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Andersson Hagiwara, M., Magnusson, C., Herlitz, J., Seffel, E., Axelsson, C., Munters, M., . . . Nilsson, L. (2019). Adverse events in prehospital emergency care: a trigger tool study. BMC Emergency Medicine, 19(1)
Open this publication in new window or tab >>Adverse events in prehospital emergency care: a trigger tool study
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2019 (English)In: BMC Emergency Medicine, Vol. 19, no 1Article in journal (Refereed) Published
Abstract [en]

Prehospital emergency care has developed rapidly during the past decades. The care is given in a complex context which makes prehospital care a potential high-risk activity when it comes to patient safety. Patient safety in the prehospital setting has been only sparsely investigated. The aims of the present study were 1) To investigate the incidence of adverse events (AEs) in prehospital care and 2) To investigate the factors contributing to AEs in prehospital care.

Keywords
Emergency medical service, Adverse events, Patient safety, Trigger tool, Prehospital
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hb:diva-15726 (URN)10.1186/s12873-019-0228-3 (DOI)
Available from: 2019-02-04 Created: 2019-02-04 Last updated: 2019-02-07Bibliographically approved
Holmén, J., Herlitz, J. & Axelsson, C. (2018). Immediate coronary intervention in prehospital cardiac arrest-Aiming to save lives.. American Heart Journal, 202, 144-147, Article ID S0002-8703(18)30158-3.
Open this publication in new window or tab >>Immediate coronary intervention in prehospital cardiac arrest-Aiming to save lives.
2018 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 202, p. 144-147, article id S0002-8703(18)30158-3Article in journal (Refereed) Published
National Category
Cardiac and Cardiovascular Systems
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15534 (URN)10.1016/j.ahj.2018.05.008 (DOI)000439985300022 ()29921418 (PubMedID)2-s2.0-85050506276 (Scopus ID)
Available from: 2018-12-20 Created: 2018-12-20 Last updated: 2019-01-11Bibliographically approved
Holmén, J., Herlitz, J. & Axelsson, C. (2018). Immediatecoronary intervention in prehospital cardiac arrest-Aiming to save lives.. American Heart Journal, 202, 144-147
Open this publication in new window or tab >>Immediatecoronary intervention in prehospital cardiac arrest-Aiming to save lives.
2018 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 202, p. 144-147Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hb:diva-15413 (URN)10.1016/j.ahj.2018.05.008 (DOI)000439985300022 ()29921418 (PubMedID)2-s2.0-85050506276 (Scopus ID)
Available from: 2018-12-03 Created: 2018-12-03 Last updated: 2019-01-14Bibliographically approved
Magnusson, C., Herlitz, J., Karlsson, T. & Axelsson, C. (2018). Initialassessment, level of care and outcome among children who were seen by emergencymedical services: a prospective observational study.. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26(1), 88
Open this publication in new window or tab >>Initialassessment, level of care and outcome among children who were seen by emergencymedical services: a prospective observational study.
2018 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, no 1, p. 88-Article in journal, Editorial material (Refereed) Published
Abstract [en]

BACKGROUND:

The assessment of children in the Emergency Medical Service (EMS) is infrequent representing 5.4% of the patients in an urban area in the western part of Sweden. In Sweden, patients are assessed on scene by an EMS nurse whom independently decides on interventions and level of care. To aid the EMS nurse in the assessment a triage instrument, Rapid Emergency Triage and Treatment System-paediatrics (RETTS-p) developed for Emergency Department (ED) purpose has been in use the last 5 years. The aim of this study was to evaluate the EMS nurse assessment, management, the utilisation of RETTS-p and patient outcome.

METHODS:

A prospective, observational study was performed on 651 children aged < 16 years from January to December 2016. Statistical tests used in the study were Mann-Whitney U test, Fisher's exact test and Spearman's rank statistics.

