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1.
Scand J Trauma Resusc Emerg Med ; 28(1): 20, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32164776

RESUMO

BACKGROUND: Trauma is a major cause of mortality and reduced quality of life. Most trauma-related research originates from trauma centres, and there are limited available data regarding the treatment of trauma patients throughout the Nordic countries. These countries differ from economically similar countries due to their cold climate, mix of rural and urban areas, and the long distances separating many residents from a trauma centre. Research funders and the general public expect trauma research to focus on all links in the treatment chain. Here we conducted a systematic review to assess the amount of trauma-related research from the Nordic countries between January 1995 and April 2018, and the distribution of this research among different countries and different parts of the trauma treatment chain. METHODS: A systematic literature search was conducted in Medline, Embase, the Cochrane Library, Web of Science, and Scopus. We included studies concerning the trauma population from Nordic countries, and published between January 1995 and April 2018. Two independent reviewers screened titles and abstracts, and performed data extraction from full-text articles. RESULTS: The literature search yielded 5117 titles and abstracts, of which 844 full-text articles were included in our analysis. During this period, the annual number of publications increased. Publications were equally distributed among Norway, Sweden, and Denmark in terms of numbers; however, Norway had more publications relative to inhabitants. There were fewer overall publications from Finland and Iceland. We identified mostly cohort studies and very few randomized controlled trials. Studies focused on the level of care were predominantly epidemiological studies. Research at the pre-hospital level was three-fold more frequent than research on other elements of the trauma treatment chain. CONCLUSION: The rate of publications in the field of trauma care in the Nordic countries has increased over recent years. However, several parts of the trauma treatment chain are still unexplored and most of the available studies are observational studies with low research evidence.

5.
Scand J Trauma Resusc Emerg Med ; 27(1): 83, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464620

RESUMO

BACKGROUND: A debate regarding the potential harmful effects of rigid neck collar and backboard usage among prehospital and hospital care providers in Norway provoked the development of an evidence-based guideline. "The Norwegian guideline for the prehospital management of adult trauma patients with potential spinal injury" was developed with rigorous scientific methods and published in 2016. An e-learning course was developed in parallel. The aim of this study is to explore whether emergency medical services personnel in Norway have implemented the guideline, and to what extent the e-learning course was applied during the implementation process. METHOD: An electronic survey was distributed individually to registered prehospital personnel in Norway 18 months after publication of the guideline. RESULTS: In all, 938 of 5500 (17%) EMS personnel responded to the survey. More than one-half confirmed knowledge of the guideline; among these, 56% claimed that the guideline was implemented in the service they work. Not having responded to trauma cases in real life was the main reason for not having executed the guideline. The e-learning course had been completed by 18% of respondents. CONCLUSION: Although the guideline has not been authorized or made compulsory by national authorities, one-half of respondents with knowledge of the guideline reported it as implemented. E-learning did not seem to have affected the implementation. The guideline was developed based on perceived needs among care providers, and this probably facilitated implementation of the guideline.


Assuntos
Serviços Médicos de Emergência , Fidelidade a Diretrizes , Guias de Prática Clínica como Assunto , Traumatismos da Coluna Vertebral/terapia , Adulto , Currículo , Educação a Distância , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Inquéritos e Questionários , Adulto Jovem
6.
Acta Anaesthesiol Scand ; 63(8): 1089-1094, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31074013

RESUMO

BACKGROUND: Finnmark, Northern Norway, had a mortality rate for paediatric injury in 1998-2007 that was more than twice the national average. We investigated whether this rate had decreased in 2008-2015 after improvements in emergency care. We also compared the mortality rate to rates of non-fatal injury and trauma team activation both regionally and in Norway. METHODS: The study was based on 4 national registries. Mortality and injury rates were calculated per 100 000 persons per year. The study population was divided into age groups; 0-5, 6-10, 11-15 and 16-17 years. RESULTS: Between 1998-2007 and 2008-2015 there was an overall decrease in paediatric mortality rate due to external causes in Norway in total from 7.1 to 4.0. Despite this, in 2008-2015, the mortality rate remained 2.5 times higher in Finnmark than in Norway (9.7, RR = 2.5 CI 1.4-4.3, P = 0.001), similar to findings for 1998-2007. Finnmark had half the rate of non-fatal injuries in 1999-2007 (5052, RR = 0.6, 95% CI 0.6-0.7, P < 0.001) and in 2008-2015 (3893, RR = 0.5, 95% CI 0.5-0.6, P < 0.001) as in Norway. The rate of trauma team activation was similar in Finnmark and Norway. CONCLUSIONS: The risk of injury-related death remained significantly higher, while the overall risk of non-fatal injury was significantly reduced for children in rural Northern Norway. Thus, injuries in this rural area seem to be less frequent but more severe. There is a need for detailed examination of each death to determine possible preventive measures.

