Do emergency medical dispatchers choose the same response to serious injury in men and women - a qualitative study.

BACKGROUND: Recent research has indicated that sex is an important determinant of emergency medical response in patients with possible serious injuries. Men were found to receive more advanced prehospital treatment and more helicopter transportation and trauma centre destinations and were more often received by an activated trauma team, even when adjusted for injury mechanism. Emergency medical dispatchers choose initial resources when serious injury is suspected after a call to the emergency medical communication centre. This study aimed to assess how dispatchers evaluate primary responses in trauma victims, with a special focus on the sex of the victim. METHODS: Emergency medical dispatchers were interviewed using focus groups and a semistructured interview guide developed specifically for this study. Two vignettes describing typical and realistic injury scenarios were discussed. Verbatim transcripts of the conversations were analysed via systematic text condensation. The findings were reported in accordance with the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist. RESULTS: The analysis resulted in the main category "Tailoring the right response to the patient", supported by three categories "Get an overview of location and scene safety", "Patient condition" and "Injury mechanism and special concerns". The informants consistently maintained that sex was not a relevant variable when deciding emergency medical response during dispatch and claimed that they rarely knew the sex of the patient before a response was implemented. Some of the participants also raised the question of whether the Norwegian trauma criteria reliably detect serious injury in women. CONCLUSIONS: The results indicate that the emergency medical response is largely based on the national trauma criteria and that sex is of little or no importance during dispatch. The observed sex differences in the emergency medical response seems to be caused by other factors during the emergency medical response phase.

Effect of wet clothing removal on skin temperature in subjects exposed to cold and wrapped in a vapor barrier: a human, randomized, crossover field study.

BACKGROUND: Prehospital care for cold-stressed and hypothermic patients focuses on effective insulation and rewarming. When encountering patients wearing wet clothing, rescuers can either remove the wet clothing before isolating the patient or isolate the patient using a vapor barrier. Wet clothing removal increases skin exposure but avoids the need to heat the wet clothing during rewarming. Leaving wet clothing on will avoid skin exposure but is likely to increase heat loss during rewarming. This study aimed to evaluate the effect of wet clothing removal compared to containing the moisture using a vapor barrier on skin temperature in a prehospital setting. METHODS: This randomized crossover experimental field study was conducted in a snow cave in Hemsedal, Norway. After an initial cooling phase of 30 min while wearing wet clothes, the participants were subjected to one of two rewarming scenarios: (1) wet clothing removal and wrapping in a vapor barrier, insulating blankets, and windproof outer shell (dry group) or (2) wrapping in a vapor barrier, insulating blankets, and windproof outer shell (wet group). The mean skin temperature was the primary outcome whereas subjective scores for both thermal comfort and degree of shivering were secondary outcomes. Primary outcome data were analyzed using the analysis of covariance (ANCOVA). RESULTS: After an initial decrease in temperature during the exposure phase, the dry group had a higher mean skin temperature compared to the wet group after only 2 min. The skin-rewarming rate was highest in the initial rewarming stages for both groups, but increased in the dry group as compared to the wet group in the first 10 min. Return to baseline temperature occurred significantly faster in the dry group (mean 12.5 min [dry] vs. 28.1 min [wet]). No intergroup differences in the subjective thermal comfort or shivering were observed. CONCLUSION: Removal of wet clothing in combination with a vapor barrier increases skin rewarming rate compared to encasing the wet clothing in a vapor barrier, in mild cold and environments without wind. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT05996757, retrospectively registered 18/08/2023.

Errors in medicine: punishment versus learning medical adverse events revisited - expanding the frame.

