Articles

Diagnostic error increases mortality and length of hospital stay in patients presenting through the emergency room

Diagnostic errors occur frequently, especially in the emergency room. Estimates about the consequences of diagnostic error vary widely and little is known about the factors predicting error. Our objectives thu...

Authors: Wolf E. Hautz, Juliane E. Kämmer, Stefanie C. Hautz, Thomas C. Sauter, Laura Zwaan, Aristomenis K. Exadaktylos, Tanja Birrenbach, Volker Maier, Martin Müller and Stefan K. Schauber

Socioeconomic disparities in prehospital stroke care

Recent studies have revealed socioeconomic disparities in stroke outcomes. Here, we investigated whether prehospital stroke care differs with respect to socioeconomic status (SES).

Authors: Amanda Niklasson, Johan Herlitz and Katarina Jood

A prospective stepped wedge cohort evaluation of the new national trauma team activation criteria in Sweden – the TRAUMALERT study

Trauma triage based on prehospital information facilitates correct allocation of in-hospital resources. The Swedish national two-tier trauma team activation (TTA) criteria were revised in 2016. The current stu...

Authors: Fredrik Linder, Lina Holmberg, Martin Bjorck, Claes Juhlin, Knut Thorbjornsen, Jan Wisinger, Per Polleryd, Hampus Eklof and Kevin Mani

Prognostic accuracy of the serum lactate level, the SOFA score and the qSOFA score for mortality among adults with Sepsis

Sepsis is a common critical condition caused by the body’s overwhelming response to certain infective agents. Many biomarkers, including the serum lactate level, have been used for sepsis diagnosis and guiding...

Authors: Zhiqiang Liu, Zibo Meng, Yongfeng Li, Jingyuan Zhao, Shihong Wu, Shanmiao Gou and Heshui Wu

The HEAVEN criteria predict laryngoscopic view and intubation success for both direct and video laryngoscopy: a cohort analysis

Existing difficult airway prediction tools are not practical for emergency intubation and do not incorporate physiological data. The HEAVEN criteria (Hypoxaemia, Extremes of size, Anatomic challenges, Vomit/bl...

Authors: Fauzia Nausheen, Nichole P. Niknafs, Derek J. MacLean, David J. Olvera, Allen C. Wolfe Jr, Troy W. Pennington and Daniel P. Davis

A paediatric case of severe tracheobronchial injury successfully treated surgically after early CT diagnosis and ECMO safely performed in the hybrid emergency room

In paediatric trauma patients, tracheobronchial injury can be a rare, life-threatening trauma. In 2011, we instituted a new trauma workflow concept called the hybrid emergency room (Hybrid ER) that combines a ...

Authors: Daiki Wada, Koichi Hayakawa, Shuhei Maruyama, Fukuki Saito, Hiroyuki Kaneda, Yasushi Nakamori and Yasuyuki Kuwagata

Application of prothrombin complex concentrate for reversal of direct oral anticoagulants in clinical practice: indications, patient characteristics and clinical outcomes compared to reversal of vitamin K antagonists

Prothrombin complex concentrate (PCC) is widely used to reverse the action of direct oral anticoagulants (DOACs) in accordance with current guidelines and because of a lack of specific reversal agents. Indicat...

Authors: Martin Müller, Jonathan Eastline, Michael Nagler, Aristomenis K. Exadaktylos and Thomas C. Sauter

Injury registration for primary prevention in a provincial Russian region: setting up a new trauma registry

The Shenkursk Injury Registry (SHIR) was established in the Shenkursk District, Northwestern Russia in 2015 for the purposes of primary prevention. The SHIR covers all injuries (ICD-10 diagnoses from S00 to T7...

Authors: Tatiana N Unguryanu, Andrej M Grjibovski, Tordis A Trovik, Børge Ytterstad and Alexander V Kudryavtsev

Repeated ambulance use is associated with chronic diseases - a population-based historic cohort study of patients’ symptoms and diagnoses

There is a growing demand for emergency medical services (EMS) and patients are repeatedly transported by ambulance services. For many patients, especially those with chronic disease, there may be better ways ...

Authors: Morten Breinholt Søvsø, Torben Anders Kløjgaard, Poul Anders Hansen and Erika Frischknecht Christensen

Chest wall thickness and depth to vital structures in paediatric patients – implications for prehospital needle decompression of tension pneumothorax

Recommendations regarding decompression of tension pneumothorax in small children are scarce and mainly transferred from the adult literature without existing evidence for the paediatric population. This CT-ba...

