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Ljungqvist H, Tommila M, Setälä P, Raatiniemi L, Pulkkinen I, Toivonen P, Nurmi J. Front of neck airway in Finnish helicopter emergency medical services. Injury 2024; 55:111689. [PMID: 38924838 DOI: 10.1016/j.injury.2024.111689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 06/03/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION An emergent front of neck airway (FONA) is needed when a 'can't intubate, can't oxygenate' crisis occurs. A FONA may also in specific cases be the primary choice of airway management. Two techniques exist for FONA, with literature favouring the surgical technique over the percutaneous. The reported need for a prehospital FONA is fortunately rare as the mortality has been shown to be high. Due to the low incidence, literature on FONA is limited with regards to different settings, techniques and operators. As a foundation for future research and improvement of patient care, we aim to describe the frequency, indications, technique, success, and outcomes of FONA in the Finnish helicopter emergency medical services (HEMS). MATERIALS AND METHODS This retrospective descriptive study reviews FONA performed at the Finnish HEMS during 1.1.2012 to 8.9.2019. The Finnish HEMS consists of six units, staffed mainly by anaesthesiologists. Clinical data was gathered from a national HEMS database and trough chart reviews. Data on mortality was obtained from a population registry. Only descriptive statistics were performed. RESULTS A total of 22 FONA were performed during the study period, 7 were primary and 14 performed after failure to intubate (missing data regarding indication for one attempt). This equals a 0.13 % (14/10,813) need for a rescue FONA and a rate of 0.20 % (22/10,813) FONA out of all advanced airway management. All but one FONA was performed using a surgical approach (20/21, 95 %, missing data = 1) and all were successful (22/22, 100 %). Indications were mainly cardiac arrest (10/22, 45 %) and trauma (6/22, 27 %), and the most common reason for a need for a secondary FONA was obstruction of airway by food or fluids (7/14, 50 %). On-scene mortality was 36 % (8/22) and 30-day mortality 90 % (19/21, missing data = 1). CONCLUSION The need for FONA is scarce in a HEMS system with experienced airway providers. Even though the procedure is successfully performed, the mortality is markedly high.
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Affiliation(s)
- Harry Ljungqvist
- Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Miretta Tommila
- Department of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Turku, Finland
| | - Piritta Setälä
- Centre for Prehospital Emergency Care, Tampere University Hospital, Tampere, Finland
| | - Lasse Raatiniemi
- Research Group of Surgery, Anaesthesiology and Intensive Care, Medical Research Centre, University of Oulu, Oulu, Finland and Department of air ambulance, University Hospital of North Norway, Tromsoe, Norway
| | - Ilkka Pulkkinen
- Prehospital Emergency Care, Lapland Hospital District, Rovaniemi, Finland
| | - Pamela Toivonen
- Centre for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland
| | - Jouni Nurmi
- Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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Pietsch U, Müllner R, Theiler L, Wenzel V, Meuli L, Knapp J, Sollid SJM, Albrecht R. Airway management in a Helicopter Emergency Medical Service (HEMS): a retrospective observational study of 365 out-of-hospital intubations. BMC Emerg Med 2022; 22:23. [PMID: 35135493 PMCID: PMC8822827 DOI: 10.1186/s12873-022-00579-8] [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: 08/03/2021] [Accepted: 01/31/2022] [Indexed: 11/29/2022] Open
Abstract
Background Airway management is a key skill in any helicopter emergency medical service (HEMS). Intubation is successful less often than in the hospital, and alternative forms of airway management are more often needed. Methods Retrospective observational cohort study in an anaesthesiologist-staffed HEMS in Switzerland. Patient charts were analysed for all calls to the scene (n = 9,035) taking place between June 2016 and May 2017 (12 months). The primary outcome parameter was intubation success rate. Secondary parameters included the number of alternative techniques that eventually secured the airway, and comparison of patients with and without difficulties in airway management. Results A total of 365 patients receiving invasive ventilatory support were identified. Difficulties in airway management occurred in 26 patients (7.1%). Severe traumatic brain injury was the most common indication for out-of-hospital Intubation (n = 130, 36%). Airway management was performed by 129 different Rega physicians and 47 different Rega paramedics. Paramedics were involved in out-of-hospital airway manoeuvres significantly more often than physicians: median 7 (IQR 4 to 9) versus 2 (IQR 1 to 4), p < 0.001. Conclusion Despite high overall success rates for endotracheal intubation in the physician-staffed service, individual physicians get only limited real-life experience with advanced airway management in the field. This highlights the importance of solid basic competence in a discipline such as anaesthesiology.
