Articles

Determining optimal needle size for decompression of tension pneumothorax in children – a CT-based study

For neonates and children requiring decompression of tension pneumothorax, specific recommendations for the choice of needle type and size are missing. The aim of this retrospective study was to determine opti...

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

Limitation of treatment in prehospital care – the experiences of helicopter emergency medical service physicians in a nationwide multicentre survey

Making ethically sound treatment limitations in prehospital care is a complex topic. Helicopter Emergency Medical Service (HEMS) physicians were surveyed on their experiences with limitations of care orders in...

Authors: Heidi Kangasniemi, Piritta Setälä, Heini Huhtala, Antti Kämäräinen, Ilkka Virkkunen, Joonas Tirkkonen, Arvi Yli-Hankala and Sanna Hoppu

Palliative care in the emergency department as seen by providers and users: a qualitative study

Much effort has been made to explore how patients with advanced chronic illness and their families experience care when they attend the Emergency Department, and many studies have investigated how healthcare p...

Authors: Silvia Di Leo, Sara Alquati, Cristina Autelitano, Massimo Costantini, Gianfranco Martucci, Francesco De Vincenzo, Beata Kuczynska, Alessandra Morini, Laura Trabucco, Raffaella Ursicelli, Gianluca Catania and Luca Ghirotto

The management of unanticipated difficult airways in children of all age groups in anaesthetic practice - the position paper of an expert panel

Children form a specific group of patients, as there are significant differences between children and adults in both anatomy and physiology. Difficult airway may be unanticipated or anticipated. Difficulties e...

Authors: Wojciech Walas, Dawid Aleksandrowicz, Maria Kornacka, Tomasz Gaszyński, Ewa Helwich, Marek Migdał, Andrzej Piotrowski, Grażyna Siejka, Tomasz Szczapa, Alicja Bartkowska-Śniatkowska and Zenon P. Halaba

Presence of a pre-hospital enhanced care team reduces on scene time and improves triage compliance for stab trauma

A reduction in pre-hospital scene time for patients with penetrating trauma is associated with reduced mortality, when combined with appropriate hospital triage. This study investigated the relationship betwee...

Authors: Alan Cowley, Mark Durham, Duncan Aldred, Richard Crabb, Paul Crouch, Adam Heywood, Andy McBride, Julia Williams and Richard Lyon

Impact of traumatic events incurred by asylum-seekers on mental health and utilization of medical services

Asylum-seekers from Africa immigrate to Israel through the Sinai desert and are often exposed to traumatic events.

Authors: Maya Siman-Tov, Moran Bodas, Alex Wang, Michael Alkan and Bruria Adini

Chest pain in the ambulance; prevalence, causes and outcome - a retrospective cohort study

Chest pain is common in acute ambulance transports. This study aims to characterize and compare ambulance-transported chest pain patients to non-chest pain patients and evaluate if patient characteristics and ...

Authors: Claus Kjær Pedersen, Carsten Stengaard, Kristian Friesgaard, Karen Kaae Dodt, Hanne Maare Søndergaard, Christian Juhl Terkelsen and Morten Thingemann Bøtker

Implementation of new guidelines in the prehospital services: a nationwide survey of Norway

A debate regarding the potential harmful effects of rigid neck collar and backboard usage among prehospital and hospital care providers in Norway provoked the development of an evidence-based guideline. “The N...

Authors: Nina Øye Thorvaldsen, Lars Didrik Flingtorp, Torben Wisborg and Elisabeth Jeppesen

Extracorporeal membrane oxygenation mitigates myocardial injury and improves survival in porcine model of ventricular fibrillation cardiac arrest

Despite decades of improved strategy in conventional cardiopulmonary resuscitation (CCPR), survival rates of favorable neurological outcome after cardiac arrest (CA) remains poor. It is indicated that the surv...

Authors: Bo Liu, Qiang Zhang, Yong Liang, Yun Zhang, Xiaoli Yuan, Jiyang Ling and Chunsheng Li

Neurocritical care physicians’ doubt about whether to withdraw life-sustaining treatment the first days after devastating brain injury: an interview study

Multilevel uncertainty exists in the treatment of devastating brain injury and variation in end-of-life decision-making is a concern. Cognitive and emotional doubt linked to making challenging decisions have n...

Authors: Annette Robertsen, Eirik Helseth, Jon Henrik Laake and Reidun Førde

Postponing intubation in spontaneously breathing major trauma patients upon emergency room admission does not impair outcome

Pre-hospital emergency anaesthesia and tracheal intubation are life-saving interventions in trauma patients. However, there is evidence suggesting that the risks associated with both procedures outweigh the be...

Authors: Philipp Schwaiger, Herbert Schöchl, Daniel Oberladstätter, Helmut Trimmel and Wolfgang G. Voelckel

Prehospital cardiopulmonary resuscitation duration and neurological outcome after out-of-hospital cardiac arrest among children by location of arrest: a Nationwide cohort study

Little is known about the associations between the duration of prehospital cardiopulmonary resuscitation (CPR) by emergency medical services (EMS) and outcomes among paediatric patients with out-of-hospital ca...

