Deputy Director for Emergency Preparedness and Training, Emergency Medical Service, South Moravia Region, Czech Republic
Accident on a ski slope has its own specifics. Usually these are accidents in the mountains, where the availability of health care professionals is difficult and even conditions for treatment and transport are more complex. Interactive learning algorithm "ski slope injury" is an excellent example of a comprehensive solution to the situation from the first aid following definitive treatment in hospital. Team of authors presents a comprehensive decision tree, which represents the most important decision-making crossroads on the way to the right patient treatment and has not forgotten the importance of ensuring the safety of rescuers in treating the injured skier on the slopes. Incorrect answers highlight the most common mistakes and underestimating situations in dealing with this incident. Importance of interactive algorithm consists mainly in the possibility to learn and make decisions on every level - from a secular savior following anesthesiologist evaluation of the patient and the risk of anaesthesia. I'm sure I was in favor of such algorithms with even more severe conditions associated eg. unconsciousness. Sometimes the decision with limited resources in a non-standard situation is more difficult than with a full complement of inquiry.
Hypothermia can be a very serious diagnosis that can lead to death of the patient if managed incorrectly. The situation can easily be underestimated, especially in alcohol-intoxicated patients. The authors present in a very illustrative way how to proceed in the treatment of a patient with hypothermia, from first aid to connection to the ECMO in the target medical facility. The algorithm succeeded in emphasizing the basic principles of the treatment of severely hypothermic patients:
- careful manipulation with the patient and prevention of further heat loss,
- airway management and maximizing oxygenation,
- resuscitation in hypothermic patient,
- the efficiency of defibrillation and drug administration in patients with a core temperature below 30 °C,
- specific therapy in hypothermic cardiac arrest - extracorporeal life support.
At the end of the algorithm, the authors also mentioned the risk of frostbite, including the basic rules for treatment.
S. Kosiński published a study in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine in 2015, which showed up to four times higher incidence of hypothermia in Poland than reported by official statistics as well as great lack of knowledge of medical staff regarding the management of patients with hypothermia. I believe that this algorithm will contribute to raising awareness of the issue of hypothermia and frostbite.