Scandinavian Journal of Trauma Resuscitation & Emergency Medicine最新文献

{"title":"Explainable transfer learning ensemble AI model for lung ultrasound pneumothorax detection with expert benchmark.","authors":"Gábor Orosz, Róbert Zsolt Szabó, Marcell Szabó, Pál Gyombolai, József T Tóth, Tamás Ruttkay, Tamás Ferenci, Tamás Ungi, Gábor Fichtinger, Tamás Haidegger","doi":"10.1186/s13049-026-01614-4","DOIUrl":"https://doi.org/10.1186/s13049-026-01614-4","url":null,"abstract":"<p><strong>Background: </strong>Lung ultrasound is essential for rapid, radiation-free bedside pneumothorax diagnosis but limited by variability in human interpretation. Key gaps include insufficiently large and diverse human datasets, inconsistent image acquisition, lack of rigorous expert benchmarking, and inadequate clinical interpretability of existing artificial intelligence models. We aimed to develop and validate a robust, explainable artificial intelligence (AI) ensemble model addressing these critical gaps.</p><p><strong>Methods: </strong>With our multidisciplinary team, we developed an explainable soft-voting ensemble model trained on 1,856 diverse ultrasound clips from critically ill patients, healthy volunteers, and tailored cadaver models. Model interpretability was ensured using visualization, with heatmaps validated by expert clinicians. The model's diagnostic performance was rigorously benchmarked against 11 experienced clinicians using an independent, balanced test set. Statistical analyses included sensitivity, specificity and inter-rater reliability.</p><p><strong>Results: </strong>The ensemble model achieved 100% sensitivity (95% CI: 85·8%-100·0%) and 100% specificity (95% CI: 85·8%-100·0%), surpassing expert sensitivity and specificity. Diagnostic performance of experts significantly differed by ultrasound mode, with notably lower specificity in M-mode imaging (p < 0·001). The AI consistently maintained perfect sensitivity and significantly reduced false positives compared to clinicians across all conditions, including challenging diagnostic scenarios (e.g., subtle pleural motions), and showed excellent generalizability to both cadaveric and clinical cases.</p><p><strong>Conclusions: </strong>Our explainable AI ensemble robustly matches the consensus-level performance of an expert \"committee,\" significantly reducing diagnostic variability and false-positive diagnoses. This AI tool can serve as a critical second reader, standardize clinical decisions at the bedside, and substantially improve patient safety.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718807","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":"Assessment of clinical and logistical contribution in a Norwegian helicopter emergency medical service using integrated data: a retrospective observational study.","authors":"Lars E Næss, Oddvar Uleberg, Andreas Asheim, Andreas Krüger, Eivinn Skjærseth, Ole Erik Ulvin, Jostein Dale, Rune Sætre, Helge Haugland","doi":"10.1186/s13049-026-01615-3","DOIUrl":"https://doi.org/10.1186/s13049-026-01615-3","url":null,"abstract":"<p><strong>Background: </strong>Physician‑staffed Helicopter Emergency Medical Services (HEMS) provide advanced pre‑hospital care, rapid transfer to hospital, and access to remote areas. These services are costly with limited capacity; therefore, their value depends on meaningful patient benefit. Although clinical and logistical capabilities are essential for selected patient groups, no unified measure of service benefit exists. In 2017 an international expert panel proposed a set of quality indicators (QIs) for Physician‑Staffed Emergency Medical Services (P‑EMS). Since 2021 the Trondheim HEMS has used these QIs to assess clinical and logistical contribution in completed missions. This study aims to describe these contribution assessments and relate them with descriptive data and established severity measures from integrated Emergency Medical Services (EMS) and hospital data.</p><p><strong>Methods: </strong>Physician‑reported assessments of clinical and logistical contribution from Trondheim HEMS (2022-2024) were linked with data from the Emergency Medical Communication Centre, HEMS records and hospital records. Contribution assessments and mission characteristics were examined using descriptive statistics. Associations and convergence between contribution assessments, severity measures and patient characteristics were explored using multivariable regression models.