (bpm) as a secondary measure. Statistical analyses included the Friedman test with Dunn-Bonferroni correction, Mann-Whitney U tests, and Spearman correlations. Results Mean HR increased from 92.8 +/- 23.0 bpm (Pre) to 117.8 +/- 18.7 bpm (During) (Delta = +25.0 bpm, +27%, p < 0.001), then decreased to 104.7 +/- 22.3 bpm (Post). RMSSD declined from 23 ms (IQR 16-33) to 19.5 ms (12-27) (Delta = -3.5 ms, -15%, p = 0.001), with partial recovery to 20 ms (15-28) (Pre vs Post phase). HR varied by age, BMI, and sex across multiple phases (e.g., mean HR: all phases p < 0.01). RMSSD differed by sex During and Post (p = 0.031 and p = 0.012), but not by age or BMI (all p >= 0.07). No monotonic association was found between mean HR and mean HRV within phases (|rho| <= 0.056, p >= 0.559). Conclusions Simulated CPR induced marked tachycardia and a short term reduction in RMSSD, indicating acute sympathetic activation with partial recovery afterward. Ultra short term HRV monitoring using wearable devices appears feasible in both training and operational contexts and may serve as an early marker of excessive psychophysical load. Incorporating HRV metrics into occupational health protocols could support risk stratification, targeted conditioning and recovery strategies, and enhance safety among emergency personnel.

Background and Objectives: Massive extremity haemorrhage remains the leading cause of preventable death on the battlefield and among trauma victims in civilian settings. Tourniquets are an effective, low-cost tool used to rapidly control bleeding. However, the availability of certified tourniquet models during a full-scale armed conflict can be significantly limited. This favours the emergence of locally manufactured devices. The aim of this study was to compare the effectiveness of the DNIPRO Gen 2 and SICH tourniquets with the CAT Gen 7 and SOFTT W Gen 4 tourniquets recommended by the Committee on Tactical Combat Casualty Care. Materials and Methods: The study included 51 Ukrainian medics experienced in prehospital care. Application speed was measured with a stopwatch, and occlusion success was confirmed by Doppler ultrasound. Pain was measured using the NRS, and participants were also able to provide subjective comments regarding the ergonomics and design of the tourniquets. Results: The four tourniquets tested demonstrated different occlusion success rates in arm and leg application. In upper extremity application, the SICH had the highest success rate (98.0%) and was associated with higher odds of successful application compared with the SOFTT-W Gen 4 (OR 25.14). In lower extremity application, the CAT Gen 7 had the highest rate of success (94.1%) and was 7.5 times more likely to achieve occlusion than the SOFTT-W Gen 4 (OR 7.54). The DNIPRO Gen 2 was rated most painful (Median 6), with significantly lower pain levels reported for the SICH (Median 4), the CAT Gen 7 (Median 5), and the SOFTT-W Gen 4 (Median 4). Conclusions: The DNIPRO Gen 2 and SICH tourniquets demonstrated high occlusion success rates, comparable to the CAT Gen 7 and superior to the SOFTT-W Gen 4. These findings suggest that Ukrainian-manufactured tourniquets may demonstrate comparable performance to CoTCCC-recommended tourniquets in a simulated prehospital setting.

Emergency medical services systems are designed to provide medical aid in the event of sudden illness or injury. Each system comprises two parts, namely the out-of-hospital emergency medical services (OHEMS) and the in-hospital emergency medical services (IHEMS). The out-of-hospital component involves receiving emergency calls and providing medical services at the scene of an incident. The Polish OHEMS is mainly based on the Anglo-American model, with noticeable elements of the French-German model. Its fundamental principle is to aid any person who has found themselves in a state of sudden health emergency, which is one of the key responsibilities of the state. The organisational structure of the Polish system is multidimensional and linked to the administrative division of Poland. Its supervision, organisation and operation are the responsibility of the Minister of Health and regional governors. An emergency notification system has been established to handle emergency calls, where emergency medical dispatchers are responsible for responding to medical incidents. At the scene of an incident, medical aid is provided by emergency medical teams, including specialist, basic, motorcycle and airborne teams. Their personnel consist of system doctors, system nurses and paramedics. These teams operate within entities whose main shareholder is the State Treasury or a local government unit. A nationwide uniform ICT system supports the activities of emergency medical dispatchers and teams. The Polish OHEMS has numerous strengths, but is nevertheless subject to constant change due to the need to adapt to current needs and evolving conditions. At the same time, its role and effectiveness are highly valued by Polish society.