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Affiliation(s)
- Urs Pietsch
- Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St, Gallen, St. Gallen, Switzerland. .,Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zürich, Switzerland. .,Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
| | - Raphael Müllner
- Department of Anaesthesiology, Cantonal Hospital Luzern, Luzern, Switzerland
| | - Lorenz Theiler
- Department of Anaesthesiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Volker Wenzel
- Department of Anaesthesiology and Intensive Care Medicine, Friedrichshafen Regional Hospital, Friedrichshafen, Germany
| | - Lorenz Meuli
- Department of Vascular Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Jürgen Knapp
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephen J M Sollid
- Norwegian Air Ambulance Foundation, PB 414 Sentrum, 0103, Oslo, Norway.,Faculty of Health Sciences, University of Stavanger, PB 8600, 4036, Stavanger, Norway
| | - Roland Albrecht
- Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St, Gallen, St. Gallen, Switzerland.,Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zürich, Switzerland.,Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
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Saviluoto A, Jäntti H, Kirves H, Setälä P, Nurmi JO. Association between case volume and mortality in pre-hospital anaesthesia management: a retrospective observational cohort. Br J Anaesth 2022; 128:e135-e142. [PMID: 34656323 PMCID: PMC8792835 DOI: 10.1016/j.bja.2021.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/12/2021] [Accepted: 08/18/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Pre-hospital anaesthesia is a core competency of helicopter emergency medical services (HEMS). Whether physician pre-hospital anaesthesia case volume affects outcomes is unknown in this setting. We aimed to investigate whether physician case volume was associated with differences in mortality or medical management. METHODS We conducted a registry-based cohort study of patients undergoing drug-facilitated intubation by HEMS physician from January 1, 2013 to August 31, 2019. The primary outcome was 30-day mortality, analysed using multivariate logistic regression controlling for patient-dependent variables. Case volume for each patient was determined by the number of pre-hospital anaesthetics the attending physician had managed in the previous 12 months. The explanatory variable was physician case volume grouped by low (0-12), intermediate (13-36), and high (≥37) case volume. Secondary outcomes were characteristics of medical management, including the incidence of hypoxaemia and hypotension. RESULTS In 4818 patients, the physician case volume was 511, 2033, and 2274 patients in low-, intermediate-, and high-case-volume groups, respectively. Higher physician case volume was associated with lower 30-day mortality (odds ratio 0.79 per logarithmic number of cases [95% confidence interval: 0.64-0.98]). High-volume physician providers had shorter on-scene times (median 28 [25th-75th percentile: 22-38], compared with intermediate 32 [23-42] and lowest 32 [23-43] case-volume groups; P<0.001) and a higher first-pass success rate for tracheal intubation (98%, compared with 93% and 90%, respectively; P<0.001). The incidence of hypoxaemia and hypotension was similar between groups. CONCLUSIONS Mortality appears to be lower after pre-hospital anaesthesia when delivered by physician providers with higher case volumes.
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Affiliation(s)
- Anssi Saviluoto
- Research and Development Unit, FinnHEMS, Vantaa, Finland; University of Eastern Finland, Kuopio, Finland
| | - Helena Jäntti
- Centre for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland
| | - Hetti Kirves
- Prehospital Emergency Care, Hyvinkää Hospital Area, Hospital District of Helsinki and Uusimaa, Hyvinkää, Finland
| | - Piritta Setälä
- Centre for Prehospital Emergency Care, Tampere University Hospital, Tampere, Finland
| | - Jouni O Nurmi
- Research and Development Unit, FinnHEMS, Vantaa, Finland; Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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Bredmose PP, Hooper J, Viggers S, Linde J, Reid C, Grier G, Mazur S. Prehospital Care: An International Comparison of Independently Developed Training Courses. Air Med J 2022; 41:73-77. [PMID: 35248348 DOI: 10.1016/j.amj.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/18/2021] [Accepted: 10/14/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Prehospital and retrieval medicine (PHRM) occurs in a complex work environment. Appropriate training is essential to ensure high standards of clinical care and logistic decision making. Before commencing the role, PHRM doctors have varying levels of experience. This narrative review article aims to describe and compare 6 internationally accepted PHRM courses. METHODS Six PHRM course directors were asked to describe their course in terms of education methods used, course content, and assessment processes. Each of the directors contributed to the discussion process. RESULTS Although developed independently, all 6 courses use a comparable combination of lectures, simulations, and discussion groups. The amount of each pedagogical modality varies between the courses. CONCLUSION We have identified significant similarities and some important differences among some well-accepted independently developed PHRM courses worldwide. Differences in content and the methods of delivery appear linked to the background of participants and service case mix. The authors believe that even in the small niche of PHRM, courses need to be tailored to the participants and the "destination of the participants" (ie, where they are going to use their skills).
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Affiliation(s)
- Per P Bredmose
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway; Norwegian Air Ambulance Foundation, Drøbak, Norway; LifeFlight Retrieval Medicine, Queensland, Australia.
| | - Jeff Hooper
- LifeFlight Retrieval Medicine, Queensland, Australia
| | - Sandra Viggers
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark; Department of Anesthesiology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Joacim Linde
- Swedish Air Ambulance, Gothenburg, SLA, Sweden, Gothenburg
| | - Cliff Reid
- NSW Ambulance Aeromedical Operations, Sydney, Australia
| | | | - Stefan Mazur
- SAAS MedSTAR, Emergency Medical Retrieval, Adelaide, Australia
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Bredmose PP, Røislien J, Østergaard D, Sollid S. National Implementation of In Situ Simulation-Based Training in Helicopter Emergency Medical Services: A Multicenter Study. Air Med J 2021; 40:205-210. [PMID: 34172225 DOI: 10.1016/j.amj.2021.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Medical simulation is used in helicopter emergency services as a tool for training the crew. Using in situ simulation, we aimed to evaluate the degree of implementation, the barriers to completing simulation training, and the crew's attitude toward this form of training. METHODS This was a 1-year prospective study on simulation at all 14 Norwegian helicopter emergency services bases and 1 search and rescue base. Local facilitators were educated and conducted simulations at their discretion. RESULTS All bases agreed to participate initially, but 1 opted out because of technical difficulties. The number of simulations attempted at each base ranged from 1 to 46 (median = 17). Regardless of the base and the number of attempted simulations, participating crews scored self-evaluated satisfaction with this form of training highly. Having 2 local facilitators increased the number of attempted simulations, whereas facilitators' travel distance to work seemed to make no difference on the number of attempted simulations. CONCLUSION Our study reveals considerable differences in the number of attempted simulations between bases despite being given the same prerequisites. The busiest bases completed fewer simulations than the rest of the bases. Our findings suggest that conditions related to the local facilitator are important for the successful implementation of simulation-based training in helicopter emergency services.
