Scandinavian Journal of Trauma Resuscitation & Emergency Medicine最新文献

{"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}

{"title":"The evolving prehospital care: a 12-year retrospective analysis.","authors":"Helena Johansson, Daniel Wilhelms, Jens Wretborn","doi":"10.1186/s13049-026-01651-z","DOIUrl":"10.1186/s13049-026-01651-z","url":null,"abstract":"<p><strong>Background: </strong>Emergency medical services (EMS) are one of the main interfaces between acutely ill patients in the prehospital environment and hospital-based care. Yet longitudinal, population-level studies of EMS patient populations remain limited. We aimed to characterize temporal trends in EMS demand, triage acuity, hospital admission, and short-term mortality among patients managed by EMS and transported to emergency departments (EDs) in a Swedish healthcare system from 2011 to 2022.</p><p><strong>Methods: </strong>This was a retrospective, population-based study of all primary EMS assignments in Region Östergötland, Sweden (catchment population 456,000), from 2011 to 2022. Data were extracted from linked electronic health records encompassing EMS, ED, and inpatient care. Triage acuity was classified using the Rapid Emergency Triage and Treatment System (RETTS). The primary outcome was the temporal trend in triage acuity among EMS patients. Secondary outcomes included hospital admission rates, 1, 7, 30, and 90-day mortality, and non-transport disposition rates. Proportional-odds ordinal regression and multivariable logistic regression were used to assess temporal trends. Descriptive statistics were used to summarize demographic data.</p><p><strong>Results: </strong>Of 474,647 included primary assignments, 394,580 (83.1%) resulted in ED transport. Triage acuity shifted progressively toward higher-severity categories. The combined proportion of acuity levels 1 and 2 (highest) increased from 32% to 57%, with an 8% annual increase in odds of higher classification (OR 1.08 per year, 95% CI 1.08-1.09). Non-transport dispositions rose from 5% to 25% of primary assignments. The hospital admission rate among EMS-transported patients was constant at approximately 50%, but their share of all ED-originating hospital admissions increased from 42% to 57%. Short-term mortality was stable; triage acuity was the strongest predictor of death at all time points (OR 1.14-5.15 per level).</p><p><strong>Conclusions: </strong>Over 12 years, EMS-transported patients presented with progressively higher triage acuity while constituting an increasing share of hospital admissions. These trends, concurrent with a fivefold expansion in non-transport dispositions, reflect a shift in the role of EMS toward field-based clinical assessment and disposition. These findings have implications for EMS resource planning, triage system evaluation, and the integration of prehospital data into hospital capacity management.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370577","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 medical care during civil unrest: a narrative review.","authors":"Luca Carenzo, Laura Leuci, Martin Dünser, Fredrik Granholm, Marius Rehn, Christoph Hüser, Jamie Ranse, Claire Park, Derrick Tin, Marta Caviglia","doi":"10.1186/s13049-026-01656-8","DOIUrl":"10.1186/s13049-026-01656-8","url":null,"abstract":"<p><strong>Background: </strong>Civil unrest is a critical societal challenge in many parts of the world. Crowd control weapons (including conducted energy devices, chemical irritants, kinetic impact projectiles, acoustic devices, and water cannons) produce agent-specific injuries that do not precisely map onto standard trauma frameworks. This narrative review synthesises the available evidence on the mechanisms, health effects, and emergency department management of casualties inflicted by crowd-control weapons.</p><p><strong>Main body: </strong>Emergency department preparedness for civil unrest rests on surge capacity planning across staffing, supplies, space, and systems, with additional demands imposed by chemical decontamination, unpredictable patient volumes, and risks to staff safety. Conducted energy devices cause injury primarily through falls during neuromuscular incapacitation and through probe penetration of sensitive structures; cardiac risk is low but may be amplified by comorbidities and intoxication. Routine cardiac monitoring is not supported for alert, asymptomatic patients after brief exposures. Riot control agents (principally 2-chlorobenzylidene malononitrile [CS], chloroacetophenone [CN], and oleoresin capsicum) activate nociceptive ion channels, producing ocular, respiratory, and dermal injury that is largely self-limiting but can be severe, especially in enclosed spaces or vulnerable populations such as infants, elderly and patients with asthma. Management centres on decontamination and supportive care. Kinetic impact projectiles are responsible for the highest burden of permanent disability, particularly ocular injury; initial presentations may appear deceptively benign, and clinicians must maintain a high index of suspicion for occult internal injury guided by mechanism rather than surface findings. Acoustic devices and water cannons cause auditory barotrauma and blunt trauma, respectively, while improvised incendiary devices produce combined burn and inhalation injury patterns. Each mechanism imposes specific demands on triage, imaging, specialist consultation, and disposition.