INTRODUCTION:This study describes interventions carried out by fire protection units in support of selected animal disease control operations in Poland in 2022-2024. MATERIALS AND METHODS:The study used operational data from the Decision Support System of the State Fire Service (DSS-SFS), provided by the Operational Planning Office. Records coded under the administrative event flag "epizootics" between January 1, 2022, and December 31, 2024, were screened and then filtered on the basis of event descriptions to retain only interventions related to the animal disease events included in this analysis. Quantitative variables were described using the mean and standard deviation, and nonparametric tests were applied at a significance level of p < 0.05. The dataset was fully anonymized. RESULTS:In 2022-2024, firefighters were dispatched 452 times to events classified in the DSS-SFS under the administrative category "epizootics" and retained in the final analytical dataset. Three event types were identified: avian influenza, African swine fever, and American foulbrood. Intervention duration differed significantly between voivodeships, with the longest mean ranks observed in Podkarpackie and Zachodniopomorskie and the shortest in Świętokrzyskie and Mazowieckie. The largest pairwise difference was found between Świętokrzyskie and Zachodniopomorskie. CONCLUSIONS:The analyzed records indicate that firefighter involvement in these events was primarily operational and supportive in nature. The most relevant findings were regional differences in intervention duration and greater vehicle deployment in avian influenza events, likely reflecting terrain conditions and the spatial scale of search activities. These data may support operational planning, but they do not allow conclusions about infectious or psychological health outcomes among firefighters.

This paper presents an analysis of interventions implemented by the National Firefighting andRescue System (NFRS) units during Medical Rescue Operations (MRO) with particular emphasis onthe use of mental support procedure. Observations of quantitative data pertained to interventions ofNRFS units based on data from the Decision Support System (DSS) from the period of 2014–2023.The databases include: total number of interventions, breakdown into fires and local threats, dailyand monthly summaries, implementation of qualified first aid (QFA) procedures, reasons forinterventions, operational times, participation of forces (firefighters and cooperating personnel) andresources (equipment, transport, materials, extinguishing agents). In the years under observation,the number of interventions of NFRS entities totalled 5.14 million. Results shows a statisticallysignificant upward trend in mental health support for injured and vulnerable people (P<0.001).Implementation of the procedure for psychological support of injured and at-risk persons dependedon the location of the incident, i.e. it was most often performed in transport means (P<0.001). TheState Fire Service (SFS) is the main service cooperating with medical units. Psychological support isone of the more commonly used procedures in Medical Rescue Operations (MRO).

ObjectiveThe study aimed to analyse purchasing trends of pharmacological products used in allergy management based on data from in-person pharmacy sales across Poland.Materials and MethodsThe research involved an analysis of the sales of pharmacological agents used to alleviate symptoms of localized and systemic allergic skin reactions. The data were collected from a nationwide sample of 6,500 brick-and-mortar pharmacies over the period from 2020 to 2023. The analysis focused exclusively on over-the-counter (OTC) products.ResultsSales data were classified into three main groups: general antiallergic agents, antipruritic preparations, and products for relief after insect bites or stings. During the observation period, a total of 63.7 million units of allergy-relief products were sold.ConclusionOTC antiallergic medications are widely used, with annual sales reaching millions of units. A clear seasonal trend was observed, with increased purchases during spring and summer months, coinciding with peak allergy seasons. Economic conditions such as inflation appeared to have minimal impact on OTC allergy product sales, likely due to their relatively low cost and high accessibility. Year-to-year purchasing trends remained stable throughout the study period. These findings may support more effective seasonal planning of OTC stock in pharmacies and inform public health initiatives aimed at allergy education and prevention. The stable demand also provides a basis for improving supply chain logistics and forecasting models related to allergy self-management.

ObjectiveTo assess health practices among Polish firefighters in relation to the high physical and mental demands of their profession.Materials and methodsA cross-sectional survey design with categorical data analysis was used. An online survey was conducted between 10 October 2024 and 25 October 2024. The survey covered 856 officers serving in organisational units of the State Fire Service (SFS) throughout Poland. The survey was based on a proprietary questionnaire, including demographics and individual health practices: nutrition, stimulants, sleep, physical activity.ResultsEight hundred seventeen respondents who answered all questions were included in the analysis. The analysis of the results did not show any statistically significant differences between the genders in terms of: participation in sports/physical activity (yes vs. no) (p = 0.088); frequency of physical activity (p = 0.541); type of diet (p = 0.741). Persons employed in command positions were the least likely to smoke cigarettes (p < 0.001). These people most often indicated that they were very satisfied with their health (p < 0.001). People in command positions were more likely to declare unhealthy eating habits, but at the same time they assessed their health better.ConclusionThis nationwide survey identified clear, actionable patterns in firefighters’ health behaviors. Overweight and obesity were common, and multiple behaviors clustered with higher BMI. Prevention should be targeted across career stages and supported organizationally integrating nutrition, hydration, sleep hygiene, and physical training with enabling conditions (duty scheduling, healthy food/water access on shift, protected time and facilities for exercise). Future studies should include objective measurements, validated psychosocial scales, and longitudinal designs to clarify directionality and evaluate interventions.

