How Poland Protects Against COVID-19

The historical fear of plagues in Poland is evident even in old religious songs and rituals intended to ward off the infected air. The demon thought responsible for such epidemics in pre-Slavic times was Trzybka. In the Middle Ages it was believed they came from God’s wrath, the influence of planets, or the appearance of comets. The real causes of epidemics, however, were more mundane: the dire sanitary conditions of cities of the time, the concentration of many people in a small area, migration, trade routes, and the tradition of burying the deceased in small church cemeteries—digging up graves for new burials released bacteria. The word quarantine itself also has a medieval origin, coming from the Italian term quaranta giorni, or simply 40 days.

The coronavirus SARS-CoV-2, causing the disease COVID-19, was first diagnosed in Wuhan, China, in December 2019, followed by outbreaks in other countries. In January the World Health Organization announced a public health emergency. SARS-CoV-2 is a virus from the coronaviridae family, occurring in animals and causing a variety of symptoms. Many infections are asymptomatic.

These viruses often mutate and unfortunately have a high ability to infect new species. Most known coronoviruses cause infections in humans, usually with respiratory symptoms and less often with symptoms that impact other systems and organs. It is possible that in addition to respiratory infections in children under 12 months of age, they can cause diarrhea. So far, six coronaviruses causing infections in humans are known. Four of them (229E, OC43, NL63, HKU1) cause a mild cold. The other two, SARS and MERS, can lead to life-threatening acute respiratory failure.

COVID-19 in Poland

The first case of COVID-19 in Poland appeared in the town of Zielona Góra, located in northwestern Poland on the border with Germany. The head of the local hospital ward is Tomasz Więckowski, an emergency physician who tries to implement the latest practices of emergency medicine and the principles of proper cooperation with middle-care personnel. It was he who introduced new COVID protocols to our unit, which we present here because, as time shows, EMS can be a barrier to help prevent introduction of the virus into hospitals.

A patient who suspects he/she has COVID-19 becomes ill and reports it to the appropriate telephone number provided on every door of the hospital. A rescuer on so-called “COVID duty” informs him/her of the appropriate entrance to which to report for “decontamination.”

A paramedic in protective clothing will conduct an epidemiological interview in the decontamination room, measure vital signs, and document his/her observations via epidemiological survey and triage card. COVID-negative patients are sent back to their primary care physician or asked to return home and call their doctor regarding symptomatic treatment.

If, on the other hand, the paramedic finds the patient’s symptoms may indicate COVID-19, he/she informs a doctor, who decides about further proceedings. If the patient is in good condition, a swab is taken and sent for examination. Data is collected from the patient, including their current address, and a report is sent to the local epidemiologic station, which regularly checks the patient’s health and compliance with strict home quarantine.

If the patient’s condition is disturbing or we suspect the development of coexisting diseases, the patient is undressed and redressed in interlining garments, dons gloves and a surgical mask (which they change every hour; this is recorded on the patient’s supervision card, where we also track their blood pressure, heart rate, SpO₂, and temperature measurements). The patient’s belongings are packed into a bag as contaminated waste. If the COVID-19 result is positive, they are destroyed (with signed consent).

The paramedic maintains communication with the ward by radio. When the patient is ready to be transferred to an isolation room, we give a message to clear the communication line through which we will pass with the patient. At the same time, the patient is registered by the medical secretary into the ward book, and when the patient “appears” in the system, the doctor orders a panel of coronavirus tests. A swab for COVID-19 is also taken and sent to the sanitary unit, and other tests are done if diagnostics for other diseases are necessary. All guidelines emphasize that diagnostics for COVID-19 will not delay the diagnosis of other diseases that may cause the symptoms presented.

One rescuer wearing protective clothing remains in the isolation room with the patient, the other “clean” rescuer, wearing a barrier apron, goggles, gloves, and a surgical mask, stands at the door of the isolation room and waits for the material to be taken for examination. The tests go into a biohazard-marked string bag and then into a plastic container which is closed and transported to the laboratory.

Safety Is Paramount

In the first version of the current procedure, lung x-rays were routinely performed. The x-ray machine was assigned to the isolation room, and the technicians coming down to take the picture were equipped with PPE. If there were more patients in isolation, all of them were equipped with lead aprons for the duration of the x-ray. After some time, however, this activity was abandoned if there were no actual indications to perform it. If dyspnea is observed, chest CT is performed as a rule. The patient remains in isolation until the result is confirmed or excluded and transported to a dedicated ward.

A patient in severe respiratory or clinically deteriorating condition is transferred to the resuscitation and treatment area, where he or she is prepared for ITU admission. The same area is used for unconscious patients for whom a reliable history cannot be gathered—e.g., with features of unbalanced post-traumatic shock or disturbances of consciousness such as respiratory abnormalities. Multiorgan trauma, severe CNS trauma, peritoneal bleeding, SCA with ongoing resuscitation, and stroke are for this reason treated in advance as COVID-positive, and therefore we use the highest protection: a biological protection uniform, FFP3 mask, goggles, gloves, and barrier surgical apron. Additional lab tests are also taken from patients with coronavirus profiles. The priority is early intubation, which also allows us to take material from the bronchial tree, providing more reliable test results for COVID-19.

Our province currently has the fewest cases of the disease in Poland. Almost every day, based on new information, experience, and our own observations, we introduce new restrictions because in all this we must not forget that the most important thing is our health. By protecting the entrance to the hospital and creating barriers to transmission inside, we protect both ourselves and our families.

At present, ambulances wait at the entrance gate to the hospital for the arrival of a triage specialist who collects epidemiological histories not only from the patient but also from the ambulance crew. The basic criterion is naturally the temperature, but we assess the patient’s condition as a whole. During the pandemic period there are no emergency situations and no immediate assistance; if necessary, we take care of suspected COVID patients in the ambulance until the ward team can get dressed and prepare to receive them. During the pandemic we continue to emphasize that our own safety is paramount.

Robert Rajtar is a medical rescuer with 14 years of service experience in hospital emergency department and EMS teams in Poland and Germany. He is an employee of the provincial emergency service station in Szczecin (branch Myślibórz). 

Katarzyna Ostaszewska is a medical rescuer, master of emergency medicine and crisis management. She currently serves at Hospital Emergency Ward Gorzów.