Authors: Haruka Shida, Tasuku Matsuyama, Kosuke Kiyohara, Tetsuhisa Kitamura, Takefumi Kishimori, Takeyuki Kiguchi, Chika Nishiyama, Daisuke Kobayashi, Satoe Okabayashi, Tomonari Shimamoto, Takashi Kawamura and Taku Iwami

Prehospital management provided by medical on-scene commanders in tunnel incidents in Oslo, Norway – an interview study

High demands are placed on the emergency medical services to handle rescue operations in challenging environments such as tunnels. In Oslo, Norway a specialised management function within the emergency medical...

Authors: Johan Hylander, Britt-Inger Saveman, Ulf Björnstig and Lina Gyllencreutz

New clinical guidelines on the spinal stabilisation of adult trauma patients – consensus and evidence based

Traumatic spinal cord injury is a relatively rare injury in Denmark but may result in serious neurological consequences. For decades, prehospital spinal stabilisation with a rigid cervical collar and a hard ba...

Authors: Christian Maschmann, Elisabeth Jeppesen, Monika Afzali Rubin and Charlotte Barfod

Clinical reasoning in the emergency medical services: an integrative review

Clinical reasoning is the process of gathering and understanding information conducted by clinicians in the emergency medical services (EMS) so as to make informed decisions. Research on clinical reasoning spa...

Authors: Ulf Andersson, Hanna Maurin Söderholm, Birgitta Wireklint Sundström, Magnus Andersson Hagiwara and Henrik Andersson

Single mission workload and influencing factors in German prehospital emergency medicine - a nationwide prospective survey of 1361emergency missions

Workload is a major determinant of system performance and human well-being. This study aims to evaluate workload in prehospital emergency medicine on a single mission level and investigates influencing factors...

Authors: Johannes Prottengeier, Johann Georg Keunecke, Christine Gall, Christian Eiche, Andreas Moritz and Torsten Birkholz

Epinephrine during resuscitation of traumatic cardiac arrest and increased mortality: a post hoc analysis of prospective observational study

The beneficial effect of epinephrine during resuscitation from out-of-hospital cardiac arrest (OHCA) has been inconclusive, and potential harm has been suggested, particularly in trauma victims. Although no si...

Authors: Ryo Yamamoto, Masaru Suzuki, Kei Hayashida, Jo Yoshizawa, Atsushi Sakurai, Nobuya Kitamura, Takashi Tagami, Taka-aki Nakada, Munekazu Takeda and Junichi Sasaki

The use of HEAVEN criteria to predict difficult laryngeal view and intubation failure with direct and video laryngoscopy

Authors: Liu-Jia-Zi Shao, Shao-Hua Liu and Fu-Shan Xue

Value of copeptin and the S-100b protein assay in ruling out the diagnosis of stroke-induced dizziness pattern in emergency departments

Dizziness is a frequent reason for visiting emergency departments (EDs). Differentiating stroke from other causes is challenging for physicians. The role of biomarkers has been poorly assessed. We evaluated wh...

Authors: N. Deboevere, N. Marjanovic, M. Sierecki, M. Marchetti, M. Dubocage, E. Magimel, O. Mimoz and J. Guenezan

Correlation between field triage criteria and the injury severity score of trauma patients in a French inclusive regional trauma system

In France, the pre-hospital field triage of trauma patients is currently based on the Vittel criteria algorithm. This algorithm was originally created in 2002 before the stratification of trauma centers and, a...

Authors: Arnaud Cassignol, Julien Marmin, Jean Cotte, Mickael Cardinale, Julien Bordes, Vanessa Pauly, François Kerbaul, Didier Demory and Eric Meaudre

Patient experience of spinal immobilisation after trauma

Spinal immobilisation of blunt trauma victims with potential spinal cord injury is considered standard of care. The traditional management has, however, been increasingly questioned and concerns about harm hav...

Authors: Camilla Ikast Ottosen, Jacob Steinmetz, Mo Haslund Larsen, Josefine S. Baekgaard and Lars S. Rasmussen

Spinal injury in alpine winter sports: a review

Alpine winter sports have become increasingly popular over recent decades, with a similar increase in accident incidence. This review provides an overview of the most recent literature concerning spinal injury...

Authors: Sebastian Frederick Bigdon, Jan Gewiess, Sven Hoppe, Aristomenis K. Exadaktylos, Lorin M. Benneker, Paul Gilbert Fairhurst and Christoph E. Albers

Meeting Abstracts: London Trauma Conference, London Cardiac Arrest Symposium, London Pre-hospital Care Conference 2018

Authors:

Fluid resuscitation with preventive peritoneal dialysis attenuates crush injury-related acute kidney injury and improves survival outcome

In-hospital renal replacement therapy (RRT) is widely used for the treatments of acute kidney injury (AKI) in crush injury (CI) victims. This study was designed to investigate whether preventive peritoneal dia...

