Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine最新文献

{"title":"The association between geospatial and temporal factors and pre-hospital response to major trauma: a retrospective cohort study in the North of England","authors":"Ryan D McHenry, Christopher A Smith","doi":"10.1186/s13049-023-01166-x","DOIUrl":"https://doi.org/10.1186/s13049-023-01166-x","url":null,"abstract":"Major trauma is a leading cause of premature death and disability worldwide, and many healthcare systems seek to improve outcomes following severe injury with provision of pre-hospital critical care. Much research has focussed on the efficacy of pre-hospital critical care and advanced pre-hospital interventions, but less is known about how the structure of pre-hospital critical care services may influence response to major trauma. This study assessed the association between likelihood of pre-hospital critical care response in major trauma and factors important in the planning and development of those services: geographic isolation, time of day, and tasking mechanism. A local trauma registry, supported with data from the Trauma Audit and Research Network alongside additional information regarding pre-hospital management, identified patients sustaining major trauma admitted to Major Trauma Centres in the North of England. Data was extracted on location and time of incident, mechanism of injury, on-scene times, and presence or absence of pre-hospital critical care team. An isochrone map was constructed for 30-minute intervals to regional Major Trauma Centres, defining geographic isolation. Univariate logistic regression compared likelihood of pre-hospital critical care response to that of conventional ambulance response for varying degrees of geographic isolation, day or night period, and mechanism of injury, and multiple linear regression assessed the association between geographic isolation, service response and on-scene time. 2619 incidents were included, with 23.3% attended by pre-hospital critical care teams. Compared to conventional ambulance services, pre-hospital critical care teams were more likely to respond major trauma in areas of greater geographic isolation (OR 1.42, 95% CI 1.30–1.55, p < 0.005). There were significant differences in the mechanism of injury attended and no significant difference in response by day or night period. Pre-hospital critical care team response and increasing geographic isolation was associated with longer on-scene times (p < 0.005). Pre-hospital critical care teams are more likely to respond to major trauma in areas of greater geographic isolation. Enhanced pre-hospital care may mitigate geographic inequalities when providing advanced interventions and transport of severely injured patients. There may be an unmet need for pre-hospital critical care response in areas close to major hospitals.","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138742357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trauma patient transport to hospital using helicopter emergency medical services or road ambulance in Sweden: a comparison of survival and prehospital time intervals","authors":"Oscar Lapidus, Rebecka Rubenson Wahlin, Denise Bäckström","doi":"10.1186/s13049-023-01168-9","DOIUrl":"https://doi.org/10.1186/s13049-023-01168-9","url":null,"abstract":"The benefits of helicopter emergency medical services (HEMS) transport of adults following major trauma have been examined with mixed results, with some studies reporting a survival benefit compared to regular emergency medical services (EMS). The benefit of HEMS in the context of the Swedish trauma system remains unclear. To investigate differences in survival and prehospital time intervals for trauma patients in Sweden transported by HEMS compared to road ambulance EMS. A total of 74,032 trauma patients treated during 2012–2022 were identified through the Swedish Trauma Registry (SweTrau). The primary outcome was 30-day mortality and Glasgow Outcome Score at discharge from hospital (to home or rehab); secondary outcomes were the proportion of severely injured patients who triggered a trauma team activation (TTA) on arrival to hospital and the proportion of severely injured patients with GCS ≤ 8 who were subject to prehospital endotracheal intubation. 