Aim: To assess, based on subjective self-assessment, the preparedness of emergency medical service (EMS) teams for multiple and mass casualty incidents (MCI) and chemical, biological, radiological, nuclear and explosive (CBRNE) events, and to analyse changes between 2019 and 2025 as well as differences in opinions by length of service. Material and methods: A two-stage repeated cross-sectional study was conducted among EMS personnel in the operational areas of the Masovian region. In 2019, 337 and in 2025, 341 fully completed anonymous questionnaires (22 items) were analysed. Variables included participation in exercises, experience with triage and acting as Medical Incident Commander (MIC), assessment of interagency cooperation, and knowledge of procedures for CBRNE incidents. Results: In 2025, respondents more often reported participation in exercises, involvement in triage and experience in the MIC role, and they rated cooperation between the national EMS system and other agencies in incidents involving hazardous substances more favourably (P<0.001). Declared knowledge of cooperation principles with counterterrorism services increased, whereas practical experience in CBRNE incidents, in the use of isolation chambers and in explosive-related threats remained limited. Conclusions: Between 2019 and 2025, an improvement was observed in declared preparedness of EMS teams and in the assessment of interagency cooperation, while deficits in practical experience during CBRNE incidents persisted. There is a need to further develop realistic simulation-based exercises and intersectoral training adapted to the needs of staff with different lengths of service.

BACKGROUND Peripheral intravenous (IV) access is a fundamental pre-hospital procedure performed by emergency medical services (EMS) personnel and remains the primary route for drug administration. Pediatric IV cannulation is often challenging in out-of-hospital settings. The aim of this study was to evaluate the frequency of peripheral intravenous access being established in pre-hospital settings by EMS staff in pediatric patients. MATERIAL AND METHODS This retrospective study analyzed 6331 records of emergency medical services (EMS) dispatches involving patients under 18 years of age between 2020 and 2022. The study protocol included an assessment of cannulation rate depending on the patient's age, case characteristics, ICD 10 (International Classification of Diseases, Tenth Revision) diagnosis and whether the patient required transport to a hospital. RESULTS Peripheral intravenous access was established in 1073 of 6331 pediatric patients (16.94%). The cannulation rate increased significantly with age, from 1.03% in infants (<1 year) to 75.12% in adolescents (12-18 years) (p<0.001). Logistic regression analysis identified age, trauma (OR=1.96), poisoning (OR=3.88), and transfer by Helicopter Emergency Medical Services (HEMS) (OR=5.86) as predictors of IV cannulation (p<0.001). CONCLUSIONS The overall rate of peripheral intravenous access establishment in pediatric patients in pre-hospital settings is relatively low, with the lowest rates observed in children under 1 year of age. Age, trauma, poisoning, and referral to HEMS teams significantly increased the likelihood of cannulation. It is essential to develop evidence-based algorithms and targeted training to support EMS personnel in managing vascular access in critically ill children.

Objective: Analysis of service records for service-related eye injuries of Polish firefighters in the years2021-2023Material and methods: The analysis was conducted on the basis of service records of the State FireService (SFS) obtained from the Occupational Health and Safety (OHS) office at the SFS Headquarters.Observations focused on the SFS officers and their tasks arising from the course of duty.The population under survey comprises all officers (except civilian employees) regardless of the typeand location of their service.Results: In the years of observations, 3934 service-related firefighter health risks occurred in the SFS(2021-n=1312; 2022-n=1266; 2023-n=1356). During this period, there were 83 eye injuriesrepresenting 2.1% of the total incidents. The distribution of events included in the analysis was asfollows: 2021 – 28 (2.1%), 2022 – 32 (2.5%), 2023 – 23 (1.6%). A statistically significant difference hasbeen ascertained for the type of injury (P<0.001). Nearly 70% of all observed injuries at night-timewere ranked in the foreign body category. In contrast, there was no statistically significant effect ofseason on the type (P=0.566) and cause of injury (P= 0.103).Conclusions: More than half of the eye injuries occurred during duties other than interventions,when firefighters do not wear personal protective equipment to protect their heads. In a part of eyeinjuries, wind (dust) was the decisive factor in the injury. Awareness should be raised amongfirefighters with the help of training and post-accident discussion of accidents.