</p><p><strong>Results: </strong>HEMS contribution was assessed for 2,286 missions. Of these, 1,696 (74%) were judged as beneficial, including 1,173 (51%) with logistical contribution and 897 (39%) with clinical contribution, with an overlap of 374 missions (16%) showing both. Logistical contribution was associated with conditions requiring rapid transfer to definitive treatment, while clinical contribution was associated with potentially critical diagnoses, higher severity scores, higher mortality rates, and greater hospital utilisation. Retrospectively, 590 missions (26%) were classified as having no contribution, more often involving younger patients and potentially critical but uncertain conditions.</p><p><strong>Conclusions: </strong>Across three years of retrospective physician‑reported assessments, three quarters of HEMS missions were retrospectively considered beneficial, reflecting approximately 50 percent logistical contribution and 40 percent clinical contribution, with a 16 percent overlap. The remaining 26 percent were viewed as not beneficial. Assessments of relative contributions varied between physicians suggests differing interpretations of the criteria, highlighting the need to strengthen a shared understanding of the underlying concepts.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718814","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":"Chest X-Ray evaluation using GPT for tube thoracostomy or conservative care in non-tension spontaneous pneumothorax.","authors":"Ertuğ Günsoy, Ahmet Aykut, Cem Yıldırım, Mehmet Veysel Öncül, Saim Türkoğlu","doi":"10.1186/s13049-026-01616-2","DOIUrl":"https://doi.org/10.1186/s13049-026-01616-2","url":null,"abstract":"<p><strong>Background/objective: </strong>Spontaneous pneumothorax (SP) commonly presents to the emergency department (ED), and clinicians must rapidly decide between conservative care and tube thoracostomy. Most artificial intelligence tools focus on pneumothorax detection rather than quantitative size estimation and actionable management recommendations. We aimed to evaluate whether a vision-enabled generative pre-trained transformer (GPT) model could estimate apical SP depth on chest radiographs (CXRs) and predict initial ED management.</p><p><strong>Methods: </strong>We conducted a single-center retrospective observational study of adult patients (≥ 18 years) with confirmed SP on pre-intervention posteroanterior CXR (January 1, 2023-December 31, 2025). GPT received only the CXR plus age and sex and returned laterality, estimated apical depth (Depth_cm), and a binary management recommendation (tube thoracostomy vs conservative). The reference outcome was tube thoracostomy within 24 h. We calculated diagnostic performance metrics and area under the receiver operating characteristic curve (AUC). We assessed agreement between GPT depth estimates and blinded radiologist measurements using intraclass correlation coefficient (ICC), Bland-Altman analysis, and mean absolute error (MAE).</p><p><strong>Results: </strong>Among 101 patients, mean age was 33.1 ± 14.6 years and 89 (88.1%) were male; 53 (52.5%) underwent tube thoracostomy within 24 h. GPT showed sensitivity 86.8% (95% CI, 75.2%-93.5%), specificity 93.8% (95% CI, 83.2%-97.9%), and accuracy 90.1% (95% CI, 82.7%-94.5%), with Cohen's κ = 0.80 and AUC 0.90 (95% CI, 0.84-0.96). Depth agreement was strong (ICC, 0.893), with MAE 0.69 cm and mean bias -0.51 cm (95% limits of agreement, - 2.30 to 1.27 cm).</p><p><strong>Conclusions: </strong>In confirmed SP, a vision-enabled GPT model produced apical depth estimates that closely agreed with radiologist measurements and generated management recommendations that substantially matched real-world ED decisions, supporting its potential role as adjunct imaging decision support.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718751","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":"\"I just needed help\": a qualitative study of patients' experiences with a single responder ambulance.","authors":"Elisabeth Larsen Engholm, Camilla Brændstrup Laursen, Penille Horsbøl Kirkegaard Jensen, Tine Bennedsen Gehrt, Ulla Væggemose","doi":"10.1186/s13049-026-01605-5","DOIUrl":"https://doi.org/10.1186/s13049-026-01605-5","url":null,"abstract":"<p><strong>Background: </strong>In response to the growing demand for prehospital care in the Central Denmark Region, a single responder ambulance, the Prehospital Visitation Unit (PVU), was introduced in early 2022. Staffed by a single paramedic, the PVU focuses on completing patient treatment on-site and/or facilitating access to appropriate healthcare services. Despite the increasing implementation of non-conveyance initiatives, little is known about patients' experiences of receiving emergency medical care in such settings. This qualitative study aimed to explore patients' expectations when calling for emergency help and their experiences with encountering the PVU in response to their need for help.