Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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. 

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. 

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.

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 OPTIMAL CPR DURATION FOR FAVORABLE NEUROLOGICAL OUTCOME?

Longer cardiopulmonary resuscitation duration in cases of out-of-hospital cardiac arrest is associated with reduced favorable neurological outcomes, thus determining the upper limit of CPR duration is essential for stopping futile resuscitation efforts. Despite of this, to date, consensus is lacking on the optimal total CPR duration. This study by SungJoon Park et al. aims to identify the upper limit of total CPR duration and optimal cut-off for pre- or in-hospital total CPR duration to achieve favorable neurological outcomes.

ENTRAPMENT INJURIES, OUTCOMES AND AGE: ANY CORRELATION?

Older road users represent 12% of car driving license holders and 9% of road miles travelled. Older casualties may be at increased risk of entrapment through decreased baseline mobility, a propensity to frailty and vulnerability to certain types of injury, although it is unknown if prolonged entrapment may represent an increased risk of poor outcome. Tim Nutbeam et al., in this study, describe the injuries, trapped status, outcomes, and potential for self-extrication for patients following an MVC across a range of age groups.

_{Related contents from the same authors: (1) Assessing spinal movements during extrication methods (2) Travel movements; (3) Role of cervical collars; (4) Trapped vs not trapped}

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.

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

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.

ACCIDENTAL HYPOTHERMIA: OBSERVED CONSCIOUS LEVEL VS CARDIAC ARREST

Patients with isolated accidental hypothermia are at risk of cardiac arrest. The fundamental cause of death in hypothermia is the level of critical brain hypoxia. The fall in brain oxygen-consumption at lower core temperatures provides some resilience, but the brain cannot withstand hypothermic cardiac arrest indefinitely. Rapid stratification of the risk of cardiac arrest is essential in the assessment of patients with isolated accidental hypothermia. S. Barrow & G. Ives quantify the direct relationship between observed conscious level and cardiac arrest and evaluate the importance of including confusion as a new assessing criterion.

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.

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