Incidence of desaturation during prehospital rapid sequence intubation in a physician-based helicopter emergency service.

BACKGROUND: Hypoxemia may occur during rapid sequence intubation (RSI). This study establishes the incidence of this adverse event in patients intubated by physicians in a helicopter emergency service in Norway. METHODS: This was a prospective, observational study of all RSIs performed by helicopter emergency service physicians during a 12-month period. Hypoxemia was defined as a decrease in Spo(2) values to below 90% or a decrease of more than 10% if the initial Spo(2) was less than 90%. RESULTS: A total of 122 prehospital intubations were performed during the study period. Spo(2) data were available for 101 (82.8%) patients. Hypoxemia was present in 11 (10.9%) patients. CONCLUSIONS: Prehospital, RSI-related hypoxemia rates in this study are lower than reported rates in similar studies and are comparable with in-hospital rates. Prehospital RSI may accordingly be considered a safe procedure when performed by experienced physicians with appropriate field training.

Landing sites and intubation may influence helicopter emergency medical services on-scene time.

BACKGROUND: Reduced transport time of patients from the scene of an accident to definitive surgical treatment is one important reason to employ ambulance helicopters on trauma missions. However, if the helicopter is unable to land close to the scene, the transport time may be increased compared to transport with ground ambulance, due to time-consuming transfer of the patient between vehicles. OBJECTIVE: The objective of this study was to evaluate how the landing site, as determined by distance from the scene, and rapid sequence intubation (RSI) affected on-scene time (OST). METHODS: This was a prospective observational study performed during a 12-month period in a mixed urban and rural anesthesiologist-staffed Helicopter Emergency Medical Service in Norway. Data regarding the landing sites, the accident, and patient treatment were recorded. RESULTS: A total of 252 primary trauma missions were included in the study. In 75% of the missions, the aircraft landed<50 meters from the scene, and in 7% the distance exceeded 200 meters. Mean OST when the patient was not intubated was 14.5 min (median 14 min). When an RSI was performed, the mean OST was significantly higher (22.7 min, median 20 min; p<0.001). CONCLUSION: Usually, a helicopter can land close to the accident scene and the location of the landing site does not contribute to a delay in arrival of the patient at the hospital. The OST is significantly higher, however, in those patients who receive endotracheal intubation before take-off. This reflects the time needed for intubation, as well as the increased complexity and workload when the patient is severely injured.

Assessment of radionuclide and metal contamination in a thorium rich area in Norway.

The Fen Central Complex in southern Norway, a geologically well investigated area of magmatic carbonatite rocks, is assumed to be among the world largest natural reservoirs of thorium ((232)Th). These rocks, also rich in iron (Fe), niobium (Nb), uranium ((238)U) and rare earth elements (REE), were mined in several past centuries. Waste locations, giving rise to enhanced levels of both radionuclides and metals, are now situated in the area. Estimation of radionuclide and metal contamination of the environment and radiological risk assessment were done in this study. The average outdoor gamma dose rate measured in Fen, 2.71 µGy h(-1), was significantly higher than the world average dose rate of 0.059 µGy h(-1). The annual exposure dose from terrestrial gamma radiation, related to outdoor occupancy, was in the range 0.18-9.82 mSv. The total activity concentrations of (232)Th and (238)U in soil ranged from 69 to 6581 and from 49 to 130 Bq kg(-1), respectively. Enhanced concentrations were also identified for metals, arsenic (As), lead (Pb), chromium (Cr) and zinc (Zn), in the vicinity of former mining sites. Both radionuclide and heavy metal concentrations suggested leaching, mobilization and distribution from rocks into the soil. Correlation analysis indicated different origins for (232)Th and (238)U, but same or similar for (232)Th and metals As, Cr, Zn, nickel (Ni) and cadmium (Cd). The results from in situ size fractionation of water demonstrated radionuclides predominately present as colloids and low molecular mass (LMM) species, being potentially mobile and available for uptake in aquatic organisms of Norsjø Lake. Transfer factors, calculated for different plant species, showed the highest radionuclide accumulation in mosses and lichens. Uptake in trees was, as expected, lower. Relationship analysis of (232)Th and (238)U concentrations in moss and soil samples showed a significant positive linear correlation.

The influence of meteorological parameters on soil radon levels in permeable glacial sediments.