</p><p><strong>Methods: </strong>The study was conducted in two stages of fieldwork: preliminary and main. Participant observation and semi-structured interviews were utilized throughout. The preliminary fieldwork took place between 1 June and 31 August 2022, and the main fieldwork between 1 February and 30 March 2023. In total, the researchers observed 12 PVU shifts, documenting patient-paramedic encounters through fieldnotes. Additionally, 22 patients completed a follow-up telephone interview. Interview transcripts and fieldnotes were analyzed using a two-cycle coding approach.</p><p><strong>Results: </strong>Overall, patients expressed satisfaction with the PVU and appreciated receiving treatment on-site rather than being transported to the hospital. When asked about their expectations after calling the Emergency Medical Services (EMS), patients consistently emphasized that they \"just needed help\". They were unconcerned about which type of EMS resource was dispatched or how many staff arrived. The PVU was perceived as less dramatic due to its smaller vehicle and single-paramedic operation. The paramedic's calm attitude, clear communication, and use of eye contact contributed to a reassuring atmosphere that put patients at ease.</p><p><strong>Conclusions: </strong>This study highlights patient satisfaction with the PVU as an EMS response, emphasizing their need for help and the benefits of on-site treatment. It contributes to the scarce literature on patient perspectives regarding non-conveyance, showing how the PVU meets patient expectations, creates a calm atmosphere, and fosters a sense of safety.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700548","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":"Beyond the evidence: The cervical collar as cultural artefact.","authors":"Tim Nutbeam","doi":"10.1186/s13049-026-01600-w","DOIUrl":"10.1186/s13049-026-01600-w","url":null,"abstract":"<p><strong>Background: </strong>Cervical collar application remains prevalent in trauma care despite the absence of evidence of neurological benefit from spinal immobilisation. Clinical behaviour in this area has proven resistant to change, and the persistence of the collar requires explanation beyond the evidential debate alone. The fear of cervical injury has origins that predate clinical practice. Neurobiological preparedness theory suggests that threat associations linked to survival-relevant stimuli are more rapidly acquired and more durably maintained than other learned fears; the cervical region is a plausible candidate for this form of prepared response. This disposition has been reinforced by centuries of cultural practice: capital punishment across civilisations has concentrated on the neck, and its apparatus has entered clinical language through terms such as the hangman's fracture and coup du lapin. The resulting cultural weight on cervical injury shapes illness behaviour, as demonstrated by natural experiments linking whiplash outcomes to compensation context. In the clinical setting, nocebo mechanisms may cause interventions that signal severity, including the collar, to perpetuate the disability they are designed to prevent. Cognitive biases compound this: pattern-based reasoning in high-stakes situations, defensive practice, and the availability heuristic all incline clinicians towards immobilisation regardless of the evidence. The collar may therefore function, in part, as an anxiety management device for clinician and patient alike.</p><p><strong>Conclusion: </strong>Resistance to reforming immobilisation practice is unlikely to yield to evidence translation alone. Effective change requires explicit engagement with the evolutionary, historical, linguistic, and cognitive determinants of cervical injury fear, alongside the evidential case for gentle patient handling.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13081358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692746","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":"Sonorheometry to detect traumatic induced coagulopathy during initial management of trauma patients: an observational, multi-center study.","authors":"Gary Duclos, Pierre Antoine Seube Remy, Mathieu Willig, Mohamed Boucekine, Charles Deregnaucourt, Charlotte Grosdidier, Paul Leblanc, Delphine Garrigue, Marc Leone","doi":"10.1186/s13049-026-01610-8","DOIUrl":"https://doi.org/10.1186/s13049-026-01610-8","url":null,"abstract":"<p><strong>Background: </strong>In severe trauma 30% of the patients develop a trauma-induced coagulopathy (TIC), which is associated with higher mortality, massive transfusion and prolonged intensive care stay. Conventional coagulation assays present limitations to detect TIC, primarily due to delayed turnaround time. To enhance early management of TIC viscoelastic tests have been included into guidelines as a standard of care. The Quantra device, based on sonorheometry analysis, offers a rapid bedside assessment of coagulation but lacks validation in a trauma population. The aim of this study was to validate Quantra to detect TIC compared with standard blood coagulation test in severe trauma patients.