4529 out of 74,032 patients were transported by HEMS during the study period. HEMS patients had significantly lower mortality compared to patients transported by EMS at 1.9% vs 4.3% (ISS 9–15), 5.4% vs 9.4% (ISS 16–24) and 31% vs 42% (ISS ≥ 25) (p < 0.001). Transport by HEMS was also associated with worse neurological outcome at discharge from hospital, as well as a higher rate of in-hospital TTA for severely injured patients and higher rate of prehospital intubation for severely injured patients with GCS ≤ 8. Prehospital time intervals were significantly longer for HEMS patients compared to EMS across all injury severity groups. Trauma patients transported to hospital by HEMS had significantly lower mortality compared to those transported by EMS, despite longer prehospital time intervals and greater injury severity. However, this survival benefit may have been at the expense of a higher degree of adverse neurological outcome. Increasing the availability of HEMS to include all regions should be considered as it may be the preferrable option for transport of severely injured trauma patients in Sweden.","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138688076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-hospital ECPR in an Australian metropolitan setting: a single-arm feasibility assessment—The CPR, pre-hospital ECPR and early reperfusion (CHEER3) study","authors":"S. A. C. Richardson, D. Anderson, A. J. C. Burrell, T. Byrne, J. Coull, A. Diehl, D. Gantner, K. Hoffman, A. Hooper, S. Hopkins, J. Ihle, P. Joyce, M. Le Guen, E. Mahony, S. McGloughlin, Z. Nehme, C. P. Nickson, P. Nixon, J. Orosz, B. Riley, J. Sheldrake, D. Stub, M. Thornton, A. Udy, V. Pellegrino, S. Bernard","doi":"10.1186/s13049-023-01163-0","DOIUrl":"https://doi.org/10.1186/s13049-023-01163-0","url":null,"abstract":"Survival from refractory out of hospital cardiac arrest (OHCA) without timely return of spontaneous circulation (ROSC) utilising conventional advanced cardiac life support (ACLS) therapies is dismal. CHEER3 was a safety and feasibility study of pre-hospital deployed extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (ECPR) for refractory OHCA in metropolitan Australia. This was a single jurisdiction, single-arm feasibility study. Physicians, with pre-existing ECMO expertise, responded to witnessed OHCA, age < 65 yrs, within 30 min driving-time, using an ECMO equipped rapid response vehicle. If pre-hospital ECPR was undertaken, patients were transported to hospital for investigations and therapies including emergent coronary catheterisation, and standard intensive care (ICU) therapy until either cardiac and neurological recovery or palliation occurred. Analyses were descriptive. From February 2020 to May 2023, over 117 days, the team responded to 709 “potential cardiac arrest” emergency calls. 358 were confirmed OHCA. Time from emergency call to scene arrival was 27 min (15–37 min). 10 patients fulfilled the pre-defined inclusion criteria and all were successfully cannulated on scene. Time from emergency call to ECMO initiation was 50 min (35–62 min). Time from decision to ECMO support was 16 min (11–26 min). CPR duration was 46 min (32–62 min). All 10 patients were transferred to hospital for investigations and therapy. 4 patients (40%) survived to hospital discharge neurologically intact (CPC 1/2). Pre-hospital ECPR was feasible, using an experienced ECMO team from a single-centre. Overall survival was promising in this highly selected group. Further prospective studies are now warranted.","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138581569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited commentary: “Identifying traumatic significant haemorrhage is challenging for patient with low and intermediate risk, not when bleeding is obvious”","authors":"Joanne E Griggs, Richard M Lyon, Martyn Sherriff, Jack W Barrett, Gary Wareham, Ewoud Ter Avest","doi":"10.1186/s13049-023-01162-1","DOIUrl":"https://doi.org/10.1186/s13049-023-01162-1","url":null,"abstract":"<p>We would like to thank the authors for their valuable comments on our study, wherein we investigated how pre-hospital lactate (P-LACT) measurements could be used to predict the need for (ongoing) in-hospital blood product transfusion in patients attended by HEMS with major traumatic haemorrhage.</p><p>As mentioned in our article, the algorithm we developed is a decision <i>support</i> tool, which means that it should be used in conjunction with other parameters, such as clinical gestalt in a heuristic approach to estimate transfusion requirements. The cut-off value of a P-LACT &lt; 2.5 mmol/l used in our population yielded a sensitivity of 80% (corresponding to a low probability of major haemorrhage as the authors rightly mention), and hence was inadequate to be used in isolation. The SOP in our service states that a P-LACT &lt; 2.5 mmol/l is used in conjunction with an SBP &gt; 100mmHg to identify patients who have a low probability of major hemorrhage. This is supported by a recent publication of Gaessler et al. (2023) wherein the authors show that P-LACT and SBP are complimentary in terms of predictive probability [1].