</p><p><strong>Conclusion: </strong>Emergency clinicians should be familiar with the distinct injury profiles associated with crowd-control weapons and be prepared to manage them within the emergency care setting. Preparedness planning, mechanism-guided clinical assessment, and awareness of agent-specific pathology are essential to optimising outcomes for casualties of civil unrest.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13390368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370557","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":"EDEN - Enhanced Dispatch for Efficient Neurointervention: mathematical model from national data.","authors":"Esa Mattila, Sanna Hoppu, Mika Mahosenaho, Pauli Vuorinen","doi":"10.1186/s13049-026-01653-x","DOIUrl":"10.1186/s13049-026-01653-x","url":null,"abstract":"<p><strong>Background: </strong>Mechanical thrombectomy (MT) has been proven to be an effective treatment for large vessel acute ischemic strokes. A debate is ongoing about whether to use the mothership or the drip-and-ship strategy for stroke patient transfers. Precious time could be lost if prehospital triage is incorrect. Combining a helicopter with an ambulance on the ground may further reduce prehospital delays.</p><p><strong>Methods: </strong>We conducted a single MT-capable center mathematical model study to assess how many individuals could reach Tampere University Hospital (Tays) within a 120-minute time limit. Population data were obtained from the Finnish Institute of Health and Welfare. Finland is divided into 1-square-kilometer grid cells in the dataset. Travel times were calculated using OpenRouteService. The primary outcome was the number of individuals reaching Tays within the time limit. We evaluated three scenarios: (1) ground transportation only, (2) the Emergency Medical Services (EMS) personnel dispatch the Helicopter Emergency Medical Services (HEMS) unit after being on scene for 10 minutes, and (3) HEMS and EMS are dispatched at the same time.</p><p><strong>Results: </strong>In the first scenario, 1,016,180 individuals could reach Tays within 120 minutes. When ground transportation is combined with a helicopter, 981,391 more individuals could reach Tays within time in scenario 2 settings, corresponding to a 97% increase. Simultaneous dispatch of EMS and HEMS further increased the population reaching Tays with 37,495 individuals. A total of 2,035,067 individuals lived within 120 minutes of the MT center we studied.</p><p><strong>Conclusions: </strong>A hybrid transportation strategy improved access to MT in a single center study. The use of a helicopter nearly doubled the population in the catchment area of Tays, while early recognition of large vessel occlusion stroke provided only a modest additional increase in the number of individuals accessing Tays within the time limit.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370653","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":"Exploring tools used in the assessment of Trauma Team Leadership using video review: a systematic review.","authors":"Cieran McKiernan, Prashant Kumar, Paul Bowie, David J Lowe","doi":"10.1186/s13049-026-01643-z","DOIUrl":"10.1186/s13049-026-01643-z","url":null,"abstract":"<p><strong>Background: </strong>Leadership is a key non‑technical determinant of trauma team performance and is associated with adherence to protocols and patient outcomes. Retrospective video review is increasingly used to evaluate trauma resuscitations; However, the structured observational tools used to evaluate trauma team leadership during video review are heterogeneous and inconsistently reported. This systematic review identifies and characterises structured observational tools used during video review to assess trauma team leadership behaviours.</p><p><strong>Methods: </strong>This systematic review was conducted in accordance with PRISMA 2020 guidelines and prospectively registered on PROSPERO (CRD42025636807). MEDLINE, Embase and CINAHL were searched without date restrictions. Studies were eligible if they used retrospective video review of real or simulated trauma resuscitations and applied a structured observational tool to assess leadership or leadership‑related non‑technical skills. Two reviewers independently screened studies extracted data and performed methodological appraisal using the Mixed Methods Appraisal Tool (MMAT). Due to substantial heterogeneity, results were synthesised narratively.</p><p><strong>Results: </strong>Twenty studies published between 1988 and 2024 were included. Most studies were conducted in the United States (n = 15), with additional studies from Canada (n = 3) and the Netherlands (n = 2). Nineteen distinct structured assessment tools were identified. The Non‑Technical Skills Scale for Trauma (T‑NOTECHS) was the most frequently used instrument (n = 7), followed by the Mayo High Performance Teamwork Scale and the EM Resuscitation Team Leadership Measure. Considerable variation existed in leadership domains assessed, scale structure, rater background and rater training. Communication, decision‑making, task management and situational awareness were the most commonly evaluated leadership attributes. Inter‑rater reliability was inconsistently reported and ranged from poor to excellent, with higher agreement generally observed in simulation‑based assessments.