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Affiliation(s)
- Per P Bredmose
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway; Air Ambulance Department, Oslo University Hospital, Oslo, Norway; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - Jo Røislien
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark
| | - Stephen Sollid
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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An analysis of prehospital critical care events and management patterns from 97 539 emergency helicopter medical service missions: A retrospective registry-based study. Eur J Anaesthesiol 2021; 38:644-651. [PMID: 33782278 DOI: 10.1097/eja.0000000000001498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND It is largely unknown how often physicians in emergency helicopter medical services (HEMS) encounter various critical care events and if HEMS exposure is associated with particular practice patterns or outcomes. OBJECTIVES This study aimed: to describe the frequency and distribution of critical care events; to investigate whether HEMS exposure is associated with differences in practice patterns and determine if HEMS exposure factors are associated with mortality. DESIGN A retrospective registry-based study. SETTING Physician-staffed HEMS in Finland between January 2012 and August 2019. PARTICIPANTS Ninety-four physicians who worked at least 6 months in the HEMS during the study period. Physicians with undeterminable HEMS exposure were excluded from practice pattern comparisons and mortality analysis, leaving 80 physicians. MAIN OUTCOME MEASURES The primary outcome measure was a physician's average annual frequencies for operational events and clinical interventions. Our secondary outcomes were the proportion of missions cancelled or denied, time onsite (OST) and proportion of unconscious patients intubated. Our tertiary outcome was adjusted 30-day mortality of patients. RESULTS The physicians encountered 62 [33 to 98], escorted 31 [17 to 41] and transported by helicopter 2.1 [1.3 to 3.5] patients annually, given as median [interquartile range; IQR]. Rapid sequence intubation was performed 11 [6.2 to 16] times per year. Physicians were involved in out-of-hospital cardiac arrest (OHCA) 10 [5.9 to 14] and postresuscitation care 5.5 [3.1 to 8.1] times per year. Physicians with longer patient intervals had shorter times onsite. Proportionally, they cancelled more missions and intubated fewer unconscious patients. A short patient interval [odds ratio (OR); 95% confidence interval (CI)] was associated with decreased mortality (0.87; 95% CI, 0.76 to1.00), whereas no association was observed between mortality and HEMS career length. CONCLUSION Prehospital exposure is distributed unevenly, and some physicians receive limited exposure to prehospital critical care. This seems to be associated with differences in practice patterns. Rare HEMS patient contacts may be associated with increased mortality.
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7
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Bredmose PP, Stave H, Eriksen M, Osbakk SA, Farstad G, Hagemo JS. Live Tissue Training on Anesthetized Pigs for Air Ambulance Crews. Air Med J 2021; 40:60-64. [PMID: 33455629 DOI: 10.1016/j.amj.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/04/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Patients with life- or limb-threatening severe injuries pose a challenge to prehospital services. Time-critical decision making and treatment are challenging because of occasional incomplete information, limited resources, adverse environments, and a range of basic and advanced technical skills available. To prepare for these infrequent critical situations, medical personnel from the helicopter emergency medical service at Oslo University Hospital developed a 1-day advanced trauma training course focusing on individual skills and teamwork during resuscitative procedures. METHODS Participants were trained under supervision in teams on an established live tissue model with anesthetized pigs. A questionnaire-based evaluation was conducted before and after training to measure the feasibility of covering the allocated learning objectives in the time allotted and participants' perception of any change in their skills as a result of the course. RESULTS The self-reported skill level in all learning objectives improved significantly. Combining all learning objectives, the median self-reported skill level was significantly increased from 4 to 6 points (P < .001). CONCLUSION Experienced prehospital physicians and other health staff reported an increased level of skill and competence in lifesaving and limb-saving procedures after completing a brief, intense 1-day course using living anesthetized pigs and cadaver models.
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Affiliation(s)
- Per P Bredmose
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway; Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway.
| | - Halvard Stave
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway
| | - Morten Eriksen
- Institute for Experimental Medical Research, Section for Preclinical Physiology, Oslo University Hospital, Oslo, Norway
| | - Svein Are Osbakk
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway
| | - Gunnar Farstad
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway
| | - Jostein S Hagemo
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway; Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
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Simon EL, Smalley CM, Meldon SW, Borden BL, Briskin I, Muir MR, Suchan A, Delgado F, Fertel BS. Procedural frequency: Results from 18 academic, community and freestanding emergency departments. J Am Coll Emerg Physicians Open 2020; 1:1669-1675. [PMID: 33392575 PMCID: PMC7771730 DOI: 10.1002/emp2.12238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Emergency physicians must maintain procedural skills, but clinical opportunities may be insufficient. We sought to determine how often practicing emergency physicians in academic, community and freestanding emergency departments (EDs) perform 4 procedures: central venous catheterization (CVC), tube thoracostomy, tracheal intubation, and lumbar puncture (LP). METHODS This was a retrospective study evaluating emergency physician procedural performance over a 12-month period. We collected data from the electronic records of 18 EDs in one healthcare system. The study EDs included higher and lower volume, academic, community and freestanding, and trauma and non-trauma centers. The main outcome measures were median number of procedures performed. We examined differences in procedural performance by physician years in practice, facility type, and trauma status. RESULTS Over 12 months, 182 emergency physicians performed 1582 of 2805 procedures (56%) and supervised (resident, nurse practitioner or physician assistant) an additional 1223 of the procedures they did not perform (43%). Median (interquartile range) physician performance for each procedure was CVC 0 [0, 2], tube thoracostomy 0 [0, 0], tracheal intubation 3 [0.25, 8], and LP 0 [0, 2]. The percentage of emergency physicians who did not perform at least one of each procedure during the 1-year time frame ranged from 25.3% (tracheal intubation) to 76.4% (tube thoracostomy). Physicians who work at high-volume EDs (>50,000 visits per year) performed nearly twice as many tracheal intubations, CVCs, and LPs than those at low-volume EDs or freestanding EDs when normalized per 1000 visits. Years out of training were inversely related to total number of procedures performed. Emergency physicians at trauma centers performed almost 3 times as many tracheal intubations and almost 4 times as many CVCs compared to non-trauma centers. CONCLUSION In a large healthcare system, regardless of ED type, emergency physicians infrequently performed the 4 procedures studied. Physicians in high-volume EDs, trauma centers, and recent graduates performed more procedures. Our study adds to a growing body of research that suggests clinical frequency alone may be insufficient for all emergency physicians to maintain competency.
