Scandinavian Journal of Trauma Resuscitation & Emergency Medicine最新文献

{"title":"Ambient oxygen enrichment during cardiopulmonary resuscitation: an overestimated risk? - Insights from a manikin study.","authors":"Dominik J Hoechter, Florian Pfeiffer, Michael Storz, Andreas Higl, Bjarne Schmalbach, Katja Petrowski, Tobias Achtsnit","doi":"10.1186/s13049-026-01669-3","DOIUrl":"https://doi.org/10.1186/s13049-026-01669-3","url":null,"abstract":"<p><strong>Background/ aim: </strong>To reduce the risk of fire, the ERC resuscitation guidelines recommend removing all oxygen-delivery devices at least 1 m away from the patient's chest prior to defibrillation. This recommendation is based on the assumption of relevant local oxygen accumulation. The presented study aimed to characterise ambient oxygen concentrations during cardiopulmonary resuscitation (CPR) and to assess the effect of removing oxygen-delivery devices.</p><p><strong>Methods: </strong>In a controlled mannequin-based simulation study, 20 resuscitation scenarios were performed under standardised conditions, varying oxygen delivery, airway management, ventilation mode, environment (room vs. ambulance), and distance of oxygen sources. Oxygen concentrations were continuously measured and recorded at 10-second intervals at three locations corresponding to typical defibrillation sites. Linear mixed-effects models were used to analyse predictors of oxygen fraction.</p><p><strong>Results: </strong>A total of 6,555 oxygen measurements were recorded. Median oxygen concentration was 21.6% (IQR 21.3-22.1%). Removing oxygen delivery devices to > 1 m did not result in lower oxygen concentrations compared with leaving them in proximity of the mannequin's head. Endotracheal intubation compared to an open airway and the use of an OxyDemand valve compared to a reservoir with 15 L/min oxygen flow were associated with slightly lower oxygen fractions, whereas other factors (handling of upper garments, site, use of mechanical CPR) showed no clinically relevant effects.</p><p><strong>Conclusion: </strong>Clinically relevant oxygen accumulation at defibrillation sites was not observed. Likewise, removing oxygen-delivery devices did not result in a reduction in oxygen concentrations. Under the tested conditions, these findings do not support clinically relevant oxygen enrichment during CPR, questioning the risk of oxygen-enriched atmospheres during CPR as well as the role of routine removal of oxygen sources prior to defibrillation.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762401","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":"Why should more than two reliability coefficients be reported in triage studies?","authors":"Amir Mirhaghi","doi":"10.1186/s13049-026-01659-5","DOIUrl":"10.1186/s13049-026-01659-5","url":null,"abstract":"<p><p></p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622238","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 performance and potential clinical benefit of the Swedish On Scene Injury Severity Prediction (OSISP) model for prehospital field triage on Norwegian trauma data.","authors":"Anna Bakidou, Eva-Corina Caragounis, Magnus Andersson Hagiwara, Olav Røise, Anders Jonsson, Bengt Arne Sjöqvist, Stefan Candefjord","doi":"10.1186/s13049-026-01662-w","DOIUrl":"10.1186/s13049-026-01662-w","url":null,"abstract":"<p><strong>Background: </strong>Rule-based field triage protocols used by Emergency Medicine Service (EMS) personnel for assessment and prioritization of trauma patients achieve suboptimal field triage performance. An On Scene Injury Severity Prediction (OSISP) model was previously developed on Swedish trauma data with indications to improve field triage performance. This study aims to apply OSISP on external Norwegian data to assess its performance and clinical impact on unseen data.</p><p><strong>Methods: </strong>Adult trauma incidents involving EMS resources at the scene of incident were included. An eXtreme Gradient Boosting OSISP model was developed on Swedish trauma registry (SweTrau) data for 2013-2020 and trained to predict severely injured patients defined as new injury severity score (NISS) > 15. OSISP was evaluated on Norwegian trauma registry (NTR) data for 2017-2022. The model performance on NTR data was evaluated using overall performance measures for discrimination and calibration (receiver operating characteristic curve, precision-recall curve, area under these curves, Brier score, calibration curve, calibration slope, calibration in the large). OSISP's clinical impact was assessed by evaluating its under- and overtriage rates and comparing to current clinical outcome and mortality.</p><p><strong>Results: </strong>The raw data from SweTrau and NTR had 75,602 and 76,529 registrations, with 47,357 and 29,709 remaining after applying eligibility criteria. In the included data, there were 16.9% and 25.2% patients with NISS > 15 in SweTrau and NTR, respectively. The OSISP predictors represented age, sex, details of the patient's condition, incident and injury details, vital signs, and administrative details. OSISP applied on NTR data yielded an overall performance of AUC_ROC=0.83, AUC_PR=0.64, Brier score = 0.14, calibration slope = 0.79, and calibration in the large=-0.09. On its own, OSISP reduced undertriage to 5.0% but increased overtriage to 61.0%, while the complementary use (NTR's triage outcomes combined with OSISP's predictions) reduced undertriage to 2.7%, overtriage to 19.7% (compare to current clinical practice with an undertriage = 56.0% and overtriage = 30.6%), and mortality from 4.1% to 3.4-3.5%.