PURPOSE OF REVIEW: Despite healthcare workers' best intentions, some patients will suffer harm and even death during their journey through the healthcare system. This represents a major challenge, and many solutions have been proposed during the last decades. How to reduce risk and use adverse events for improvement? RECENT FINDINGS: The concept of safety culture must be acknowledged and understood for moving from blame to learning. Procedural protocols and reports are only parts of the solution, and this overview paints a broader picture, referring to recent research on the nature of adverse events. The potential harm from advice based on faulty evidence represents a serious risk. SUMMARY: Focus must shift from an individual perspective to the system, promoting learning rather than punishment and disciplinary sanctions, and the recent opioid epidemic is an example of bad guidelines.

Trauma team training in Norwegian hospitals: an observational study.

BACKGROUND: Traumatic injuries are a leading cause of deaths in Norway, especially among younger males. Trauma-related mortality can be reduced by structural measures, such as organization of a trauma system. Many hospitals in Norway treat few seriously injured patients, one of the reasons for development of the Norwegian trauma system. Since its implementation, there has been continuous improvement of this system, including trauma team training. Regular trauma team training is compulsory, with the aims of compensating for lack of experience and maintaining competence. The purpose of this study was to present an overview of current trauma team training activities in Norway. METHODS: For this observational study, the authors developed an online questionnaire and mailed it to local trauma coordinators from 38 Norwegian hospitals-including four trauma centers and 34 acute hospitals with trauma function. The study was performed during April-June 2020, with a two-month response window. Trauma team training frequency was assessed in four predefined intervals: < 5, 5-9, 10-15 and > 15 times per year. The response rate was 33 of 38, 87%. RESULTS: All responding hospitals conducted regular trauma team training. The frequency of training increased significantly from 2013 to 2020 (Chi square test, Chi2 8.33, p = 0.04). All hospitals described a quite homogenous approach. The trauma centres trained more frequently as compared to the acute care hospitals (Chi square test, Chi2 8.24, p = 0.04). CONCLUSIONS: All responding hospitals performed regular trauma team training using a homogenous approach, which is in line with previous assessments. We observed a minor improvement in frequency compared to prior assessments. Our findings suggest that Norwegian trauma teams likely maintain their competence through team training. All hospitals followed the current recommendations from the National Trauma Plan.

Ten years of the Helsinki Declaration on patient safety in anaesthesiology: An expert opinion on peri-operative safety aspects.

: Patient safety is an activity to mitigate preventable patient harm that may occur during the delivery of medical care. The European Board of Anaesthesiology (EBA)/European Union of Medical Specialists had previously published safety recommendations on minimal monitoring and postanaesthesia care, but with the growing public and professional interest it was decided to produce a much more encompassing document. The EBA and the European Society of Anaesthesiology (ESA) published a consensus on what needs to be done/achieved for improvement of peri-operative patient safety. During the Euroanaesthesia meeting in Helsinki/Finland in 2010, this vision was presented to anaesthesiologists, patients, industry and others involved in health care as the 'Helsinki Declaration on Patient Safety in Anaesthesiology'. In May/June 2020, ESA and EBA are celebrating the 10th anniversary of the Helsinki Declaration on Patient Safety in Anaesthesiology; a good opportunity to look back and forward evaluating what was achieved in the recent 10 years, and what needs to be done in the upcoming years. The Patient Safety and Quality Committee (PSQC) of ESA invited experts in their fields to contribute, and these experts addressed their topic in different ways; there are classical, narrative reviews, more systematic reviews, political statements, personal opinions and also original data presentation. With this publication we hope to further stimulate implementation of the Helsinki Declaration on Patient Safety in Anaesthesiology, as well as initiating relevant research in the future.

Loss of life years due to unavailable helicopter emergency medical service: a single base study from a rural area of Norway.

