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Jamtli B, Hov MR, Jørgensen TM, Kramer-Johansen J, Ihle-Hansen H, Sandset EC, Kongsgård HW, Hardeland C. Telephone triage and dispatch of ambulances to patients with suspected and verified acute stroke - a descriptive study. BMC Emerg Med 2024; 24:43. [PMID: 38486156 PMCID: PMC10941420 DOI: 10.1186/s12873-024-00962-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/07/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES In this study we aimed to explore EMCC triage of suspected and confirmed stroke patients to gain more knowledge about the initial phase of the acute stroke response chain. Accurate dispatch at the Emergency Medical Communication Center (EMCC) is crucial for optimal resource utilization in the prehospital service, and early identification of acute stroke is known to improve patient outcome. MATERIALS AND METHODS We conducted a descriptive retrospective study based on data from the Emergency Department and EMCC records at a comprehensive stroke center in Oslo, Norway, during a six-month period (2019-2020). Patients dispatched with EMCC stroke criteria and/or discharged with a stroke diagnosis were included. We identified EMCC true positive, false positive and false negative stroke patients and estimated EMCC stroke sensitivity and positive predictive value (PPV). Furthermore, we analyzed prehospital time intervals and identified patient destinations to gain knowledge on ambulance services assessments. RESULTS We included 1298 patients. EMCC stroke sensitivity was 77% (95% CI: 72 - 82%), and PPV was 16% (95% CI: 14 - 18%). EMCC false negative stroke patients experienced an increased median prehospital delay of 11 min (p < 0.001). Upon arrival at the scene, 68% of the EMCC false negative patients were identified as suspected stroke cases by the ambulance services. Similarly, 68% of the false positive stroke patients were either referred to a GP, out-of-hours GP acute clinic, local hospitals or left at the scene by the ambulance services, indicating that no obvious stroke symptoms were identified by ambulance personnel upon arrival at the scene. CONCLUSIONS This study reveals a high EMCC stroke sensitivity and an extensive number of false positive stroke dispatches. By comparing the assessments made by both the EMCC and the ambulance service, we have identified specific patient groups that should be the focus for future research efforts aimed at improving the sensitivity and specificity of stroke recognition in the EMCC.
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Affiliation(s)
- Bjørn Jamtli
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
- Prehospital affiliationision, Oslo University Hospital, Oslo, Norway.
| | - Maren Ranhoff Hov
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- The Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Trine Møgster Jørgensen
- Faculty of Health Sciences, Department for Prehospital Emergency Medicine, Oslo Metropolitan University, Oslo, Norway
| | - Jo Kramer-Johansen
- Air Ambulance department, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Else Charlotte Sandset
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- The Norwegian Air Ambulance Foundation, Oslo, Norway
| | | | - Camilla Hardeland
- Faculty of Health and Welfare, Østfold University College, Fredrikstad, Norway
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital, Fredrikstad, Norway
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Petrovich P, Berve PO, Barth-Heyerdahl Roald B, Wahl Kongsgård H, Stray-Pedersen A, Kramer-Johansen J, Wik L. Injuries associated with mechanical chest compressions and active decompressions after out-of-hospital cardiac arrest: A subgroup analysis of non-survivors from a randomized study. Resusc Plus 2023; 13:100362. [PMID: 36798487 PMCID: PMC9926013 DOI: 10.1016/j.resplu.2023.100362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/08/2023] [Accepted: 01/18/2023] [Indexed: 02/04/2023] Open
Abstract
Background Both skeletal and visceral injuries are reported after cardiopulmonary resuscitation (CPR). This subgroup analysis of a randomized clinical study describes/compares autopsy documented injury patterns caused by two mechanical, piston-based chest compression devices: standard LUCAS® 2 (control) and LUCAS® 2 with active decompression (AD, intervention) in non-survivors with out-of-hospital cardiac arrest (CA). Method We compared injuries documented by autopsies (medical/forensic) after control and intervention CPR based on written relatives consent to use patients' data. The pathologists were blinded for the device used. The cause of CA and injuries reported were based on a prespecified study autopsy template. We used Pearson's chi-squared test and logistic regression analysis with an alpha level of 0.05. Results 221 patients were included in the main study (April 2015-April 2017) and 207 did not survive. Of these, 114 (55%, 64 control and 50 intervention) underwent medical (N = 73) or forensic (N = 41) autopsy. The cause of CA was cardiac 53%, respiratory 17%, overdose/intoxication 14%, ruptured aorta 10%, neurological 1%, and other 5%. There were no differences between control and intervention in the incidence of rib fractures (67% vs 72%; p-value = 0.58), or sternal fractures (44% vs 48%; p-value = 0.65), respectively. The most frequent non-skeletal complication was bleeding (26% of all patients) and intrathoracic was the most common location. Ten of the 114 patients had internal organ injuries, where lungs were most affected. Conclusion In non-survivors of OHCA patients, the most frequent cause of cardiac arrest was cardiogenic. Skeletal and non-skeletal fractures/injuries were found in both control and intervention groups. Bleeding was the most common non-skeletal complication. Internal organ injuries were rare.