RESULTS:

The dispatch centre indexed life-threatening priority in 69% of the missions but, of all children, only 6.1% were given a life threatening RETTS-p red colour by the EMS nurse. A total of 69.7% of the children were transported to the ED and, of these, 31.7% were discharged without any interventions. Among the non-conveyed patients, 16 of 197 (8.1%) visited the ED within 72 h but only two were hospitalised. Full triage, including five out of five vital signs measurements and an emergency severity index, was conducted in 37.6% of all children. A triage colour was not present in 146 children (22.4%), of which the majority were non-conveyed. The overall 30-day mortality rate was 0.8% (n = 5) in children 0-15 years.

CONCLUSIONS:

Despite the incomplete use of all vital signs according to the RETTS-p, the EMS nurse assessment of children appears to be adapted to the clinical situation in most cases and the patients appear to be assessed to the appropriate level of care but indicating an over triage. It seems that the RETTS-p with full triage is used selectively in the pre-hospital assessment of children with a risk of death during the first 30 days of less than 1%.

Keywords
Triage, Children, Pre-hospital assessment, Patient safety, EMS nurse, Level of care
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15412 (URN)10.1186/s13049-018-0560-8 (DOI)000447850100002 ()30340502 (PubMedID)2-s2.0-85055076048 (Scopus ID)
Available from: 2018-12-03 Created: 2018-12-03 Last updated: 2019-01-14Bibliographically approved
Andersson, H., Axelsson, C., Larsson, A., Bremer, A., Gellerstedt, M., Bång, A., . . . Ljungström, L. (2018). The early chain of care in bacteraemia patients: Early suspicion, treatment and survivalin prehospital emergency care. American Journal of Emergency Medicine
Open this publication in new window or tab >>The early chain of care in bacteraemia patients: Early suspicion, treatment and survivalin prehospital emergency care
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2018 (English)In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171Article in journal (Refereed) Epub ahead of print
Abstract [en]

Introduction: Bacteraemia is a first stage for patients risking conditions such as septic shock. The primary aim ofthis study is to describe factors in the early chain of care in bacteraemia, factors associated with increased chanceof survival during the subsequent 28 days after admission to hospital. Furthermore, the long-term outcome wasassessed.

Methods: This study has a quantitative design based on data fromEmergencyMedical Services (EMS) and hospitalrecords.

Results: In all, 961 patients were included in the study. Of these patients, 13.5% died during the first 28 days. TheEMS was more frequently used by non-survivors. Among patients who used the EMS, the suspicion of sepsis alreadyon scene was more frequent in survivors. Similarly, EMS personnel noted the ESS code “fever, infection”more frequently for survivors upon arriving on scene. The delay time fromcall to the EMS and admission to hospitaluntil start of antibiotics was similar in survivors and non-survivors. The five-year mortality rate was 50.8%.Five-year mortalitywas 62.6% among those who used the EMS and 29.5% among those who did not (p b 0.0001).

Conclusion: This study shows that among patientswith bacteraemiawho used the EMS, an early suspicion of sepsisor fever/infection was associated with improved early survival whereas the delay time from call to the EMSand admission to hospital until start of treatment with antibiotics was not. 50.8% of all patients were deadafter five years.

Keywords
Bacteraemia, Prehospital emergency care
National Category
Infectious Medicine
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-13974 (URN)10.1016/j.ajem.2018.04.004 (DOI)000451027100014 ()29653787 (PubMedID)2-s2.0-85045050891 (Scopus ID)
Available from: 2018-04-13 Created: 2018-04-13 Last updated: 2019-01-09Bibliographically approved
Magnusson, C., Axelsson, C., Nilsson, L., Strömsöe, A., Munters, M., Herlitz, J. & Andersson Hagiwara, M. (2018). The final assessment and its association with field assessment in patients who were transported by the emergency medical service.. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26(1), Article ID 111.
Open this publication in new window or tab >>The final assessment and its association with field assessment in patients who were transported by the emergency medical service.
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2018 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, no 1, article id 111Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In patients who call for the emergency medical service (EMS), there is a knowledge gap with regard to the final assessment after arriving at hospital and its association with field assessment.

AIM: In a representative population of patients who call for the EMS, to describe a) the final assessment at hospital discharge and b) the association between the assessment in the field and the assessment at hospital discharge.