Background: Despite the potential benefits of physician-staffed Helicopter Emergency Medical Service (HEMS), many dispatches to primary HEMS missions in Norway are cancelled before patient encounter. Information is sparse regarding the health consequences when medically indicated HEMS missions are cancelled and the patients are treated by a GP and ambulance staff only. We aimed to estimate the potential loss of life years for patients in these situations. Method: We included all HEMS requests in the period 2010-2013 from Sogn and Fjordane County that were medically indicated but subsequently cancelled. This provided a selection of patients, with the purpose of studying cancellations independently of the patient's medical status A multidisciplinary expert panel retrospectively assessed each patient's potential loss of life years due to the lack of helicopter transport and intervention by a HEMS physician. Results: The study included 184 patients from 176 missions. Because of unavailable HEMS, seven patients (4%) were anticipated to have lost a total of 18 life years. Three patients suffered from myocardial infarction, three from stroke and one from abdominal haemorrhage. The main contribution from HEMS care in these seven cases might have been rapid transport to definitive care. The probability of a patient losing life years when in need of HEMS evacuation was found to be 0.2%. Conclusion: During the four years period seven patients lost 18 life years. Lack of rapid transport seems to be the primary cause of lost life years in this specific geographical area. Key Points Knowledge about to what extent HEMS contributes to an increased survival and a better outcome for patients is limited. Compared to similar studies on life years gained the estimated loss of life years was minor when HEMS evacuation was unavailable in this rural area. The findings indicates that lack of rapid HEMS transport was the primary cause of the estimated loss of life years.

Adverse events and in-hospital mortality: an analysis of all deaths in a Norwegian health trust during 2011.

BACKGROUND: The estimated number of in-hospitals deaths due to adverse events is often different when using data from deceased patients compared with that of a population experiencing adverse events. METHODS: The study was conducted at three hospitals in the Bergen Hospital Trust, including a 950-bed university hospital. The objective was to study the reported deaths and investigate the probable number of deaths caused by adverse events. Information about all patients who died in the hospitals during 2011 was retrieved from the electronic patient data management system and the medical records. All deaths were classified into two groups according to Norwegian law based on whether or not the death was sudden and/or unexpected. The cause of death in the latter group was further classified as being due to either natural or unnatural causes according to national requirements. An expert review panel screened the patient records for information regarding adverse events and possible (≥ 50%) preventability. Age, length of hospital stay, and Charlson Comorbidity Index were also registered. RESULTS: There were 59,605 unique patients admitted in 2011 and 1185 registered deaths (1.98%). The mean and median ages of the deceased were 73,8 and 78 years, respectively, and the median length of stay was 5.6 days (range). Of these deaths, 290 (24.5%) were considered sudden and/or unexpected and 218 were considered to be due to natural causes. Of the 72 unnatural deaths, 16 (1.4%) were classified as preventable or probably preventable. For 18 deaths (%) it was impossible to confirm or rule out preventability. CONCLUSIONS: Using this method, we identified a small proportion of hospital deaths that could be classified as unnatural. Furthermore, there was a ≥ 50% chance or more that 34 deaths (2.9%) were due to causes that could have been prevented.

The European Board of Anaesthesiology recommendations for safe medication practice: First update.

These European Board of Anaesthesiology (EBA) recommendations for safe medication practice replace the first edition of the EBA recommendations published in 2011. They were updated because evidence from critical incident reporting systems continues to show that medication errors remain a major safety issue in anaesthesia, intensive care, emergency medicine and pain medicine, and there is an ongoing need for relevant up-to-date clinical guidance for practising anaesthesiologists. The recommendations are based on evidence wherever possible, with a focus on patient safety, and are primarily aimed at anaesthesiologists practising in Europe, although many will be applicable elsewhere. They emphasise the importance of correct labelling practice and the value of incident reporting so that lessons can be learned, risks reduced and a safety culture developed.

Mountain rescue cardiopulmonary resuscitation: a comparison between manual and mechanical chest compressions during manikin cardio resuscitation.

