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Bång, Angela
Alternative names
Publications (10 of 75) Show all publications
Rawshani, A., Rawshani, N., Gelang, C., Andersson, J.-O., Larsson, A., Bång, A., . . . Gellerstedt, M. (2017). Emergency medical dispatch priority in chest pain patients due to life threatening conditions: A cohort study examining circadian variations and impact of the education.. International Journal of Cardiology, 236, 43-48, Article ID S0167-5273(16)32916-3.
Open this publication in new window or tab >>Emergency medical dispatch priority in chest pain patients due to life threatening conditions: A cohort study examining circadian variations and impact of the education.
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2017 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 236, p. 43-48, article id S0167-5273(16)32916-3Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: We examined the accuracy in assessments of emergency dispatchers according to their education and time of the day. We examined this in chest pain patients who were diagnosed with a potentially life-threatening condition (LTC) or died within 30days.

METHODS: Among 2205 persons, 482 died, 1631 experienced an acute coronary syndrome (ACS), 1914 had a LTC. Multivariable logistic regression was used to study how time of the call and the dispatcher's education were associated with the risk of missing to give priority 1 (the highest).

RESULTS: Among patients who died, a 7-fold increase in odds of missing to give priority 1 was noted at 1.00pm, as compared with midnight. Compared with assistant nurses, odds ratio for dispatchers with no (medical) training was 0.34 (95% CI 0.14 to 0.77). Among patients with an ACS, odds ratio for calls arriving before lunch was 2.02 (95% CI 1.22 to 3.43), compared with midnight. Compared with assistant nurses, odds ratio for operators with no training was 0.23 (95% CI 0.13 to 0.40). Similar associations were noted for those with any LTC. Dispatcher's education was not associated with the patient's survival.

CONCLUSIONS: In this group of patients, which experience substantial mortality and morbidity, the risk of not obtaining highest dispatch priority was increased up to 7-fold during lunchtime. Dispatch operators without medical education had the lowest risk, compared with nurses and assistant nurses, of missing to give priority 1, at the expense of lower positive predictive value.

KEY MESSAGES: What is already known about this subject? Use of the emergency medical service (EMS) increases survival among patients with acute coronary syndromes. It is unknown whether the efficiency - as judged by the ability to identify life-threatening cases among patients with chest pain - varies according to the dispatcher's educational level and the time of day. What does this study add? We provide evidence that the dispatcher's education does not influence survival among patients calling the EMS due to chest discomfort. However, medically educated dispatchers are at greatest risk of missing to identify life-threatening cases, which is explained by more parsimonious use of the highest dispatch priority. We also show that the risk of missing life-threatening cases is at highest around lunch time. How might this impact on clinical practice? Dispatch centers are operated differently all over the world and chest discomfort is one of the most frequent symptoms encountered; we provide evidence that it is safe to operate a dispatch center without medically trained personnel, who actually miss fewer cases of acute coronary syndromes. However, non-medically trained dispatchers consume more pre-hospital resources.

National Category
Clinical Medicine
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-13343 (URN)10.1016/j.ijcard.2017.02.047 (DOI)000402476500008 ()28237735 (PubMedID)2-s2.0-85013682744 (Scopus ID)
Available from: 2018-01-04 Created: 2018-01-04 Last updated: 2018-01-04Bibliographically approved
Herlitz, J., Ravi-Fischer, A., Svensson, L., Bremer, A. & Bång, A. (2016). Circulation: Bröstsmärtor (2ed.). In: Björn-Ove Suserud och Lars Lundberg (Ed.), Prehospital Akutsjukvård: (pp. 308-321). Liber
Open this publication in new window or tab >>Circulation: Bröstsmärtor
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2016 (Swedish)In: Prehospital Akutsjukvård / [ed] Björn-Ove Suserud och Lars Lundberg, Liber, 2016, 2, p. 308-321Chapter in book (Other academic)
Place, publisher, year, edition, pages
Liber, 2016 Edition: 2
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-11520 (URN)
Available from: 2016-12-26 Created: 2016-12-26 Last updated: 2016-12-28Bibliographically approved
Gellerstedt, M., Rawshani, N., Herlitz, J., Bång, A., Gelang, C., Andersson, J.-O., . . . Rawshani, A. (2016). Could prioritisation by emergency medicine dispatchers be improved by using computer-based decision support? A cohort of patients with chest pain.. International Journal of Cardiology, 220, 734-738
Open this publication in new window or tab >>Could prioritisation by emergency medicine dispatchers be improved by using computer-based decision support? A cohort of patients with chest pain.
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2016 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 220, p. 734-738Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: To evaluate whether a computer-based decision support system could improve the allocation of patients with acute coronary syndrome (ACS) or a life-threatening condition (LTC). We hypothesised that a system of this kind would improve sensitivity without compromising specificity.

METHODS: A total of 2285 consecutive patients who dialed 112 due to chest pain were asked 10 specific questions and a prediction model was constructed based on the answers. We compared the sensitivity of the dispatchers' decisions with that of the model-based decision support model.