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Affiliation(s)
- Erin L. Simon
- Department of Emergency MedicineCleveland Clinic Akron GeneralAkronOhioUSA
- Northeast Ohio Medical UniversityRootstownOhioUSA
| | - Courtney M. Smalley
- Cleveland Clinic Lerner College of MedicineCleveland Clinic Emergency Services InstituteClevelandOhioUSA
| | - Stephen W. Meldon
- Cleveland Clinic Lerner College of MedicineCleveland Clinic Emergency Services InstituteClevelandOhioUSA
| | - Bradford L. Borden
- Cleveland Clinic Lerner College of MedicineCleveland Clinic Emergency Services InstituteClevelandOhioUSA
| | - Isaac Briskin
- Cleveland Clinic Emergency Services InstituteClevelandOhioUSA
| | | | - Andrew Suchan
- Department of Emergency MedicineCleveland Clinic Akron GeneralAkronOhioUSA
- Northeast Ohio Medical UniversityRootstownOhioUSA
| | - Fernando Delgado
- Cleveland ClinicCleveland Clinic Emergency Services InstituteOhioUSA
| | - Baruch S. Fertel
- Enterprise Quality and Safety, Cleveland Clinic Lerner College of MedicineEmergency Services Institute Cleveland Clinic FoundationClevelandOhioUSA
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In situ simulation training in helicopter emergency medical services: feasible for on-call crews? Adv Simul (Lond) 2020; 5:7. [PMID: 32550015 PMCID: PMC7294664 DOI: 10.1186/s41077-020-00126-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/14/2020] [Indexed: 11/10/2022] Open
Abstract
Simulation-based training of emergency teams offers a safe learning environment in which training in the management of the critically ill patient can be planned and practiced without harming the patient. We developed a concept for in situ simulation that can be carried out during on-call time. The aim of this study is to investigate the feasibility of introducing in situ, simulation-based training for the on-call team on a busy helicopter emergency medical service (HEMS) base. We carried out a one-year prospective study on simulation training during active duty at a busy Norwegian HEMS base, which has two helicopter crews on call 24/7. Training was conducted as low fidelity in situ simulation while the teams were on call. The training took place on or near the HEMS base. Eight scenarios were developed with learning objectives related to the mission profile of the base which includes primary missions for both medical and trauma patients of all ages, and interhospital transport of adults, children, and neonates. All scenarios included learning objectives for non-technical skills. A total of 44 simulations were carried out. Total median (quartiles) time consumption for on-call HEMS crew was 65 (59-73) min. Time for preparation of scenarios was 10 (5-11) min, time for simulations was 20 (19-26) min, cleaning up 7 (6-10) min, and debrief 35 (30-40) min. For all items on the questionnaire, the majority of respondents replied with the two most positive categories on the Likert scale. Our results demonstrate that in situ simulation training for on-call crews on a busy HEMS base is feasible with judicious investment of time and money. The participants were very positive about their experience and the impact of this type of training.
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Glick Y, Avital B, Oppenheimer J, Nahman D, Wagnert-Avraham L, Eisenkraft A, Dym L, Levi D, Agur A, Gustus B, Furer A. Augmenting prehospital care. BMJ Mil Health 2020; 167:158-162. [PMID: 32086268 DOI: 10.1136/jramc-2019-001320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The challenging environment of prehospital casualty care demands providers to make prompt decisions and to engage in lifesaving interventions, occasionally without them being adequately experienced. Telementoring based on augmented reality (AR) devices has the potential to decrease the decision time and minimise the distance gap between an experienced consultant and the first responder. The purpose of this study was to determine whether telementoring with AR glasses would affect chest thoracotomy performance and self-confidence of inexperienced trainees. METHODS Two groups of inexperienced medical students performed a chest thoracotomy in an ex vivo pig model. While one group was mentored remotely using HoloLens AR glasses, the second performed the procedure independently. An observer assessed the trainees' performance. In addition, trainees and mentors evaluated their own performance. RESULTS Quality of performance was found to be superior with remote guidance, without significant prolongation of the procedure (492 s vs 496 s, p=0.943). Moreover, sense of self-confidence among participant was substantially improved in the telementoring group in which 100% of the participants believed the procedure was successful compared with 40% in the control group (p=0.035). CONCLUSION AR devices may have a role in future prehospital telementoring systems, to provide accessible consultation for first responders, and could thus positively affect the provider's confidence in decision-making, enhance procedure performance and ultimately improve patient prognosis. That being said, future studies are required to estimate full potential of this technology and additional adjustments are necessary for maximal optimisation and implementation in the field of prehospital care.