7.
Tidsskr Nor Laegeforen ; 139(8)2019 05 07.
Artigo em Norueguês | MEDLINE | ID: mdl-31062568
8.
Tidsskr Nor Laegeforen ; 139(7)2019 Apr 09.
Artigo em Norueguês, Inglês | MEDLINE | ID: mdl-30969063

RESUMO

BACKGROUND: Previous studies have shown a high occurrence of injuries and deaths related to the use of snowmobiles and other off-road vehicles in Northern Norway. No public statistics are available to permit monitoring of these findings over time. The objective of our study was to provide new figures for the prevalence of injuries and deaths from the use of snowmobiles and other off-road vehicles, and assess the consistency between different sources of data. MATERIAL AND METHOD: Information on registered deaths and personal injuries requiring hospitalisation in Northern Norway in the period 1 January 2013-31 December 2014 was collected from the police and hospitals. We also searched through open online sources. RESULTS: We found 7 deaths and 87 personal injuries requiring hospitalisation: 13 incidents with ATVs and 81 involving snowmobiles. Median age was 31.5 years, and 41 (44 %) victims were below 30 years of age. All the fatalities and 66 (76 %) of those injured were men. Altogether 42 (45 %) of the incidents had occurred in Finnmark county. Of the seven fatalities, the police found six in their records and the hospitals found two. In searching through open online sources we found one further ATV-related and three snowmobile-related fatalities in the same region and period. INTERPRETATION: No reliable records of fatalities and personal injuries resulting from the use of snowmobiles and ATVs are available. The findings of this study may serve as a reference point for preventive efforts by the police and health services and for purposes of further study.


Assuntos
Acidentes , Veículos Off-Road , Ferimentos e Lesões , Acidentes/mortalidade , Acidentes/estatística & dados numéricos , Adulto , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Polícia , Estatística como Assunto/normas , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/mortalidade , Adulto Jovem
10.
BMJ Open ; 8(11): e023749, 2018 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-30391920

RESUMO

OBJECTIVES: Explore the function of three specific modes of talk (discourse types) in decision-making processes. DESIGN: Ten real-life admissions of patients with critical illness were audio/video recorded and transcribed. Activity-type analysis (a qualitative discourse analytical method) was applied. SETTING: Interdisciplinary emergency teams admitting patients with critical illness in a Norwegian university hospital emergency department (ED). PARTICIPANTS: All emergency teams consisted of at least two internal medicine physicians, two ED nurses, one anaesthetist and one nurse anaesthetist. The number of healthcare professionals involved in each emergency team varied between 11 and 20, and some individuals were involved with more than one team. RESULTS: The three discourse types played significant roles in team decision-making processes when negotiating meaning. Online commentaries (ONC) and metacommentaries (MC) created progression while offline commentaries (OFC) temporarily placed decisions on hold. Both ONC and MC triggered action and distributed tasks, resources and responsibility in the team. OFC sought mutual understanding and created a broader base for decisions. CONCLUSION: A discourse analytical perspective on team talk in medical emergencies illuminates both the dynamics and complexity of teamwork. Here, we draw attention to the way specific modes of talk function in negotiating mutual understanding and distributing tasks and responsibilities in non-algorithm-driven activities. The analysis uncovers a need for an enhanced focus on how language can trigger safe team practice and integrate this knowledge in teamwork training to improve communication skills in ad hoc emergency teams.


Assuntos
Comunicação , Estado Terminal/terapia , Tomada de Decisões , Equipe de Respostas Rápidas de Hospitais , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesiologistas , Enfermagem em Emergência , Serviço Hospitalar de Emergência , Feminino , Processos Grupais , Hospitais Universitários , Humanos , Medicina Interna , Masculino , Pessoa de Meia-Idade , Noruega , Enfermeiras Anestesistas , Enfermeiras e Enfermeiros , Médicos , Pesquisa Qualitativa , Gravação em Vídeo
12.
BMC Emerg Med ; 18(1): 6, 2018 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-29426282

RESUMO

ERRATUM: The original article [1] contains an error whereby all authors' names were mistakenly interchanged. The original article has now been corrected to present the authors' names correctly.

