Scandinavian Journal of Trauma Resuscitation & Emergency Medicine最新文献

{"title":"The effectiveness and perceived value of feedback used in cardiac arrest simulation education: a mixed-method systematic review.","authors":"Rachael Vella, Elise Baker, Kristin Akerjordet, Liz Thyer","doi":"10.1186/s13049-025-01456-6","DOIUrl":"https://doi.org/10.1186/s13049-025-01456-6","url":null,"abstract":"<p><strong>Objectives: </strong>This review evaluated the effectiveness and perceived value of feedback methods in cardiac arrest simulation-based education for healthcare, nursing, medical students and professionals.</p><p><strong>Methods: </strong>A mixed-method systematic review was conducted, incorporating quantitative, qualitative, and mixed-method studies on feedback provided before, during, or after cardiac arrest simulations. Studies focusing on non-cardiac arrest simulations, not focusing on feedback outcomes, or reporting on real cardiac arrest experiences were excluded. A convergent integrated approach to data synthesis was used, with quantitative findings \"qualitised\" and a qualitative content analysis providing a narrative synthesis.</p><p><strong>Results: </strong>Out of 3455 articles screened, 203 were assessed for eligibility, and 160 were included (154 quantitative, 3 qualitative, 3 mixed method). Three themes emerged regarding feedback effectiveness and value in cardiac arrest simulation education. All feedback, whether human or device-based, improves performance. However, objective, device-based feedback is preferred. Current literature primarily focuses on technical skills measured by quantitative methods, with limited research on non-technical aspects and qualitative explorations of participant experiences.</p><p><strong>Conclusion: </strong>Feedback in cardiac arrest simulation education is just as important as the simulation itself and should align with the learner's educational objectives. There is a notable underreporting of integral non-technical aspects of cardiac arrest management and the use of appropriate use of qualitative methodologies to investigate them. To gain the necessary insights into both the technical and non-technical skill acquisition recommended in resuscitation guidelines, future research needs to integrate quantitative and qualitative approaches.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"164"},"PeriodicalIF":3.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Staff Observation Aggression Scale - Revised for Ambulance Services (SOAS-RA).","authors":"May Elin Juliusdatter Haug, Elisabeth Haug, Roger Almvik, Tom Palmstierna, Hege Skundberg-Kletthagen","doi":"10.1186/s13049-025-01472-6","DOIUrl":"10.1186/s13049-025-01472-6","url":null,"abstract":"<p><strong>Introduction: </strong>Ambulance personnel frequently encounter aggression in dynamic and unpredictable environments. Despite growing awareness of workplace violence in healthcare, few validated tools exist for systematic documentation in ambulance services.</p><p><strong>Objective: </strong>This study aimed to adapt and validate the Staff Observation Aggression Scale - Revised (SOAS-R) for use in ambulance services (SOAS-RA), and to examine the relationship between SOAS-RA severity scores and staff's subjective perceptions of incident severity using a Visual Analogue Scale (VAS).</p><p><strong>Methods: </strong>Using a modified Delphi method, a panel of ambulance professionals adapted the SOAS-R to the ambulance service context. Data were collected from 34 ambulance stations across Norway using paper-based SOAS-RA forms. A total of 402 reports were submitted, with 302 including valid VAS scores. Descriptive and inferential statistical analyses examined associations between objective severity scores (SOAS-RA) and subjective ratings (VAS).</p><p><strong>Results: </strong>SOAS-RA total scores showed a small to moderate correlation with VAS ratings (r = 0.350, p < 0.001). The strongest predictor of perceived severity was \"consequences for the victim\" (β = 0.274, p < 0.001), followed by \"means used by the aggressor\" (β = 0.180, p < 0.001). Female staff rated incidents as more severe than male staff (p = 0.030), despite similar SOAS-RA scores.</p><p><strong>Conclusions: </strong>The SOAS-RA, combined with VAS, may serve as a valid, context-sensitive tool for documenting aggression in ambulance services. Future research should explore broader implementation and digital integration to enhance usability, data quality, and support organizational learning.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"163"},"PeriodicalIF":3.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12512913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"War-related traumatic brain injury in Gaza: a multi-center prospective analysis of patterns and outcomes.","authors":"Baker Abojarad, Ahmed J H Elhissi, Belal Aldabbour","doi":"10.1186/s13049-025-01477-1","DOIUrl":"10.1186/s13049-025-01477-1","url":null,"abstract":"<p><strong>Background: </strong>Since October 2023, the Gaza War has caused thousands to suffer from war-related traumatic brain injuries (TBIs) amid the collapse of Gaza's healthcare system. Little is known about the epidemiology and outcomes of TBI in such severely resource-limited settings.