Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

COVID-19 UPDATES

COVID-19 has greatly impacted our lives and the healthcare system in the most recent times.
Air ambulance services are facing several challenges when dealing with highly infectious patients.
We collect here all most recent research updates on COVID-19 emergency procedures published in the journal to make them easily discoverable to the research community

ASSESSING SPINAL MOVEMENT DURING EXTRICATION METHODS: A BIOMECHANICAL STUDY

Motor vehicle collisions are a common cause of death and serious injury. Trapped patients have more injuries and are more likely to die than their untrapped counterparts. Current extrication methods focus on movement minimisation but how they affect spinal movement is unknown. T. Nutbeam et al, in this biomechanical study, evaluate the movement at the cervical and lumbar spine for four commonly used extrication techniques.

MENTAL HEALTH-, POSTTRAUMATIC STRESS AND POST EXPOSURE CHANGES IN AMBULANCE PERSONNEL

Emergency service personnel are exposed to an array of potentially traumatic events, which may influence their physical or psychological wellbeing. Exposure to traumatic events entail increased risk of developing posttraumatic stress symptoms, as well as other forms of psychological distress. Bjørn Ole Reid et al. report the prevalence of depression, anxiety, posttraumatic development, and posttraumatic stress disorders in Norwegian ambulance personnel. 

MAIN ISSUES ASSOCIATED WITH PRE-HOSPITAL THORACOSTOMY

Open thoracostomies have become the standard of care in pre-hospital critical care in patients with chest injuries receiving positive pressure ventilation. Nevertheless, the thoracic cavity contains several life-sustaining structures, whose injury can place a person at immediate threat of severe disability or death, thus it may be appropriate to withhold intervention in the absence of clinical features. Clinicians should also consider the environment where the patient will be monitored during care and transfer, and chest ultrasound can be used as an adjunct to assessment. Read S. Mohrsen et al.'s review to get  more insights on this important clinical issue.

WHAT'S THE BEST APPROACH TO PATIENTS EXPOSED TO ELECTRICAL INJURY?

The damage caused by electrical injuries can range from minor skin burns to life-threatening damage to vital organs. Current evidence suggests that patients exposed to electrical injury who have a normal ECG on admission after a low-voltage injury, with no loss of consciousness or initial cardiac arrest may be discharged home after a short observation time (usually 24h). But.... is this the best approach?
J. Ahmed et al. analysed the characteristics of 465 patients exposed to electrical injury and their outcomes after hospital discharge. 

RECURRENT VENTRICULAR FIBRILLATION CARDIAC ARRESTS IN A 3-MONTH OLD BOY

Sudden cardiac arrest in infancy is an extremely rare evenience. The overall low numbers of out-of-hospital cardiac arrests, together with the obvious ethical restrictions on clinical trials in children, has resulted in national guidelines mainly relying on  case reports, retrospective registry studies, animal modelling and studies exploring resuscitation in the adult population. This results in a lack of high-quality evidence on which to make recommendations on many fundamental aspects of a resuscitation. 
Here P. Kingsley et al. report a very challenging case of resuscitation for recurrent ventricular fibrillation cardiac arrests in an infant.

HOW AND WHY HAS EMERGENCY DEPARTMENT AND PRE-HOSPITAL EMERGENCY ANAESTHESIA CHANGED?

Emergency airway management both in the emergency dept. and in the pre-hospital phase of care is not only a key intervention but also a cause of much controversy and uncertainty. Rapid sequence induction (RSI) is the method that we use to try to achieve definitive airway control effectively and rapidly. The original descriptions of RSI delivered great consistency for many years but almost every aspect has been challenged. Avery & coll., in this review, reminded us of what was originally described and looked at how and why this consensus has been lost. There are very good reasons why variations occur and this article gives an insight into how emergency anaesthesia is conducted now and what factors are likely to influence practice in the immediate future. 
SJTREM Editorial Team

GCS ≤ 8: IS INTUBATION THE FIRST CHOICE?

Despite the relationship between the level of consciousness and intubation need is not yet sufficiently subject to evidence-based medicine, it is customary to believe that a patient with GCS ≤ 8 should be intubated to avoid aspiration, or aspiration pneumonia/pneumonitis, and consequently, reduce mortality. Does the coma's state etiology have a word on this?  Read more in D. Orso et al. study.