13.
BMC Emerg Med ; 18(1): 4, 2018 01 24.
Artigo em Inglês | MEDLINE | ID: mdl-29368642

RESUMO

BACKGROUND: Major incidents affect us globally, and are occurring with increasing frequency. There is still no evidence-based standard regarding the best medical emergency response to major incidents. Currently, reports on major incidents are non-standardised and variable in quality. This pilot study examines the first systematic reports from a consensus-based, freely accessible database, aiming to identify how descriptive analysis of reports submitted to this database can be used to improve the major incident response. METHODS: Majorincidentreporting.net is a website collecting reports on major incidents using a standardised template. Data from these reports were analysed to compare the emergency response to each incident. RESULTS: Data from eight reports showed that effective triage by experienced individuals and the use of volunteers for transport were notable successes of the major incident response. Inadequate resources, lack of a common triage system, confusion over command and control and failure of communication were reported failures. The following trends were identified: Fires had the slowest times for several aspects of the response and the only three countries to have a single dialling number for all three emergency services had faster response times. Helicopter Emergency Medical services (HEMS) were used for transport and treatment in rural locations and for triage and treatment in urban locations. In two incidents, a major incident was declared before the arrival of the first Emergency Medical Services (EMS) personnel. CONCLUSION: This study shows that we can obtain relevant data from major incidents by using systematic reporting. Though the sample size from this pilot study is not large enough to draw any specific conclusions it illustrates the potential for future analyses. Identified lessons could be used to improve the emergency medical response to major incidents.


Assuntos
Bases de Dados Factuais , Medicina de Desastres/organização & administração , Serviços Médicos de Emergência/organização & administração , Comunicação , Planejamento em Desastres/organização & administração , Humanos , Projetos Piloto , Triagem/organização & administração , Voluntários
14.
Tidsskr Nor Laegeforen ; 138(2)2018 01 23.
Artigo em Norueguês | MEDLINE | ID: mdl-29357624
15.
Tidsskr Nor Laegeforen ; 137(23-24)2017 12 12.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-29231639

RESUMO

BACKGROUND: It is preferred that duty doctors in municipal health services participate in call-outs in emergency situations. The frequency of participation has previously been shown to vary. We wanted to examine the newly qualified doctors' expectations and experiences ­ both before and after the general practice internship ­ of emergency medicine and ambulance call-outs. MATERIAL AND METHOD: All 23 of the interns who were to undertake their general practice internship in Finnmark county in the period 2015­16 answered a questionnaire and participated in a focus group interview before the start of the internship. Twenty-one of the interns participated in the focus group interview after completing the internship. Each doctor took part in two interviews. We analysed the transcripts from the focus group interviews using the grounded theory method. RESULTS: The responses from the questionnaire before the general practice internship showed that the interns felt they needed more training in intravenous cannulation and in teamwork. Their expectations in connection with the challenges of call-outs are best characterised by the core category 'Can I do anything useful?' from the focus groups before the internship. After the internship, however, the core category 'It all went well in the end', was the best fit. Due to short transport times and their knowledge of certain patients, some of the doctors chose not to take part in call-outs. INTERPRETATION: During the general practice internship, the interns were initially anxious about whether they might be superfluous in call-outs, but eventually found their footing in the call-out role. The study shows that there is a need for more practice in certain practical procedures, and that doctors' non-technical skills need to be improved. This can be done through training in team leader roles before the general practice internship.


Assuntos
Serviços Médicos de Emergência , Medicina Geral/educação , Internato e Residência , Papel do Médico/psicologia , Ambulâncias , Atitude do Pessoal de Saúde , Competência Clínica , Grupos Focais , Humanos , Noruega , Equipe de Assistência ao Paciente , Inquéritos e Questionários
16.
Scand J Trauma Resusc Emerg Med ; 25(1): 109, 2017 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-29126452

RESUMO

BACKGROUND: High quality team leadership is important for the outcome of medical emergencies. However, the behavioral marker of leadership are not well defined. The present study investigated frequency of behavioral markers of shared mental models (SMM) on quality of medical management. METHOD: Training video recordings of 27 trauma teams simulating emergencies were analyzed according to team -leader's frequency of shared mental model behavioral markers. RESULTS: The results showed a positive correlation of quality of medical management with leaders sharing information without an explicit demand for the information ("push" of information) and with leaders communicating their situational awareness (SA) and demonstrating implicit supporting behavior. When separating the sample into higher versus lower performing teams, the higher performing teams had leaders who displayed a greater frequency of "push" of information and communication of SA and supportive behavior. No difference was found for the behavioral marker of team initiative, measured as bringing up suggestions to other teammembers. CONCLUSION: The results of this study emphasize the team leader's role in initiating and updating a team's shared mental model. Team leaders should also set expectations for acceptable interaction patterns (e.g., promoting information exchange) and create a team climate that encourages behaviors, such as mutual performance monitoring, backup behavior, and adaptability to enhance SMM.


