Purpose: We aimed to assess whether insulating covers and warming systems cause artifacts in fluoroscopy, and whether they alter the radiation dose. Methods: Eight insulating and warming systems were wrapped around the phantom in order to obtain images in fluoroscopy, and to measure the absorbed and scattered radiation dose. A dosimeter, endovascular catheters, and stents were placed into a phantom. The other dosimeter was placed outside of a C-arm table, at the operator’s and anesthesiologist’s locations. Results: Most of the insulating covers did not cause artifacts in the fluoroscopy and led to a significant decrease in both the absorbed and scattered radiation dose. The highest decrease in the absorbed dose was observed with metalized foil (− 2.09%; p = 0.001) and in the scattered dose with Helios cover (− 55%; p < 0.001). Only one heating system (Ready Heat combined with Hypothermia Prevention and Management Kit cover) caused significant artifacts and increased radiation up to 99% (p < 0.001). Conclusion: Thermal insulation may be maintained during X-ray-guided emergency endovascular procedures in trauma victims. Self-heating blankets should be replaced with another warming system.

Purpose: The use of thermal insulations reduces the risk of hypothermia, therefore decreases the risk of death in trauma victims. The aim of the study was to assess whether thermal insulations cause artifacts, which may hinder the diagnosis of injuries, and how the used thermo-systems alter the radiation dose in polytrauma computed tomography. Methods: Computed tomography scans were made using the road accident victim body wrapped consecutively with 7 different covers. 14 injury areas were listed and evaluated by 22 radiologists. The radiation dose was measured using a dosimeter placed on the victim in the abdominal area. Results: No significant artifacts in any of the tested covers were observed. The presence of few minor artifacts did not hinder the assessment of injuries. Certain materials increased (up to 19,1%) and some decreased (up to -30,3%) the absorbed radiation dose. Conclusions: Thermal insulation systems tested in this study do not cause significant artifacts hindering assessment of injuries in CT scans. Concern for artifacts and increased radiation dose should not be a reason to remove patients’ thermal insulation during performing trauma CT-scanning.

We are very impressed with the article Tourniquet Application for Bleeding Control in a Rural Trauma System: Outcomes and Implications for Prehospital Providers by Hala Bedri et al (1). We do not a...

Little is known about the nature and magnitude of conductive heat loss in outdoor environments. Although manikin studies provide reproducible and consistent data, they may not fully reflect all aspects of human physiological responses. This preliminary study assessed heat loss in volunteers under simulated outdoor conditions, with a focus on heat flux toward the ground, which primarily represents heat conduction. An experimental study was conducted with seven healthy volunteers in a thermoclimatic chamber. A two-phase rescue scenario was employed in which a person immobilized on a spineboard was placed directly on the ground (Phase 1) and then lifted upwards under windy conditions (Phase 2). Heat flux was measured via heat flow sensors placed on the volunteers’ skin. The driving force for conductive heat loss was determined on the basis of the temperature difference between the skin and the spineboard. A linear regression model was used to analyse the relationship between heat flux and temperature difference. The mean skin-spineboard temperature difference was 23,6 ± 2,9 °C and increased over time. The mean heat flux through the contact area was 467 ± 97 W/m2. A significant increase in heat flux to 560 ± 45 W/m2 was recorded in Phase 2 of the experiment. Multiplication of the heat flux per area times the contact area resulted in a mean heat loss of 159 Watts. In both phases, a strong linear relationship was found between back skin temperature and heat flux. In Phase 1, the relationship was positive (β=+31 W/m² per 1 °C decrease in skin temperature; R²=0.986; p < 0.001), whereas in Phase 2, it was negative (β=−20 W/m² per 1 °C decrease; R²=0.946; p < 0.001). The heat flux through the skin-to-spineboard interface, which is mainly conductive loss, is one-fourth greater than the heat flux through the skin of anterior body. Heat conduction towards the ground accounts for approximately one-fifth of the total heat loss. The heat flux through the skin-to-spineboard contact surface may increase when the spineboard is lifted from the ground in windy conditions.

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.