Authors: Xian-Long Zhou, Shao-Zhou Ni, Dan Xiong, Xue-Qi Cheng, Peng Xu and Yan Zhao

Derivation and internal validation of the screening to enhance prehospital identification of sepsis (SEPSIS) score in adults on arrival at the emergency department

Prehospital recognition of sepsis may inform case management by ambulance clinicians, as well as inform transport decisions. The objective of this study was to develop a prehospital sepsis screening tool for u...

Authors: Michael A. Smyth, Daniel Gallacher, Peter K. Kimani, Mark Ragoo, Matthew Ward and Gavin D. Perkins

Accuracy of low-weight versus standard syringe infusion pump devices depending on altitude

Intravenous drug infusions in critically ill patients require accurate syringe infusion pumps (SIPs). This is particularly important during transportation of critically ill patients by helicopter emergency med...

Authors: Marc Blancher, Maxence Repellin, Maxime Maignan, Cyrielle Clapé, Arnaud Perrin, José Labarère, Guillaume Debaty and Damien Viglino

Road bike accidents involving cervical fractures presenting as cardiac arrest: a report of two cases

We present two cases in which elderly male recreational cyclists suffered from cervical fractures and coinciding injuries of the spinal cord that subsequently led to cardiac arrest.

Authors: Anne Marie Kabell Nissen, Louise Gramstrup Nielsen, Søren Mikkelsen and Anne Craveiro Brøchner

Defining a mission-based method to determine a HEMS unit’s actual service area

Geographical service areas are used as descriptive system indicators in Emergency Medical Service (EMS) related studies and reporting templates. The actual service area may differ significantly from administra...

Authors: Jukka Pappinen, Anna Olkinuora and Päivi Laukkanen-Nevala

Letter to the editor: in response to Alstrup et. al.

Authors: Cor Slagt, Amon Heijne and Geert-Jan van Geffen

Pre-hospital emergent intubation in trauma patients: the influence of etomidate on mortality, morbidity and healthcare resource utilization

Due to its favorable hemodynamic characteristics and by providing good intubation conditions etomidate is often used for induction of general anesthesia in trauma patients. It has been linked to temporary adre...

Authors: Michael Gäßler, Matthias Ruppert, Rolf Lefering, Bertil Bouillon and Arasch Wafaisade

An evaluation of the Swiss staging model for hypothermia using hospital cases and case reports from the literature

The Swiss staging model for hypothermia uses clinical indicators to stage hypothermia and guide the management of hypothermic patients. The proposed temperature range for clinical stage 1 is < 35–32 °C, for st...

Authors: M. Pasquier, P. N. Carron, A. Rodrigues, F. Dami, V. Frochaux, C. Sartori, T. Deslarzes and V. Rousson

Response to letter to the editor: “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 respond to a comment highlighting potential statistical biases in an analysis of our recently published article. We therefore specified the method for selecting the ...

Authors: François Javaudin, Arnaud Legrand, Philippe Pes, Emmanuel Montassier and Christelle Volteau

Acute Dysnatremias - a dangerous and overlooked clinical problem

Dysnatremias are common electrolyte disturbances with significant morbidity and mortality. In chronic dysnatremias a slow correction rate (<10 mmol/L/24 h) is indicated to avoid neurological complications. In ...

Authors: David Joergensen, Kiarash Tazmini and Dag Jacobsen

The effect of a terrorist attack on emergency department inflow: an observation study using difference-in-differences methodology

The objective of this study was to investigate how the terrorist attack in Stockholm, Sweden affected patient inflow to the general emergency departments (EDs) in close proximity of the attack. The study analy...

Authors: Andreas Ekström, Fredrik Eng-Larsson, Olov Isaksson, Lisa Kurland and Martin Nordberg

A prospective pilot study using metabolomics discloses specific fatty acid, catecholamine and tryptophan metabolic pathways as possible predictors for a negative outcome after severe trauma

We wanted to define metabolomic patterns in plasma to predict a negative outcome in severe trauma patients.

Authors: Luis Servià, Mariona Jové, Joaquim Sol, Reinald Pamplona, Mariona Badia, Neus Montserrat, Manuel Portero-Otin and Javier Trujillano

Live video footage from scene to aid helicopter emergency medical service dispatch: a feasibility study

Obtaining accurate information from a 112 caller is key to correct tasking of Helicopter Emergency Medical Services (HEMS). Being able to view the incident scene via video from a mobile phone may assist HEMS d...

Authors: E. ter Avest, E. Lambert, R. de Coverly, H. Tucker, J. Griggs, M. H. Wilson, A. Ghorbangholi, J. Williams and R. M. Lyon

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