</p><p><strong>Conclusions: </strong>Multiple tools have been used to assess trauma team leadership using video review, with marked heterogeneity in design, rater approach, and reliability reporting. While T-NOTECHS is the most commonly applied instrument, variation in constructs and scoring limits comparability across studies and trauma centres and complicates evaluation of leadership-focused education and quality-improvement initiatives. Inconsistent reliability evidence also constrains outcome-linked research. Greater consistency in leadership assessment tools, rater training, and psychometric reporting is therefore required to support benchmarking, robust evaluation of improvement programmes, and research linking leadership behaviours to clinical and system outcomes.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148363434","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":"Management and outcome of patients with traumatic brain injury treated in three major Nordic intensive care units: a comparative cohort study.","authors":"Hanna Lidström, Anna Hutchens, Logan Froese, David W Nelson, Jiri Bartek, Alexander Fletcher-Sandersjöö, Dag Ferner Netteland, Mads Aarhus, Cecilia A I Åkerlund, Wivi Taalas, Jari Siironen, Juho Vehviläinen, Markus B Skrifvars, Rahul Raj, Eric P Thelin, Cathrine Tverdal","doi":"10.1186/s13049-026-01657-7","DOIUrl":"10.1186/s13049-026-01657-7","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is a major cause of death and disability, with large variations in management strategies and outcomes across countries. Nordic countries are similar in demographics, but differences in treatment strategies likely exist and outcome differences have been reported. We aimed to assess temporal differences in treatments and outcomes in three large Nordic centers, with a hypothesis that outcomes, after adjustment for injury severity, are generally similar and have improved over time.</p><p><strong>Materials and methods: </strong>We performed an international, multicenter, retrospective, observational registry study including consecutive intensive care unit (ICU) managed TBI patients from three of the largest university hospitals in the Nordics (Helsinki (HUS), Finland [2005-2020]; Stockholm (KUH), Sweden [2005-2022]; Oslo (OUH), Norway [2015-2022]). Our primary outcome was 6-12-month unfavorable Glasgow Outcome Scale (GOS, 1-3) and secondary outcome was 30-day mortality. We compared outcomes after adjusting for TBI outcome predictors: age, pupil responsiveness and admission Glasgow Coma Scale (GCS) over time. Other known outcome predictors like computerized tomography (CT) scores (Marshall CT classification and Rotterdam CT score) were collected if available, and intracranial pressure monitoring (ICP) for GCS 3-8 patients was specifically analyzed.</p><p><strong>Results: </strong>In total, 5,970 patients were included (HUS = 2,769, KUH = 1,390, OUH = 1,811). Six-months crude unfavorable outcome was 43% and predicted unfavorable outcome was 44%. Crude 30-day mortality was 17% and predicted 30-day mortality was 18%. Of the included patients, 72% had a moderate-to-severe TBI (GCS 3-12) and 54% underwent some form of neurosurgical intervention. Model application diminished differences between centers, across both outcome measures. Minimal variation in outcomes between hospitals was observed, with a hospital-level variance after applying the model of 0.02 (SD 0.15) for unfavorable outcome and 0.06 (SD 0.24) for 30-day mortality. Overall, no significant temporal trend in predicted unfavorable outcome was observed (OR per year 0.95, 95% CI 0.88-1.03, p = 0.20). Variations in ICP monitoring, but also caseload, were observed.</p><p><strong>Conclusion: </strong>Differences in patient case-mix and caseload between hospitals were associated with variation in treatment strategies and crude outcomes. However, after adjusting for TBI outcome predictors, no meaningful between-hospital variation in outcomes was observed, and no temporal trends in outcome found over the study period.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13309966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148340756","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":"Maintenance of prehospital anaesthesia using an intermittent bolus regime in blunt trauma patients with a high GCS and hemodynamic reserve: a retrospective cohort study.","authors":"Brad Sheridan, Joanne Griggs, Pedro Mondim, Ewoud Ter Avest, Richard Lyon","doi":"10.1186/s13049-026-01654-w","DOIUrl":"10.1186/s13049-026-01654-w","url":null,"abstract":"<p><strong>Background: </strong>In-hospital intravenous maintenance of anaesthesia is commonly achieved by continuous infusion, while prehospital maintenance of anaesthesia after rapid sequence induction (RSI) is currently commonly provided by intermittent boluses. However, the practice effect of this approach has never been fully established.