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Nikolaj Blomberg S, Jensen TW, Porsborg Andersen M, Folke F, Kjær Ersbøll A, Torp-Petersen C, Lippert F, Collatz Christensen H. When the machine is wrong. Characteristics of true and false predictions of Out-of-Hospital Cardiac arrests in emergency calls using a machine-learning model. Resuscitation 2023; 183:109689. [PMID: 36634755 DOI: 10.1016/j.resuscitation.2023.109689] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 01/10/2023]
Abstract
BACKGROUND A machine-learning model trained to recognize emergency calls regarding Out-of-Hospital Cardiac Arrest (OHCA) was tested in clinical practice at Copenhagen Emergency Medical Services (EMS) from September 2018 to December 2019. We aimed to investigate emergency call characteristics where the machine-learning model failed to recognize OHCA or misinterpreted a call as being OHCA. METHODS All emergency calls were linked to the dispatch database and verified OHCAs were identified by linkage to the Danish Cardiac Arrest Registry. Calls with either false negative or false positive predictions of OHCA were evaluated by trained auditors. Descriptive analyses were performed with absolute numbers and percentages reported. RESULTS The machine-learning model processed 169,236 calls to Copenhagen EMS and suspected 5,811 (3.4%) of the calls as OHCA, resulting in 84.5% sensitivity and 97.1% specificity. Among OHCAs not recognised by machine-learning model, a condition completely different from OHCA was presented by caller in 31% of the cases. In 28% of unrecognised calls, patient was reported breathing normally, and language barriers were identified in 23% of the cases. Among falsely suspected OHCA, the patient was reported unconscious in 28% of the cases, and in 13% of the false positive cases the machine-learning model interpreted calls regarding dead patients with irreversible signs of death as OHCA. CONCLUSION Continuous optimization of the language model is needed to improve the prediction of OHCA and thereby improve sensitivity and specificity of the machine-learning model on recognising OHCA in emergency telephone calls.
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Affiliation(s)
- Stig Nikolaj Blomberg
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Theo W Jensen
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | - Fredrik Folke
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Cardiology, Herlev Gentofte University Hospital, Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- Copenhagen Emergency Medical Services, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Christian Torp-Petersen
- Department of Cardiology, Nordsjællands Hospital, Denmark; Department of Public Health, University of Copenhagen, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Falck, Denmark
| | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Danish Clinical Quality Program (RKKP), National Clinical Registries, Denmark
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2
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Kirby K, Voss S, Bird E, Benger J. Features of Emergency Medical System calls that facilitate or inhibit Emergency Medical Dispatcher recognition that a patient is in, or at imminent risk of, cardiac arrest: A systematic mixed studies review. Resusc Plus 2021; 8:100173. [PMID: 34841368 PMCID: PMC8605417 DOI: 10.1016/j.resplu.2021.100173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/19/2022] Open
Abstract
Aim To identify and appraise evidence relating to the features of an Emergency Medicine System call interaction that enable, or inhibit, an Emergency Medical Dispatcher’s recognition that a patient is in out-of-hospital cardiac arrest, or at imminent risk of out-of-hospital cardiac arrest. Methods All study designs were eligible for inclusion. Data sources included Medline, BNI, CINAHL, EMBASE, PubMed, Cochrane Database of Systematic Reviews, AMED and OpenGrey. Stakeholder resources were screened and experts in resuscitation were asked to review the studies identified. Studies were appraised using the Mixed Methods Appraisal Tool. Synthesis was completed using a segregated mixed research synthesis approach. Results Thirty-two studies were included in the review. Three main themes were identified: Key features of the Emergency Medical Service call interaction; Managing the Emergency Medical Service call; Emotional distress. Conclusion A dominant finding is the difficulty in recognising abnormal/agonal breathing during the Emergency Medical Service call. The interaction between the caller and the Emergency Medical Dispatcher is critical in the recognition of patients who suffer an out-of-hospital cardiac arrest. Emergency Medical Dispatchers adapt their approach to the Emergency Medical Service call, and regular training for Emergency Medical Dispatchers is recommended to optimise out-of-hospital cardiac arrest recognition. Further research is required with a focus on the Emergency Medical Service call interaction of patients who are alive at the time of the Emergency Medical Service call and who later deteriorate into OHCA. PROSPERO registration: CRD42019155458.
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Affiliation(s)
- Kim Kirby
- South Western Ambulance Service NHS Foundation Trust, Eagle Way, Exeter EX2 7HY, United Kingdom
- University of the West of England, Blackberry Hill, Stapleton, Bristol BS16 1DD, United Kingdom
- Corresponding author at: South Western Ambulance Service NHS Foundation Trust, Eagle Way, Exeter EX2 7HY, United Kingdom.
| | - Sarah Voss
- University of the West of England, Blackberry Hill, Stapleton, Bristol BS16 1DD, United Kingdom
| | - Emma Bird
- University of the West of England, Blackberry Hill, Stapleton, Bristol BS16 1DD, United Kingdom
| | - Jonathan Benger
- University of the West of England, Blackberry Hill, Stapleton, Bristol BS16 1DD, United Kingdom
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3
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Breindahl N, Granholm A, Jensen TW, Ersbøll AK, Myklebust H, Lippert F, Lippert A. Assessment of breathing in cardiac arrest: a randomised controlled trial of three teaching methods among laypersons. BMC Emerg Med 2021; 21:114. [PMID: 34627156 PMCID: PMC8502323 DOI: 10.1186/s12873-021-00513-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this trial was to compare a video- and a simulation-based teaching method to the conventional lecture-based method, hypothesizing that the video- and simulation-based teaching methods would lead to improved recognition of breathing patterns during cardiac arrest. Methods In this Danish, investigator-initiated, stratified, randomised controlled trial, adult laypersons (university students, military conscripts and elderly retirees) participating in European Resuscitation Council Basic Life Support courses were randomised to receive teaching on how to recognise breathing patterns using a lecture- (usual practice), a video-, or a simulation-based teaching method. The primary outcome was recognition of breathing patterns in nine videos of actors simulating normal breathing, no breathing, and agonal breathing (three of each). We analysed outcomes using logistic regression models and present results as odds ratios (ORs) with 95% confidence intervals (CIs) and P-values from likelihood ratio tests. Results One hundred fifty-three participants were included in the analyses from February 2, 2018 through May 21, 2019 and recognition of breathing patterns was statistically significantly different between the teaching methods (P = 0.013). Compared to lecture-based teaching (83% correct answers), both video- (90% correct answers; OR 1.77, 95% CI: 1.19–2.64) and simulation-based teaching (88% correct answers; OR 1.48; 95% CI: 1.01–2.17) led to significantly more correct answers. Video-based teaching was not statistically significantly different compared to simulation-based teaching (OR 1.20; 95% CI: 0.78–1.83). Conclusion Video- and simulation-based teaching methods led to improved recognition of breathing patterns among laypersons participating in adult Basic Life Support courses compared to the conventional lecture-based teaching method. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00513-4.