</p><p><strong>Methods: </strong>We conducted a prospective cohort study at the two largest neurosurgical centers in the southern Gaza Strip from July 15, 2024, to January 19, 2025. Patients with war-related TBI were enrolled consecutively and followed for 30 days after admission. Data were collected on demographics, clinical presentation, imaging findings, interventions, complications, and outcomes. The primary outcome was 30-day mortality, while secondary outcomes included the neurological status at discharge and complications.</p><p><strong>Results: </strong>A total of 244 patients were included, with a median age of 21 years, and 74.5% were males. The 30-day mortality rate was 26.2%. Severe TBI (GCS ≤ 8) at admission was associated with a higher mortality compared to mild and moderate TBI (p < 0.001). Non-survivors had significantly higher rates of multilobar and bilateral injuries, subdural and intraventricular hemorrhages, midline shifts, and effaced basal cisterns. Among survivors (n = 180), 27.2% experienced neurological deficits at discharge, most commonly motor impairment and aphasia. Neurological deficits were linked to penetrating injuries, multilobar involvement, midline shifts, and ≥ 3 shrapnel fragments on imaging. Complication rates were generally low but higher among individuals with neurological impairments. Multivariate regression analysis showed that TBI severity (moderate: aRR = 7.05, 95% CI: 2.32-14.23; severe: aRR = 9.91, 95% CI: 4.56-18.64), older age (aRR = 1.02 per year, 95% CI: 1.01-1.03), brain matter extrusion (aRR = 2.24, 95% CI: 1.06-4.70), intraventricular hemorrhage (aRR = 2.38, 95% CI: 1.39-4.03), and subdural hemorrhage (aRR = 1.90, 95% CI: 1.30-4.03) were significant predictors of 30-day mortality.</p><p><strong>Conclusion: </strong>In this cohort of war-related TBI patients in Gaza, mortality was significantly linked to admission GCS, age, brain matter extrusion, IVH, and SDH. The study highlights how resource-limited, conflict-driven healthcare disruptions impact TBI outcomes and emphasizes the need to strengthen neurosurgical capacity, emergency response systems, and rehabilitation efforts in such environments.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"162"},"PeriodicalIF":3.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12512489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival and cost-effectiveness of helicopter versus ground emergency medical services: a systematic review and meta-analysis with meta-regression and trial sequential analysis.","authors":"Daniele Orso, Luca Flaibani, Ugo Giulio Sisto, Marco Bonsano, Federico Fonda, Rocco Pangallo, Tiziana Bove","doi":"10.1186/s13049-025-01478-0","DOIUrl":"10.1186/s13049-025-01478-0","url":null,"abstract":"<p><strong>Objective: </strong>To synthesise the available literature comparing outcomes of ground emergency medical services (GEMS) and helicopter emergency medical services (HEMS).</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis, reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from 1995 to 2024. Studies comparing HEMS with GEMS in emergency conditions were eligible.</p><p><strong>Results: </strong>The search retrieved 1,595 records; 181 studies were assessed in full text, and 77 were included, accounting for a pooled population of 2,618,483 patients. The relative risk (RR) of mortality in HEMS compared with GEMS was 1.13 (95% CI 0.96-1.34). The RR of disability was 1.24 (95% CI 0.99-1.55). The total incremental net benefit was €980,000 per QALY per patient, based on cost-effectiveness studies and a willingness-to-pay threshold of €35 million per QALY per patient.</p><p><strong>Conclusion: </strong>Very low-quality evidence, due to high heterogeneity, potential confounding from registry-based enrolment, and possible multiple imputation bias, suggested that HEMS did not improve survival compared with GEMS. High-quality studies are needed to further investigate this question.</p><p><strong>Clinical trial registration: </strong>PROSPERO: International prospective register of systematic reviews, 2024, CRD42024628317.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"160"},"PeriodicalIF":3.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Silent crisis on the frontlines: a systematic review of suicidal behaviors among disaster responders - epidemiology, risk pathways, and evidence-based interventions.","authors":"Shandiz Moslehi, Asghar Tavan, Mehdi Khezeli, Samira Soleimanpour, Sajjad Narimani","doi":"10.1186/s13049-025-01479-z","DOIUrl":"10.1186/s13049-025-01479-z","url":null,"abstract":"<p><strong>Background: </strong>First responders (including paramedics, firefighters, police, and dispatchers) experience significantly elevated suicide risk due to repeated trauma exposure, high rates of PTSD and depression, and systemic barriers to mental healthcare. This systematic review examines (1) suicide prevalence, (2) psychological and occupational risk factors, and (3) interventions across different emergency service roles and global contexts.