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Identification and characteristics of biological agents in work environment of medical emergency services in selected ambulances

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Bielawska-Drózd A., Cieślik P., Wlizło-Skowronek B., Winnicka I., Kubiak L., Jaroszuk-Ściseł J., Depczyńska D., Bohacz J., Korniłłowicz-Kowalska T., Skopińska-Różewska E., Kocik J.
International Journal of Occupational Medicine and Environmental Health
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2017
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vol. 30
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issue 4
617-627
EN
Objectives Assessment of microbial air quality and surface contamination in ambulances and administration offices as a control place without occupational exposure to biological agents; based on quantitative and qualitative analysis of bacteria, yeasts and filamentous fungi found in collected samples. Material and Methods The sampling was done by wet cyclone technology using the Coriolis recon apparatus, imprint and swab methods, respectively. In total, 280 samples from 28 ambulances and 10 offices in Warszawa were tested. Data was analyzed using Shapiro-Wilk normality test, Kruskal-Wallis test with α = 0.05. P value ≤ 0.05 was considered as significant. Results The levels of air contamination were from 0 to 2.3×10¹ colony-forming unit (CFU)/m³ for bacteria and for yeast and filamentous fungi were from 0 to 1.8×10¹ CFU/m³. The assessment of office space air samples has shown the following numbers of microorganisms: bacteria from 3.0×10¹ to 4.2×10¹ CFU/m³ and yeast and filamentous fungi from 0 to 1.9×10¹ CFU/m³. For surface contamination the mean bacterial count in ambulances has been between 1.0×10¹ and 1.3×102 CFU/25 cm² and in offices – between 1.1×10¹ and 8.5×10¹ CFU/25 cm². Mean fungal count has reached the level from 2.8×10⁰ to 4.2×10¹ CFU/25 cm² in ambulances and 1.3×10¹ to 5.8×10¹ CFU/25 cm² in offices. The qualitative analysis has revealed the presence of Acinetobacter spp. (surfaces), coagulase – negative Staphylococci (air and surfaces), Aspergillus and Penicillium genera (air and surfaces). Conclusions The study has revealed a satisfactory microbiological quantity of analyzed air and surface samples in both study and control environments. However, the presence of potentially pathogenic microorganisms in the air and on surfaces in ambulances may endanger the medical emergency staff and patients with infection. Disinfection and cleaning techniques therefore should be constantly developed and implemented. Int J Occup Med Environ Health 2017;30(4):617–627
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Serum fluoride levels in ambulance staff after commencement of methoxyflurane administration compared to meta-analysis results for the general public

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Allison S. J., Docherty P. D., Pons D., Chase J. G.
International Journal of Occupational Medicine and Environmental Health
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2021
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vol. 34
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issue 6
767-777
EN
ObjectivesAmbulance officers administering methoxyflurane as an inhalational analgesic may be exposed to trace vapor. Fluoride is a methoxyflurane metabolite, and has been associated with acute renal failure in anesthesia patients and skeletal fluorosis with chronic elevated serum levels from other sources. However, there has been no direct measurement of serum fluoride in occupationally exposed ambulance officers. Thus, this study directly measures serum fluoride over a prolonged period in order to determine renal toxic and skeletal fluorosis risk to ambulance officers who are administering methoxyflurane.Material and MethodsSerum inorganic fluoride concentrations were measured in a prospective observational study of 12 emergency medical technicians (EMTs). The study took 7 serum fluoride measurements over 24 months. A meta-analysis of healthy adult serum fluoride ranges was also conducted.ResultsThe typical healthy adult serum fluoride range was determined to be 0.21–2.11 μmol/l (p < 0.001). The EMTs’ baseline median (IQR) serum fluoride concentrations were 0.4 μmol/l (0.2; 1.0) with maximum 1.6 μmol/l. The EMTs’ overall median serum fluoride was 0.4 μmol/l (0.2; 1.3) with maximum 4.0 μmol/l, usually within healthy reference ranges. All results were ≤10% of the suggested single-dose renal toxic threshold. One result was above a threshold for skeletal fluorosis. The highest measured serum fluoride was 24% of the lowest level associated with radiologic evidence of fluorosis. There was no evidence overall of increasing serum fluoride levels.ConclusionsThere was no evidence that EMTs’ exposure to methoxyflurane resulted in sustained increased serum fluoride. These results imply EMTs’ occupational safety from acute renal toxicity when activated carbon filtration is used on patient exhalation. However, 1 serum fluoride result above a skeletal fluorosis threshold suggests that the risk of mild skeletal fluorosis cannot be excluded.
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Road ambulances: working conditions of paramedics – pilot studies

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Bęczkowska S., Grabarek I., Pilip S., Szpakowski L., Gałązkowski R.
International Journal of Occupational Medicine and Environmental Health
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2019
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vol. 33
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issue 1
91-105
EN
ObjectivesThe article presents the results of selected pilot studies conducted in medical ambulances. Their aim was to determine the working conditions and identify troublesome factors accompanying the performance of basic medical procedures by rescue teams.Material and MethodsThe study of working conditions was carried out in Mercedes-Benz ambulances, type S and P. Fifty-one paramedics of the Emergency Medical Rescue Service in Siedlce took part in the research. The questionnaire expert survey method and the direct observation method were used.ResultsAs a result of the applied research methods, knowledge was gained on the irregularities and difficulties that occur at the workplace of a paramedic, i.e., in an ambulance, including the lack of access to essential elements of medical equipment and their different location inside the vehicle, and the diversity of solutions for the spatial structure of ambulances, which all cause difficulties at work. Research has shown that paramedics take, on average, 33 min to familiarize themselves with the location of equipment in an ambulance other than the one in which they are usually on duty. There was no correlation between the lifeguard’s length of service and the time necessary for getting acquainted with the equipment, which was studied using Pearson’s correlation coefficient. In the study, rescuers also pointed to musculoskeletal ailments, mainly spinal pains resulting from taking forced positions during medical activities in an ambulance.ConclusionsThe results obtained constitute the basis for the author’s methodology of complex research aimed at defining the ergonomic recommendations necessary in the modification process of the operated medical fleet. The next step will be to formulate uniform guidelines for the construction of medical compartments of ambulances, the application of which will lead to the unification of their spatial structure regardless of the vehicle brand.
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