Objective:To quantify and characterize Isolated Emergency Medical Incidents (IEMIs) managed by National Firefighting and Rescue System (NFRS) units in Poland in 2020-2023 and to identify temporal and regional patterns. Materials and methods:Retrospective nationwide analysis of anonymised State Fire Service decision-support records. Inclusion required NFRS arrival before EMS, documented direct actions, duration over 1 min, and dates 01.01.2020-31.12.2023. Descriptive statistics were compiled at the voivodeship level. Group differences were tested with Kruskal-Wallis and Dunn-Bonferroni procedures. Associations were examined with Spearman correlation. Visualizations included heat maps, box plots, and a choropleth. Seasonality was assessed by calendar quarter. Results:Approximately 2.25 million interventions were undertaken; medical rescue comprised about 35%. Regional heterogeneity was significant (χ2 = 46.72; p < 0.001). Mean IEMI duration differed by year (χ2 = 28.35; p < 0.001), peaking in 2021 and declining in 2022-2023 (medians 13-12 min). Pairwise contrasts showed 2020 > 2022 (p = 0.015), 2020 > 2023 (p = 0.001), 2021 > 2022 (p = 0.001), and 2021 > 2023 (p < 0.001). Minimum time did not correlate with the mean (ρ = 0.05; p = 0.7); maximum time did (ρ = 0.55; p < 0.001). Incident counts correlated with population (ρ = 0.518) and urbanization (ρ = 0.446), modestly with number of EMS teams (ρ = 0.396), and weakly with area (ρ = 0.277). Q4 increases were consistent for cardiac arrest, unconsciousness, and dyspnoea; hemorrhage, choking, psychiatric disorders, and other showed no seasonality. Annual totals did not differ (H(3) = 1.83; p = 0.608). Conclusion:IEMIs form a stable share of NFRS activity, dominated by cardiac arrest, syncope, trauma, and neurological disorders, with a Q4 peak. Seasonal readiness in October-December, targeted QFA training on CPR/AED, resource allocation by per capita and urbanization metrics, early activation thresholds, standardized winter workflows, and quarterly quality monitoring may improve timeliness and reduce demand.

Russia's invasion of Ukraine is the largest European land offensive since World War II. Individuals affected by conflicts such as war are at an increased risk of mental disorders, which result from frequent exposure to traumatic events and the breakdown of supportive social networks. The aim of the study was to assess the prevalence and determinants of PTSD, anxiety, and depression in Ukrainian civilian physicians and paramedics six months after the Russian invasion of Ukraine. A cross-sectional study was conducted using validated questionnaires: The Life Events Checklist, PTSD Checklist for DSM-5, The International Trauma Questionnaire (ICD-11), The Generalized Anxiety Disorder-7, The Patient Health Questionnaire-9, The World Health Organization Disability Assessment Schedule 2.0. The study showed that 61.1 % of participants indicated combat or exposure to a war zone as the most bothersome event in their experience. Physicians and paramedics did not differ in the prevalence of PTSD according to the DSM-5 diagnostic rule and of depression (criteria met by 14.5 % and 9 % of participants, respectively). However, more physicians than paramedics met the criteria of PTSD according to the ICD-11 diagnostic rule (5.1 % vs. 1.2 %) and of anxiety (16.5 % vs. 10.0 %). The risk factors for the mental health problems included personal combat experience, total trauma exposure, parenthood, and economic situation. Despite the differences found in the prevalence of PTSD depending on the criteria used, the severity of mental problems and disability in this group is significant. It is advisable to monitor the mental state and need for help among Ukrainian civilian medical personnel.

COVID-19 disease is characterised by a wide range of symptoms that in most cases resemble flu or cold. Early detection of infections, monitoring of patients’ conditions, and identification of patients with worsening symptoms became crucial during the peak of pandemic. The aim of this study was to assess and compare the performance of common early warning scores at the time of admission to an emergency department in predicting in-hospital mortality in patients with COVID-19. The study was based on a retrospective analysis of patients with SARS-CoV-2 infection admitted to an emergency department between March 2020 and April 2022. The prognostic value of early warning scores in predicting in-hospital mortality was assessed using the receiver operating characteristic (ROC) curve. Patients’ median age was 59 years, and 52.33% were male. Among all the EWS we assessed, REMS had the highest overall accuracy (AUC 0.84 (0.83–0.85)) and the highest NPV (97.4%). REMS was the most accurate scoring system, characterised by the highest discriminative power and negative predictive value compared to the other analysed scoring systems. Incorporating these tools into clinical practice in a hospital emergency department could provide more effective assessment of mortality and, consequently, avoid delayed medical assistance.