</p><p>To identify patients with a high likelihood of major haemorrhage requiring in-hospital transfusion, a P-LACT of 6.0 mmol/l was used, as at this this point the predicted probability curve (Fig. 2 in our original article) starts to flatten: using a higher cut-off would not have yielded a higher specificity, whereas a lower cut-off would have dropped specificity whilst not yielding a much higher proportion of the population meeting the cut-off criteria (n = 13, 6.7% for a lactate of 6.0 mmol/l vs. n = 17, 8.7% for a lactate of 5.5 mmol/l). Although we agree that it is likely that many patients with a lactate &gt; 6.0 mmol/l will show clinical signs of shock, 5/13 patients had an SBP &gt; 100 mmHg on first occasion, two of whom also did not exhibit tachycardia. In these patients P-LACT may still be a useful tool. Despite this however, the major challenge remains to identify the bleeding patients in the P-LACT group of 2.5-6 mmol/l, and serial measurements may be the way forward in this group.</p><p>Finally, we acknowledge that transfusion requirement is not always a good surrogate to use for outcome, especially not when confounding by indication may be present: using lactate may result in transfusing more patients in the pre-hospital setting, which again may result in a lower threshold to continue transfusion in-hospital. However, as 2/3 of the patients in our cohort received a massive transfusion (&gt; 10 units PRBC within 24 h) rather than a major transfusion, we think transfusion requirement was a reasonable surrogate for risk of death from bleeding in our population. We agree however, that ideally outcome studies should be performed using hard endpoints to confirm this.</p><p>Not applicable.</p><ol data-track-component=\"outbound reference\"><li data-counter=\"1.\"><p>Gaessler H, Helm M, Kulla M, et al. Prehospital predicto","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138580084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selective aortic arch perfusion: a first-in-human observational cadaveric study","authors":"Max Marsden, Jon Barratt, Helen Donald-Simpson, Tracey Wilkinson, Jim Manning, Paul Rees","doi":"10.1186/s13049-023-01148-z","DOIUrl":"https://doi.org/10.1186/s13049-023-01148-z","url":null,"abstract":"Selective aortic arch perfusion (SAAP) is a novel endovascular technique that combines thoracic aortic occlusion with extracorporeal perfusion of the brain and heart. SAAP may have a role in both haemorrhagic shock and in cardiac arrest due to coronary ischaemia. Despite promising animal studies, no data is available that describes SAAP in humans. The primary aim of this study was to assess the feasibility of selective aortic arch perfusion in humans. The secondary aim of the study was to assess the feasibility of achieving direct coronary artery access via the SAAP catheter as a potential conduit for salvage percutaneous coronary intervention. Using perfused human cadavers, a prototype SAAP catheter was inserted into the descending aorta under fluoroscopic guidance via a standard femoral percutaneous access device. The catheter balloon was inflated and the aortic arch perfused with radio-opaque contrast. The coronary arteries were cannulated through the SAAP catheter. The procedure was conducted four times. During the first two trials the SAAP catheter was passed rapidly and without incident to the intended descending aortic landing zone and aortic arch perfusion was successfully delivered via the device. The SAAP catheter balloon failed on the third trial. On the fourth trial the left coronary system was cannulated using a 5Fr coronary guiding catheter through the central SAAP catheter lumen. For the first time using a perfused cadaveric model we have demonstrated that a SAAP catheter can be easily and safely inserted and SAAP can be achieved using conventional endovascular techniques. The SAAP catheter allowed successful access to the proximal aorta and permitted retrograde perfusion of the coronary and cerebral circulation.","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138580274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to ‘Chest compressions at altitude are of decreased quality, require more effort and cannot reliably be self-evaluated’","authors":"Maximilian Niederer, Dominik Roth, Alexander Egger","doi":"10.1186/s13049-023-01158-x","DOIUrl":"https://doi.org/10.1186/s13049-023-01158-x","url":null,"abstract":"<p>To the editor,</p><p>We thank van Veelen and colleagues for their interest in our article on an ascent to high altitude on physical exhaustion during cardiopulmonary resuscitation (CPR) [1].