Assuntos
Comunicação , Serviços Médicos de Emergência , Liderança , Equipe de Assistência ao Paciente/organização & administração , Qualidade da Assistência à Saúde , Feminino , Humanos , Masculino , Modelos Psicológicos , Treinamento por Simulação , Gravação em Vídeo
18.
Scand J Trauma Resusc Emerg Med ; 25(1): 112, 2017 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-29169401

RESUMO

BACKGROUND: Non-operative management of splenic injuries has become the treatment of choice in hemodynamically stable patients over the last decades. The aim of the study is to describe the incidence, initial treatment and early outcome of patients with splenic injuries on a national level. METHODS: All hospitals in Norway admitting trauma patients were invited to participate in the study. The study period was January through December 2013. The hospitals delivered anonymous data on primarily admitted patients with splenic injury. RESULTS: Three of the four regional trauma centers and 26 of the remaining 33 acute care hospitals delivered data on a total of 151 patients with splenic injury indicating an incidence of 4 splenic injuries per 100,000 inhabitants/year, and a median of 4 splenic injuries per hospital per year. A total of 128 (85%) patients were successfully treated non-operatively including 20 patients who underwent an angiographic procedure. The remaining 23 (15%) patients underwent open splenectomy or spleen-preserving surgery. CONCLUSION: Most patients with splenic injuries are managed non-operatively. Despite the low number of splenic injuries per hospital, the results indicate satisfactory outcome on a national level.


Assuntos
Traumatismos Abdominais/terapia , Baço/lesões , Ferimentos não Penetrantes/terapia , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/epidemiologia , Adolescente , Adulto , Angiografia , Embolização Terapêutica , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Admissão do Paciente , Estudos Retrospectivos , Esplenectomia , Centros de Traumatologia , Resultado do Tratamento , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/epidemiologia , Adulto Jovem
20.
Scand J Trauma Resusc Emerg Med ; 25(1): 27, 2017 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-28270170

RESUMO

BACKGROUND: Emergency medical communication centres (EMCCs) dispatch and allocate ambulance resources, and provide first-aid guidance to on-scene bystanders. We aimed to 1) evaluate whether dispatcher guidance improved bystander first aid in trauma, and 2) to evaluate whether dispatchers and on-scene emergency medical services (EMS) crews identified the same first aid measures as indicated. METHODS: For 18 months, the crew on the first EMS crew responding to trauma calls used a standard form to assess bystander first aid. Audio recordings of the corresponding telephone calls from bystanders to the EMCC were reviewed. RESULTS: A total of 311 trauma calls were included. The on-scene EMS crew identified needs for the following first-aid measures: free airway in 26 patients, CPR in 6 patients, and hypothermia prevention in 179 patients. EMCC dispatchers advised these measures, respectively, in 16 (62%), 5 (83%), and 54 (30%) of these cases. Dispatcher guidance was not correlated with correctly performed bystander first aid. For potentially life saving first aid measures, all (20/20) callers who received dispatcher guidance attempted first aid, while only some few (4/22) of the callers who did not receive dispatcher guidance did not attempt first aid. DISCUSSION: Overall, the EMCC dispatchers had low sensitivity and specificity for correctly identifying trauma patients requiring first-aid measures. Dispatcher guidance did not significantly influence whether on-scene bystander first aid was performed correctly or attempted in this study setting, with a remarkably high willingness to perform first-aid. However, the findings for potentially lifesaving measures suggests that there may be differences that this study was unable to detect. CONCLUSION: This study found a high rate of first-aid willingness and performance, even without dispatcher prompting, and a low precision in dispatcher advice. This underlines the need for further knowledge about how to increase EMCC dispatchers' possibility to identify trauma patients in need of first aid. The correlation between EMCC-guidance and bystander first aid should be investigated in study settings with lower spontaneous first-aid rates.


Assuntos
Operador de Emergência Médica , Sistemas de Comunicação entre Serviços de Emergência , Primeiros Socorros/normas , Comportamento de Ajuda , Ferimentos e Lesões/terapia , Humanos , Estudos Prospectivos , Gravação de Fita
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