METHODS: Thirty randomly selected patients reached by a dispatched ambulance each month between 1 Jan and 31 Dec 2016 in one urban, one rural and one mixed ambulance organisation in Sweden took part in the study. The exclusion criteria were age < 18 years, dead on arrival, transport between health-care facilities and secondary missions. Each patient received a unique code based on the ICD code at hospital discharge and field assessment.

RESULTS: In all, 1080 patients took part in the study, of which 1076 (99.6%) had a field assessment code. A total of 894 patients (83%) were brought to a hospital and an ICD code (ICD-10-SE) was available in 814 patients (91% of these cases and 76% of all cases included in the study). According to these ICD codes, the most frequent conditions were infection (15%), trauma (15%) and vascular disease (9%). The most frequent body localisation of the condition was the thorax (24%), head (16%) and abdomen (13%). In 118 patients (14% of all ICD codes), the condition according to the ICD code was judged as time critical. Among these cases, field assessment was assessed as potentially appropriate in 75% and potentially inappropriate in 12%.

CONCLUSION: Among patients reached by ambulance in Sweden, 83% were transported to hospital and, among them, 14% had a time-critical condition. In these cases, the majority were assessed in the field as potentially appropriate, but 12% had a potentially inappropriate field assessment. The consequences of these findings need to be further explored.

Keywords
Assessment, Diagnose, Prehospital
National Category
Other Medical Sciences not elsewhere specified
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15560 (URN)10.1186/s13049-018-0579-x (DOI)30587210 (PubMedID)
Projects
Prehospital patientsäkerhet
Available from: 2018-12-28 Created: 2018-12-28 Last updated: 2019-01-03Bibliographically approved
Djarv, T., Axelsson, C., Herlitz, J., Stromsoe, A., Israelsson, J. & Claesson, A. (2018). Traumatic cardiac arrest in Sweden 1990-2016 - a population-based national cohort study.. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26(1), Article ID 30.
Open this publication in new window or tab >>Traumatic cardiac arrest in Sweden 1990-2016 - a population-based national cohort study.
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2018 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, no 1, article id 30Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Trauma is a main cause of death among young adults worldwide. Patients experiencing a traumatic cardiac arrest (TCA) certainly have a poor prognosis but population-based studies are sparse. Primarily to describe characteristics and 30-day survival following a TCA as compared with a medical out-of-hospital cardiac arrest (medical CA).

METHODS: A cohort study based on data from the nationwide, prospective population-based Swedish Registry for Cardiopulmonary Resuscitation (SRCR), a medical cardiac arrest registry, between 1990 and 2016. The definition of a TCA in the SRCR is a patient who is unresponsive with apnoea where cardiopulmonary resuscitation and/or defibrillation have been initiated and in whom the Emergency Medical Services (EMS, mainly a nurse-based system) reported trauma as the aetiology. Outcome was overall 30-day survival. Descriptive statistics as well as multivariable logistic regression models were used.

RESULTS: In all, between 1990 and 2016, 1774 (2.4%) cases had a TCA and 72,547 had a medical CA. Overall 30-day survival gradually increased over the years, and was 3.7% for TCAs compared to 8.2% following a medical CA (p < 0.01). Among TCAs, factors associated with a higher 30-day survival were bystander witnessed and having a shockable initial rhythm (adjusted OR 2.67, 95% C.I. 1.15-6.22 and OR 8.94 95% C.I. 4.27-18.69, respectively).

DISCUSSION: Association in registry-based studies do not imply causality but TCA had short time intervals in the chain of survival as well as high rates of bystander-CPR.

CONCLUSION: In a medical CA registry like ours, prevalence of TCAs is low and survival is poor. Registries like ours might not capture the true incidence. However, many individuals do survive and resuscitation in TCAs should not be seen futile.

