Cutting the Prehospital On-Scene Time of Stroke Thrombolysis in Helsinki: A Prospective Interventional Study.

BACKGROUND AND PURPOSE: Significant portion of the prehospital delay consists of minutes spent on the scene with the patient. We implemented a training program for the emergency medical services personnel with the aim to optimize the on-scene time (OST) and to study the impact of different elements of prehospital practice to the OST duration. METHODS: In this prospective interventional study, key operational emergency medical service performance variables were analyzed from all thrombolysis candidates transported to the Helsinki University Hospital emergency department. The catchment period was 4 months before and 4 months after the implementation. RESULTS: One hundred and forty-one patients were managed as thrombolysis candidates before and 148 patients after the training program implementation. The OST duration for the groups was 25 (20.5-31) and 22.5 (18-28.5) minutes, respectively (P<0.001). Physician consultations via telephone were associated with a longer (odds ratio 0.546 [0.333-0.893]) and advanced life support training with a shorter OST (odds ration 1.760 [1.070-2.895]). CONCLUSIONS: Implementation of the emergency medical services training program successfully decreased the OST of thrombolysis candidates by 10%. Higher expertise level of the ambulance crew was associated with shorter OST, and decisions to consult a physician via telephone were reflected by longer OST.

Epidemiology and aetiology of impaired level of consciousness in prehospital nontrauma patients in an urban setting.

BACKGROUND: There is little information on the epidemiology and aetiology of nontraumatic loss of consciousness in patients in the Emergency Department, and this high-risk patient group has been poorly characterized in the prehospital setting as well. The aim of this study was to study the epidemiology and aetiology of nontraumatic impaired level of consciousness among the patients treated by an urban Emergency Medical Service (EMS) system in Finland. METHODS: Data of all emergency calls not related to trauma in an urban EMS system in southern Finland during 2012 were analysed. The inclusion criterion in this study was impaired level of consciousness as identified from the EMS run sheets. Diagnoses made in the receiving facility were cross-checked with the data. RESULTS: During the study period, the EMS was alerted to 22 184 emergency calls. Of these, 306 calls met the inclusion criterion. The included patients could be categorized into four groups: seizures (32%), diabetes (24%), intoxication (17%) and impaired level of consciousness with no other obvious or specific cause (27%). The overall case fatality rate was 8%. CONCLUSION: Of all EMS calls, patients who presented with an impaired level of consciousness represented 1.4% of all patients, but the fatality rate in those who remained with an impaired level of consciousness during the prehospital phase was considerable. Impaired level of consciousness was associated with a multitude of aetiologies, of which seizures were the most common.

Teaching anaesthesia induction to medical students: comparison between full-scale simulation and supervised teaching in the operating theatre.

BACKGROUND AND OBJECTIVE: The aim of the study was to compare the effectiveness of teaching of general anaesthesia induction to medical students using either full-scale simulation or traditional supervised teaching with patients in the operating theatre. METHODS: Forty-six fourth year students attending their course in anaesthesiology were enrolled. The students were randomly assigned to two groups. The simulation group received training in the simulator. The traditional training group was supervised by a senior consultant anaesthetist. After the training sessions all students were tested in the simulator setting. The test was assessed using a 40-item evaluation list. RESULTS: Thirty-three per cent of students in the traditional group and 87% of the students in the simulation group passed the test. Statistically significant differences were: request of glycopyrrolate (P < 0.001), Sp(O2) monitoring (P < 0.001), used gloves when placing an intravenous cannula (P = 0.012), intubation attempt within 30 s (P < 0.04), anaesthesia gas set at MAC at least 1 (P < 0.04), instructed anaesthetic nurse to keep Sp(O2) at least 95% (P < 0.05), keep MAP at least 60 mmHg (P < 0.05), keep heart rate more than 50 beats per minute (P < 0.002), keep end-tidal p(CO2) 4-5.5 kPa (P < 0.002). CONCLUSION: The simulation group performed better in 25% of the tasks and similarly in the others compared with the traditional teaching group. With the same time and amount of teaching personnel we trained five or six students in the simulator compared with one student in the operating theatre. Further research will reveal whether these promising results with simulation may be applied more generally in anaesthesiology teaching to medical students.