</p><p>We wholeheartedly concur with the assessment that performing CPR under such unique circumstances requires greater effort and impairs providers’ ability to adhere to resuscitation guidelines at high altitudes. Whether the ascent was simulated through the use of a hypobaric chamber [2], made by car [3], or through an arduous ascent exceeding 1,200 m as in our case [1], the analysis of vital parameters showed pronounced exhaustion due to the demands of chest compressions at high altitude.</p><p>From this perspective, the findings by van Veelen et al. on providers’ struggle to reliably self-evaluate the quality of chest compressions at high altitudes is both interesting and significant. This is in line with our previous findings on the discrepancy between subjective exhaustion and actual quality of CPR at high altitude [4]. We could demonstrate that during ventilation phases, heart rate immediately decreases, even after 14 min of CPR, underlining the importance of frequent resting phases.</p><p>We also concur with the assessment of a need for widespread adoption of mechanical chest compression devices in alpine settings, as those have been shown to be viable, even in difficult terrain [5].</p><p>We fully endorse the call to adjust the guidelines for CPR in the alpine setting in the light of recent findings. There is a critical need to emphasize the widespread use of mechanical chest compression devices. In their absence, a minute-by-minute rotation of chest compressions might be advocated and should be further studied.</p><ol data-track-component=\"outbound reference\"><li data-counter=\"1.\"><p>Niederer M, Tscherny K, Burger J, et al. Influence of high altitude after a prior ascent on physical exhaustion during cardiopulmonary resuscitation: a randomised crossover alpine field experiment. Scand J Trauma Resusc Emerg Med. 24. Oktober 2023;31(1):59.</p><p>Article Google Scholar </p></li><li data-counter=\"2.\"><p>Vögele A, Van Veelen MJ, Dal Cappello Tet al. Effect of Acute Exposure to Altitude on the Quality of Chest Compression-Only Cardiopulmonary Resuscitation in Helicopter Emergency Medical Services Personnel: A Randomized, Controlled, Single‐Blind Crossover Trial. J Am Heart Assoc. 7. Dezember 2021;10(23):e021090.</p></li><li data-counter=\"3.\"><p>Narahara H, Kimura M, Suto T, et al. Effects of Cardiopulmonary Resuscitation at High Altitudes on the Physical Condition of untrained and unacclimatized rescuers. Wilderness Environ Med Juni. 2012;23(2):161–4.</p><p>Article Google Scholar </p></li><li data-counter=\"4.\"><p>Egger A, Niederer M, Tscherny K, et al. Influence of physical strain at high altitude on the quality of cardiopulmonary resuscitation. Scand J Trauma Resusc Emerg Med Dezember. 2020;28(1):19.</p><p>Article Google Scholar </p></li><li data-count","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138581841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frostbite treatment: a systematic review with meta-analyses","authors":"Ivo B. Regli, Rosmarie Oberhammer, Ken Zafren, Hermann Brugger, Giacomo Strapazzon","doi":"10.1186/s13049-023-01160-3","DOIUrl":"https://doi.org/10.1186/s13049-023-01160-3","url":null,"abstract":"Our objective was to perform a systematic review of the outcomes of various frostbite treatments to determine which treatments are effective. We also planned to perform meta-analyses of the outcomes of individual treatments for which suitable data were available. We performed a systematic review and meta-analyses in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched PubMed, Cochrane Trials, and EMBase to identify primary references from January 1, 1900, to June 18, 2022. After eliminating duplicates, we screened abstracts to identify eligible studies containing information on treatment and outcomes of Grade 2 to 4 frostbite. We performed meta-analyses of groups of articles that provided sufficient data. We registered our review in the prospective registry of systematic reviews PROSPERO (Nr. 293,693). We identified 4,835 potentially relevant studies. We excluded 4,610 studies after abstract screening. We evaluated the full text of the remaining 225 studies, excluding 154. Ultimately, we included 71 articles with 978 cases of frostbite originating from 1 randomized controlled trial, 