Keywords
OHCA, Prevalence, Resuscitation, TCA, Trauma
National Category
Anesthesiology and Intensive Care
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15550 (URN)10.1186/s13049-018-0500-7 (DOI)29685180 (PubMedID)2-s2.0-85045768123 (Scopus ID)
Available from: 2018-12-20 Created: 2018-12-20 Last updated: 2018-12-20
Ranta, A., Angelov, K., Höglind, R., Axelsson, C. & Sandsjö, L. (2017). A Mobile Language Interpreter App for Prehospital/Emergency Care. In: Medicinteknikdagarna 2017: . Paper presented at Medicinteknikdagarna, Västerås Sweden, October 10-11, 2017.
Open this publication in new window or tab >>A Mobile Language Interpreter App for Prehospital/Emergency Care
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2017 (English)In: Medicinteknikdagarna 2017, 2017Conference paper, Oral presentation only (Other academic)
Abstract [en]

Lack of a shared language is a common communication situation in the globalizing world. Sometimes this can be mitigated by the use of machine translation technology, such as Google translate, but there are mission-critical tasks, like in health care, where one has to be sure about the correctness of the translation. In such situations, human interpreters are the best choice, but interpreters are scarce and in urgent situations they are not always available. This calls for improved and more reliable machine translation initiatives.

The project to be presented is developing a mobile translator for ambulance personnel use. The translator uses a verifiable and controllable machine translation technology, which is based on semantics, grammars, and professional terminology. The technology has been developed in the international open source project Grammatical Framework (GF) and tested in numerous research projects as well as commercial applications. This project is the first one to apply GF in a healthcare setting. The aim is to develop a platform for a range of health care applications, provided this pilot project for ambulance/emergency care is successful.

The translator works as a mobile app, in which the user can speak and write questions and other phrases, and get them translated to speech and text in other languages. The phrases cover the concepts used in the SBAR protocol (Situation-Bakgrund-Aktuellt tillstånd-Rekommendation) for ambulance use, as gathered from available documents and a questionnaire sent out to professionals at SU Ambulans. The SBAR protocol is also made available as a dynamic phrasebook, where the user can select appropriate phrases from menus. To help translate spontaneous speech and writing, the translator will also have a facility of suggesting nearest-matching phrases and ranking them by proximity to the verified standard phrases.

The current prototype covers around 400 concepts, from which millions of phrases can be built. It will work for 7 languages and enable translation between any two of them, although the primary use case is translation from Swedish to another language and translating simple answers from the other language to Swedish. GF has potential for extending the application to over 30 languages.

National Category
Communication Systems
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-13366 (URN)
Conference
Medicinteknikdagarna, Västerås Sweden, October 10-11, 2017
Projects
Mobil tolkningsapp för ambulanspersonal (Innovationsfonden/VGR: 2016-0170)
Funder
Region Västra Götaland, 2016-0170
Available from: 2018-01-04 Created: 2018-01-04 Last updated: 2018-01-05Bibliographically approved
Claesson, A., Herlitz, J., Svensson, L., Ottosson, L., Bergfeldt, L., Engdahl, J., . . . Bremer, A. (2017). Defibrillation before EMS arrival in western Sweden.. American Journal of Emergency Medicine, 35(8), 1043-1048, Article ID S0735-6757(17)30117-1.
Open this publication in new window or tab >>Defibrillation before EMS arrival in western Sweden.
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2017 (English)In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 35, no 8, p. 1043-1048, article id S0735-6757(17)30117-1Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Bystanders play a vital role in public access defibrillation (PAD) in out-of-hospital cardiac arrest (OHCA). Dual dispatch of first responders (FR) alongside emergency medical services (EMS) can reduce time to first defibrillation. The aim of this study was to describe the use of automated external defibrillators (AEDs) in OHCAs before EMS arrival.

METHODS: All OHCA cases with a shockable rhythm in which an AED was used prior to the arrival of EMS between 2008 and 2015 in western Sweden were eligible for inclusion. Data from the Swedish Register for Cardiopulmonary Resuscitation (SRCR) were used for analysis, on-site bystander and FR defibrillation were compared with EMS defibrillation in the final analysis.