</p><p><strong>Method: </strong>This study rigorously adhered to the PRISMA guidelines in conducting a systematic and comprehensive analysis of 24 peer-reviewed studies (up to February 2025), meticulously sourced from PubMed, Scopus, Web of Science, and Embase. Only studies providing unique qualitative or quantitative insights into Suicidal Behaviors Among Disaster Responders were included. The extracted data was meticulously examined using advanced thematic analysis and robust descriptive statistics, ensuring a deep, evidence-based exploration of this critical issue.</p><p><strong>Results: </strong>The systematic analysis of 24 studies revealed four critical categories shaping suicidal behaviors among disaster responders: (1) Epidemiology and Prevalence, highlighting elevated risks in firefighters and EMS personnel; (2) Psychological and Occupational Risk Factors, including PTSD, depression, and workplace burnout; (3) Systemic and Cultural Barriers, such as stigma and rural access gaps; and (4) Interventions and Solutions, demonstrating efficacy in trauma-focused therapies, peer support, and policy reforms like Houston's zero-suicide program. Thematic synthesis underscored the interplay of individual vulnerabilities and structural failures, urging integrated, occupation-specific prevention strategies.</p><p><strong>Conclusion: </strong>Effective prevention requires integrated clinical interventions (trauma-focused therapies), organizational reforms (routine screenings), and cultural shifts (destigmatization).</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"161"},"PeriodicalIF":3.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating GPT-4o for emergency disposition of complex respiratory cases with pulmonology consultation: a diagnostic accuracy study.","authors":"Cem Yıldırım, Ahmet Aykut, Ertuğ Günsoy, Mehmet Veysel Öncül","doi":"10.1186/s13049-025-01475-3","DOIUrl":"10.1186/s13049-025-01475-3","url":null,"abstract":"<p><strong>Background: </strong>Large Language Models (LLMs), such as GPT-4o, are increasingly investigated for clinical decision support in emergency medicine. However, their real-world performance in disposition prediction remains insufficiently studied. This study evaluated the diagnostic accuracy of GPT-4o in predicting ED disposition-discharge, ward admission, or ICU admission-in complex emergency respiratory cases requiring pulmonology consultation and chest CT, representing a selective high-acuity subgroup of ED patients.</p><p><strong>Methods: </strong>We conducted a retrospective observational study in a tertiary ED between November 2024 and February 2025. We retrospectively included ED patients with complex respiratory presentations who underwent pulmonology consultation and chest CT, representing a selective high-acuity subgroup rather than the general ED respiratory population. GPT-4o was prompted to predict the most appropriate ED disposition using three progressively enriched input models: Model 1 (age, sex, oxygen saturation, home oxygen therapy, and venous blood gas parameters); Model 2 (Model 1 plus laboratory data); and Model 3 (Model 2 plus chest CT findings). Model performance was assessed using accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F1 score.</p><p><strong>Results: </strong>Among the 221 patients included, 69.2% were admitted to the ward, 9.0% to the intensive care unit (ICU), and 21.7% were discharged. For hospital admission prediction, Model 3 demonstrated the highest sensitivity (91.9%) and overall accuracy (76.5%), but the lowest specificity (20.8%). In contrast, for discharge prediction, Model 3 achieved the highest specificity (91.9%) but the lowest sensitivity (20.8%). Numerical improvements were observed across models, but none reached statistical significance (all p > 0.22). Model 1 therefore performed comparably to Models 2-3 while being less complex. Among patients who were discharged despite GPT-4o predicting admission, the 14-day ED re-presentation rates were 23.8% (5/21) for Model 1, 30.0% (9/30) for Model 2, and 28.9% (11/38) for Model 3.</p><p><strong>Conclusion: </strong>GPT-4o demonstrated high sensitivity in identifying ED patients requiring hospital admission, particularly those needing intensive care, when provided with progressively enriched clinical input. However, its low sensitivity for discharge prediction resulted in frequent overtriage, limiting its utility for autonomous decision-making. This proof-of-concept study demonstrates GPT-4o's capacity to stratify disposition decisions in complex respiratory cases under varying levels of limited input data. However, these findings should be interpreted in light of key limitations, including the selective high-acuity cohort and the absence of vital signs, and require prospective validation before clinical implementation.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"159"},"PeriodicalIF":3.