Scandinavian Journal of Trauma Resuscitation & Emergency Medicine最新文献

{"title":"Long-term outcomes of out-of-center veno-arterial ECMO cannulation for cardiopulmonary failure: investigation of prognostic parameters for a decision support tool - a 16-year retrospective study.","authors":"Walter Petermichl, Alois Philipp, Maik Foltan, Andrea Stadlbauer, Peter-Paul Ellmauer, Christian Merten, Sebastian Blecha, Thomas Müller, Bernhard Ulm, Bernhard Graf, Dirk Lunz","doi":"10.1186/s13049-025-01401-7","DOIUrl":"10.1186/s13049-025-01401-7","url":null,"abstract":"<p><strong>Background: </strong>Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has served as a crucial intervention for critically ill patients with persistent cardiopulmonary failure. A standardized approach improves VA ECMO outcomes, which is why ECMO is currently limited to specialized centers. However, transferring critically ill patients to these ECMO centers is not without risk. Portable ECMO devices allow implantation in out-of-center settings prior to transportation. Despite efforts to standardize decision-making, significant variability remains, particularly in out-of-center (OoC) settings with limited data. Due to persistently high mortality, accurate indications are needed to optimize outcomes. This study aims to identify key factors associated with favorable outcomes in OoC VA ECMO and to develop practical decision-making tools for clinicians in these settings.</p><p><strong>Methods: </strong>We retrospectively investigated the outcomes of VA ECMO implantation in out-of-center settings between 2006 and 2022 at our institution. Parameters assessed prior to VA ECMO implantation, including organ failure count, mean arterial pressure (MAP), and laboratory data, were analyzed. Follow-up data were collected to evaluate functional (Eastern Cooperative Oncology Group [ECOG] performance status) and neurological (cerebral performance category score [CPC]) (outcomes. Statistical analyses were performed using non-parametric methods and SHAP importance analysis.</p><p><strong>Results: </strong>A total of 56.5% (195 of 345 patients) who underwent VA ECMO implantation in OoC survived, and 43.8% had a favorable neurological outcome (CPC 1). 37.6% of patients had good functional outcomes (ECOG 0-1). Patients with a MAP > 54 mmHg had better long-term functional outcomes, and those with a MAP > 64 mmHg had better mid-term neurological outcomes. Poor outcomes were associated with reduced coagulation activity and increased thrombogenicity. Renal and multi-organ failure prior to VA ECMO implantation were associated with poor neurological and functional outcomes.</p><p><strong>Conclusions: </strong>Through importance analyses, we identified key and secondary factors associated with favorable outcomes in OoC VA ECMO. The extent and severity of organ failure prior to VA ECMO implantation are crucial in determining outcomes. Hemodynamic status, as reflected by MAP, along with organ failure prior to VA-ECMO implantation, significantly influences neurological and functional outcomes. Patients with better hemodynamic stability and coagulation profiles had significantly improved chances of survival with favorable neurological and functional outcomes.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"81"},"PeriodicalIF":3.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989562","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":"Association of central capillary refill time with mortality in adult trauma patients: a secondary analysis of the crash-2 randomised controlled trial data.","authors":"Sabrina Jegerlehner, Tim Harris, Martin Mueller, Ben Bloom","doi":"10.1186/s13049-025-01407-1","DOIUrl":"10.1186/s13049-025-01407-1","url":null,"abstract":"<p><strong>Background: </strong>Trauma-related injuries account for up to 4.4 million deaths annually worldwide. Failure to identify haemorrhage in trauma patients increases mortality. This study examines the association of central capillary refill time (CRT) and mortality in adult trauma patients, especially in the subgroup with normal heart rate (HR) and blood pressure (BP).</p><p><strong>Methods: </strong>This retrospective observational study analysed data from the CRASH-2 trial, conducted in 274 hospitals across 40 countries and 5 continents between May 2005 and January 2010. A total of 19,054 out of 20,207 adult trauma patients with recorded CRT and complete dataset were included. CRT was taken centrally (sternum) and categorized as ≤ 2, 3-4, and ≥ 5 s. The primary outcome was 28-day mortality, while secondary outcomes included need for transfusion, surgical intervention and thromboembolic events. Univariable and multivariable logistic regression analysis were conducted, incorporating random effects for continent/cluster. Receiver operating characteristic curves were used to assess the discriminatory ability of central CRT measurement.