</p><p><strong>Conclusions: </strong>OSISP's overall performance was successfully validated and a potential capability to improve triage and decrease mortality was observed, also for elderly and patients from the northern region, groups often missed with current triage tools.</p><p><strong>Registration: </strong>Not applicable.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13401289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586001","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":"Known to crews, missing from the literature - electrostatic discharge during helicopter hoist operations.","authors":"Jostein Rødseth Brede","doi":"10.1186/s13049-026-01666-6","DOIUrl":"10.1186/s13049-026-01666-6","url":null,"abstract":"","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13401304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585949","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":"Expanding the framework of non-technical skills in resuscitation: why family communication matters.","authors":"Yusuf Kantar","doi":"10.1186/s13049-026-01665-7","DOIUrl":"10.1186/s13049-026-01665-7","url":null,"abstract":"","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13397666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581016","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":"Correction: The epidemiology of canyoning rescue operations in Italy: a retrospective 15-year database study.","authors":"Alexandre Tomasi, Michiel Jan Van Veelen, Marco Biasioni, Tomas Dal Cappello, Giacomo Strapazzon","doi":"10.1186/s13049-026-01660-y","DOIUrl":"10.1186/s13049-026-01660-y","url":null,"abstract":"","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13390244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551137","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":"Early non-intravenous analgesia in prehospital trauma care: time to act.","authors":"Julian Klug, Benedick Satari, Roland Albrecht, Alexander Fuchs, Urs Pietsch","doi":"10.1186/s13049-026-01663-9","DOIUrl":"10.1186/s13049-026-01663-9","url":null,"abstract":"","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473928","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":"Geographical alignment of prehospital critical care services with population need for out-of-hospital cardiac arrest patients.","authors":"Adam J Boulton, Nigel Lang, Joshua Miller, Gregory Adam Whitley, Oliver Zorab, Adam de Paeztron, Caroline Leech, Paramjit Gill, Gavin D Perkins, João Porto de Albuquerque, Terry P Brown, Joyce Yeung","doi":"10.1186/s13049-026-01655-9","DOIUrl":"10.1186/s13049-026-01655-9","url":null,"abstract":"<p><strong>Background: </strong>Prehospital critical care is associated with improved outcomes following out-of-hospital cardiac arrest (OHCA), but may not be distributed equitably.</p><p><strong>Aim: </strong>To examine the alignment between prehospital critical care provision and neighbourhood OHCA risk, predicted survival, and deprivation across three neighbouring ambulance regions in England.</p><p><strong>Methods: </strong>Data on all OHCAs treated by three neighbouring English ambulance services (2018-2023) were aggregated to the neighbourhood level. Prehospital critical care response time predictions were generated from service-supplied operational parameters and calibrated against observed data with rural-urban adjustment. High-risk neighbourhoods were defined by above-median OHCA incidence and below-median bystander CPR. Pre-EMS predicted survival was estimated using a published model. Deprivation was measured with Index of Multiple Deprivation. Weighted regression models with service-by-response time interaction terms examined each neighbourhood metric per 5-minute response time increase. A secondary analysis examined a HEMS-only configuration by removing the unique urban, NHS car asset in service B.</p><p><strong>Results: </strong>Overall, 52.9% of the resident population and 51.3% of OHCAs were within 15 min of a prehospital critical care response. In two services, increasing response time was associated with higher odds of a neighbourhood being high-risk and with greater deprivation. For pre-EMS predicted survival, poor alignment was found in one service, favourable alignment in another, and no significant association in the third. Service B showed favourable alignment across all three metrics. Removing the urban car asset (HEMS-only configuration) reversed this favourable pattern, producing gradients consistent with the other two services. Sensitivity analysis using observed response times and distances produced consistent but attenuated associations.</p><p><strong>Conclusion: </strong>Prehospital critical care provision, particularly HEMS, is generally poorly aligned with neighbourhood OHCA risk, pre-EMS predicted survival, and deprivation. The only region demonstrating favourable cardiac arrest alignment was attributable to its urban NHS car asset. Expanding car-based prehospital critical care in deprived urban areas may warrant consideration as a strategy to reach more OHCA patients and improve equity of access.