The influence of meteorological parameters on soil radon concentrations in a permeable ice-marginal deposit in Kinsarvik, Norway, was investigated based on continuous measurements of soil radon concentrations, temperature, precipitation, wind speed, wind direction, air pressure and soil moisture content over a period of 10 months. The results show that the soil radon concentrations exhibit distinct seasonal and diurnal variations that predominantly are caused by changes in air temperature. Air flows between areas of different elevation occur in the ice-marginal deposit due to temperature differences between soil air and atmospheric air, and instantaneous changes in air flow direction were recorded when the atmospheric air temperature reached the average annual air temperature. Air pressure was found to be the second most important parameter influencing soil radon concentrations, while no apparent effect of precipitation, wind speed, wind direction or soil moisture was observed. Seasonal variations in indoor and soil radon levels were also investigated in a glaciofluvial deposit located 40 km southwest of Kinsarvik, and the close correlation between the seasonal variation patterns observed in the two areas suggests that the results of the Kinsarvik study also might be applicable to other areas of highly permeable building grounds where differences in terrain elevation exist.

Large-scale radon hazard evaluation in the Oslofjord region of Norway utilizing indoor radon concentrations, airborne gamma ray spectrometry and geological mapping.

We test whether airborne gamma ray spectrometer measurements can be used to estimate levels of radon hazard in the Oslofjord region of Norway. We compile 43,000 line kilometres of gamma ray spectrometer data from 8 airborne surveys covering 10,000 km2 and compare them with 6326 indoor radon measurements. We find a clear spatial correlation between areas with elevated concentrations of uranium daughters in the near surface of the ground and regions with high incidence of elevated radon concentrations in dwellings. This correlation permits cautious use of the airborne data in radon hazard evaluation where direct measurements of indoor radon concentrations are few or absent. In radon hazard evaluation there is a natural synergy between the mapping of radon in indoor air, bedrock and drift geology mapping and airborne gamma ray surveying. We produce radon hazard forecast maps for the Oslofjord region based on a spatial union of hazard indicators from all four of these data sources. Indication of elevated radon hazard in any one of the data sets leads to the classification of a region as having an elevated radon hazard potential. This approach is inclusive in nature and we find that the majority of actual radon hazards lie in the assumed elevated risk regions.

[A 54-year old man with severe circulatory collapse]. / En 54 år gammel mann med alvorlig sirkulasjonssvikt.

The frequent use of mechanical circulatory assistive devices in the treatment of patients in cardiogenic shock increases the need for advanced air and ground transport services. In this article we describe a critically ill patient with acute myocardial infarction. He was treated with intraaortic balloon pump at the local hospital before transfer to a university hospital by air. Close cooperation between the university hospital, the Norwegian Air Ambulance and the Norwegian aviation authorities has facilitated this service.

Should radon be reduced in homes? A cost-effect analysis.

BACKGROUND: Radon is a radioactive gas that may leak into buildings from the ground. Radon exposure is a risk factor for lung cancer. An intervention against radon exposure in homes may consist of locating homes with high radon exposure (above 200 Bq m(-3)) and improving these, and protecting future houses. The purpose of this paper is to calculate the costs and the effects of this intervention. METHODS: We performed a cost-effect analysis from the perspective of the society, followed by an uncertainty and sensitivity analysis. The distribution of radon levels in Norwegian homes is lognormal with mean = 74.5 Bq m(-3), and 7.6% above 200 Bq m(-3). RESULTS: The preventable attributable fraction of radon on lung cancer was 3.8% (95% uncertainty interval: 0.6%, 8.3%). In cumulative present values the intervention would cost $238 (145, 310) million and save 892 (133, 1981) lives; each life saved costs $0.27 (0.09, 0.9) million. The cost-effect ratio was sensitive to the radon risk, the radon exposure distribution, and the latency period of lung cancer. Together these three parameters explained 90% of the variation in the cost-effect ratio. CONCLUSIONS: The uncertainty in the estimated cost per life is large, mainly due to uncertainty in the risk of lung cancer from radon. Based on estimates from road construction, the Norwegian society has been willing to pay $1 million to save a life. This is above the upper uncertainty limit of the cost per life. The intervention against radon in homes, therefore, seems justifiable.

Oslo government district bombing and Utøya island shooting July 22, 2011: the immediate prehospital emergency medical service response.

BACKGROUND: On July 22, 2011, a single perpetrator killed 77 people in a car bomb attack and a shooting spree incident in Norway. This article describes the emergency medical service (EMS) response elicited by the two incidents. METHODS: A retrospective and observational study was conducted based on data from the EMS systems involved and the public domain. The study was approved by the Data Protection Official and was defined as a quality improvement project. RESULTS: We describe the timeline and logistics of the EMS response, focusing on alarm, dispatch, initial response, triage and evacuation. The scenes in the Oslo government district and at Utøya island are described separately. CONCLUSIONS: Many EMS units were activated and effectively used despite the occurrence of two geographically separate incidents within a short time frame. Important lessons were learned regarding triage and evacuation, patient flow and communication, the use of and need for emergency equipment and the coordination of helicopter EMS.