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Affiliation(s)
- Niklas Breindahl
- Copenhagen Academy for Medical Education and Simulation, Centre for HR&U, Borgmester Ib Juuls Vej 1, 2730, Herlev, Capital Region of Denmark, Denmark.
| | - Anders Granholm
- Copenhagen Academy for Medical Education and Simulation, Centre for HR&U, Borgmester Ib Juuls Vej 1, 2730, Herlev, Capital Region of Denmark, Denmark.,Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Theo Walther Jensen
- Copenhagen Academy for Medical Education and Simulation, Centre for HR&U, Borgmester Ib Juuls Vej 1, 2730, Herlev, Capital Region of Denmark, Denmark.,Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Freddy Lippert
- Copenhagen Emergency Medical Services, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Lippert
- Copenhagen Academy for Medical Education and Simulation, Centre for HR&U, Borgmester Ib Juuls Vej 1, 2730, Herlev, Capital Region of Denmark, Denmark
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4
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Gerwing J, Steen-Hansen JE, Mjaaland T, Jensen BF, Eielsen O, Thomas OMT, Gulbrandsen P. Evaluating a training intervention for improving alignment between emergency medical telephone operators and callers: a pilot study of communication behaviours. Scand J Trauma Resusc Emerg Med 2021; 29:107. [PMID: 34332640 PMCID: PMC8325801 DOI: 10.1186/s13049-021-00917-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/09/2021] [Indexed: 11/22/2022] Open
Abstract
Background Calls to emergency medical lines are an essential component in the chain of survival. Operators make critical decisions based on information they elicit from callers. Although smooth cooperation is necessary, the field lacks evidence-based guidelines for how to achieve it while adhering to strict parameters of index-driven questioning. We aimed to evaluate the effect of a training intervention for emergency medical operators at a call centre in Tønsberg, Norway. The course was designed to enhance operators’ communication skills for smoothing cooperation with callers. Methods Calls were analyzed using inductively developed coding based on the course rationale and content. To evaluate whether the course generated consolidated behavioral change in everyday practice, the independent analyst evaluated 32 calls, selected randomly from eight operators, two calls before and two after course completion. To measure whether skill attainment delayed decision making, we compared the time to the first decision logged by intervention operators to eight control operators. Analysis included 3034 calls: 1375 to intervention operators (T1 = 815; T2 = 560) and 1659 to control operators (T1 = 683; T2 = 976). Results Operators demonstrated improved behaviours on how they greeted the caller (p < .001), acknowledged the caller (p < .001), and displayed empathy (p = 0.015). No change was found in the use of open-ended questions and agreeing with the caller. Contrary to expectations, operators who took the course logged first decisions more quickly than the control group (p < .001). Conclusions This pilot study demonstrated that the training intervention generated behavioural change in these operators, providing justification for scaling up the intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00917-y.
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Affiliation(s)
- Jennifer Gerwing
- Health Services Research Unit, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway.
| | - Jon Erik Steen-Hansen
- Division of Prehospital Care, Vestfold Hospital Trust, Box 2168, NO-3103, Tønsberg, Norway
| | - Trond Mjaaland
- Somsagt AS, Forskningsparken / Oslo Science Park, Gaustadalleen 21, 0349, Oslo, Norway
| | - Bård Fossli Jensen
- Somsagt AS, Forskningsparken / Oslo Science Park, Gaustadalleen 21, 0349, Oslo, Norway
| | | | | | - Pål Gulbrandsen
- Health Services Research Unit, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, PO box 1171, Blindern, 0318, Oslo, Norway
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5
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Hardeland C, Claesson A, Blom MT, Blomberg SNF, Folke F, Hollenberg J, Kramer-Johansen J, Lippert F, Nord A, Nygaard AM, Olasveengen TM, Ringh M, Svensson L, Møller TP. Description of call handling in emergency medical dispatch centres in Scandinavia: recognition of out-of-hospital cardiac arrests and dispatcher-assisted CPR. Scand J Trauma Resusc Emerg Med 2021; 29:88. [PMID: 34193226 PMCID: PMC8247132 DOI: 10.1186/s13049-021-00903-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 06/11/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The European resuscitation council have highlighted emergency medical dispatch centres as an important key player for early recognition of Out-of-Hospital Cardiac Arrest (OHCA) and in providing dispatcher assisted cardiopulmonary resuscitation (CPR) before arrival of emergency medical services. Early recognition is associated with increased bystander CPR and improved survival rates. The aim of this study is to describe OHCA call handling in emergency medical dispatch centres in Copenhagen (Denmark), Stockholm (Sweden) and Oslo (Norway) with focus on sensitivity of recognition of OHCA, provision of dispatcher-assisted CPR and time intervals when CPR is initiated during the emergency call (NO-CPRprior), and to describe OHCA call handling when CPR is initiated prior to the emergency call (CPRprior). METHODS Baseline data of consecutive OHCA eligible for inclusion starting January 1st 2016 were collected from respective cardiac arrest registries. A template based on the Cardiac Arrest Registry to Enhance Survival definition catalogue was used to extract data from respective cardiac arrest registries and from corresponding audio files from emergency medical dispatch centres. Cases were divided in two groups: NO-CPRprior and CPRprior and data collection continued until 200 cases were collected in the NO-CPRprior-group. RESULTS NO-CPRprior OHCA was recognised in 71% of the calls in Copenhagen, 83% in Stockholm, and 96% in Oslo. Abnormal breathing was addressed in 34, 7 and 98% of cases and CPR instructions were started in 50, 60, and 80%, respectively. Median time (mm:ss) to first chest compression was 02:35 (Copenhagen), 03:50 (Stockholm) and 02:58 (Oslo). Assessment of CPR quality was performed in 80, 74, and 74% of the cases. CPRprior comprised 71 cases in Copenhagen, 9 in Stockholm, and 38 in Oslo. Dispatchers still started CPR instructions in 41, 22, and 40% of the calls, respectively and provided quality assessment in 71, 100, and 80% in these respective instances. CONCLUSIONS We observed variations in OHCA recognition in 71-96% and dispatcher assisted-CPR were provided in 50-80% in NO-CPRprior calls. In cases where CPR was initiated prior to emergency calls, dispatchers were less likely to start CPR instructions but provided quality assessments during instructions.