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient and mission characteristics of helicopter emergency medical services in the Republic of Ireland: a retrospective analysis.","authors":"D Hennelly, S Masterson, C O'Donnell, P A Jennings, S McHugh, R Quinn, C Deasy","doi":"10.1186/s13049-025-01459-3","DOIUrl":"10.1186/s13049-025-01459-3","url":null,"abstract":"<p><strong>Background: </strong>The National Ambulance Service (NAS) has operated a Paramedic-staffed Helicopter Emergency Medical Services (HEMS) in the Republic of Ireland since 2012. This study describes patient and mission characteristics, to provide insight into this service and inform future service development.</p><p><strong>Methods: </strong>A nationwide population-based retrospective study of HEMS missions was conducted from routinely collected health data over an 11- year period between 1 July 2012 and 30 June 2023.</p><p><strong>Results: </strong>In the study period HEMS in Ireland received 8,392 mission requests, Patient contact occurred in 60.1% of missions (n = 5,045) and 73.4% (n = 3703) were airlifted to hospital. Adults represented 90.3% (n = 4,535) of patients, predominantly male at 69.1%, with a median age of 55 years (IQR: 34 years) [35:69]. Medical patients accounted for 50.3% (n = 2,524), cardiac aetiologies (32.3%) and out of hospital cardiac arrest (OHCA) (30.3%) were the most common medical presentation. Trauma patients account for 49.7% (n = 2,498). Road Traffic Collisions (RTCs) (31.4%) followed by farming and machinery incidents (17.4%) were the most common trauma presentation. HEMS teams significantly reduced pain in both trauma (ꭕ² = 680, p < .001) and medical cases (ꭕ² = 186.13, p < .001) during the care provided. The majority 73.1% (n = 6133) of total missions were conducted within a 20 min flight time radius of the HEMS base.</p><p><strong>Conclusions: </strong>Over the past decade, HEMS in Ireland has provided a valuable contribution to the care of seriously ill and injured patients, particularly in the west and southwest. Service use reflects HEMS base proximity, indicating potential benefits from geographic expansion. Current activation criteria appears to target an appropriate patient cohort, however sustained reassessment of dispatch criteria and hours of operation may enhance service availability. Continued development should focus on adopting evidence based-practices and advancing critical care capacity to align with international HEMS standards.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"158"},"PeriodicalIF":3.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Soundwaves of innovation: a qualitative exploration of POCUS in Australasian ambulance and retrieval services.","authors":"Jake Donovan, Kelly-Ann Bowles, Brendan Shannon, David Anderson, Samuel Burton, Benjamin Meadley","doi":"10.1186/s13049-025-01471-7","DOIUrl":"10.1186/s13049-025-01471-7","url":null,"abstract":"<p><strong>Objectives: </strong>Point-of-Care Ultrasound (POCUS) represents an advancement in diagnostic ability and procedural success for paramedics in out-of-hospital settings. Despite its potential to rapidly identify life-threatening conditions and improve patient management, the adoption of POCUS faces multiple challenges, including the need for standardized training, credentialing, and robust governance. This study aims to evaluate the current use of POCUS by paramedics in Australasia, focusing on training, credentialing, governance, and auditing systems. It also explores the main barriers and facilitators that influence its effective integration and operational effectiveness in out-of-hospital environments.</p><p><strong>Methods: </strong>This qualitative study utilized reflexive thematic analysis following Braun and Clarke's methodology to capture deep insights into POCUS usage. Participants included medical directors and clinical leads from jurisdictional ambulance services and retrieval services across Australasia. They were selected via purposive sampling and interviewed using semi-structured techniques, which allowed for an in-depth exploration of their experiences and perceptions related to POCUS.</p><p><strong>Results: </strong>Four major themes were identified: (1) Pillars of POCUS: highlighting the necessity of robust governance, education, and infrastructure for effective POCUS programs; (2) System Buy-In: emphasizing the need for medical and institutional support to maximize the benefits of POCUS; (3) Culture Change in Paramedicine: discussing the shifts required in paramedic practices and attitudes towards adopting new diagnostic technologies; and (4) What's the Worth: evaluating the cost-effectiveness and value of POCUS in the face of budget constraints and its potential to improve patient outcomes.</p><p><strong>Conclusions: </strong>The study underscores significant disparities in POCUS training and a lack of standardized governance across Australasian services, which are major impediments to its adoption. Additionally, financial considerations and the perceived value of POCUS impact its acceptance and expansion. To fully leverage the capabilities of POCUS in enhancing paramedic practice, development of comprehensive, standardized frameworks addressing these challenges is essential. Future efforts should focus on demonstrating the economic and clinical benefits of POCUS to support its widespread adoption in emergency medical services.