RESULTS: A total of 2048 patients answered all 10 questions. Among the 235 patients with ACS, 194 were allocated the highest prioritisation by dispatchers (sensitivity 82.6%) and 41 patients were given a lower prioritisation (17.4% false negatives). The allocation suggested by the model used the highest prioritisation in 212 of the patients with ACS (sensitivity of 90.2%), while 23 patients were underprioritised (9.8% false negatives). The results were similar when the two systems were compared with regard to LTC and 30-day mortality. This indicates that computer-based decision support could be used either for increasing sensitivity or for saving resources. Three questions proved to be most important in terms of predicting ACS/LTC, [1] the intensity of pain, [2] the localisation of pain and [3] a history of ACS.

CONCLUSION: Among patients with acute chest pain, computer-based decision support with a model based on a few fundamental questions could improve sensitivity and reduce the number of cases with the highest prioritisation without endangering the patients.

Keywords
ACS, Chest pain, Decision support model, Mortality, Prehospital
National Category
Clinical Medicine
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-11504 (URN)10.1016/j.ijcard.2016.06.281 (DOI)000381582000139 ()27393857 (PubMedID)2-s2.0-84979074167 (Scopus ID)
Available from: 2016-12-22 Created: 2016-12-22 Last updated: 2017-11-29Bibliographically approved
Rawshani, N., Rawshani, A., Gelang, C., Herlitz, J., Bång, A., Andersson, J.-O. & Gellerstedt, M. (2016). Could ten questions asked by the dispatch center predict the outcome for patients with chest discomfort?. International Journal of Cardiology, 209, 223-225
Open this publication in new window or tab >>Could ten questions asked by the dispatch center predict the outcome for patients with chest discomfort?
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2016 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 209, p. 223-225Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: From 2009 to 2010, approximately 14,000 consecutive persons who called for the EMS due to chest discomfort were registered. From the seventh month, dispatchers ask 2285 patient ten pre-specified questions. We evaluate which of these questions was independently able to predict an acute coronary syndrome (ACS), life-threatening condition (LTC) and death.

METHODS: The questions asked mainly dealt with previous history and type of symptoms, each with yes/no answers. The dispatcher took a decision on priority; 1) immediately with sirens/blue light; 2) EMS on the scene within 30min; 3) normal waiting time.We examined the relationship between the answers to these questions and subsequent dispatch priority, as well as outcome, in terms of ACS, LTC and all-cause mortality.

RESULTS: 2285 patients (mean age 67years, 49% women) took part, of which 12% had a final diagnosis of ACS and 15% had a LTC. There was a significant relationship between all the ten questions and the priority given by dispatchers. Localisation of the discomfort to the center of the chest, more intensive pain, history of angina or myocardial infarction as well as experience of cold sweat were the most important predictors when evaluating the probability of ACS and LTC. Not breathing normally and having diabetes were related to 30-day mortality.

CONCLUSIONS: Among individuals, who call for the EMS due to chest discomfort, the intensity and the localisation of the pain, as well as a history of ischemic heart disease, appeared to be the most strongly associated with outcome.

Keywords
acute coronary syndrome, aged, angina pectoris, apparent life threatening event, Article, breathing disorder, clinical decision making, cold sweat, diabetes mellitus, disease association, emergency health service, female, health care availability, health care need, heart infarction, human, ischemic heart disease, major clinical study, male, medical history, mortality, outcome assessment, pain assessment, priority journal, symptomatology, telephone interview, thorax pain
National Category
Clinical Medicine
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-11510 (URN)10.1016/j.ijcard.2016.02.011 (DOI)000372530700061 ()26897074 (PubMedID)2-s2.0-84961743190 (Scopus ID)
Available from: 2016-12-22 Created: 2016-12-22 Last updated: 2017-11-29Bibliographically approved
Wibring, K., Herlitz, J., Christensson, L., Lingman, M. & Bång, A. (2016). Prehospital factors associated with an acute life-threatening condition in non-traumatic chest pain patients - A systematic review.. International Journal of Cardiology, 219, 373-379
Open this publication in new window or tab >>Prehospital factors associated with an acute life-threatening condition in non-traumatic chest pain patients - A systematic review.
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2016 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 219, p. 373-379Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Chest pain is a common symptom among patients contacting the emergency medical services (EMS). Risk stratification of these patients is warranted before arrival in hospital, regarding likelihood of an acute life-threatening condition (LTC).

AIM: To identify factors associated with an increased risk of acute LTC among patients who call the EMS due to non-traumatic chest pain.

METHODS: Several databases were searched for relevant articles. Identified articles were quality-assessed using the Scottish Intercollegiate Guidelines Network checklists. Extracted data was analysed using a semi-quantitative synthesis evaluating the level of evidence of each identified factor.

RESULTS: In total, 10 of 1245 identified studies were included. These studies provided strong evidence for an increased risk of an acute LTC with increasing age, male gender, elevated heart rate, low systolic blood pressure and ST elevation or ST depression on a 12-lead ECG. The level of evidence regarding the history of myocardial infarction, angina pectoris or presence of a Q wave or a Left Bundle Branch Block on the ECG was moderate. The evidence was inconclusive regarding dyspnoea, cold sweat/paleness, nausea/vomiting, history of chronic heart failure, smoking, Right Bundle Branch Block or T-inversions on the ECG.