Background: Rescue service interventions for patients with behavioral disorders are quite common. The aim of this study is to analyze interventions of Polish State Fire Service units in incidents involving health threats to victims with behavioral disorders. Materials and Methods: This study used data from the Decision Support System of the State Fire Service. Events in the period of 1 January 2020 at 00.00-31 December 2022 at 23:59 were used for analysis. Results: In the 2020-2022 period, firefighters were dispatched 321 times to interventions concerning injured individuals with behavioral disorders. Isolated emergency medical incidents most often concerned mental disorders (23%) and least often concerned suicide attempts (8%) (p = 0.033). It was shown that the duration of the intervention (emergency care time) was significantly longer in the case of interventions related to the autumn period (p < 0.001). Conclusions: Our results describe parameters associated with behavioral health responses within the Polish fire service.

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.

Background: The World Health Organization (WHO) estimates that 180,000 patients die from burns every year, which is considered a serious public health issue. Patients with burns require immediate pre-hospital care and transport to specialized treatment facilities. The aim of this study was to outline the profile of the burn patient from the perspective of the Polish Medical Air Rescue (PMAR), as well as to analyze the medical procedures being implemented. Methods: The study includes 2154 interventions by air emergency medical teams (AEMS) which provided aid for burn patients. The analysis covered the period from 2018 to 2022, including nationwide data made available from the IT systems of the PMAR. Statistical design was used, allowing for correlations of variables, at a significance level of p < 0.05. Results: Patients’ ages ranged from 1 month to 96 years (mean 35.05; SD ± 26.88). Adult patients (n = 1409; 65.41%) constituted the vast majority. The number of interventions to children below 1-year-old was noticeable (n = 394; 18.29%). Men were the most likely to suffer burns, up to three times more often than women (n = 1574, 73.07% vs. n = 570, 26.46%. T29—burns to multiple body areas (n = 890)—and T21—burns to the trunk (n = 255)—were most frequently reported as diagnoses according to the ICD-10 classification. A statistically significant association was found between age group and ICD-10 diagnosis (p < 0.001). The vast majority of patients were transported from the scene directly to Burn Treatment Centers (n = 1373; 63.74%). Treatment of pain by helicopter emergency medical services (HEMS) crews appeared to be effective (p < 0.001), and other interventions consisted of administering medications—ketamine (23.72%), rocuronium bromide (15.78%), propofol (14.02%)—and procedures such as sedation (30.87%), as well as intubation (13.42%) and mechanical ventilation (13.23%). Conclusions: The burn patient profile indicates men with a mean age of 35 years. Nevertheless, HEMS crews often carry out missions to infants and newborns. The most common diagnosis was extensive body burns. In 63.74% of the missions, patients were transported to the Burn Treatment Center. The HEMS crews implement effective pharmacological analgesia, and handle rescue medications and procedures to stabilize the patient’s condition.

The effective management of diabetes is a complex issue and may be determined according to numerous patient-dependent and patient-independent factors. This study aimed to analyze the relationship between the place of residence and selected sociodemographic, psychological and diabetes-related parameters in people with type 1 diabetes (T1D). This study was conducted on 419 adults with T1D using nonprobability sampling. The following questionnaires were used: the Diabetes Dietary Guidelines Adherence Index, the Acceptance of Illness Scale, the Sense of Responsibility for Health Scale, the Diabetes Eating Problem Survey-Revised scale, the Eating Attitudes Test and questions on sociodemographic and diabetes-related parameters. People living in rural areas were characterized by a significantly lower age and level of education, a higher incidence of being overweight, a higher glycated hemoglobin concentration, a lower number of glucose measurements during the day and a higher level of acceptance of the disease compared to urban residents. The degree of adherence to dietary recommendations and the sense of responsibility for one’s own health were significantly higher among urban residents. It is necessary to assess barriers to a proper diet and to increase the effectiveness in managing the disease in rural communities. Targeted actions promoting the health of type 1 diabetics need to be developed with particular emphasis on patients from rural areas.