WHAT'S PRIMARILY TO CARE IN PATIENTS TRAPPED IN MOTOR VEHICLE COLLISIONS?

Prolonged entrapment and/or intrusion into a vehicle after a collision is considered high risk for significant injury. Extrication methods are focused on the prevention of secondary spinal injury through movement minimisation and mitigation .....but which types and in what rate other time-critical injuries occur?
T. Nutbeam et al. analysed data from 63,625 injured patients to help guide meaningful patient-focused interventions and future extrication strategies.

EFFECTIVE PAEDIATRIC PRE-HOSPITAL PAIN MANAGEMENT

Effective analgesia is one of the top outcome measures of pre-hospital care aiming at relieving suffering and improving recovery. Despite of this, 52–88% of children do not receive adequate pain medication the pre-hospital setting due to fear of side effects, difficulties with intravenous line access, lack of a pain assessment and the assumption that children need less analgesia than adults. 
Y. Abebe et al., in this systematic review, evaluate the preferable drugs for pre-hospital pain relief in paediatric patients with acute pain, irrespective of aetiology.

THE IMPORTANCE OF MAJOR INCIDENT PREPAREDNESS: THE GREAT BELT TRAIN ACCIDENT

On January 2nd, 2019, a high-speed passenger train collided with a trailer falling from a freight train on the Great Belt Bridge near Nyborg, Denmark. The incident turned out to be the most severe major incident in Denmark for thirty years.
Despite harsh weather conditions and complex logistics, the massive and prompt prehospital response allowed a successful management of the incident although some difficulties arose.
What did we learn and what could be improved? Read the detailed analysis by P.M. Hansen et al.

PREHOSPITAL EMERGENCY MANAGEMENT OF GERIATRIC TRAUMA PATIENTS: THE 6 BIGGEST CHALLENGES!

Trauma happens regularly to older people (≥65 years) - a rapidly growing patient group, especially in the prehospital field. Because of altered physiology, covert mechanisms of injury, non-linear presentations and co-morbidities, it increasingly challenges prehospital teams.
This Scoping Review by Eichinger et al. summarises the six biggest challenges for prehospital providers of a patient's journey, from the dispatch to the outcome.

DOES AMBULANCE DECELERATION CAUSE AN INCREASE IN INTRA CRANIAL PRESSURE?

Ambulance drivers are trained to drive fast when transporting a head injured patient, nevertheless acceleration and deceleration have the potential to create pressure changes in the head that may worsen outcome. In this study, Iscander M. Maissan et al. evaluate the effects of driving and deceleration during ambulance transportation on the intra cranial pressure in supine position and 30° upright position

CHALLENGES IN MOUNTAIN RESCUE

Multiple trauma management in mountain environments can be demanding. Safety of the rescuers and the victim has priority and time for on-site medical treatment must be balanced against the need for rapid transfer to a trauma centre and should be as short as possible. Read the Evidence based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MedCom) for physicians and other advanced life support personnel.

PROS & CONS OF SMARTPHONE-BASED ACTIVATION OF COMMUNITY FIRST RESPONDERS FOR OUT OF HOSPITAL CARDIAC ARREST

A Community First Responder (CFR) is a local volunteer who agrees to undertake training in Basic Life Support. Over the past decade Smartphone-based activation (SBA) of Community First Responders (CFR) to out-of-hospital cardiac arrests (OHCA) has gained much attention and popularity throughout Europe. C. Metelmann et al. review the current state of SBA of CFR in five European countries, reveal pros & cons, and presents consensus statements to support public decision making on future strategies.

REBOA: WHERE ARE WE & WHERE DO WE GO?

The role of the Resuscitative Endovascular Occlusion of the Aorta (REBOA) has been recently rediscovered and many trauma centres and some pre-hospital services are considering whether endovascular resuscitation should have a place in their services. M.A. Thrailkill et al. from the Uniformed Services University of the Health Sciences in Bethesda give a comprehensive and balanced description of the techniques, the evidence to date and where the immediate future is likely to take us.

The top five research priorities in physician-provided pre-hospital critical care

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