</p><p><strong>Results: </strong>Among the patients, 6,756 (35.5%) had a CRT ≤ 2 s, 9,142 (48%) had a CRT of 3-4 s, and 3,156 (16.6%) had a CRT ≥ 5 s. Compared to the reference category (CRT ≤ 2 s), the odds of death were significantly higher in patients with CRT of 3-4 s (OR 1.7, 95% CI 1.6-1.9) and CRT ≥ 5 s (OR 3.2, 95% CI 2.8-3.5). Higher CRT was also associated with an increased likelihood of blood transfusion, surgical intervention, and thromboembolic events. The AUC values ranged from 0.63 to 0.74 and were consistent with a significant association between the variables.</p><p><strong>Conclusion: </strong>Central CRT is associated with increased mortality and adverse outcomes in trauma patients. In bleeding trauma patients, an increasing central CRT is linked to higher mortality risk, with a central CRT ≥ 5 s being particularly predictive of worse outcomes. This also applies to patients with stable vital signs (normal HR and BP), suggesting that CRT may offer additional value as an indicator of hidden hypoperfusion.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"82"},"PeriodicalIF":3.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994254","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":"EMCC dispatch priority for trauma patients in Norway: a retrospective cohort study.","authors":"Inger Marie Waal Nilsbakken, Torben Wisborg, Stephen Sollid, Elisabeth Jeppesen","doi":"10.1186/s13049-025-01387-2","DOIUrl":"10.1186/s13049-025-01387-2","url":null,"abstract":"<p><strong>Background: </strong>Dispatch priority assessments in emergency medical communication centres (EMCC) play a crucial role in determining how quickly emergency medical services reach the scene after an injury. Consequently, accurate prioritization of resources is important in ensuring that patients requiring specialized care receive timely treatment to optimize their outcome. Both dispatch under-triage, where patients with severe injuries receive low priority, and dispatch over-triage, which unnecessarily allocates limited emergency resources, can impact patient outcomes and system efficiency. This study aimed to assess dispatch priority in the EMCC for a cohort of trauma patients in Norway.</p><p><strong>Methods: </strong>This registry-based study included 3633 patients from the Norwegian Trauma Registry and Oslo EMCC during 2019-2020. We assessed sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false negative rate (dispatch under-triage rate), false positive rate (dispatch over-triage rate), and accuracy of dispatch priority. The New Injury Severity Score (NISS) > 15 was used as a reference standard. Differences in dispatch priority assessments were analysed using descriptive statistics. Two logistic regression models were used to examine the relationship between dispatch priority and factors associated with the assessment.</p><p><strong>Results: </strong>Our analysis revealed the following dispatch metrics: sensitivity (85%), specificity (11%), PPV (38%), NPV (53%), dispatch under-triage rate (15%), dispatch over-triage rate (89%), and overall accuracy (40%). Under-triaged dispatches frequently involved elderly trauma patients (53%) and patients with low-energy falls (51%). Elderly trauma patients had more than 7 times the odds of receiving inappropriately low dispatch priority compared to children and nearly twice the odds compared to adults, after accounting for factors such as injury mechanism. Similarly, female patients had 81% higher odds of receiving inappropriately low dispatch priority compared to male patients, when controlling for factors like age and injury mechanism. Among over-triaged dispatches, transport-related injuries accounted for half of the cases (50%).</p><p><strong>Conclusion: </strong>This study primarily evaluated the national trauma system's dispatch priority criteria. Our findings indicate that elderly trauma patients, those with low-energy falls and female patients were often assigned inadequate priority by current criteria, indicating a need to reassess the current criteria to better address these patients' needs. Additionally, we found that patients involved in transport-related accidents were overrepresented among over-triaged dispatches, highlighting a potential misallocation of resources.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"83"},"PeriodicalIF":3.