20 cohort studies and 51 case reports. We found wide variations in classifications of treatments and outcomes. The two meta-analyses we performed both found that patients treated with thrombolytics within 24 h had better outcomes than patients treated with other modalities. The one randomized controlled trial found that the prostacyclin analog iloprost was beneficial in severe frostbite if administered within 48 h. Iloprost and thrombolysis may be beneficial for treating frostbite. The effectiveness of other commonly used treatments has not been validated. More prospective data from clinical trials or an international registry may help to inform optimal treatment.","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138569009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suspension syndrome: a scoping review and recommendations from the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)","authors":"Simon Rauch, Raimund Lechner, Giacomo Strapazzon, Roger B. Mortimer, John Ellerton, Sven Christjar Skaiaa, Tobias Huber, Hermann Brugger, Mathieu Pasquier, Peter Paal","doi":"10.1186/s13049-023-01164-z","DOIUrl":"https://doi.org/10.1186/s13049-023-01164-z","url":null,"abstract":"Suspension syndrome describes a multifactorial cardio-circulatory collapse during passive hanging on a rope or in a harness system in a vertical or near-vertical position. The pathophysiology is still debated controversially. The International Commission for Mountain Emergency Medicine (ICAR MedCom) performed a scoping review to identify all articles with original epidemiological and medical data to understand the pathophysiology of suspension syndrome and develop updated recommendations for the definition, prevention, and management of suspension syndrome. A literature search was performed in PubMed, Embase, Web of Science and the Cochrane library. The bibliographies of the eligible articles for this review were additionally screened. The online literature search yielded 210 articles, scanning of the references yielded another 30 articles. Finally, 23 articles were included into this work. Suspension Syndrome is a rare entity. A neurocardiogenic reflex may lead to bradycardia, arterial hypotension, loss of consciousness and cardiac arrest. Concomitant causes, such as pain from being suspended, traumatic injuries and accidental hypothermia may contribute to the development of the Suspension Syndrome. Preventive factors include using a well-fitting sit harness, which does not cause discomfort while being suspended, and activating the muscle pump of the legs. Expediting help to extricate the suspended person is key. In a peri-arrest situation, the person should be positioned supine and standard advanced life support should be initiated immediately. Reversible causes of cardiac arrest caused or aggravated by suspension syndrome, e.g., hyperkalaemia, pulmonary embolism, hypoxia, and hypothermia, should be considered. In the hospital, blood and further exams should assess organ injuries caused by suspension syndrome.","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138563360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Calling for help: i need you to listen’’: a qualitative study of callers’ experience of calls to the emergency medical communication centre","authors":"Trine Berglie Spjeldnæs, Kristine A. Vik Nilsen, Lars Myrmel, Jan-Oddvar Sørnes, Guttorm Brattebø","doi":"10.1186/s13049-023-01161-2","DOIUrl":"https://doi.org/10.1186/s13049-023-01161-2","url":null,"abstract":"The Emergency Medical Communications Center (EMCC) is essential in emergencies and often represents the public’s first encounter with the healthcare system. Previous research has mainly focused on the dispatcher’s perspective. Therefore, there is a lack of insight into the callers’ perspectives, the attainment of which may contribute significantly to improving the quality of this vital public service. Most calls are now made from mobile phones, opening up novel approaches for obtaining caller feedback using tools such as short-message services (SMS). Thus, this study aims to obtain a better understanding of callers’ actual experiences and how they perceived their interaction with the EMCC. A combination of quantitative and qualitative study methods was used. An SMS survey was sent to the mobile phone numbers of everyone who had contacted 113 during the last months. This was followed by 31 semi-structured interviews with people either satisfied or dissatisfied. Thematic analysis was used to investigate the interviews. We received 1680 (35%) responses to the