</p><p><strong>Methods: </strong>In a single centre retrospective observational study at a helicopter emergency medical service (HEMS) in the UK, post-RSI anaesthesia maintenance by intermittent boluses was studied between 1 January 2019 and 28 February 2023. Time- and weight-adjusted average maintenance drug doses (as a surrogate for efficacy of sedation) were calculated for a consecutive sample of 101 blunt trauma patients receiving a prehospital anaesthetic with a Glasgow Coma Scale (GCS) ≥ 9 and without significant cardiovascular instability. Associations between (cumulative) maintenance drug doses and induction doses, patient characteristics, physiological parameters, and anaesthesia duration were evaluated using Pearson correlation coefficients and 95% confidence intervals.</p><p><strong>Results: </strong>Median time of prehospital anaesthetic duration was 56 min (range 16-116 min). Maintenance dosing of fentanyl clustered around a median [IQR] dose of 0.64 [0-1.41] mcg/kg/h (minimum non-zero: 0.26mcg/kg/h, maximum: 5.56 mcg/kg/h). For midazolam, this was 0.028 [0-0.041] mg/kg/h (minimum non-zero: 0.005 mg/kg/h, maximum 0.157 mg/kg/h), and for ketamine 0 [0-0.23] mg/kg/h (minimum non-zero 0.05 mg/kg/h, maximum: 1.62 mg/kg/h). Eight patients (duration of anaesthesia between 48 and 74 min), received no maintenance sedation or analgesic agents. No clinically relevant associations were identified between maintenance dosing of any agent and induction dosing, patient demographics or pre-induction physiological parameters.</p><p><strong>Conclusion: </strong>This retrospective analysis of a homogeneous cohort of patients with haemodynamic reserve and a GCS ≥ 9 undergoing prehospital emergency anaesthesia showed that anaesthesia maintenance by an intermittent bolus-only regimen comes with notable variability in cumulative doses administered and may result in a potential risk of sub-therapeutic plasma levels.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148334009","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":"Need-standardised comparisons must not become a barrier to recognising and addressing sex and gender disparities in major trauma care.","authors":"Francois-Xavier Ageron, Tim Nutbeam, Amandine Ghika-Nanchen, Perrine Truong, Pierre-Nicolas Carron, Carole Clair, Angèle Gayet-Ageron","doi":"10.1186/s13049-026-01652-y","DOIUrl":"10.1186/s13049-026-01652-y","url":null,"abstract":"","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310187","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":"Trends in urgency levels and risk of acute critical condition among prehospital patients. A seven-year observational historic register-based cohort study.","authors":"Kristine Sørensen, Torben Anders Kløjgård, Erika Frischknecht Christensen, Tim Alex Lindskou, Morten Breinholt Søvsø","doi":"10.1186/s13049-026-01646-w","DOIUrl":"10.1186/s13049-026-01646-w","url":null,"abstract":"<p><strong>Background: </strong>In our region, as in Western countries, the number of emergencies requesting an ambulance is increasing. Whether this may be due to increased disease burden and/or lower threshold for calling is not clear. This study aimed to examine the development over the years in the number and urgency levels of ambulances and the actual acute disease severity, as indicated by initial vital signs measured on scene, together with patient demographics, comorbidity, and mortality trends over time.</p><p><strong>Methods: </strong>We conducted a registry-based observational cohort study of patients aged ≥ 18 years assigned an ambulance in the North Denmark Region from 2017 to 2023. The primary outcomes were urgency level and acute critical severity, assessed by a modified National Early Warning Score. Linear regression was applied to examine for alignment between trends in urgency level over the years and critically versus non-critically severity in prehospital patients assigned to urgency level A (most urgent, potentially life-threatening) and B (less urgent), respectively.</p><p><strong>Results: </strong>Among 202,746 prehospital patients, the proportion assessed as urgency level A decreased from 62% to 59%, while urgency level B increased from 38% to 41%. While the proportion of patients in acute critical condition was 16% vs. 8% among level of urgency A and B, and stable during the period, the number of patients in acute critical condition increased by 3.6 (95% confidence interval (CI) 0.7-6.6) and 6.1 (95% CI 4.4-7.8) per quarter. Across the total population, patient age increased from 64 to 66 years, and the proportion with severe comorbidity increased from 11% to 14%.</p><p><strong>Conclusion: </strong>From 2017 to 2023, the number of patients assigned with an ambulance through 1-1-2 increased, as did patient age and comorbidity. During the years were similar proportions of acute critical severity, but increasingly more among urgency level B. Thus, the acute severity among prehospital patients has not diminished. The lack of alignment between the level of urgencies and the acuity severity found on scene should be monitored carefully, together with mortality and clinical outcomes.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297158","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}