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Affiliation(s)
- Camilla Hardeland
- Department of Health and Welfare, Østfold University College, P.O. box 700, NO-1757, Halden, Norway. .,Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Division of Prehospital Services, Oslo University Hospital and University of Oslo, Oslo, Norway.
| | - Andreas Claesson
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Marieke T Blom
- Department of Cardiology, Heart Centre, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Fredrik Folke
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Jo Kramer-Johansen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Division of Prehospital Services, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | - Anette Nord
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Anne Mette Nygaard
- Department of Health and Welfare, Østfold University College, P.O. box 700, NO-1757, Halden, Norway
| | | | - Mattias Ringh
- Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Leif Svensson
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - Thea Palsgaard Møller
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
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6
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Olasveengen TM, Semeraro F, Ristagno G, Castren M, Handley A, Kuzovlev A, Monsieurs KG, Raffay V, Smyth M, Soar J, Svavarsdóttir H, Perkins GD. [Basic life support]. Notf Rett Med 2021; 24:386-405. [PMID: 34093079 PMCID: PMC8170637 DOI: 10.1007/s10049-021-00885-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/13/2022]
Abstract
The European Resuscitation Council has produced these basic life support guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include cardiac arrest recognition, alerting emergency services, chest compressions, rescue breaths, automated external defibrillation (AED), cardiopulmonary resuscitation (CPR) quality measurement, new technologies, safety, and foreign body airway obstruction.
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Affiliation(s)
- Theresa M. Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norwegen
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Maggiore Hospital, Bologna, Italien
| | - Giuseppe Ristagno
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Mailand, Italien
- Department of Pathophysiology and Transplantation, University of Milan, Mailand, Italien
| | - Maaret Castren
- Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finnland
| | | | - Artem Kuzovlev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, V.A. Negovsky Research Institute of General Reanimatology, Moskau, Russland
| | - Koenraad G. Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Antwerpen, Belgien
| | - Violetta Raffay
- Department of Medicine, School of Medicine, European University Cyprus, Nikosia, Zypern
| | - Michael Smyth
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, CV4 7AL Coventry, Großbritannien
- West Midlands Ambulance Service, DY5 1LX Brierly Hill, West Midlands Großbritannien
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, Großbritannien
| | - Hildigunnur Svavarsdóttir
- Akureyri Hospital, Akureyri, Island
- Institute of Health Science Research, University of Akureyri, Akureyri, Island
| | - Gavin D. Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, CV4 7AL Coventry, Großbritannien
- University Hospitals Birmingham, B9 5SS Birmingham, Großbritannien
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7
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8
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Heidet M, Da Cunha T, Brami E, Mermet E, Dru M, Simonnard B, Lecarpentier E, Chollet-Xémard C, Bergeron C, Khalid M, Grunau B, Marty J, Audureau E. EMS Access Constraints And Response Time Delays For Deprived Critically Ill Patients Near Paris, France. Health Aff (Millwood) 2021; 39:1175-1184. [PMID: 32634362 DOI: 10.1377/hlthaff.2019.00842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Increased emergency medical services (EMS) response times and areas of low socioeconomic status are both associated with poorer outcomes for several time-sensitive medical conditions attended to by medical personnel before a patient is hospitalized. We evaluated the association between EMS response times, area deprivation level, and on-scene access constraints encountered by EMS in a large urban area in France. We conducted a multicenter prospective cohort study of EMS dispatches occurring in the forty-seven cities in a region southeast of Paris. We fit multilevel mixed-effects linear regression models for multivariate assessment of the predictors of EMS response times and then used multivariate logistic regression on outcomes among a subgroup of patients presenting with out-of-hospital cardiac arrest. We found evidence that access constraints were more frequently encountered by EMS in the most deprived areas compared to less deprived ones, and were associated with increased EMS response times until patient contact and with poorer outcomes from cardiac arrest. Strategies to anticipate and overcome access constraints should be implemented to improve outcomes for emergent conditions attended to by prehospital medical teams.