Authors: Tom Terboven, Georg Leonhard, Lucas Wessel, Tim Viergutz, Marcus Rudolph, Michael Schöler, Meike Weis and Holger Haubenreisser

Impact of caller’s degree-of-worry on triage response in out-of-hours telephone consultations: a randomized controlled trial

Telephone triage entails assessment of urgency and direction of flow in out-of-hours (OOH) services, while visual cues are inherently lacking. Triage tools are recommended but current tools fail to provide sys...

Authors: Hejdi Gamst-Jensen, Erika Frishknecht Christensen, Freddy Lippert, Fredrik Folke, Ingrid Egerod, Mikkel Brabrand, Janne Schurmann Tolstrup, Lau Caspar Thygesen and Linda Huibers

Availability of suPAR in emergency departments may improve risk stratification: a secondary analysis of the TRIAGE III trial

Soluble urokinase plasminogen activator receptor (suPAR) is a prognostic and nonspecific biomarker associated with short-term mortality in emergency department (ED) patients. Therefore, the blood level of suPA...

Authors: Martin Schultz, Line J. H. Rasmussen, Thomas Kallemose, Erik Kjøller, Morten N. Lind, Lisbet Ravn, Theis Lange, Lars Køber, Lars S. Rasmussen, Jesper Eugen-Olsen and Kasper Iversen

Key performance indicators for pre hospital emergency Anaesthesia - a suggested approach for implementation

Pre-hospital Emergency Anaesthesia (PHEA) is regarded as one of the highest risk interventions that pre-hospital providers perform. AAGBI guidance from 2017 suggests the use of Key Performance Indicators (KPIs...

Authors: James Raitt, James Hudgell, Henry Knott and Syed Masud

Could we employ the queueing theory to improve efficiency during future mass causality incidents?

Preparation for a disaster or accident-related mass casualty events is often based on experience. The objective measures or tools for evaluating decision-making and effectiveness during such events are underde...

Authors: Chih-Chuan Lin, Chin-Chieh Wu, Chi-Dan Chen and Kuan-Fu Chen

Drone delivery of an automated external defibrillator – a mixed method simulation study of bystander experience

Out-of-hospital cardiac arrest (OHCA) affects some 275,000 individuals in Europe each year. Time from collapse to defibrillation is essential for survival. As emergency medical services (EMS) response times in...

Authors: J. Sanfridsson, J. Sparrevik, J. Hollenberg, P. Nordberg, T. Djärv, M. Ringh, L. Svensson, S. Forsberg, A. Nord, M. Andersson-Hagiwara and A. Claesson

The effects of prehospital system delays on the treatment efficacy of STEMI patients

Cardiovascular disease accounts for nearly half of all deaths in Poland. The aim of this study was to assess both the duration and the delays of prehospital treatment in ST-segment elevation myocardial infarction...

Authors: Magdalena Żurowska-Wolak, Patryk Piekos, Jacek Jąkała and Marcin Mikos

The Danish helicopter emergency medical service database: high quality data with great potential

The Danish Helicopter Emergency Medical Service (HEMS) is part of the Danish pre-hospital response offering advanced patient care on scene and during rapid transport to definitive care.

Authors: Karen Alstrup, Jens Aage Kølsen Petersen, Charlotte Barfod, Lars Knudsen, Leif Rognås and Thea Palsgaard Møller

Comment on unplanned out-of-hospital birth and risk factors of adverse perinatal outcome: findings from a prospective cohort

The aim of this Letter to the Editor was to report some methodological shortcomings in a recently published Article. We proved that the obtained results are subjected to the sparse data bias and presented some...

Authors: Razieh Bidhendi Yarandi and Mohammad Hossein Panahi

Diagnostic accuracy of physician-staffed emergency medical teams: a retrospective observational cohort study of prehospital versus hospital diagnosis in a 10-year interval

In Germany, emergency medical teams are staffed with physicians but evidence regarding their prehospital diagnostic accuracy remains poor.