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Affiliation(s)
- Yuval Glick
- Medical Corps, Israel Defense Forces, Ramat-Gan, Israel.,Orthopedic Department, Assuta Ashdod Hospital, Ashdod, Israel
| | - B Avital
- Institute for Research in Military Medicine, The Hebrew University of Jerusalem and Israel Defense Forces Medical Corps, Jerusalem, Israel
| | - J Oppenheimer
- Institute for Research in Military Medicine, The Hebrew University of Jerusalem and Israel Defense Forces Medical Corps, Jerusalem, Israel
| | - D Nahman
- Institute for Research in Military Medicine, The Hebrew University of Jerusalem and Israel Defense Forces Medical Corps, Jerusalem, Israel.,Department of Internal Medicine 'A', Hadassah University Hospital, Jerusalem, Israel
| | - L Wagnert-Avraham
- Institute for Research in Military Medicine, The Hebrew University of Jerusalem and Israel Defense Forces Medical Corps, Jerusalem, Israel
| | - A Eisenkraft
- Institute for Research in Military Medicine, The Hebrew University of Jerusalem and Israel Defense Forces Medical Corps, Jerusalem, Israel
| | - L Dym
- Obstetrics and Gynaecology Division, Soroka Medical Centre, Beer Sheva, Israel
| | - D Levi
- Medical Corps, Israel Defense Forces, Ramat-Gan, Israel
| | - A Agur
- Medical Corps, Israel Defense Forces, Ramat-Gan, Israel.,Neurosurgery Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - B Gustus
- Medical Corps, Israel Defense Forces, Ramat-Gan, Israel.,Pediatric Department, Asaf Harofe Hospital, Zerifin, Israel
| | - A Furer
- Medical Corps, Israel Defense Forces, Ramat-Gan, Israel .,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Crewdson K, Lockey D, Voelckel W, Temesvari P, Lossius HM. Best practice advice on pre-hospital emergency anaesthesia & advanced airway management. Scand J Trauma Resusc Emerg Med 2019; 27:6. [PMID: 30665441 PMCID: PMC6341545 DOI: 10.1186/s13049-018-0554-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/25/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Effective and timely airway management is a priority for sick and injured patients. The benefit and conduct of pre-hospital emergency anaesthesia (PHEA) and advanced airway management remains controversial but there are a proportion of critically ill and injured patients who require urgent advanced airway management prior to hospital arrival. This document provides current best practice advice for the provision of PHEA and advanced airway management. METHOD This best practice advice was developed from EHAC Medical Working Group enforced by pre-hospital critical care experts. The group used a nominal group technique to establish the current best practice for the provision of PHEA and advanced airway management. The group met on three separate occasions to discuss and develop the guideline. All members of the working party were able to access and edit the guideline online. RESULTS This EHAC best practice advice covers all areas of PHEA and advanced airway management and provides up to date evidence of current best practice. CONCLUSION PHEA and advanced airway management are complex interventions that should be delivered by appropriately trained personnel using a well-rehearsed approach and standardised equipment. Where advanced airway interventions cannot be delivered, careful attention should be given to applying basic airway interventions and ensuring their effectiveness at all times.
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Affiliation(s)
| | - David Lockey
- Norwegian Air Ambulance Foundation, Drøbak, Norway
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Training and assessment of non-technical skills in Norwegian helicopter emergency services: a cross-sectional and longitudinal study. Scand J Trauma Resusc Emerg Med 2019; 27:1. [PMID: 30616604 PMCID: PMC6323750 DOI: 10.1186/s13049-018-0583-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Deficient non-technical skills (NTS) among providers of critical care in helicopter emergency medical services (HEMS) is a threat to patient and operational safety. Skills can be improved through simulation-based training and assessment. A previous study indicated that physicians underwent less frequent training compared to pilots and HEMS crew members (HCM) and that all professional groups in Norwegian HEMS received limited training in how to cope with fatigue. Since then, training initiatives and a fatigue risk management project has been initiated. Our study aimed to explore if the frequency of simulation-based training and assessment of NTS in Norwegian HEMS has changed since 2011 following these measures. Methods A cross-sectional web-based survey from October through December 2016, of physicians, HCM and pilots from all civilian Norwegian HEMS-bases reporting the overall extent of simulation-based training and assessment of NTS. Results Of 214 invited, 109 responses were eligible for analysis. The frequency of simulation-based training and assessment of NTS has increased significantly for all professional groups in Norwegian HEMS, most prominently for the physicians. For all groups, the frequency of assessment is generally lower than the frequency of training. Conclusions Physicians in Norwegian HEMS seem to have adjusted to the NTS training culture of the other crew member groups. This might be a consequence of improved NTS training programs. The use of behavioural marker systems systematically in HEMS should be emphasized. Electronic supplementary material The online version of this article (10.1186/s13049-018-0583-1) contains supplementary material, which is available to authorized users.