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Affiliation(s)
- Matthieu Heidet
- Matthieu Heidet is a physician with Service d'aide médicale urgente (SAMU) 94 and with Urgences at Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), in Créteil, France
| | - Thierry Da Cunha
- Thierry Da Cunha is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP
| | - Elise Brami
- Elise Brami is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP
| | - Eric Mermet
- Eric Mermet is a scientist at the Centre d'analyse et de mathématique sociales (CAMS), at the Centre national de la recherche scientifique (CNRS) and École des hautes études en sciences sociales (EHESS), in Paris, France
| | - Michel Dru
- Michel Dru is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP
| | - Béatrice Simonnard
- Béatrice Simonnard is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP
| | - Eric Lecarpentier
- Eric Lecarpentier is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP
| | | | - Corinne Bergeron
- Corinne Bergeron is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP
| | - Mohamed Khalid
- Mohamed Khalid is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP
| | - Brian Grunau
- Brian Grunau is a physician in the Department of Emergency Medicine, University of British Columbia, in Vancouver, British Columbia, Canada
| | - Jean Marty
- Jean Marty is a physician with SAMU 94 at Hôpital Henri Mondor, AP-HP, and head of the research team Analysis of Risks in Complex Health Systems (ARCHeS), Université Paris-Est Créteil (UPEC), in Créteil, France
| | - Etienne Audureau
- Etienne Audureau is a public health physician and scientist with the research team Clinical Epidemiology and Ageing Unit (CEpiA), UPEC
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9
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Abstract
The European Resuscitation Council (ERC) has produced these Systems Saving Lives guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include chain of survival, measuring performance of resuscitation, social media and smartphones apps for engaging community, European Restart a Heart Day, World Restart a Heart, KIDS SAVE LIVES campaign, lower-resource setting, European Resuscitation Academy and Global Resuscitation Alliance, early warning scores, rapid response systems, and medical emergency team, cardiac arrest centres and role of dispatcher.
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10
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Olasveengen TM, Semeraro F, Ristagno G, Castren M, Handley A, Kuzovlev A, Monsieurs KG, Raffay V, Smyth M, Soar J, Svavarsdottir H, Perkins GD. European Resuscitation Council Guidelines 2021: Basic Life Support. Resuscitation 2021; 161:98-114. [PMID: 33773835 DOI: 10.1016/j.resuscitation.2021.02.009] [Citation(s) in RCA: 243] [Impact Index Per Article: 81.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The European Resuscitation Council has produced these basic life support guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include cardiac arrest recognition, alerting emergency services, chest compressions, rescue breaths, automated external defibrillation (AED), CPR quality measurement, new technologies, safety, and foreign body airway obstruction.
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Affiliation(s)
- Theresa M Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway.
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Maggiore Hospital, Bologna, Italy
| | - Giuseppe Ristagno
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Maaret Castren
- Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | | | - Artem Kuzovlev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, V.A. Negovsky Research Institute of General Reanimatology, Moscow, Russia
| | - Koenraad G Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Belgium
| | - Violetta Raffay
- Department of Medicine, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Michael Smyth
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom; West Midlands Ambulance Service and Midlands Air Ambulance, Brierly Hill, West Midlands DY5 1LX, United Kingdom
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Hildigunnur Svavarsdottir
- Akureyri Hospital, Akureyri, Iceland; Institute of Health Science Research, University of Akureyri, Akureyri, Iceland
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom; University Hospitals Birmingham, Birmingham B9 5SS, United Kingdom
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11
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Kaminsky E, Lindberg Y, Spangler D, Winblad U, K Holmström I. Registered nurses' understandings of emergency medical dispatch center work: A qualitative phenomenographic interview study. Nurs Health Sci 2021; 23:430-438. [PMID: 33665977 DOI: 10.1111/nhs.12824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/23/2021] [Indexed: 11/26/2022]
Abstract
Non-urgent and urgent telephone nursing services are increasing globally, and phenomenographic research has shown that how work is understood may influence work performance. This descriptive study makes a qualitative inductive investigation of understandings of emergency medical dispatch center work among registered nurses. Twenty-four registered nurses at three mid Swedish emergency medical dispatch centers were interviewed. Analysis based on phenomenographic principles identified five categories in the interviews: (i) Assess, prioritize, direct, or refer; (ii) Facilitate ambulance nursing work; (iii) Perform nursing care; (iv) Always be available for the public; and (v) Have the person behind the patient in mind. The first constitutes the basis of the work. The second emphasizes cooperation with and support for the ambulance staff. The third entails remotely providing nursing care, whilst the fourth stresses serving the entire population. The fifth and most comprehensive way of understanding work involves having a holistic view of the person in need, including person-centered care. Provision of high-quality emergency medical dispatch center work involves all categories. Combined, they constitute a "work map," valuable for reflection, competence development, and introduction of new staff.
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Affiliation(s)
- Elenor Kaminsky
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ylva Lindberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Douglas Spangler
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Uppsala Center for Prehospital Research, Department of Surgical Sciences - Anesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Inger K Holmström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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12
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Gram KH, Præst M, Laulund O, Mikkelsen S. Assessment of a quality improvement programme to improve telephone dispatchers' accuracy in identifying out-of-hospital cardiac arrest. Resusc Plus 2021; 6:100096. [PMID: 34223361 PMCID: PMC8244530 DOI: 10.1016/j.resplu.2021.100096] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 01/20/2023] Open
Abstract
Introduction Early recognition of out-of-hospital cardiac arrest (OHCA) by the medical dispatcher is a prerequisite for an effective chain of survival, leading to rapid dispatch of emergency medical services. Aim To analyse and compare the accuracy of the Emergency Medical Dispatch Centre in identifying OHCA before and after an educational intervention. Methods A quality-assessment study collecting data from prehospital medical voice logs in Southern Denmark during two periods. Baseline data and post-interventional data were obtained during December, January, and February 2017/2018 and 2019/2020, respectively. We imposed an intervention consisting of a specifically targeted education in quick assessment of OHCA and instructions regarding telephone-assisted-CPR. The primary outcome measure was the dispatcher's ability to recognise OHCA. Secondary outcome measures were time from contact with the caller to the dispatcher formulated essential questions related to the NO-NO-GO algorithm. These questions included an assessment of the patients’ consciousness and respiratory efforts and if both negative, would ideally lead to the dispatcher initiating telephone-assisted-CPR. All data was analysed in accordance with the recommendations and performance goals made by Resuscitation Academy. Results Baseline data included 209 calls. Post-interventional data was based on 208 calls. The sensitivity for recognition of OHCA was 82.3% (95% CI: 76.4–87.2%) before and 92.7% (95% CI: 88.2–95.8%) after the intervention (p = 0.0014). The median duration of calls before recognition of OHCA was 68 and 56 s before and after the intervention (p = 0.097). Conclusion After the period of intervention, the accuracy of OHCA recognition by dispatchers improved. The median time to identify OHCA or recognise the first compression did not differ significantly. This indicates that continuing education and quality assessment may be beneficial and necessary.