AIM: Chest compression devices are useful during mountain rescue but may cause a delay in transport if not immediately available. The aims of this prospective observational study were to compare manual and mechanical cardiopulmonary resuscitation (CPR) during transport on a sledge connected to a snowmobile with a non-moving setting and to compare CPR quality between manual and two mechanical chest compression devices. METHODS: Sixteen healthcare providers simulated four different combined CPR scenarios on a sledge in a non-moving setting and during transport and two mechanical chest compression devices during transport on the sledge. The study was conducted in May 2015 in a mountain in Norway. The primary outcome measures were compression rate (compressions per minute), compression depth in millimetres, leaning (incomplete chest wall release after compression in millimetres) and chest compression fraction (fraction of total time were compression were performed). The results were analysed by descriptive and graphical methods and paired t-tests were used to compare the differences between techniques. RESULTS: We did not observe a significant difference between moving and non-moving conditions with respect to manual compression rate (p=0.34), compression depth (p=0.50) or leaning (p=0.92). However, both the manual compression depth (p<0.001) and the leaning (p=0.04) showed a significantly larger variance during the moving runs. CONCLUSION: Manual chest compression is possible on a snowmobile during transport even in challenging terrain. This experimental study shows that high-quality chest compressions and manual ventilation can be performed in an intubated patient during a short-term transportation on a sledge.

Learning by viewing versus learning by doing: A comparative study of observer and participant experiences during an interprofessional simulation training.

Larger student groups and pressure on limited faculty time have raised the question of the learning value of merely observing simulation training in emergency medicine, instead of active team participation. The purpose of this study was to examine observers and hands-on participants' self-reported learning outcomes during simulation-based interprofessional team training regarding non-technical skills. In addition, we compared the learning outcomes for different professions and investigated team performance relative to the number of simulations in which they participated. A concurrent mixed-method design was chosen to evaluate the study, using questionnaires, observations, and focus group interviews. Participants included a total of 262 postgraduate and bachelor nursing students and medical students, organised into 44 interprofessional teams. The quantitative data showed that observers and participants had similar results in three of six predefined learning outcomes. The qualitative data emphasised the importance of participating in different roles, training several times, and training interprofessionally to enhance realism. Observing simulation training can be a valuable learning experience, but the students' preferred hands-on participation and learning by doing. For this reason, one can legitimise the observer role, given the large student groups and limited faculty time, as long as the students are also given some opportunity for hands-on participation in order to become more confident in their professional roles.

Effect of a vapor barrier in combination with active external rewarming for cold-stressed patients in a prehospital setting: a randomized, crossover field study.

BACKGROUND: Use of a vapor barrier in the prehospital care of cold-stressed or hypothermic patients aims to reduce evaporative heat loss and accelerate rewarming. The application of a vapor barrier is recommended in various guidelines, along with both insulating and wind/waterproof layers and an active external rewarming device; however, evidence of its effect is limited. This study aimed to investigate the effect of using a vapor barrier as the inner layer in the recommended "burrito" model for wrapping hypothermic patients in the field. METHODS: In this, randomized, crossover field study, 16 healthy volunteers wearing wet clothing were subjected to a 30-minute cooling period in a snow chamber before being wrapped in a model including an active heating source either with (intervention) or without (control) a vapor barrier. The mean skin temperature, core temperature, and humidity in the model were measured, and the shivering intensity and thermal comfort were assessed using a subjective questionnaire. The mean skin temperature was the primary outcome, whereas humidity and thermal comfort were the secondary outcomes. Primary outcome data were analyzed using analysis of covariance (ANCOVA). RESULTS: We found a higher mean skin temperature in the intervention group than in the control group after approximately 25 min (p < 0.05), and this difference persisted for the rest of the 60-minute study period. The largest difference in mean skin temperature was 0.93 °C after 60 min. Humidity levels outside the vapor barrier were significantly higher in the control group than in the intervention group after 5 min. There were no significant differences in subjective comfort. However, there was a consistent trend toward increased comfort in the intervention group compared with the control group. CONCLUSIONS: The use of a vapor barrier as the innermost layer in combination with an active external heat source leads to higher mean skin rewarming rates in patients wearing wet clothing who are at risk of accidental hypothermia. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05779722.