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White L, Melhuish T, Holyoak R, Ryan T, Kempton H, Vlok R. Advanced airway management in out of hospital cardiac arrest: A systematic review and meta-analysis. Am J Emerg Med 2018; 36:2298-2306. [PMID: 30293843 DOI: 10.1016/j.ajem.2018.09.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/16/2018] [Accepted: 09/25/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To assess the difference in survival and neurological outcomes between endotracheal tube (ETT) intubation and supraglottic airway (SGA) devices used during out-of-hospital cardiac arrest (OHCA). METHODS A systematic search of five databases was performed by two independent reviewers until September 2018. Included studies reported on (1) OHCA or cardiopulmonary resuscitation, and (2) endotracheal intubation versus supraglottic airway device intubation. Exclusion criteria (1) stimulation studies, (2) selectively included/excluded patients, (3) in-hospital cardiac arrest. Odds Ratios (OR) with random effect modelling was used. Primary outcomes: (1) return of spontaneous circulation (ROSC), (2) survival to hospital admission, (3) survival to hospital discharge, (4) discharge with a neurologically intact state. RESULTS Twenty-nine studies (n = 539,146) showed that overall, ETT use resulted in a heterogeneous, but significant increase in ROSC (OR = 1.44; 95%CI = 1.27 to 1.63; I2 = 91%; p < 0.00001) and survival to admission (OR = 1.36; 95%CI = 1.12 to 1.66; I2 = 91%; p = 0.002). There was no significant difference in survival to discharge or neurological outcome (p > 0.0125). On sensitivity analysis of RCTs, there was no significant difference in ROSC, survival to admission, survival to discharge or neurological outcome (p > 0.0125). On analysis of automated chest compression, without heterogeneity, ETT provided a significant increase in ROSC (OR = 1.55; 95%CI = 1.20 to 2.00; I2 = 0%; p = 0.0009) and survival to admission (OR = 2.16; 95%CI = 1.54 to 3.02; I2 = 0%; p < 0.00001). CONCLUSIONS The overall heterogeneous benefit in survival with ETT was not replicated in the low risk RCTs, with no significant difference in survival or neurological outcome. In the presence of automated chest compressions, ETT intubation may result in survival benefits.
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Affiliation(s)
- Leigh White
- School of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Anaesthesia and Perioperative Medicine, Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia.
| | - Thomas Melhuish
- Intensive Care Service, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Rhys Holyoak
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Thomas Ryan
- Department of Orthopaedics, John Hunter Hospital, Newcastle, NSW, Australia; Sydney Clinical School, University of Notre Dame, Sydney, NSW, Australia
| | - Hannah Kempton
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Department of Medicine, St Vincent's Hospital, Sydney, NSW, Australia
| | - Ruan Vlok
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Sydney Clinical School, University of Notre Dame, Sydney, NSW, Australia; Wagga Wagga Rural Referral Hospital, Wagga Wagga, NSW, Australia
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Kornhall D, Näslund R, Klingberg C, Schiborr R, Gellerfors M. The mission characteristics of a newly implemented rural helicopter emergency medical service. BMC Emerg Med 2018; 18:28. [PMID: 30157756 PMCID: PMC6114183 DOI: 10.1186/s12873-018-0176-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 07/30/2018] [Indexed: 11/17/2022] Open
Abstract
Background Physician-staffed helicopter emergency services (HEMS) can provide benefit through the delivery of specialist competence and equipment to the prehospital scene and through expedient transport of critically ill patients to specialist care. This paper describes the integration of such a system in a rural Swedish county. Methods This is a retrospective database study recording the outcomes of every emergency call centre dispatch request as well as the clinical and operational data from all completed missions during this service’s first year in operation. Results During the study period, HEMS completed 478 missions out of which 405 (84,7%) were primary missions to prehospital settings and 73 (15,3%) were inter-hospital critical care transfers. A majority (55,3%) of primary missions occurred in the regions furthest from our hospitals, in municipalities housing only 15,6% of the county’s population. The NACA (IQR) score on primary and secondary missions was 4 (2) and 5 (1), respectively. Conclusions This study describes the successful integration of a physician-based air ambulance service in a Scandinavian rural region. Municipalities distant from our hospitals benefitted as they now have access to early specialist intervention and expedient transport to critical hospital care. Our hospitals and most populated areas benefitted from HEMS secondary mission capability as they gained a dedicated ICU transport service that could provide specialist intensive care during rapid inter-hospital transfer.
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Affiliation(s)
- Daniel Kornhall
- Swedish Air Ambulance (SLA), Mora, Sweden. .,East Anglian Air Ambulance, Cambridge, UK. .,Nordland Hospital, Bodø, Norway.