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Affiliation(s)
- Kristel Hadberg Gram
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mikkel Præst
- The Mobile Emergency Care Unit, Department of Anaesthesiology and Intensive Care, Odense University Hospital, Denmark.,Emergency Medical Dispatch Centre, Region of Southern Denmark, Denmark
| | - Ole Laulund
- Emergency Medical Dispatch Centre, Region of Southern Denmark, Denmark
| | - Søren Mikkelsen
- The Mobile Emergency Care Unit, Department of Anaesthesiology and Intensive Care, Odense University Hospital, Denmark.,The Prehospital Research Unit, Region of Southern Denmark, University of Southern Denmark, Odense, Denmark
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13
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Diagnosis of out-of-hospital cardiac arrest by emergency medical dispatch: A diagnostic systematic review. Resuscitation 2020; 159:85-96. [PMID: 33253767 DOI: 10.1016/j.resuscitation.2020.11.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/01/2020] [Accepted: 11/18/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Cardiac arrest is a time-sensitive condition requiring urgent intervention. Prompt and accurate recognition of cardiac arrest by emergency medical dispatchers at the time of the emergency call is a critical early step in cardiac arrest management allowing for initiation of dispatcher-assisted bystander CPR and appropriate and timely emergency response. The overall accuracy of dispatchers in recognizing cardiac arrest is not known. It is also not known if there are specific call characteristics that impact the ability to recognize cardiac arrest. METHODS We performed a systematic review to examine dispatcher recognition of cardiac arrest as well as to identify call characteristics that may affect their ability to recognize cardiac arrest at the time of emergency call. We searched electronic databases for terms related to "emergency medical dispatcher", "cardiac arrest", and "diagnosis", among others, with a focus on studies that allowed for calculating diagnostic test characteristics (e.g. sensitivity and specificity). The review was consistent with Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method for evidence evaluation. RESULTS We screened 2520 article titles, resulting in 47 studies included in this review. There was significant heterogeneity between studies with a high risk of bias in 18 of the 47 which precluded performing meta-analyses. The reported sensitivities for cardiac arrest recognition ranged from 0.46 to 0.98 whereas specificities ranged from 0.32 to 1.00. There were no obvious differences in diagnostic accuracy between different dispatching criteria/algorithms or with the level of education of dispatchers. CONCLUSION The sensitivity and specificity of cardiac arrest recognition at the time of emergency call varied across dispatch centres and did not appear to differ by dispatch algorithm/criteria used or education of the dispatcher, although comparisons were hampered by heterogeneity across studies. Future efforts should focus on ways to improve sensitivity of cardiac arrest recognition to optimize patient care and ensure appropriate and timely resource utilization.
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Adult Basic Life Support: International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2020; 156:A35-A79. [PMID: 33098921 PMCID: PMC7576327 DOI: 10.1016/j.resuscitation.2020.09.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science With Treatment Recommendations on basic life support summarizes evidence evaluations performed for 20 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 3 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review. Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest. The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.
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15
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Olasveengen TM, Mancini ME, Perkins GD, Avis S, Brooks S, Castrén M, Chung SP, Considine J, Couper K, Escalante R, Hatanaka T, Hung KK, Kudenchuk P, Lim SH, Nishiyama C, Ristagno G, Semeraro F, Smith CM, Smyth MA, Vaillancourt C, Nolan JP, Hazinski MF, Morley PT, Svavarsdóttir H, Raffay V, Kuzovlev A, Grasner JT, Dee R, Smith M, Rajendran K. Adult Basic Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S41-S91. [DOI: 10.1161/cir.0000000000000892] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This2020 International Consensus on Cardiopulmonary Resuscitation(CPR)and Emergency Cardiovascular Care Science With Treatment Recommendationson basic life support summarizes evidence evaluations performed for 22 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 5 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review.Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest.The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.
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16
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Brookfield K, Scott I, Tinker A, Ward Thompson C. Perspectives on "Novel" Techniques for Designing Age-Friendly Homes and Neighborhoods with Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051800. [PMID: 32164296 PMCID: PMC7084173 DOI: 10.3390/ijerph17051800] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 11/16/2022]
Abstract
Worldwide, growth in the older population creates a pressing need to develop supportive environments that enhance quality of life as people age. Too often, built environments present barriers and challenges to older adults that compromise independent living and adversely affect health and life outcomes. Designing homes, buildings, and neighborhoods with older adults, through exercises in participatory or co-design, could help ensure that environments are better able to facilitate healthy aging. However, while it is potentially advantageous to involve this age group in environmental design decisions, doing so can be difficult. Analysis of and guidance on effective ways to involve older adults in these activities could make the challenge easier. With this aim in mind, this article provides critical perspectives on eight “less traditional” engagement techniques—walking interviews, photovoice, photo-elicitation, Talking Mats®, participatory mapping, drawing, model-making, and the “Design Fair”. Insights into the strengths and limitations of these techniques, gained from observation of their use in participatory design activities, as well as feedback collected from older co-design participants, are presented. The article concludes by offering a number of practical recommendations for those interested in designing age-friendly homes and neighborhoods with older people.