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Affiliation(s)
- Polina Petrovich
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Per Olav Berve
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway,Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Borghild Barth-Heyerdahl Roald
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway,Department of Pathology, Oslo University Hospital, Norway
| | - Håvard Wahl Kongsgård
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway
| | - Arne Stray-Pedersen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway,Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, Norway
| | - Jo Kramer-Johansen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway,Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Lars Wik
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway,Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway,Corresponding author at: Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway.
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Elliott P, Aresu M, Gao H, Vergnaud AC, Heard A, McRobie D, Spear J, Singh D, Kongsgård HW, Mbema C, Muller DC. Use of TETRA personal radios and sickness absence in the Airwave Health Monitoring Study of the British police forces. Environ Res 2019; 175:148-155. [PMID: 31125718 DOI: 10.1016/j.envres.2019.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Terrestrial Trunked Radio (TETRA) is used for radiocommunications among the British police forces. OBJECTIVES To investigate association of personal radio use and sickness absence among police officers and staff from the Airwave Health Monitoring Study. METHODS Participant-level sickness absence records for 26 forces were linked with personal radio use for 32,102 participants. We used multivariable logistic regression to analyse TETRA usage in year prior to enrolment and sickness absence (lasting more than 7 or 28 consecutive days) in the following year and a zero-inflated negative binomial model for analyses of number of sickness absence episodes of any duration ('spells') over the same period. In secondary analyses, we looked at an extended period of observation among a sub-cohort with linked data over time, using Cox proportional hazards regression. RESULTS Median personal radio use (year prior to enrolment) was 29.7 min per month (interquartile range 7.5, 64.7) among users. In the year following enrolment there were 25,655 sickness absence spells among 15,248 participants. There were similar risks of sickness absence lasting more than seven days among users and non-users, although among users risk was higher with greater use, odds ratio = 1.04 (95% confidence interval [CI] 1.02 to 1.06) per doubling of radio use. There was no association for sickness absence of more than 28 days. For sickness absence spells, risk was lower among users than non-users (incidence rate ratio = 0.91; 95% CI 0.75 to 1.11), again with higher risk among users for greater radio use. There was no association between radio use and sickness absence in secondary analyses. DISCUSSION There were similar or lower risks of sickness absence in TETRA radio users compared with non-users. Among users, the higher risk of sickness absence with greater radio use may reflect working pattern differences among police personnel rather than effects of radiofrequency exposure.
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Affiliation(s)
- Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; NIHR Health Protection Research Unit on Health Effects of Environmental Hazards, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; UK Dementia Research Institute (UK DRI) at Imperial College, Imperial College London, London, UK.