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"157"},"PeriodicalIF":3.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital locoregional anesthesia: a case series.","authors":"Lorenzo Vizzolo, Cédric Luyet, Pierre Metrailler, Alexandre Moser","doi":"10.1186/s13049-025-01460-w","DOIUrl":"10.1186/s13049-025-01460-w","url":null,"abstract":"<p><strong>Background: </strong>Standard prehospital pain management relies on opioids, which involved avoidable risks. Few studies have evaluated pre-hospital locoregional anesthesia (LRA), especially fascia iliaca compartment blocks (FICB) and femoral nerve blocks (FB). We aimed to analyze the safety and opioid sparing potential of LRA in a Swiss alpine Helicopter Emergency Medical Service (HEMS).</p><p><strong>Methods: </strong>Retrospective analysis over 36 months. Variables recorded included type of block, ultrasound guidance, provider training, injury mechanism, diagnosis, patient data, on site time, pain scores evolution, complementary medication before/after LRA and complications. Descriptive statistics and non-parametric test were used.</p><p><strong>Results: </strong>Twenty-eight procedures were performed (0.26% of all missions): 25 FICB (89.3%) and 3 FB (10.7%). Ultrasound was used in 21.4% of cases (12% of FICBs, 100% of FBs). Ski accidents accounted for 64,3% and femoral diaphyseal fracture was suspected in 82,1%. Eight missions required hoisting, one terrestrial evacuation. Sixty percent 60.0% of blocs were performed by non-anesthesiologist. Only lidocaine 1% was used. Time on site was similar with or without ultrasound (p = 0.25). Pain score documentation (NRS) was incomplete in 50% but scores significantly decreased after LRA (p < 0.001). The need for complementary analgesic and or sedative was reduced (p = 0.025). Fentanyl use significantly decreased (p = 0.028), midazolam and ketamine did not (p = 0.16 and 0.56). No complications were documented.</p><p><strong>Conclusions: </strong>LRA appears effective and safe in prehospital (alpine) settings, providing substantial pain relief and reducing fentanyl use. Further studies are needed to investigate whether LRA protocols could reduce opioid-related morbidity and mortality.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"153"},"PeriodicalIF":3.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of norepinephrine in shockable cardiac arrest, a scoping review.","authors":"S J M Bouman, E Baldussu, G H L M Franssen, G J van Geffen, J Bruhn, C Slagt, L P W Mommers","doi":"10.1186/s13049-025-01480-6","DOIUrl":"10.1186/s13049-025-01480-6","url":null,"abstract":"<p><strong>Background: </strong>Out-of-hospital cardiac arrest is considered a major public health issue with an incidence of 67-170 per 100.000 inhabitants in Europe. Sufficient coronary perfusion pressure is a requisite for successful defibrillation and return of spontaneous circulation (ROSC). Although epinephrine (E) was found to increase ROSC and hospital survival when compared to placebo, its role in shockable arrest is under debate due to the absence of favorable neurological outcome.</p><p><strong>Objective: </strong>Norepinephrine (NE) increases coronary perfusion pressure and may be an alternative for epinephrine because of differences in affinity in alpha- and beta- adrenergic receptors.</p><p><strong>Methods: </strong>An extensive literature search was conducted in PreMedline, Medline, Embase and Cochrane electronic databases. All original studies (randomized controlled trials, experimental and observational studies, including case-reports) were included; guidelines, (editorial) reviews and commentaries were excluded, no date constraints were applied. Articles were included in the literature review if they described intra-arrest administration of norepinephrine and contained at least an abstract in English, French, or German.</p><p><strong>Results: </strong>A total of 3308 articles were screened after deduplication. Following initial title/ abstract screening, full-texts analysis was performed in n = 46 studies. A total of 18 articles were included, consisting of 5 human and 13 animal studies. Norepinephrine appears to optimize macrocirculatory-and myocardial hemodynamics, increased regional cerebral blood flow and might improve survival.</p><p><strong>Conclusion: </strong>Norepinephrine has shown several beneficial effects when administered during shockable cardiac arrest in animal studies, with similar signals suggested in human studies. Despite the limited evidence, norepinephrine appears to offer potential advantages over epinephrine in terms of multiple haemodynamic parameters and possible survival.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"155"},"PeriodicalIF":3.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}