| | | | - Cecilia Klingberg
- Swedish Air Ambulance (SLA), Mora, Sweden.,Department of Anaesthesiology and Intensive Care, Falun County Hospital, Falun, Sweden
| | - Regina Schiborr
- Swedish Air Ambulance (SLA), Mora, Sweden.,Department of Anaesthesiology and Intensive Care, Mora Hospital, Mora, Sweden
| | - Mikael Gellerfors
- Swedish Air Ambulance (SLA), Mora, Sweden.,Department of Clinical Science and Education, Section of Anaesthesiology and Intensive Care, Karolinska Institutet, Stockholm, Sweden.,Department of Anaesthesiology and Intensive Care, Sodersjukhuset, Stockholm, Sweden.,SAE Medevac Helicopter, Swedish Armed Forces, Linkoping, Sweden
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Gałązkowski R, Farkowski MM, Rabczenko D, Marciniak-Emmons M, Darocha T, Timler D, Sterliński M. Additional data from clinical examination on site significantly but marginally improve predictive accuracy of the Revised Trauma Score for major complications during Helicopter Emergency Medical Service missions. Arch Med Sci 2018; 14:865-870. [PMID: 30002706 PMCID: PMC6040125 DOI: 10.5114/aoms.2016.61884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The Revised Trauma Score (RTS) accurately identifies trauma patients at high risk of adverse events or death. Less is known about its usefulness in the general population and non-trauma recipients of Helicopter Emergency Medical Service (HEMS). The RTS is a simple tool and omits a lot of other data obtained during clinical evaluation. The aim was to assess the role of the RTS to identify patients at risk of major complications (death, cardiopulmonary resuscitation, defibrillation, intubation) in the general population of HEMS patients. Clinical factors beyond the RTS were analyzed to identify additional prognostic factors for predicting major complications. MATERIAL AND METHODS A retrospective analysis of medical records of adult patients routinely collected during HEMS missions in the years 2011-2014 was performed. RESULTS The analysis included 19 554 HEMS missions. Patients were 55 ±20 years old and 68% were male. The most common indication for HEMS was diseases of the circulatory system - 41%. Major complications occurred in 2072 (10.6%) cases. In the general population of HEMS patients, the RTS accurately identified individuals at risk of major complications at a cut-off value of 10.5 and area under the curve (AUC) of 93.5%. In multivariate analysis, additional clinical data derived from clinical examination (ECG; skin, pupil and breathing examination) significantly but marginally improved the accuracy of RTS assessment: AUC 95.6% (p < 0.001 for the difference). CONCLUSIONS The Revised Trauma Score accurately identifies individuals at risk of major complications during HEMS missions regardless of the indication. Additional clinical data significantly but marginally improved the accuracy of RTS in the general population of HEMS patients.
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Affiliation(s)
- Robert Gałązkowski
- Department of Emergency Medical Services, Medical University of Warsaw, Warsaw, Poland
| | - Michał M. Farkowski
- Second Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Daniel Rabczenko
- Department for Monitoring and Analysis of Population Health Status, National Institute of Public Health – National Institute of Hygiene, Warsaw, Poland
| | | | - Tomasz Darocha
- Department of Anesthesiology and Intensive Care, John Paul II Hospital, Medical College Jagiellonian University, Krakow, Poland
- Polish Medical Air Rescue, Krakow, Poland
| | - Dariusz Timler
- Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Lodz, Poland
| | - Maciej Sterliński
- Second Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
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Abstract
PURPOSE OF REVIEW The care administered on air ambulances has become increasing complex. This has led to a discussion among experts as to whether air ambulance travel should be manned by physicians. This review provides evidence in support of anaesthesiologists being the physician-leaders in air ambulance medicine, because of their training in advanced airway management, critical care, and resuscitation. RECENT FINDINGS Successful prehospital care requires the ability to perform a complex set of advanced diagnostics and interventions. These include airway management, haemorrhage control, pain management, point-of-care diagnostics, complex interfacility transport, and advanced interventions. This skill set closely mirrors the training and expertise of anaesthesiologists. SUMMARY There are few studies investigating the specific benefit of anaesthesiologists in air ambulance medicine. However, current evidence indicates that their presence does improve patient care and safety. Future studies on this topic should use evidence-based quality indicators and standardized data sets to seek answers to optimal staffing of air ambulance teams.
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Bjørnsen LP, Solheim AM, Uleberg O, Skogvoll E. Compliance With a National Standard by Norwegian Helicopter Emergency Physicians. Air Med J 2018; 37:46-50. [PMID: 29332776 DOI: 10.1016/j.amj.2017.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/28/2017] [Accepted: 10/14/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The "National Standard Requirements for Helicopter Emergency Medicine Services Physicians" gives recommendations on medical requirements for flight physicians. This study describes the level of formal competence, experience, and guideline compliance of Norwegian helicopter emergency medical service (HEMS) physicians. METHODS In May 2013, all HEMS physicians with full-time engagement at Norwegian HEMS bases were invited to participate in a cross-sectional survey using a structured, Web-based questionnaire. RESULTS A total of 108 (79%) of 136 physicians replied to the survey, and all bases were represented. The majority (89%) had specialist training, and more than 60% had longer than 6 years of experience as a flight physician. Over 60% had attended trauma, pediatric, and incubator courses, and all physicians worked regularly in an anesthesia department. Most physicians were participating in simulation and procedure training. CONCLUSION Many of the basic requirements of the guidelines were met by HEMS physicians, but room exists for improvements. Norwegian HEMS physicians are experienced, but a need exists for a more structured curriculum in emergency medicine for HEMS physicians based on the broad spectrum of presented medical conditions to ensure optimal quality of care and safety for all patients in Norway.