| | - Maria Aresu
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - He Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Anne-Claire Vergnaud
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Andy Heard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Dennis McRobie
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Jeanette Spear
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Deepa Singh
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | | | - Catherine Mbema
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Consultant in Public Health, Lewisham Council, London, UK
| | - David C Muller
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Gao H, Aresu M, Vergnaud AC, McRobie D, Spear J, Heard A, Kongsgård HW, Singh D, Muller DC, Elliott P. Personal radio use and cancer risks among 48,518 British police officers and staff from the Airwave Health Monitoring Study. Br J Cancer 2019; 120:375-378. [PMID: 30585256 PMCID: PMC6354010 DOI: 10.1038/s41416-018-0365-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 11/30/2018] [Accepted: 11/30/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Radiofrequency electromagnetic fields (RF-EMF) from mobile phones have been classified as potentially carcinogenic. No study has investigated use of Terrestrial Trunked Radio (TETRA), a source of RF-EMF with wide occupational use, and cancer risks. METHODS We investigated association of monthly personal radio use and risk of cancer using Cox proportional hazards regression among 48,518 police officers and staff of the Airwave Health Monitoring Study in Great Britain. RESULTS During median follow-up of 5.9 years, 716 incident cancer cases were identified. Among users, the median of the average monthly duration of use in the year prior to enrolment was 30.5 min (inter-quartile range 8.1, 68.1). Overall, there was no association between personal radio use and risk of all cancers (hazard ratio [HR] = 0.98, 95% confidence interval [CI]: 0.93, 1.03). For head and neck cancers HR = 0.72 (95% CI: 0.30, 1.70) among personal radio users vs non-users, and among users it was 1.06 (95% CI: 0.91, 1.23) per doubling of minutes of personal radio use. CONCLUSIONS With the limited follow-up to date, we found no evidence of association of personal radio use with cancer risk. Continued follow-up of the cohort is warranted.
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Affiliation(s)
- He Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Maria Aresu
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Anne-Claire Vergnaud
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Dennis McRobie
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Jeanette Spear
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Andy Heard
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Håvard Wahl Kongsgård
- Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Deepa Singh
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - David C Muller
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
- NIHR Health Protection Research Unit in Health Effects of Environmental Hazards, Imperial College London, London, UK.
- UK Dementia Research Institute (DRI) at Imperial College, Imperial College London, London, UK.
- Health Data Research-UK (HDR) London Centre at Imperial College, Imperial College London, London, UK.
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Vergnaud AC, Aresu M, Kongsgård HW, McRobie D, Singh D, Spear J, Heard A, Gao H, Carpenter JR, Elliott P. Estimation of TETRA radio use in the Airwave Health Monitoring Study of the British police forces. Environ Res 2018; 167:169-174. [PMID: 30014898 DOI: 10.1016/j.envres.2018.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/06/2018] [Accepted: 07/07/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The Airwave Health Monitoring Study aims to investigate the possible long-term health effects of Terrestrial Trunked Radio (TETRA) use among the police forces in Great Britain. Here, we investigate whether objective data from the network operator could be used to correct for misreporting in self-reported data and expand the radio usage availability in our cohort. METHODS We estimated average monthly usage of personal radio in the 12 months prior to enrolment from a missing value imputation model and evaluated its performance against objective and self-reported data. Factors associated with TETRA radio usage variables were investigated using Chi-square tests and analysis of variance. RESULTS The imputed data were better correlated with objective than self-reported usage (Spearman correlation coefficient = 0.72 vs. 0. 52 and kappa 0.56 [95% confidence interval 0.55, 0.56] vs. 0.46 [0.45, 0.47]), although the imputation model tended to under-estimate use for higher users. Participants with higher personal radio usage were more likely to be younger, men vs. women and officer vs. staff. The median average monthly usage level for the entire cohort was estimated to be 29.3 min (95% CI: [7.2, 66.6]). CONCLUSION The availability of objective personal radio records for a large proportion of users allowed us to develop a robust imputation model and hence obtain personal radio usage estimates for ~50,000 participants. This substantially reduced exposure misclassification compared to using self-reported data and will allow us to carry out analyses of TETRA usage for the entire cohort in future work.
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Affiliation(s)
- Anne-Claire Vergnaud
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Maria Aresu
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Dennis McRobie
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Deepa Singh
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Jeanette Spear
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Andy Heard
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - He Gao
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - James R Carpenter
- Medical Statistics Unit, London School of Hygiene and Tropical Medicine London, WC1E 7HT, United Kingdom
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom; Imperial College London NIHR Biomedical Research Centre, London, United Kingdom; Health Data Research UK-London, London, United Kingdom.
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Kongsgård HW. [Aid as weapon]. Tidsskr Nor Laegeforen 2011; 131:450. [PMID: 21383790 DOI: 10.4045/tidsskr.10.1257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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