Authors: Jens-Christian Schewe, Jochen Kappler, Katharina Dovermann, Ingo Graeff, Stefan Felix Ehrentraut, Ulrich Heister, Andreas Hoeft, Stefan Ulrich Weber and Stefan Muenster

Use of pre-hospital emergency medical services in urban and rural municipalities over a 10 year period: an observational study based on routinely collected dispatch data

Pre-hospital emergency medical services (EMS) are an integral part of emergency medical care. EMS planning can be achieved by analyzing patterns of use. However, long-term time trends of EMS use have rarely be...

Authors: Kathrin Hegenberg, Heiko Trentzsch, Stefan Gross and Stephan Prückner

Epidemiology of emergency ambulance service calls related to mental health problems and self harm: a national record linkage study

People experiencing a mental health crisis receive variable and poorer quality care than those experiencing a physical health crisis. Little is known about the epidemiology, subsequent care pathways of mental ...

Authors: Edward A. S. Duncan, Catherine Best, Nadine Dougall, Silje Skar, Josie Evans, Alasdair R. Corfield, David Fitzpatrick, Isabella Goldie, Margaret Maxwell, Helen Snooks, Cameron Stark, Chris White and Wojtek Wojcik

Response to: Best practice advice on pre-hospital emergency anaesthesia & advanced airway management

The European HEMS and Air ambulance Committee’s Medical working group recently published Best Practice advice on pre-hospital emergency anaesthesia and advanced airway management. We believe that this initiati...

Authors: Jostein S. Hagemo, Per P. Bredmose, Halvard Stave, Marius Rehn and Christian Buskop

Diagnostic value of prehospital arterial blood gas measurements – a randomised controlled trial

Arterial blood gas analysis is an important diagnostic tool in managing critically ill patients within the hospital. Whether prehospital application of this diagnostic modality contributes to more exact diagno...

Authors: Stine T. Zwisler, Yecatarina Zincuk, Caroline B. Bering, Aleksander Zincuk, Mads Nybo and Søren Mikkelsen

Female risk-adjusted survival advantage after injuries caused by falls, traffic or assault: a nationwide 11-year study

A female survival advantage after injury has been observed, and animal models of trauma have suggested either hormonal or genetic mechanisms as component causes. Our aim was to compare age and risk-adjusted se...

Authors: Robert Larsen, Denise Bäckström, Mats Fredrikson, Ingrid Steinvall, Rolf Gedeborg and Folke Sjoberg

Pneumonia in severely injured patients with thoracic trauma: results of a retrospective observational multi-centre study

While the incidence and aspects of pneumonia in ICU patients has been extensively discussed in the literature, studies on the occurrence of pneumonia in severely injured patients are rare. The aim of the prese...

Authors: Sebastian Wutzler, Felix M. Bläsius, Philipp Störmann, Thomas Lustenberger, Michael Frink, Marc Maegele, Matthias Weuster, Jörg Bayer, Michael Caspers, Andreas Seekamp, Ingo Marzi, Hagen Andruszkow and Frank Hildebrand

Emergency department non-invasive cardiac output study (EDNICO): a feasibility and repeatability study

There is little published data investigating non-invasive cardiac output monitoring in the emergency department (ED). We assessed six non-invasive fluid responsiveness monitoring methods which measure cardiac ...

Authors: D. McGregor, S. Sharma, S. Gupta, S. Ahmad, T. Godec and Tim Harris

The effect of hemorrhagic shock and intraosseous adrenaline injection on the delivery of a subsequently administered drug - an experimental study

Intraosseous (IO) access is a recommended method when venous access cannot be rapidly established in an emergency. Experimental data suggest that major hemorrhage and catecholamine administration both reduce b...

Authors: Mats Eriksson, Anders Larsson, Miklós Lipcsey and Gunnar Strandberg

Treatment delay in status epilepticus – more effective prehospital symptom recognition warranted

The outcome of status epilepticus (SE) can be improved by facilitating early recognition and treatment with antiepileptic drugs. The purpose of this study was to analyze the treatment delay of SE in a prospect...

Authors: Joni J. Sairanen, Anne-Mari Kantanen, Harri T. Hyppölä and Reetta K. Kälviäinen

Interhospital transport of critically ill patients: experiences and challenges, a qualitative study

No consensus based national standard for interhospital transports of critically ill patients exists in Norway. The local hospitals are responsible for funding, organizing and performing these transports, resul...

Authors: Helge Eiding, Ulf E. Kongsgaard and Anne-Cathrine Braarud

Unplanned out-of-hospital birth and risk factors of adverse perinatal outcome: findings from a prospective cohort

In France, while most babies are delivered at hospital, emergency medical services (EMS) weekly manage calls for unplanned out-of-hospital births. The objective of our study was to describe neonatal morbidity ...

