Emergency medicine for 25 Years in Iceland - history of the specialty in a nutshell.

After the early implementation of Emergency Medicine (EM) 25 years ago, Iceland became the first Nordic country to nationally realize the benefits of this specialty. However, the road has been rocky as in many other countries. The early years of EM in Iceland were characterized by a significant shortage of resources, particularly a lack of medical staff dedicated to EM and properly trained for the services required. The main task for the first couple of decades was to build the infrastructure of an operational emergency department based primarily on the model of EM. Although these efforts eventually led to a critical number of specialists becoming certified in EM, recruiting more people remains a priority in order to fully meet the need for specialty trained emergency physicians in Iceland. A key step towards achieving this goal was the initiation of a two-year residency program for specialty training in EM in year 2002. The program was based on a curriculum produced by the Icelandic Society for Emergency Medicine, which had been founded in year 2000. This training program is currently being redeveloped and the curriculum of the Royal College of Emergency Medicine in the UK will be adopted for use in Iceland. Another important milestone was the appointment of the first faculty member dedicated to EM at the University of Iceland. This created an opportunity to teach medical students EM and advance training at the graduate level. Also, conditions for scientific research in EM have been improved, following the establishment of an EM research institute in 2010.Other Nordic countries may be able to benefit from lessons learned and experiences gained from the development of emergency medicine in Iceland during the past quarter of a century.

Risk of repeat visits, hospitalisation and death after uncompleted and completed visits to the emergency department: a prospective observation study.

OBJECTIVES: The needs of patients with uncompleted visits to the emergency department (ED) are uncertain. The aim was to evaluate ED patients who leave against medical advice (AMA) and who leave without being seen (WBS) regarding repeat ED visits, hospitalisation and mortality within 30 days. METHODS: The National University Hospital operates the only ED for adults in the capital area of Reykjavik. The source of data was the electronic records for patients 18 years or older, who left AMA, who left WBS, who had the ICD-10 code Z53.2, or who completed their visits. ED visits, hospital admissions and the death registry are filed with the personal identification number, which enabled recognition of the index visit, and the outcomes, rates of return visits, hospitalisation and death. RESULTS: Of 107 119 patients, 77 left AMA, 4471 left WBS and 423 had code Z53.2. The HR for returning to the ED within 30 days was 4.79 for AMA patients, 4.84 for WBS patients and 3.67 for Z53.2 patients. The HR for hospitalisation within 30 days was 6.90 for AMA patients, 1.09 for WBS patients and 1.07 for Z53.2 patients. The HR for death within 30 days was 10.97 for AMA patients, 0.84 for WBS and no deaths occurred among Z53.2 patients. DISCUSSION: During 30 days follow-up, AMA and WBS patients had an increased rate of repeat ED visits compared with those patients who completed their ED visits. AMA patients also had an increased rate of hospitalisations.

[In-hospital cardiopulmonary resuscitation at Landspitali University Hospital in Reykjavik]. / Imflang og árangur endurlífgunarstarfsemi á Landspítala.

INTRODUCTION: Survival after in-hospital cardiac arrest has not been previously reported in Iceland and the purpose of this study was to examine the outcomes of in-hospital resuscitation over a two year period. MATERIAL AND METHODS: There are resuscitation teams on each of the two campuses of the University Hospital in Reykjavik. Since the beginning of 2006, the resuscitation teams have compiled their reports in a structured form, Utstein style. RESULTS: During 2006 and 2007 resuscitation teams were activated on a total of 311 occasions. Of those, there was need for a full cardiopulmonary resuscitation because of cardiac arrest of in patients in 80 cases (26%). Return of spontaneous circulation was achieved or the patient survived to be transferred to the intensive care unit in 55 (69%) of the 80 cases. Survival to discharge was 33%. Survival to discharge was better if the arrest occurred between 8 AM and 4 PM during daytime (50%), than outside of regular working hours (23%, p=0.02). The survival was better if ventricular tachycardia or fibrillation was the first rhythm encountered (50%) than if the initial rhythm turned out to be asystole or pulseless electrical activity (12%, p=0.002). Those who survived resuscitation were generally younger than those who did not (p=0.002). CONCLUSION: The outcomes were similar to those reported at institutions in our neighboring countries. The survival rate was lower if the cardiac arrest occurred outside of regular working hours and if ventricular tachycardia or fibrillation was the first encountered rhythm.