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Affiliation(s)
- Lars Petter Bjørnsen
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav's University Hospital/AHL, Trondheim, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Andrea Marie Solheim
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Oddvar Uleberg
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav's University Hospital/AHL, Trondheim, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
| | - Eirik Skogvoll
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Raatiniemi L, Liisanantti J, Niemi S, Nal H, Ohtonen P, Antikainen H, Martikainen M, Alahuhta S. Short-term outcome and differences between rural and urban trauma patients treated by mobile intensive care units in Northern Finland: a retrospective analysis. Scand J Trauma Resusc Emerg Med 2015; 23:91. [PMID: 26542684 PMCID: PMC4635532 DOI: 10.1186/s13049-015-0175-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/02/2015] [Indexed: 02/03/2023] Open
Abstract
Background Emergency medical services are an important part of trauma care, but data comparing urban and rural areas is needed. We compared 30-day mortality and length of intensive care unit (ICU) stay for trauma patients injured in rural and urban municipalities and collected basic data on trauma care in Northern Finland. Methods We examined data from all trauma patients treated by the Finnish Helicopter Emergency Medical Services in 2012 and 2013. Only patients surviving to hospital were included in the analysis but all pre-hospital deaths were recorded. All data was retrieved from the national Helicopter Emergency Medical Services database, medical records, and the Finnish Causes of Death Registry. Patients were defined as urban or rural depending on the type of municipality where the injury occurred. Results A total of 472 patients were included. Age and Injury Severity Score did not differ between rural and urban patients. The pre-hospital time intervals and distances to trauma centers were longer for rural patients and a larger proportion of urban patients had intentional injuries (23.5 % vs. 9.3 %, P <0.001). The 30-day mortality for severely injured patients (Injury Severity Score >15) was 23.9 % in urban and 13.3 % in rural municipalities. In the multivariate regression analysis the odds ratio (OR) for 30-day mortality was 2.8 (95 % confidence interval 1.0 to 7.9, P = 0.05) in urban municipalities. There was no difference in the length of ICU stay or scores. Twenty patients died on scene or during transportation and 56 missions were aborted because of pre-hospital death. Conclusions The severely injured urban trauma patients had a trend toward higher 30-day mortality compared with patients injured in rural areas but the length of ICU stay was similar. However, more pre-hospital deaths occurred in rural municipalities. The time before mobile ICU arrival appears to be critical for trauma patients’ survival, especially in rural areas.
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Affiliation(s)
- Lasse Raatiniemi
- Department of Anaesthesia and Intensive Care, Lapland Central Hospital, Rovaniemi, Finland. .,Centre for Pre-Hospital Emergency Services, Oulu University Hospital, Oulu, Finland. .,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.
| | - Janne Liisanantti
- Division of Intensive Care Medicine, Oulu University Hospital, Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Suvi Niemi
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Heini Nal
- Centre for Pre-Hospital Emergency Services, Oulu University Hospital, Oulu, Finland
| | - Pasi Ohtonen
- Division of Operative Care, Oulu University Hospital, Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | | | - Matti Martikainen
- Centre for Pre-Hospital Emergency Services, Oulu University Hospital, Oulu, Finland
| | - Seppo Alahuhta
- Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
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Tarpgaard M, Hansen TM, Rognås L. Anaesthetist-provided pre-hospital advanced airway management in children: a descriptive study. Scand J Trauma Resusc Emerg Med 2015; 23:61. [PMID: 26307040 PMCID: PMC4549899 DOI: 10.1186/s13049-015-0140-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 08/15/2015] [Indexed: 11/20/2022] Open
Abstract
Background Pre-hospital advanced airway management has been named one of the top-five research priorities in physician-provided pre-hospital critical care. Few studies have been made on paediatric pre-hospital advanced airway management. The aim of this study was to investigate pre-hospital endotracheal intubation success rate in children, first-pass success rates and complications related to pre-hospital advanced airway management in patients younger than 16 years of age treated by pre-hospital critical care teams in the Central Denmark Region (1.3 million inhabitants). Methods A prospective descriptive study based on data collected from eight anaesthetist-staffed pre-hospital critical care teams between February 1st 2011 and November 1st 2012. Primary endpoints were 1) pre-hospital endotracheal intubation success rate in children 2) pre-hospital endotracheal intubation first-pass success rate in children and 3) complications related to prehospital advanced airway management in children. Results The pre-hospital critical care anaesthetists attempted endotracheal intubation in 25 children, 13 of which were less than 2 years old. In one patient, a neonate (600 g birth weight), endotracheal intubation failed. The patient was managed by uneventful bag-mask ventilation. All other 24 children had their tracheas successfully intubated by the pre-hospital critical care anaesthetists resulting in a pre-hospital endotracheal intubation success rate of 96 %. Overall first pass success-rate was 75 %. In the group of patients younger than 2 years old, first pass success-rate was 54 %. The total rate of airway management related complications such as vomiting, aspiration, accidental intubation of the oesophagus or right main stem bronchus, hypoxia (oxygen saturation < 90 %) or bradycardia (according to age) was 20 % in children younger than 16 years of age and 38 % in children younger than 2 years of age. No deaths, cardiac arrests or severe bradycardia (heart rate <60) occurred in relation to pre-hospital advanced airway management. Conclusion Compared with the total population of patients receiving pre-hospital advanced airway management in our system, the overall success rate following pre-hospital endotracheal intubations in children is acceptable but the first-pass success rate is low. The complication rates in the paediatric population are higher than in our pre-hospital advanced airway management patient population as a whole. This illustrates that young children may represent a substantial pre-hospital airway management challenge even for experienced pre-hospital critical care anaesthetists. This may influence future training and quality insurance initiatives in paediatric pre-hospital advanced airway management.
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Affiliation(s)
- Mona Tarpgaard
- Pre-hospital Critical Care Team, Aarhus University Hospital, Oluf Palmes Alle 32, Aarhus N, 8200, Denmark. .,Department of Pre-hospital Medical Services, Central Denmark Region, Oluf Palmes Alle 34, Aarhus N, 8200, Denmark.
| | - Troels Martin Hansen
- Pre-hospital Critical Care Team, Aarhus University Hospital, Oluf Palmes Alle 32, Aarhus N, 8200, Denmark. .,Department of Pre-hospital Medical Services, Central Denmark Region, Oluf Palmes Alle 34, Aarhus N, 8200, Denmark.
| | - Leif Rognås
- Pre-hospital Critical Care Team, Aarhus University Hospital, Oluf Palmes Alle 32, Aarhus N, 8200, Denmark. .,Department of Pre-hospital Medical Services, Central Denmark Region, Oluf Palmes Alle 34, Aarhus N, 8200, Denmark.
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