Authors: François Javaudin, Valérie Hamel, Arnaud Legrand, Sybille Goddet, François Templier, Christine Potiron, Philippe Pes, Gilles Bagou and Emmanuel Montassier

Impact of initial coagulation and fibrinolytic markers on mortality in patients with severe blunt trauma: a multicentre retrospective observational study

Acute coagulopathy is a well-known predictor of poor outcomes in patients with severe trauma. However, using coagulation and fibrinolytic markers, how one can best predict mortality to find out potential candi...

Authors: Kenta Ishii, Takahiro Kinoshita, Kazutaka Kiridume, Atsushi Watanabe, Kazuma Yamakawa, Shota Nakao, Satoshi Fujimi and Tetsuya Matsuoka

Changes in anaesthetic use for trauma patients in German HEMS – a retrospective study over a ten-year period

Airway management and use of intravenous anaesthetics to facilitate tracheal intubation after major trauma remains controversial. Numerous agents are available and used for pre-hospital rapid-sequence inductio...

Authors: Arasch Wafaisade, Michael Caspers, Bertil Bouillon, Matthias Helm, Matthias Ruppert and Michael Gäßler

Inhaled nitric oxide might be a contributing tool for successful resuscitation of cardiac arrest related to pulmonary hypertension

We describe a case where inhaled nitric oxide (iNO) was successfully initiated during cardiopulmonary resuscitation (CPR) in a younger patient with cardiac arrest related to pulmonary hypertension after dissem...

Authors: Per P. Bredmose, Christian Buskop and Anne Birthe Lømo

Connect dispatch centers for call handling improves performance

The aim of this Letter to the Editor was to report a strategy to reduce time waiting for emergency calls in a dispatch center, in line with a recently published article that reviewed evidence for medical dispa...

Authors: Yann Penverne, Michel Terré, François Javaudin, Joël Jenvrin, Frédéric Berthier, Julien Labady, Brice Leclere and Emmanuel Montassier

Airway Management in the Emergency Department (The OcEAN-Study) - a prospective single centre observational cohort study

Emergency airway management (AM) is a major key for successful resuscitation of critically ill non-traumatic (CINT) patients. Details of the AM of these patients in German emergency departments (ED) are unknow...

Authors: Michael Bernhard, Sönke Nils Bax, Thomas Hartwig, Maryam Yahiaoui-Doktor, Sirak Petros, Sven Bercker, Alexandra Ramshorn-Zimmer and André Gries

Sepsis: mechanisms of bacterial injury to the patient

In bacteremia the majority of bacterial species are killed by oxidation on the surface of erythrocytes and digested by local phagocytes in the liver and the spleen. Sepsis-causing bacteria overcome this mechan...

Authors: Hayk Minasyan

Does injury pattern among major road trauma patients influence prehospital transport decisions regardless of the distance to the nearest trauma centre? – a retrospective study

Prehospital undertriage occurs when the required level of care for a major trauma patient is underestimated and the patient is transported to a lower-level emergency care facility. One possible reason is that ...

Authors: Helen Fagerlind, Lara Harvey, Stefan Candefjord, Johan Davidsson and Julie Brown

Challenges of helicopter mountain rescue missions by human external cargo: need for physicians onsite and comprehensive training

Human external cargo (HEC) extrication during helicopter rescue missions is commonly used in mountain emergency medical services. Furthermore, longline or winch operations offer the opportunity to deliver prof...

Authors: Urs Pietsch, Giacomo Strapazzon, Dimitri Ambühl, Volker Lischke, Simon Rauch and Jürgen Knapp

Is there an association between female gender and outcome in severe trauma? A multi-center analysis in the Netherlands

Little evidence suggest that female gender is associated with a lower risk of mortality in severely injured patients, especially in premenopausal women. Previous clinical studies have shown contradictory resul...

Authors: M. Pape, G. F. Giannakópoulos, W. P. Zuidema, E. S. M. de Lange-Klerk, E. J. Toor, M. J. R. Edwards, M. H. J. Verhofstad, T. N. Tromp, E. M. M. van Lieshout, F. W. Bloemers and L. M. G. Geeraedts

Comparison of two different intraosseous access methods in a physician-staffed helicopter emergency medical service – a quality assurance study

Intravenous access in critically ill and injured patients can be difficult or impossible in the field. Intraosseous access is a well-established alternative to achieve access to a noncollapsible vascular netwo...