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Affiliation(s)
- Katherine Brookfield
- Environment and Geography Department, University of York, York YO10 5NG, UK
- Correspondence:
| | - Iain Scott
- Edinburgh School of Architecture and Landscape Architecture, University of Edinburgh; Edinburgh EH1 1JZ, UK;
| | - Anthea Tinker
- Institute of Gerontology, Department of Global Health & Social Medicine, King’s College London, London WC2B 4BG, UK;
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Dispatcher Identification of Out-of-Hospital Cardiac Arrest and Neurologically Intact Survival: A Retrospective Cohort Study. Prehosp Disaster Med 2019; 35:17-23. [DOI: 10.1017/s1049023x19005077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroduction:To date, there are no published data on the association of patient-centered outcomes and accurate public-safety answering point (PSAP) dispatch in an American population. The goal of this study is to determine if PSAP dispatcher recognition of out-of-hospital cardiac arrest (OHCA) is associated with neurologically intact survival to hospital discharge.Methods:This retrospective cohort study is an analysis of prospectively collected Quality Assurance/Quality Improvement (QA/QI) data from the San Antonio Fire Department (SAFD; San Antonio, Texas USA) OHCA registry from January 2013 through December 2015. Exclusion criteria were: Emergency Medical Services (EMS)-witnessed arrest, traumatic arrest, age <18 years old, no dispatch type recorded, and missing outcome data. The primary exposure was dispatcher recognition of cardiac arrest. The primary outcome was neurologically intact survival (defined as Cerebral Performance Category [CPC] 1 or 2) to hospital discharge. The secondary outcomes were: bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, and prehospital return of spontaneous return of circulation (ROSC).Results:Of 3,469 consecutive OHCA cases, 2,569 cases were included in this analysis. The PSAP dispatched 1,964/2,569 (76.4%) of confirmed OHCA cases correctly. The PSAP dispatched 605/2,569 (23.6%) of confirmed OHCA cases as another chief complaint. Neurologically intact survival to hospital discharge occurred in 99/1,964 (5.0%) of the recognized cardiac arrest group and 28/605 (4.6%) of the unrecognized cardiac arrest group (OR = 1.09; 95% CI, 0.71–1.70). Bystander CPR occurred in 975/1,964 (49.6%) of the recognized cardiac arrest group versus 138/605 (22.8%) of the unrecognized cardiac arrest group (OR = 3.34; 95% CI, 2.70–4.11).Conclusion:This study found no association between PSAP dispatcher identification of OHCA and neurologically intact survival to hospital discharge. Dispatcher identification of OHCA remains an important, but not singularly decisive link in the OHCA chain of survival.
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18
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Leonardsen AC, Ramsdal H, Olasveengen TM, Steen-Hansen JE, Westmark F, Hansen AE, Hardeland C. Exploring individual and work organizational peculiarities of working in emergency medical communication centers in Norway- a qualitative study. BMC Health Serv Res 2019; 19:545. [PMID: 31375098 PMCID: PMC6679546 DOI: 10.1186/s12913-019-4370-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 07/24/2019] [Indexed: 01/10/2023] Open
Abstract
Background Emergency Medical call-takers working in Emergency Medical Communication Centers (EMCCs) are addressing complex and potentially life threatening problems. The call-takers have to make fast decisions, responding to problems described in phone calls. Recent studies focus mainly on individual aspects of call-takers’ work. The objectives of this study were to explore 1) What characterizes individual work performance of call takers in EMCCs? and 2) What characterizes work organizational factors call takers see as most relevant to the performance of their work? Methods The research is based upon in-depth interviews with call takers at three EMCCs in Norway (n = 19). Interviews were performed during the period May 2013 to September 2014. Data was analyzed using thematic analysis. Results Two main themes that related to individual work performance and to work organizational factors in EMCCs were identified, namely: 1) “Core technologies” and 2) “Environmental issues” . The theme “Core technologies” included the subthemes a) multiple tasks, b) critical incidents, and c) unpredictability. The theme “Environmental issues” included the subthemes a) lack of support, b) lack of resources, c) exposure to complaints, and d) an invisible service. Conclusion At the individual level, multiple tasks, how to cope with critical incidents, and the unpredictability of daily work when calls are received, make the work of call takers both stressful and challenging. The individual call taker’s ability to interprete the situation by intuition and experience when calls are received, is the main factor behind the peculiarities working in the centers at the individual level. At the organizational level, the lack of resources and managerial support seems to provoke concerns about the quality of services rendered by the centers. These aspects should be taken into account in the managing of these services, making them a more integrated part of the health service system. Electronic supplementary material The online version of this article (10.1186/s12913-019-4370-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ann-Chatrin Leonardsen
- Department of Health and Welfare, Ostfold University College, Postal box code (PB) 700, NO-1757, Halden, Norway. .,Ostfold Hospital Trust, Surgical Ward, PB 300, NO-1714, Sarpsborg, Norway.
| | - Helge Ramsdal
- Department of Health and Social Studies, Ostfold University College, PB 700, NO-1757, Halden, Norway
| | - Theresa M Olasveengen
- Department of Anaesthesiology, Oslo University Hospital, PB 4956, NO-0424, Nydalen, Oslo, Norway
| | - Jon E Steen-Hansen
- Vestfold Hospital Trust, Prehospital Clinic, PB 2168, NO-3103, Tønsberg, Norway
| | - Fredrik Westmark
- Ostfold HF Hospital Trust, Prehospital Clinic, PB 300, NO-1714, Sarpsborg, Norway
| | - Andreas E Hansen
- Prehospital clinic, Oslo University Hospital, PB 4956, NO-0424, Nydalen, Oslo, Norway
| | - Camilla Hardeland
- Department of Health and Social Studies, Ostfold University College, PB 700, NO-1757, Halden, Norway
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19
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Olasveengen TM, Hardeland C. Man vs. machine? The future of emergency medical dispatching. Resuscitation 2019; 138:304-305. [DOI: 10.1016/j.resuscitation.2019.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 12/13/2022]
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20
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Zhang Q, Liu B, Qi Z, Li C. Prognostic value of gasping for short and long outcomes during out-of-hospital cardiac arrest: an updated systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med 2018; 26:106. [PMID: 30547829 PMCID: PMC6295104 DOI: 10.1186/s13049-018-0575-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/29/2018] [Indexed: 01/06/2023] Open
Abstract
Objective We systematically reviewed the literature to investigate whether gasping could predict short and long outcomes in patients with out of hospital cardiac arrest (OHCA). Methods PubMed, Embase, and Cochrane Library were searched for observational studies regarding the prognostic effect of gasping on short and long outcomes in adults with OHCA. The primary outcome was return of spontaneous circulation (ROSC). The secondary outcomes were favorable neurological outcome at discharge or at 30 days after cardiac arrest;long term (≥6 months) survival; initial shockable rhythm.The Mantel-Haenszel method with random-effects model was used to calculate pooled relative risks (RRs) and 95% confidence intervals (CIs). Results Five studies (six cohorts) were included in the final analysis. In the pooled analysis, gasping was not only associated with a significant increase in ROSC (RR, 1.87; 95% CI, 1.64–2.13; I2 = 70%), but also a high likelihood of favorable neurological outcomes (RR, 3.79; 95% CI, 1.86–7.73), long-term survival (RR, 3.46; 95% CI, 1.70–7.07), and initial shockable rhythm (RR, 2.25; 95% CI, 2.05–2.48). Conclusions Current evidence indicates that gasping can predict short and long outcomes in patients with OHCA.In addition, gasping is associated with a high likelihood of initial shockable rhythm,which may contribute to positive outcomes.