</p><p><strong>Methods: </strong>We performed a multicenter analysis of prospectively collected data (January 1, 2022-December 31, 2024) across four level-1 trauma centers. Trauma patients > 16 years underwent simultaneous Quantra and standard laboratory testing at hospital admission. Diagnostic performance for prespecified thresholds-activated partial thromboplastin time (aPTT) ratio > 1.5, prothrombin time ratio (PTr) > 1.5, fibrinogen ≤ 1.5 g/L, and platelet concentration ≤ 50, ≤ 100, and ≤ 150 G/L-was assessed by receiver operating characteristic curves in a derivation cohort, with Youden-optimized cutoffs applied to an external validation cohort to determine their specific positive and negative predictive values.</p><p><strong>Results: </strong>The derivation and validation cohorts included 285 and 219 patients, respectively. In the derivation cohort, the areas under the curve (AUCs) were 0.91 [0.84-0.98] for clot time to predict an aPTT ratio > 1.5 with a best cutoff of 144.5s; 0.82 [0.75-0.90] for clot stiffness to predict a PTr > 1.5 (best cutoff 15.4hPa); 0.87 [0.81-0.93] for fibrinogen contribution to clot stiffness to predict a fibrinogen concentration < 1.5g/L (best cutoff 1.1hPa); 0.90 [0.84-0.95] for platelet contribution to clot stiffness to predict a platelets count ≤ 100G/L (best cutoff 12.4hPa). In the validation cohort, positive predictive and negative predictive values for best cutoffs were 0.67 [0.50-0.80] and 1.00 [0.98-1.00] for clot time, 0.50 [0.39-0.61] and 0.88 [0.80-0.93] for clot stiffness, 0.58 [0.44-0.70] and 0.91 [0.85-0.95] for fibrinogen contribution to clot stiffness, 0.13 [0.24-0.99] and 0.99 [0.96-1.00] for platelets contribution to clot stiffness.</p><p><strong>Conclusion: </strong>Early Quantra analysis seems to provide rapid and reliable exclusion of TIC. Prospective investigations remain required to determine usefulness in TIC management.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693101","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":"Future perspectives in prehospital emergency medicine.","authors":"Åke Erling L Andresen, Ulf-Erik Kongsgaard, Thomas Kristiansen, Hans Morten Lossius","doi":"10.1186/s13049-026-01590-9","DOIUrl":"10.1186/s13049-026-01590-9","url":null,"abstract":"","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13081560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693067","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":"Intra-aortic adrenaline titration during cardiac arrest.","authors":"James E Manning, Ed B G Barnard, Jon Barratt, Paul S C Rees","doi":"10.1186/s13049-026-01609-1","DOIUrl":"10.1186/s13049-026-01609-1","url":null,"abstract":"<p><p>Adrenaline has been the principal vasoactive drug in cardiac arrest for decades. It reliably increases return of spontaneous circulation but has not shown a consistent improvement in long-term survival with favourable neurological outcome. High cumulative doses are associated with poorer neurological outcomes among survivors. Unreliable systemic delivery of intravenous adrenaline during the low-flow state of cardiopulmonary resuscitation (CPR) may be responsible for this disconnect. When return of spontaneous circulation follows multiple doses, abrupt mobilisation of accumulated adrenaline may be deleterious and contribute to post-resuscitation shock. We describe the \"Adrenaline Dilemma\": patients with the lowest coronary perfusion pressure are most in need of vasoconstriction to improve blood flow, yet they are also those in whom intravenous adrenaline is least likely to circulate promptly; conversely, patients with adequate coronary perfusion pressure may be exposed to excessive dosing. Thoracic aortic catheterisation via femoral arterial access provides rapid systemic arterial drug delivery and real-time haemodynamic feedback. Continuous aortic pressure monitoring allows optimisation of CPR mechanics and rapid titration of intra-aortic adrenaline as small, diluted boluses or continuous infusion targeting an observed physiological endpoint. Preclinical experiments and early prehospital clinical experience have shown favourable results. Haemodynamically guided intra-aortic adrenaline administration during CPR is a plausible, testable endovascular adjunct and warrants prospective evaluation within modern resuscitation pathways.