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036407","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":"Introducing an on-site Helicopter Emergency Medical Service (HEMS) physician at the Emergency Medical Communication Centre - implications for dispatch precision at a Norwegian HEMS base.","authors":"Ole Erik Ulvin, Oddvar Uleberg, Andreas Asheim, Helge Haugland","doi":"10.1186/s13049-025-01396-1","DOIUrl":"https://doi.org/10.1186/s13049-025-01396-1","url":null,"abstract":"<p><strong>Background: </strong>Dispatch precision of Helicopter Emergency Medical Services (HEMS) is a key topic in prehospital research. In Norway, the combined role of the HEMS physician on-call and the Emergency Medical Communication Centre (EMCC) physician has been challenged. This study aimed to evaluate the impact on HEMS dispatch precision by transferring the medical decision-making from an on-call HEMS physician to an on-site HEMS physician in the EMCC.</p><p><strong>Methods: </strong>In this quasi-experimental study, a HEMS physician was on-site in Trondheim EMCC during defined working hours from February 1st through July 5th, 2024. When on-site, the decision to dispatch Trondheim HEMS was made by this EMCC physician. Primary outcome was unnecessary HEMS dispatches, i.e. missions where neither advanced treatment nor logistical contributions were provided following HEMS dispatch. Secondary outcomes were HEMS alarm and activation time, rejected HEMS missions and National Advisory Committee for Aeronautics (NACA)-scores of encountered HEMS patients. Outcomes were analysed by difference-in-differences analyses.</p><p><strong>Results: </strong>785 HEMS missions were included in the analyses. There was no significant difference in the risk of an unnecessary mission (percentage point risk difference [RD] 5.6, 95% confidence interval [CI] -7.4-18.6) or the proportion of patients with NACA scores of 4 or higher (RD -5.8, 95% CI -17.9-6.3) following the intervention.</p><p><strong>Conclusion: </strong>We found no evidence of increased HEMS dispatch precision, measured by the proportion of missions without medical or logistical contributions, when transferring the medical decision regarding HEMS dispatch from the HEMS physician on-call to an on-site EMCC physician in this study.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"80"},"PeriodicalIF":3.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046971","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":"Confined space airway management: a narrative review.","authors":"Soren S Rudolph, Christopher W Root, Michael Friis Tvede, Trond Fedog, Patrick Wenger, Mikael Gellerfors, Jelsche Apel, Luca Ünlü","doi":"10.1186/s13049-025-01357-8","DOIUrl":"https://doi.org/10.1186/s13049-025-01357-8","url":null,"abstract":"<p><strong>Background: </strong>Airway management is a critical component of prehospital and emergency care, often complicated by the environment in which it is performed. Confined space airway management (CSAM) refers to scenarios were restricted physical space challenges conventional airway techniques. These situations may occur in unpredictable environments, such as vehicle entrapments or collapsed structures, and controlled settings like helicopters. This narrative review aims to synthesize current knowledge, expert opinions, and evidence on CSAM.</p><p><strong>Main body: </strong>CSAM poses logistical and technical challenges, including limited access to the patient, restricted movement, and reduced visibility. These factors increase the difficulty of performing standard airway management procedures and increase the risk of complications. Supraglottic airways (SGA), due to their ease of insertion and high success rates, are recommended as a first-line approach in CSAM, especially when intubation is delayed or infeasible. Tracheal intubation (TI) may require significant modifications in technique. Alternative methods and adjuncts such as face-to-face intubation and stylets may be considered but are highly dependent on provider expertise and the specific scenario. Emergency front of neck access (eFONA) is provided with high success rated in confined spaces. In controlled settings, systematic preparation can improve success rates and reduce procedural times. In uncontrolled environments, prioritizing patient extrication and maintaining oxygenation is essential, as definitive airway management may conflict with rescue efforts.</p><p><strong>Conclusion: </strong>CSAM requires a strategic blend of medical expertise, adaptive techniques, and logistical planning. A focus on training, preparedness, and the use of supraglottic airway devices may mitigate challenges in these high-stakes scenarios.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"79"},"PeriodicalIF":3.