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Affiliation(s)
- Qiang Zhang
- Department of Emergency Medicine, Beijing Chao-Yang Hospital,Capital Medical University, 8# Worker's Stadium South Road, Chao-Yang District, Beijing, 100020, China
| | - Bo Liu
- Department of Emergency Medicine, Beijing Chao-Yang Hospital,Capital Medical University, 8# Worker's Stadium South Road, Chao-Yang District, Beijing, 100020, China
| | - Zhijiang Qi
- Department of Emergency Medicine, Beijing Chao-Yang Hospital,Capital Medical University, 8# Worker's Stadium South Road, Chao-Yang District, Beijing, 100020, China
| | - Chunsheng Li
- Department of Emergency Medicine, Beijing Chao-Yang Hospital,Capital Medical University, 8# Worker's Stadium South Road, Chao-Yang District, Beijing, 100020, China.
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21
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Riou M, Ball S, Whiteside A, Bray J, Perkins GD, Smith K, O'Halloran KL, Fatovich DM, Inoue M, Bailey P, Cameron P, Brink D, Finn J. 'We're going to do CPR': A linguistic study of the words used to initiate dispatcher-assisted CPR and their association with caller agreement. Resuscitation 2018; 133:95-100. [PMID: 30316951 DOI: 10.1016/j.resuscitation.2018.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 09/27/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND In emergency ambulance calls for out-of-hospital cardiac arrest (OHCA), dispatcher-assisted cardiopulmonary resuscitation (CPR) plays a crucial role in patient survival. We examined whether the language used by dispatchers to initiate CPR had an impact on callers' agreement to perform CPR. METHODS We analysed 424 emergency calls relating to cases of paramedic-confirmed OHCA where OHCA was recognised by the dispatcher, the caller was with the patient, and resuscitation was attempted by paramedics. We investigated the linguistic choices used by dispatchers to initiate CPR, and the impact of those choices on caller agreement to perform CPR. RESULTS Overall, CPR occurred in 85% of calls. Caller agreement was low (43%) when dispatchers used terms of willingness ("do you want to do CPR?"). Caller agreement was high (97% and 84% respectively) when dispatchers talked about CPR in terms of futurity ("we are going to do CPR") or obligation ("we need to do CPR"). In 38% (25/66) of calls where the caller initially declined CPR, the dispatcher eventually secured their agreement by making several attempts at initiating CPR. CONCLUSION There is potential for increased agreement to perform CPR if dispatchers are trained to initiate CPR with words of futurity and/or obligation.
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Affiliation(s)
- Marine Riou
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia.
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia
| | | | - Janet Bray
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria, 3004, Australia
| | - Gavin D Perkins
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, 3004, Australia; Emergency Medicine, The University of Western Australia, Crawley, WA, 6009, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, 3004, Australia; Ambulance Victoria, Blackburn North, Victoria, 3130, Australia
| | - Kay L O'Halloran
- School of Education, Curtin University, Bentley, WA, 6102, Australia
| | - Daniel M Fatovich
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia; Emergency Medicine, The University of Western Australia, Crawley, WA, 6009, Australia; Emergency Medicine, Royal Perth Hospital, Perth, WA, 6001, Australia; Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, WA, 6847, Australia
| | - Madoka Inoue
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia
| | - Paul Bailey
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia; St John Ambulance (WA), Belmont, WA, 6104, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, 3004, Australia
| | - Deon Brink
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia; St John Ambulance (WA), Belmont, WA, 6104, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia; St John Ambulance (WA), Belmont, WA, 6104, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria, 3004, Australia; Emergency Medicine, The University of Western Australia, Crawley, WA, 6009, Australia
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Park JH, Shin SD, Ro YS, Song KJ, Hong KJ, Kim TH, Lee EJ, Kong SY. Implementation of a bundle of Utstein cardiopulmonary resuscitation programs to improve survival outcomes after out-of-hospital cardiac arrest in a metropolis: A before and after study. Resuscitation 2018; 130:124-132. [DOI: 10.1016/j.resuscitation.2018.07.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/27/2018] [Accepted: 07/19/2018] [Indexed: 11/16/2022]
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Ko SY, Shin SD, Ro YS, Song KJ, Hong KJ, Park JH, Lee SC. Effect of detection time interval for out-of-hospital cardiac arrest on outcomes in dispatcher-assisted cardiopulmonary resuscitation: A nationwide observational study. Resuscitation 2018; 129:61-69. [DOI: 10.1016/j.resuscitation.2018.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/05/2018] [Accepted: 06/01/2018] [Indexed: 11/28/2022]
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Perkins GD, Olasveengen TM, Maconochie I, Soar J, Wyllie J, Greif R, Lockey A, Semeraro F, Van de Voorde P, Lott C, Monsieurs KG, Nolan JP. European Resuscitation Council Guidelines for Resuscitation: 2017 update. Resuscitation 2017; 123:43-50. [PMID: 29233740 DOI: 10.1016/j.resuscitation.2017.12.007] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/06/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Gavin D Perkins
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium.