RESULTS: Of the reported 6675 cases, 24% suffered ventricular fibrillation (VF), 162 patients (15%) of all VF cases were defibrillated before EMS arrival, 46% with a public AED on site. The proportion of cases defibrillated before EMS arrival increased from 5% in 2008 to 20% in 2015 (p<0.001). During this period, 30-day survival increased in patients with VF from 22% to 28% (p=0.04) and was highest when an AED was used on site (68%), with a median delay of 6.5min from collapse to defibrillation. Adjusted odds ratio for on-site defibrillation versus dispatched defibrillation for 30-day survival was 2.45 (95% CI: 1.02-5.95).

CONCLUSIONS: The use of AEDs before the arrival of EMS increased over time. This was associated with an increased 30-day survival among patients with VF. Thirty-day survival was highest when an AED was used on site before EMS arrival.

Keywords
Automated external defibrillator, Emergency medical services, First responder, Out-of-hospital cardiac arrest
National Category
Clinical Medicine
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-13342 (URN)10.1016/j.ajem.2017.02.030 (DOI)000407941000001 ()28238537 (PubMedID)2-s2.0-85013677603 (Scopus ID)
Available from: 2018-01-04 Created: 2018-01-04 Last updated: 2018-01-04Bibliographically approved
Zhang, Y., Jiménez-Herrera, M., Axelsson, C. & Cheng, Y. (2017). Not Bad: Passive Leg Raising in Cardiopulmonary Resuscitation-A New Modeling Study. Frontiers in Physiology, 7, 665
Open this publication in new window or tab >>Not Bad: Passive Leg Raising in Cardiopulmonary Resuscitation-A New Modeling Study
2017 (English)In: Frontiers in Physiology, ISSN 1664-042X, E-ISSN 1664-042X, Vol. 7, p. 665-Article in journal, Editorial material (Refereed) Published
Abstract [en]

Aim: To evaluate, using a simulated haemodynamic circulation model, whether passive leg raising (PLR) is able to improve the effect during cardiopulmonary resuscitation (CPR); to expose the possible reasons why PLR works or not.

Materials and Methods: We adapted a circulatory model for CPR with PLR. First we compared cardiac output (CO), coronary perfusion pressure (CPP), blood flow to heart (Qheart), and blood flow to neck and brain (Qhead) of standard chest compression-only CPR with and without PLR; second we simulated the effects of PLR in different situations, by varying the thoracic pump factor (TPF) from 0 to 1; third we simulated the effects when the legs are lifted to the different heights. Finally, we compared our results with those obtained from a published clinical study.

Results: According to the simulation model, (1) When TPF is in the interval (0,1), CPP, CO, Qheart, and Qhead are improved with PLR, among them with half-thoracic/half-cardiac pump effect (TPF is 0.5), CPP, CO, Qhead, and Qheart increase the most (by 14, 14, 15, and 17%). (2) When TPF is 1 (pure thoracic pump, with an emphysema or extremely thick thorax), PLR has almost no effect on CPP, CO, and Qheart (-1, 2, and 0%), whereas Qhead is increased by 9%; (3) Regardless of whether there is a cardiac or thoracic pump effect, PLR is able to increase Qhead by 9-15%. (4) When the legs are lifted to 30 degrees to the ground, the volume transferred from legs to upper body is 36% of the initial volume in legs; when the legs are lifted to 45 degrees , the volume transferred is 43%; when the legs are lifted to 60 degrees , the volume transferred is 47%; when the legs are lifted to 90 degrees , the volume transferred is 50%.

Conclusion: Generally PLR is able to achieve improved cerebral perfusion and coronary perfusion. In some extreme situations, it has no effect on cardiac output and coronary perfusion, but still improves cerebral perfusion. PLR could be a beneficial supplement to CPR, and it is not necessary to lift the legs too high above the ground.

Keywords
cardiopulmonary resuscitation; passive leg raising, thoracic/cardiac pump effect, coronary perfusion, cerebral perfusion
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hb:diva-13513 (URN)10.3389/fphys.2016.00665 (DOI)000391355700001 ()28119619 (PubMedID)2-s2.0-85011850254 (Scopus ID)
Available from: 2018-01-15 Created: 2018-01-15 Last updated: 2018-01-16Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6505-9132

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