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13081435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693030","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":"''Sugar for the Heart'', a bitter pill for tenecteplase: the crystallisation trap of pre-hospital fibrinolysis.","authors":"Thibaut Prevautel, Alisson Adet, Guillaume Michoud","doi":"10.1186/s13049-026-01594-5","DOIUrl":"10.1186/s13049-026-01594-5","url":null,"abstract":"<p><strong>Background: </strong>Recent evidence suggests that empiric prehospital administration of tenecteplase in out-of-hospital cardiac arrest is associated with decreased survival and lower rates of return of spontaneous circulation. While diagnostic uncertainty is a primary factor, operational hazards in austere environments must also be examined. This comment explores an underappreciated and potentially lethal operational hazard: the immediate chemical incompatibility between tenecteplase and dextrose-containing solutions. In chaotic pre-hospital settings, clinicians often rely on the cognitive heuristic of using dextrose lines to limit sodium intake, especially during cardiac emergencies. However, mixing tenecteplase with dextrose triggers instant crystallization and line occlusion. This effectively denies the patient the fibrinolytic agent while simultaneously compromising a critical intravenous access. To mitigate this risk, we propose three clinical safety barriers: physical segregation of dextrose from acute coronary syndrome kits, the mandatory implementation of a 20-mL normal saline flush before and after administration, and the use of point-of-care cognitive aids on drug packaging.</p><p><strong>Conclusion: </strong>Addressing the complex outcomes of prehospital thrombolysis requires mitigating simple, yet catastrophic, chemical errors. Environmental design and strict operational protocols are essential to ensure the safe delivery of tenecteplase in the field.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13081237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693111","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":"Fentanyl or Morphine? a qualitative investigation of solo responding paramedics´ decision-making in prehospital care.","authors":"Andreas Gustavsen, Randi Simensen","doi":"10.1186/s13049-026-01608-2","DOIUrl":"10.1186/s13049-026-01608-2","url":null,"abstract":"<p><strong>Background: </strong>Solo responding unit (SRU) paramedics at Oslo University Hospital (OUH) can administer either morphine or fentanyl for prehospital pain management. Although both opioids are available, the choice between them is made by individual clinicians in time-critical situations, often with limited information, variable transport conditions, and minimal organisational feedback. Existing research has primarily focused on comparative efficacy and safety, while less attention has been paid to how paramedics reason in practice. This study explores the clinical, logistical, and organisational factors that influence SRU paramedics' opioid selection, how advantages and disadvantages of morphine and fentanyl are perceived, and how local norms and decision-making support shape practice.</p><p><strong>Methods: </strong>This qualitative descriptive study employed three face-to-face focus groups with a total of 11 participants. The sessions were recorded, transcribed, and analysed thematically. The first author's dual role as an SRU paramedic was acknowledged and used reflexively to enhance the interpretation of the findings.</p><p><strong>Results: </strong>The participants (1 female, 10 male, mean age 42 years, mean 19.6 years of ambulance experience from urban and rural regions within OUH) emphasised the role of personal experience and intuitive judgement in selecting between morphine and fentanyl. Fentanyl was favoured for rapid onset in acute traumatic pain or short transports, while morphine was selected for its longer duration in frail patients or lengthy transports. \"Ambulance truths\", informal, station-specific beliefs, filled gaps where formal guidance was lacking. Safety concerns existed for both drugs, although severe adverse events were rarely experienced by participants.</p><p><strong>Conclusion: </strong>SRU paramedics' opioid selection is shaped by an interplay of pharmacological reasoning, familiarity, organisational protocols, and cultural norms. The findings suggest that formalised training, streamlined documentation, and structured feedback mechanisms may support more consistent decision-making in prehospital analgesia.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13109881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693103","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}