Scand J Trauma Resus
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Scand J Trauma Resus · Feb 2019
Observational StudyImpact 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 in known icing conditions. Icing is a widely known phenomenon in aviation, but there is a lack of evidence about its influence on HEMS operations and patients. ⋯ In this study the incidence of icing weather conditions was substantial compared to all HEMS missions in year 2017. The delay in definitive treatment was accentuated among trauma and internal medicine patients. During the 1-year study period many patients whose definitive treatment was delayed would have had a notable (> 60 min) time saved by helicopter transport. A helicopter equipped with an adequate ice protection system for the weather conditions in Northern Finland would have shortened the delay in patients' definitive treatment significantly.
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Scand J Trauma Resus · Feb 2019
Editorial CommentPermissive 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 insightful. In our commentary, we propose possible reasons why mortality was lower in the permissive hypotension group and how the need for blood transfusion decreased in this group. No significant difference in acute kidney injury (AKI) was evident among patient groups, possibly because all these patients might have AKI. However, we do agree that permissive hypotension is of considerable benefit to trauma patients and worth further study.
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Scand J Trauma Resus · Feb 2019
Comparative StudyRating 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 unknown who should evaluate it. In clinical practice, experts are obliged to participate in resuscitation efforts and are thus unavailable to assess teamwork quality. Consequently, we sought to determine if raters with little clinical experience and experts provide comparable evaluations of teamwork behaviour. ⋯ Experts' and novices' ratings were similarly distributed, implying that raters with limited experience can provide reliable data on teamwork behaviour. Novices show a consistent, but slightly more lenient rating behaviour. Clinical studies and real-life teams may thus employ novices using a structured observational tool such as TEAM to inform their performance review and improvement.
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Scand J Trauma Resus · Feb 2019
Randomized Controlled TrialPrehospital 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 provided with treatment protocols with dosing restrictions, however, with the concomitant risk of insufficient pain treatment of the patients. The aim of this study was to investigate the impact of a liberal intravenous fentanyl treatment protocol on efficacy and safety measures. ⋯ Liberalising an intravenous fentanyl treatment protocol applied by ambulance personnel slightly increased the number of patients with sufficient pain relief at hospital arrival without compromising patient safety. Future efforts of training ambulance personnel are needed to further improve protocol adherence and quality of treatment.
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Scand J Trauma Resus · Feb 2019
"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 about EMS providers' HH perception and motivations related to HH quality. Therefore, we aimed to investigate the HH perception and assess potential factors related to self-reported HH compliance among the EMS cohort. ⋯ Danish EMS providers acknowledged the impact of infections and the preventive effect of HH, and perceived access to HH supplies at the point of care, having or being "a good example" and simple instructions effective to improve HH compliance. Moreover, several behavioral-, normative- and control beliefs were associated with self-reported HH compliance, and thus future improvement strategies should be multimodal.