In June 2013 the first Polish system of qualification for extracorporeal rewarming of patients in severe hypothermia was developed, it encompasses with its reach the patients of Lesser Poland Voivodeship. The core of the system is Severe Hypothermia Treatment Centre (SHTC) by Department of Anaesthesiology and Intensive Care at John Paul II Hospital in Kraków. Its objective is treatment of severe stages of hypothermia with extracorporeal membrane oxygenation (ECMO) method as well support of cooperating entities with knowledge and aiding them in decision making process. The concept of the entire programme and procedure itself were based upon experts’ recommendations as well as experience of other centres in the world [1–3], but reach and range of activity of SHTC are exceptional.
The idea of the system development was based on previous experience of the systems originators and information gathered via countrywide questionnaire concerning hypothermia diagnosis and treatment . Hypothermia, and its severe stages in particular, is diagnosed sporadically, but its incidence rate is probably higher than implied by the official statistical data. The means of treatment which were put to use have not always been successful, and instances of extracorporeal techniques were merely anecdotal. We assumed that the only way of increasing the efficacy of treatment is developing a system which will provide full care of the patients – from early identification, through safe transportation, up to present-day and efficient possibilities of rewarming and life support. Initially the victims of acute exposure hypothermia (e.g. in the mountains, after cold water immersion) were in the scope of our interest, but, according to our expectations, chronic urban hypothermia has proven to be the greatest challenge.
The system would fail to function without broad educational and information campaign. Series of trainings for physicians, nurses, paramedics and also for the police, fire departments, and other entities cooperating with the system was initiated. During the meetings the means of recognising and treatment of hypothermia were discussed, population at risk was identified, and newly developed algorithm was presented. Educational materials and information on methods of notifying system coordinator reached all emergency departments (20 emergency departments proper and 11 inpatient departments), ambulance stations, fire departments, railroad police units, employees of 6 national parks, border guard, and police departments within the voivodeship.