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457588","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":"Cross-border collaboration in a major incident: emergency medical services response to a train crash.","authors":"Peter Martin Hansen, Dana Raub, Sanne Bjerre, Jesper Broesby, Trond Nuland Fedog, Jakob Kjersgaard Johansen, Søren Mikkelsen","doi":"10.1186/s13049-026-01661-x","DOIUrl":"10.1186/s13049-026-01661-x","url":null,"abstract":"<p><strong>Background: </strong>On 15 August 2025, a fatal train crash happened in Southern Denmark following a collision with a truck at an unsecured railway crossing, resulting in derailment and one overturned carriage. One person was killed, and 29 people were injured. This case report aims to give a detailed description of the response of emergency medical services to evaluate cross-border and inter-authority cooperation as well as adherence to major incident guidelines and established communication pathways.</p><p><strong>Case presentation: </strong>Initial calls indicated several critical patients and numerous school children on the train. Nineteen Danish and German units, including four helicopters, were dispatched to the scene. Access to the site was restricted to a single narrow countryside road, requiring careful organization of staging areas, access/egress routes, and casualty clearing stations. A Joint Incident Command was formed, and patients were triaged, treated, and registered using an electronic prehospital system allowing for continuous coordination with the dispatch center for hospital allocation. Two critically injured patients were transported by helicopter to two trauma centers in Denmark and Germany, and the remaining patients were distributed across three regional hospitals. The response to this incident largely aligned with national guidelines and cross-border cooperation agreements. However, delays in incident management were identified, and responders criticized infrequent training opportunities for major incidents. The rate of unauthorized radio shifts was lower than previously described.</p><p><strong>Conclusions: </strong>This report describes the response to a major incident, characterized by effective inter-authority cooperation and successful cross-border collaboration between Danish and German emergency services. Routine collaboration during everyday responses proved crucial to ensure efficient collaboration during crises. While adherence to major incident protocols was generally high, challenges remained regarding the site organization and timely establishment of command structures. The observed delays may reflect limited experience with major incident management among regular responders, prompting the need for comprehensive incident command training of prehospital physicians. Compared to previous incidents, communication consistency was notably improved, likely due to dedicated training efforts after prior communication failure. The incident underscored the importance of joint inter-authority response concepts and the central coordinating role of the dispatch center. Enhanced training accessibility and continued evaluation of real-life incidents are recommended to further improve preparedness for future incidents.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13555936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425700","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":"Impact of Helicopter Emergency Medical Services on endovascular thrombectomy delays, clinical outcomes, and societal costs in large vessel occlusion stroke: a retrospective registry based counterfactual simulation study.","authors":"Axel Ackermann, Sami Curtze, Paulus Torkki, Jukka Pappinen","doi":"10.1186/s13049-026-01658-6","DOIUrl":"10.1186/s13049-026-01658-6","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke is highly time-dependent. This study evaluates the logistical, clinical, and economic utility of physician-staffed Helicopter Emergency Medical Services (HEMS) within a centralized stroke network.</p><p><strong>Methods: </strong>This retrospective study (2021-2025) of 617 EVT-treated LVO patients used spatial simulations on a 159-patient subset, excluding those with missing data, non-transport delays, and distances ≤ 30 km. Simulation 1 compared 42 realized HEMS missions to simulated ground transports across varying on-scene times (OST). Simulation 2 modeled 117 ground-transported patients (> 30 km) as hypothetical HEMS missions under simultaneous vs. secondary dispatch protocols. Clinical and economic impacts were estimated using ordinal logistic regression, HERMES meta-analysis estimates, and a 2-year societal cost model.</p><p><strong>Results: </strong>HEMS patients had higher baseline severity (median NIHSS 19 vs. 14, p < 0.001). Multivariable regression confirmed EVT delay independently predicted a 90-day mRS shift. In Simulation 1, a \"scene-time paradox\" was identified: prolonged on-scene stabilization negated the aerial transit advantage, with the Rapid-Extrication Scenario showing a modest 1.7-minute HEMS saving whereas the Matched-OST Scenario isolating pure transit speed yielded a 19.7-minute advantage. In Simulation 2, simultaneous HEMS dispatch saved a median of 4.8 min for patients located > 30 km away, with over 31% saving > 20 min. Conversely, secondary dispatch caused a median time loss of 3.8 min. Implementing an optimized simultaneous dispatch protocol could prevent 0.76 to 1.98 cases of severe disability over the 5-year period, equating to 2-year societal savings of €39,000 to €107,000 (annualized ~€7,800 to €21,400 per operational year).</p><p><strong>Conclusions: </strong>While HEMS provides a transit advantage for LVO stroke, its utility is heavily influenced by on-scene critical care requirements and dispatch timing. Because secondary dispatch negates aerial speed advantages, simultaneous dispatch is essential for maximizing both clinical and economic benefits.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413448","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}