Authors: Renate Sørgjerd, Geir Arne Sunde and Jon-Kenneth Heltne

Permissive hypotensive resuscitation in patients with traumatic hemorrhagic shock

We read the article “Risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis” by Natthida Owattanapanich et al. with great interest and found it to be insi...

Authors: Kai-Hung Ho, Yih-Wen Tarng, Yi-Pin Chou and Hsing-Lin Lin

Impact of icing weather conditions on the patients in helicopter emergency medical service: a prospective study from Northern Finland

A high number of denied or cancelled HEMS missions are caused by poor weather conditions especially during winter season. Furthermore, many helicopter manufacturers have denied their helicopters to be operated...

Authors: Ilkka Pulkkinen, Jari Pirnes, Ari Rissanen and Päivi Laukkanen-Nevala

Rating the quality of teamwork—a comparison of novice and expert ratings using the Team Emergency Assessment Measure (TEAM) in simulated emergencies

Training in teamwork behaviour improves technical resuscitation performance. However, its effect on patient outcome is less clear, partly because teamwork behaviour is difficult to measure. Furthermore, it is ...

Authors: Julia Freytag, Fabian Stroben, Wolf E. Hautz, Stefan K. Schauber and Juliane E. Kämmer

Prehospital intravenous fentanyl administered by ambulance personnel: a cluster-randomised comparison of two treatment protocols

Prehospital acute pain is a frequent symptom that is often inadequately managed. The concerns of opioid induced side effects are well-founded. To ensure patient safety, ambulance personnel are therefore provid...

Authors: Kristian D. Friesgaard, Hans Kirkegaard, Claus-Henrik Rasmussen, Matthias Giebner, Erika F. Christensen and Lone Nikolajsen

“Hand hygiene perception and self-reported hand hygiene compliance among emergency medical service providers: a Danish survey”

Hand hygiene (HH), a cornerstone in infection prevention and control, lacks quality in emergency medical services (EMS). HH improvement includes both individual and institutional aspects, but little is known a...

Authors: Heidi Storm Vikke, Svend Vittinghus, Martin Betzer, Matthias Giebner, Hans Jørn Kolmos, Karen Smith, Maaret Castrén, Veronica Lindström, Marja Mäkinen, Heini Harve and Christian Backer Mogensen

Prehospital on-scene anaesthetist treating severe traumatic brain injury patients is associated with lower mortality and better neurological outcome

Patients with isolated traumatic brain injury (TBI) are likely to benefit from effective prehospital care to prevent secondary brain injury. Only a few studies have focused on the impact of advanced interventi...

Authors: Toni Pakkanen, Jouni Nurmi, Heini Huhtala and Tom Silfvast

Medical dispatchers’ perception of visual information in real out-of-hospital cardiac arrest: a qualitative interview study

Authors: Gitte Linderoth, Thea Palsgaard Møller, Fredrik Folke, Freddy K. Lippert and Doris Østergaard

Penetrating stab injuries in Iceland: a whole-nation study on incidence and outcome in patients hospitalized for penetrating stab injuries

Studies on penetrating injuries in Europe are scarce and often represent data from single institutions. The aim of this study was to describe the incidence and demographic features of patients hospitalized for...

Authors: Una Johannesdottir, Gudrun Maria Jonsdottir, Bergros K. Johannesdottir, Alexandra Aldis Heimisdottir, Elias Eythorsson, Tomas Gudbjartsson and Brynjolfur Mogensen

Best practice advice on pre-hospital emergency anaesthesia & advanced airway management

Effective and timely airway management is a priority for sick and injured patients. The benefit and conduct of pre-hospital emergency anaesthesia (PHEA) and advanced airway management remains controversial but...

Authors: Kate Crewdson, David Lockey, Wolfgang Voelckel, Peter Temesvari and Hans Morten Lossius

Patient and rescuer safety: recommendations for dispatch and prioritization of rescue resources based on a retrospective study of Norwegian avalanche incidents 1996–2017

Avalanche emergency response should address current accident scenarios to optimize survival chances of victims and to keep rescuers safe. The purpose of this article is to present a basis for evaluation and ne...

Authors: Albert Lunde and Christen Tellefsen