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12054197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056424","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":"Emergency department interventions and their effect on subsequent healthcare resource use after discharge: an overview of systematic reviews.","authors":"Tom Roberts, Callum Taylor, Edward Carlton, Mathew Booker, Sarah Voss, Nicola Trevett, Daniel Wattley, Jonathan Benger","doi":"10.1186/s13049-025-01377-4","DOIUrl":"https://doi.org/10.1186/s13049-025-01377-4","url":null,"abstract":"<p><strong>Background: </strong>Due to the worldwide pressures on Emergency Departments (EDs), there is a focus on ED interventions to alleviate pressure. Ensuring interventions do not inadvertently impact upon other healthcare sectors is an important outcome. This overview of systematic reviews aimed to evaluate the impact of ED based interventions on subsequent healthcare resource use after ED discharge.</p><p><strong>Methods: </strong>An overview of systematic reviews was conducted in accordance with the Cochrane Collaboration. Search criteria were devised using the PRESS standard and duplicate screening and extraction conducted for one third of systematic reviews. A primary study matrix was designed to reduce the impact of duplicate primary studies. Data was extracted in the form presented in the underlying review.</p><p><strong>Results: </strong>After removal of overlapping primary studies, 38 systematic reviews and 213 primary studies were included. Overall confidence in the reviews was high in 12, moderate in seven, low in nine and critically low in 10 reviews. In the 38 reviews, 30 different intervention-population-resource use combinations were analysed. ED based interventions decreased subsequent healthcare resource use in 23.3% (n = 7/30) of the intervention-population-resource use combinations and had no effect in 40% (n = 12/30). The most common resource use reported was ED Revisit. The most common follow-up length from ED discharge was 12 months (n = 52/216), followed by the combined group of one month (n = 44/216).</p><p><strong>Conclusions: </strong>ED based interventions decrease subsequent healthcare resource use in a fifth of population-intervention-resource use combinations. Future research should produce a standardised set of outcome measures for subsequent healthcare resource use.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"76"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12044817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028160","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 Norwegian national trauma registry: development process and essential data insights.","authors":"Kjetil Gorseth Ringdal, Kjetil Tengesdal Holm, Olav Røise","doi":"10.1186/s13049-025-01390-7","DOIUrl":"https://doi.org/10.1186/s13049-025-01390-7","url":null,"abstract":"<p><strong>Background: </strong>Understanding trauma epidemiology, patient demographics, injury characteristics, and outcomes is essential for optimising trauma systems. The Norwegian Trauma Registry (NTR) monitors and improves the Norwegian Trauma System, setting care standards and overseeing system development. The registry was officially recognised as a national register in 2013. This study outlines the establishment of the population-based national registry and provides an overview of selected data.</p><p><strong>Methods: </strong>Norway's trauma system includes trauma centres, acute care hospitals, and prehospital services. The registry collects injury details, clinical outcomes, and patient experiences. Local NTR databases that are linked to a central database are maintained at each hospital, and only certified data registrars can enter and validate data. This enables data linkages across hospitals. The NTR includes potentially severely injured patients but also includes undertriaged patients (defined as severely injured patients who are not met by a trauma team activation upon hospital arrival). Descriptive statistics were used to analyse data from trauma patients registered between 2015 and 2023. Patient-Reported Outcome Measures (PROMs) from 2022 were also assessed.</p><p><strong>Results: </strong>From 2015 to 2023, 78 275 trauma patients were recorded, with annual patient inclusion rising from 7586 in 2015 to 9759 in 2023. All 38 Norwegian hospitals contributed data in 2023. Median age was 41 years (IQR: 21-62), and 66.5% were men. The highest injury rate was among those aged 15-24 years. Penetrating injuries accounted for 4.6% of cases. Severely injured patients with New Injury Severity Score (NISS) ≥ 16 totalled 16 678 (21.3%), while 10 509 (13.4%) had an Injury Severity Score (ISS) ≥ 16. Polytrauma was identified in 3783 (4.9%) of patients using the Newcastle definition and in 2508 (3.2%) patients using the Berlin definition. In 2023, a trauma team was activated for 8731(89.4%) patients recorded in the registry. PROMs data from 2022 showed that 47.2% (1018/2157) of the patients reported anxiety or depression 12 months post-injury. Among those without physical injuries, 8.0% (11/138) were out of work or education. Of the severely injured patients (NISS ≥ 16) who were employed or in education prior to the injury, 26.4% (83/314) had not returned to work or education after 12 months.