Distributed team processes in healthcare services: a scoping review.

Objective: High-quality healthcare services is delivered by teams rather than individuals and depends heavily on multidisciplinary cooperation between dispersed healthcare professionals. The aim of this scoping review is to identify common barriers and innovative applications of technology supporting team processes and patient safety, in geographically dispersed healthcare services. Methods: Studies were identified from searches in APA PsychINFO, Epistemonikos and Medline databases, from 2010 to 2023. A detailed search strategy was performed, and studies were included, based on prior established criteria. Results: Among the 19 studies that fulfilled our inclusion criteria, the majority (85%) were from Europe or North America, and most studies (53%) were quantitative, with a cross-sectional study design. Several reported observed distributed team processes in training and education. Most studies described barriers and detailed how innovative approaches and technological solutions were introduced to improve communication, coordination, and shared mental models in distributed healthcare settings. A small proportion of studies (16%) used health services data to examine interpersonal exchange and team processes. Conclusion: The scoping review offer recommendations to enhance future research on distributed team processes in healthcare services.

"Calling for help: i need you to listen'': a qualitative study of callers' experience of calls to the emergency medical communication centre.

BACKGROUND: The Emergency Medical Communications Center (EMCC) is essential in emergencies and often represents the public's first encounter with the healthcare system. Previous research has mainly focused on the dispatcher's perspective. Therefore, there is a lack of insight into the callers' perspectives, the attainment of which may contribute significantly to improving the quality of this vital public service. Most calls are now made from mobile phones, opening up novel approaches for obtaining caller feedback using tools such as short-message services (SMS). Thus, this study aims to obtain a better understanding of callers' actual experiences and how they perceived their interaction with the EMCC. METHODS: A combination of quantitative and qualitative study methods was used. An SMS survey was sent to the mobile phone numbers of everyone who had contacted 113 during the last months. This was followed by 31 semi-structured interviews with people either satisfied or dissatisfied. Thematic analysis was used to investigate the interviews. RESULTS: We received 1680 (35%) responses to the SMS survey, sent to 4807 unique numbers. Most respondents (88%) were satisfied, evaluating their experience as 5 or 6 on a six-point scale, whereas 5% answered with 1 or 2. The interviews revealed that callers were in distress before calling 113. By actively listening and taking the caller seriously, and affirming that it was the right choice to call the emergency number, the EMCC make callers experience a feeling of help and satisfaction, regardless of whether an ambulance was dispatched to their location. If callers did not feel taken seriously or listened to, they were less satisfied. A negative experience may lead to a higher distress threshold and an adjusted strategy before the caller makes contact 113 next time. Callers with positive experiences expressed more trust in the healthcare systems. CONCLUSIONS: For the callers, the most important was being taken seriously and listened to. Additionally, they welcomed that dispatchers express empathy and affirm that callers made the right choice to call EMCC, as this positively affects communication with callers. The 113 calls aimed to cooperate in finding a solution to the caller's problem.

Developing local crisis leadership - A research and training agenda.

The crisis triggered by Covid-19 has exposed the interdependencies of modern society and sparked interest in local response to protracted and complex crisis situations. There has been a growing awareness and interest in the key roles of political and professional stakeholders, their emotional regulation and how they influence team performance and outcomes in dealing with uncertainty and complex crisis situations. While cognitive and behavioral aspects of crisis leadership are well researched, less is understood about how one can mitigate negative emotions, instill trust, or restore public faith and support of security forces and emergency response teams during crises. In addressing this gap, we propose a simplified conceptual roadmap for research and training of local crisis leadership. In this, we emphasize complex problem solving, team interaction, team context and technology and team training design. These four factors represent significant barriers if neglected. On the other side, they may be considerable force multipliers when better understood and managed. We suggest how seven research and training questions could be linked to the four conceptual factors and guide an evidence-based approach to develop local crisis leadership.