| | | | - Ian Maconochie
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Jasmeet Soar
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Jonathan Wyllie
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Robert Greif
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Andrew Lockey
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Federico Semeraro
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | | | - Carsten Lott
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Koenraad G Monsieurs
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Jerry P Nolan
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
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25
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Riou M, Ball S, Williams TA, Whiteside A, Cameron P, Fatovich DM, Perkins GD, Smith K, Bray J, Inoue M, O'Halloran KL, Bailey P, Brink D, Finn J. 'She's sort of breathing': What linguistic factors determine call-taker recognition of agonal breathing in emergency calls for cardiac arrest? Resuscitation 2017; 122:92-98. [PMID: 29183831 DOI: 10.1016/j.resuscitation.2017.11.058] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/27/2017] [Accepted: 11/24/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND In emergency ambulance calls, agonal breathing remains a barrier to the recognition of out-of-hospital cardiac arrest (OHCA), initiation of cardiopulmonary resuscitation, and rapid dispatch. We aimed to explore whether the language used by callers to describe breathing had an impact on call-taker recognition of agonal breathing and hence cardiac arrest. METHODS We analysed 176 calls of paramedic-confirmed OHCA, stratified by recognition of OHCA (89 cases recognised, 87 cases not recognised). We investigated the linguistic features of callers' response to the question "is s/he breathing?" and examined the impact on subsequent coding by call-takers. RESULTS Among all cases (recognised and non-recognised), 64% (113/176) of callers said that the patients were breathing (yes-answers). We identified two categories of yes-answers: 56% (63/113) were plain answers, confirming that the patient was breathing ("he's breathing"); and 44% (50/113) were qualified answers, containing additional information ("yes but gasping"). Qualified yes-answers were suggestive of agonal breathing. Yet these answers were often not pursued and most (32/50) of these calls were not recognised as OHCA at dispatch. CONCLUSION There is potential for improved recognition of agonal breathing if call-takers are trained to be alert to any qualification following a confirmation that the patient is breathing.
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Affiliation(s)
- Marine Riou
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia.
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia
| | - Teresa A Williams
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; St John Ambulance (WA), Belmont, WA 6104, Australia; Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Emergency Medicine, Royal Perth Hospital, Perth, WA 6001, Australia
| | | | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia
| | - Daniel M Fatovich
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Emergency Medicine, Royal Perth Hospital, Perth, WA 6001, Australia; Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, WA 6847, Australia
| | - Gavin D Perkins
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Karen Smith
- Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria 3004, Australia; Ambulance Victoria, Blackburn North, Victoria 3130, Australia
| | - Janet Bray
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia
| | - Madoka Inoue
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia
| | - Kay L O'Halloran
- School of Education, Curtin University, Bentley, WA 6102, Australia
| | - Paul Bailey
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; St John Ambulance (WA), Belmont, WA 6104, Australia
| | - Deon Brink
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; St John Ambulance (WA), Belmont, WA 6104, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; St John Ambulance (WA), Belmont, WA 6104, Australia; Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia
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Hardeland C, Skåre C, Kramer-Johansen J, Birkenes TS, Myklebust H, Hansen AE, Sunde K, Olasveengen TM. Targeted simulation and education to improve cardiac arrest recognition and telephone assisted CPR in an emergency medical communication centre. Resuscitation 2017; 114:21-26. [PMID: 28236428 DOI: 10.1016/j.resuscitation.2017.02.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/17/2017] [Accepted: 02/02/2017] [Indexed: 11/16/2022]
Abstract
AIM Recognition of cardiac arrest and prompt activation time by emergency medical dispatch are key process measures that have been associated with improved survival after out-of-hospital cardiac arrest (OHCA). The aim of this study is to improve recognition of OHCA and time to initiation of telephone assisted chest compressions in an emergency medical communication centre (EMCC). METHODS A prospective, interventional study implementing targeted interventions in an EMCC. Interventions included: (1) lectures focusing on agonal breathing and interrogation strategy (2) simulation training (3) structured dispatcher feedback (4) web-based telephone assisted CPR training program. All ambulance-confirmed OHCA calls in the study period were assessed and relevant process and result measures were recorded pre- and post-intervention. Cardiac arrest was reported as (1) recognised, (2) not recognised or (3) delayed recognition. RESULTS We included 331 and 230 calls pre- and post-intervention, respectively. Recognition of cardiac arrest improved significantly after intervention (89 vs. 95%, p=0.024). Delayed recognition was significantly reduced (21 vs. 6%, p>0.001), as was misinterpretation of agonal breathing (25 vs. 10%, p<0.001). Telephone assisted compressions increased (71% vs. 83%, p=0.002) whereas bystander performed ventilations decreased after intervention (23% vs. 15%, p=0.016). Time intervals for initiation of chest compression instructions (2.6 vs. 2.3min, p=0.042) and delivery of telephone assisted chest compressions (3.3 vs. 2.8min, p=0.015) were significantly shortened after intervention. CONCLUSION Targeted simulation, education and feedback significantly improved recognition of OHCA and reduced time to first chest compression. Continuous measurement of key quality metrics can facilitate development of targeted education and training.
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Affiliation(s)
- Camilla Hardeland
- Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, N-0318 Oslo, Norway; Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.
| | - Christiane Skåre
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; Department of Anaesthesiology, Oslo University Hospital and University of Oslo, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Jo Kramer-Johansen
- Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, N-0318 Oslo, Norway; Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Tonje S Birkenes
- Laerdal Medical AS, Tanke Svilandsgate 30, N-4002 Stavanger, Norway
| | - Helge Myklebust
- Laerdal Medical AS, Tanke Svilandsgate 30, N-4002 Stavanger, Norway
| | - Andreas E Hansen
- Prehospital Clinic, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Kjetil Sunde
- Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, N-0318 Oslo, Norway; Department of Anaesthesiology, Oslo University Hospital and University of Oslo, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Theresa M Olasveengen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; Department of Anaesthesiology, Oslo University Hospital and University of Oslo, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
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27
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Resuscitation highlights in 2016. Resuscitation 2017; 114:A1-A7. [PMID: 28212838 DOI: 10.1016/j.resuscitation.2017.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/05/2017] [Indexed: 11/21/2022]
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