</p><p><strong>Conclusions: </strong>The Norwegian Trauma Registry has been successfully implemented in all trauma hospitals in Norway, enabling comprehensive data collection to support trauma care improvements and research.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"78"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12044736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992496","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":"Benefits of targeted deployment of physician-led interprofessional pre-hospital teams on the care of critically ill and injured patients: the 'science' explained.","authors":"Michael D Christian, Matthew D Lavery, Arshbir Aulakh","doi":"10.1186/s13049-025-01398-z","DOIUrl":"https://doi.org/10.1186/s13049-025-01398-z","url":null,"abstract":"","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"77"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12044708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043955","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":"Response to Bollig and Zelco.","authors":"Matthew Hooper, Marius Rehn","doi":"10.1186/s13049-025-01394-3","DOIUrl":"https://doi.org/10.1186/s13049-025-01394-3","url":null,"abstract":"<p><p>In this reply we discuss the comments raised by Bollig and Zelco on our Editorial on Emergency Last Aid (ELA). We focus on that ELA is a clinician-focused educational initiative specifically tailored for those working in high-acuity, high-consequence settings such as pre-hospital, emergency, and critical care environments. The course is designed specifically for clinicians operating in environments where leadership, decision-making, and compassionate communication often occur under intense pressure, frequently with limited time and support.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"73"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12044730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062922","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":"Factors influencing the pre-hospital management of civilian burn mass casualty incidents in the 21st century: a scoping review.","authors":"Andreas Lindquist, Resha Al-Azzawi, Torsten Risør, Lasse Raatiniemi","doi":"10.1186/s13049-025-01380-9","DOIUrl":"10.1186/s13049-025-01380-9","url":null,"abstract":"<p><strong>Background: </strong>Burn mass casualty incidents (BMCI) are unique and catastrophic events that are uncommon but recurring and comprehensively challenge all emergency services involved. The causes range from forces of nature to accidental or intentional explosions, indoor fires and chemical burns. A growing population, climate change exacerbated fire weather, increasing industrial activity and a rising threat of worldwide transnational terrorism all increase the risk of BMCIs. Emergency response strategies are thus of critical importance and can be improved upon by learning from previous incidents through the identification of recurrent themes.</p><p><strong>Objectives: </strong>Identify, categorise, and describe key themes and factors reported as having a favourable or detrimental influence on the professional management of civilian BMCIs.</p><p><strong>Materials and methods: </strong>A scoping review following the Arksey and O'Malley framework with enhancements by Levac, Colquhoun and O'Brien, and PRISMA-ScR, was conducted using six electronic databases, including a search for grey literature from January 2001 to March 2024. A total of 51 documents, containing descriptions, discussions, and/or experiences of the pre-hospital management of burn mass casualty incidents in civilian, non-war settings, were included and analysed using thematic analysis for qualitative data and labelled for themes and factors.</p><p><strong>Results: </strong>Thirteen key themes and 71 factors were identified to influence the pre-hospital management of BMCIs. The key themes were Command, Communication, Contextual, Education, Environment, Evacuation, Fortuity, Human Factors, Preparedness, Response Tactics, Safety, Triage, and Volunteer. The 71 identified factors were for example self-evacuation, varied non-medical transport methods, traffic congestion and decontamination.</p><p><strong>Conclusion: </strong>The identified themes and factors provide insights from real-life incidents on what is reported to influence the situation at hand. The identified factors can be used to target specific areas for further improvement in future BMCIs, particularly in preparedness planning and training, for example by taking self-evacuation into account in future disaster plans.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"74"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12044938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055512","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}