SMS survey, sent to 4807 unique numbers. Most respondents (88%) were satisfied, evaluating their experience as 5 or 6 on a six-point scale, whereas 5% answered with 1 or 2. The interviews revealed that callers were in distress before calling 113. By actively listening and taking the caller seriously, and affirming that it was the right choice to call the emergency number, the EMCC make callers experience a feeling of help and satisfaction, regardless of whether an ambulance was dispatched to their location. If callers did not feel taken seriously or listened to, they were less satisfied. A negative experience may lead to a higher distress threshold and an adjusted strategy before the caller makes contact 113 next time. Callers with positive experiences expressed more trust in the healthcare systems. For the callers, the most important was being taken seriously and listened to. Additionally, they welcomed that dispatchers express empathy and affirm that callers made the right choice to call EMCC, as this positively affects communication with callers. The 113 calls aimed to cooperate in finding a solution to the caller’s problem.","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138552848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambulance deployment without transport: a retrospective difference analysis for the description of emergency interventions without patient transport in Bavaria","authors":"Florian Dax, Heiko Trentzsch, Marc Lazarovici, Kathrin Hegenberg, Katharina Kneißl, Florian Hoffmann, Stephan Prückner","doi":"10.1186/s13049-023-01159-w","DOIUrl":"https://doi.org/10.1186/s13049-023-01159-w","url":null,"abstract":"Not all patients who call the ambulance service are subsequently transported to hospital. In 2018, a quarter of deployments of an emergency ambulance in Bavaria were not followed by patient transport. This study describes factors that influence patient transport rates. This is a retrospective cross-sectional study based on data from all Integrated Dispatch Centres of the Free State of Bavaria in 2018. Included were ambulance deployments without emergency physician involvement, which were subdivided into ambulance deployments without transport and ambulance deployments with transport. The proportion of transported patients were determined for the primary reasons for deployment and for the different community types. On-scene time was compared for calls with and without patient transport. Differences were tested for statistical significance using Chi2 tests and the odds ratio was calculated to determine differences between groups. Of 510,145 deployments, 147,621 (28.9%) could be classified as ambulance deployments without transport and 362,524 (71.1%) as ambulance deployments with transport.The lowest proportion of patients transported was found for activations where the fire brigade was involved (“fire alarm system” 0.6%, “fire with emergency medical services” 5.4%) and “personal emergency response system active alarm” (18.6%). The highest transport rates were observed for emergencies involving “childbirth/delivery” (96.9%) and “trauma” (83.2%). A lower proportion of patients is transported in large cities as compared to smaller cities or rural communities; in large cities, the odds ratio for emergencies without transport is 2.02 [95% confidence interval 1.98–2.06] referenced to rural communites. The median on-scene time for emergencies without transport was 20.8 min (n = 141,052) as compared to 16.5 min for emergencies with transport (n = 362,524). The shortest on-scene times for emergencies without transport were identified for activations related to “fire alarm system” (9.0 min) and “personal emergency response system active alarm” (10.6 min). This study indicates that the proportion of patients transported depends on the reason for deployment and whether the emergency location is urban or rural. Particularly low transport rates are found if an ambulance was dispatched in connection with a fire department operation or a personal emergency medical alert button was activated. The on-scene-time of the rescue vehicle is increased for deployments without transport. The study could not provide a rationale for this and further research is needed. Trial registration This paper is part of the study “Rettungswageneinsatz ohne Transport” [“Ambulance deployment without transport”] (RoT), which was registered in the German Register of Clinical Studies under the number DRKS00017758.","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138493202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}