Nordic physician-staffed prehospital services - organisation and preparedness for major emergency surgical procedures.

Background: Prehospital physician-staffed services in the Nordic countries vary in crew structure, medical specialisation of crew and preparedness for major emergency surgical procedures. Performing emergency surgical procedures in prehospital settings requires equipment, training and clinical ability. This study aimed to explore the organisation of Nordic prehospital physician-staffed services and their preparedness for resuscitative thoracotomy, perimortem caesarean section and prehospital amputation.

Methods: A cross-sectional survey was conducted among Nordic prehospital physician-staffed services. A web-based questionnaire was distributed to medical directors. The questions included local organisation, equipment, training, and the ability of the service to perform major emergency surgical procedures. The responses were analysed using descriptive statistics.

Results: Out of 61 prehospital physician-staffed services, 54 responded (89% response rate). The various organisations showed variability in geographical coverage, staffing, and transportation options. Resuscitative thoracotomy had been carried out by 41% of the services, 85% had equipment for the procedure, and 48% had established local guidelines. Perimortem caesarean section had been performed by 7% of the services, 80% had equipment for the procedure, and 31% had established local guidelines. Prehospital amputations had been carried out by 35% of the services, 81% had equipment for the procedure, and 22% had established guidelines. Preparation for the procedures varied. 61% of the services carried out special training for resuscitative thoracotomy, 22% for perimortem caesarean section, and 39% for prehospital amputation.

Conclusions: Prehospital physician-staffed units need to be prepared and have a strategy and guidelines for the treatment of unusual but life-threatening conditions. To perform major surgical procedures outside a hospital, guidelines, training, equipment, and experience are required. The study has demonstrated significant differences between Nordic countries and regions in how major surgical procedures outside the hospital are addressed. Many services lack standardised procedures and training. Addressing these gaps by implementing protocols and training programs may improve patient care. However, the potential benefits for a small number of patients should be weighed against the investment to have the ability to perform major surgical procedures outside the hospital.