CONCLUSIONS: Factors reflecting age, gender, myocardial ischemia and a compromised cardiovascular system predicted an increased risk of an acute life-threatening condition in the prehospital setting in cases of acute chest pain. These factors may form the basis for prehospital risk stratification in acute chest pain.

Keywords
Acute coronary syndrome, Chest pain, Emergency medical services, Prehospital, Risk assessment
National Category
Clinical Medicine
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-11505 (URN)10.1016/j.ijcard.2016.06.066 (DOI)000380817400064 ()27352210 (PubMedID)2-s2.0-84976329676 (Scopus ID)
Available from: 2016-12-22 Created: 2016-12-22 Last updated: 2017-11-29Bibliographically approved
Ambjörnsson, J., Jonsson, A., Strömsöe, A., Andersson, H., Bång, A. & Bremer, A. (2016). Prehospital suspicion and identification of adult septic patients:Experiences of a screening tool. In: : . Paper presented at 2nd Global Conference on Emergency Nursing & Trauma Care, Sitges (Spain) September 22 - 24, 2016.
Open this publication in new window or tab >>Prehospital suspicion and identification of adult septic patients:Experiences of a screening tool
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2016 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Introduction:  Sepsis  is life threatening  and  requires  urgent healthcare  to reduce  suffering  and death. Therefore it is important that septic patients are identified early to enable treatment.

 

Aim: To investigate to what extent EMS personnel identified patients with sepsis using the "BAS

90-30-90"  model, and to describe assessments and medical procedures that were  undertaken by the personnel.

 

Methods: This was a retrospective study where  185 EMS medical records were  reviewed. The inclusion was based on patients who were later diagnosed with sepsis in the hospital.

 

Results: A physician assessed the patients  in 74 of the EMS cases, which lead to exclusion  of these  records  in  regard  to  the  EMS  personnel's  ability  to  identify  sepsis.  The  personnel documented  suspicion  of severe sepsis in eight (n=8) of the remaining 111 records (7.2%). The proportion  of patients  065 years  of age was 73% (n=135)  of which  37% (n=50) were over 80 years  old. Thirty-nine percent  (39%,  n=72)  were  females. The  personnel  documented blood pressure   in  91%  (n=168),  respiratory   rate  in  76%  (n=140),   saturation   in  100%  (n=185), temperature  in 76%  (n=141),  and  heart  rate  in  94%  (n=174)  of  the  records.  Systolic  blood pressure  <90 mmHg  was  documented  in 14,2%  (n=24),  respiratory  rate  030 in 36%  (n=50), saturation <90 in 49%   (n=91). temperature >38°C in 37.6% (n=53), and heart rate 090 in 70% (n=121) of the records. Documented medical procedures and treatments were intravenous  lines (70%, n=130), intravenous  fluids (10%, n=19) and administration  of oxygen (72%, n=133).

 

Conclusion:  The EMS personnel identified  only a few septic patients  with the help of the BAS

90-30-90  model when  all three criteria  would  be met for severe  sepsis. Either  advanced age (>65  years),   fever   (>38°C)   or  tachypnea (020  breaths/min)   appeared   to   increase  the personnel's suspicion  of sepsis. Oxygen, but not intravenous  fluids, was given in an adequate way.

Keywords
Sepsis, Assessment, Screening tool, Medical record review
National Category
Nursing
Identifiers
urn:nbn:se:hb:diva-10675 (URN)
Conference
2nd Global Conference on Emergency Nursing & Trauma Care, Sitges (Spain) September 22 - 24, 2016
Available from: 2016-09-09 Created: 2016-09-09 Last updated: 2017-05-04Bibliographically approved
Axelsson, C., Herlitz, J., Karlsson, A., Sjöberg, H., Jiménez-Herrera, M., Bång, A., . . . Ljungström, L. (2016). The Early Chain of Care in Patients with Bacteraemia with the Emphasis on the Prehospital Setting. Prehospital and Disaster Medicine, 31(3), 1-6
Open this publication in new window or tab >>The Early Chain of Care in Patients with Bacteraemia with the Emphasis on the Prehospital Setting
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2016 (English)In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 31, no 3, p. 1-6Article in journal (Refereed) Published
Abstract [en]

Purpose:  There is a lack of knowledge  about the early phase of severe infection. This reportdescribes the early chain of care in bacteraemia as follows:  (a) compare patients who were and were not transported by the Emergency Medical Services (EMS); (b) describe various aspects of the EMS chain; and (c) describe factors of importance for the delay to the start ofintravenous antibiotics. It was hypothesized that, for patients with suspected sepsis judged by the EMS clinician, the delay until the onset of antibiotic treatment would be shorter.

Basic Procedures: All  patients  in the Municipality of Gothenburg  (Sweden) with apositive blood culture, when assessed at the Laboratory of Bacteriology in the Municipality of Gothenburg, from February 1 through April 30, 2012 took part in the survey.

Main Findings/Results:  In all, 696 patients fulfilled the inclusion criteria. Their mean agewas 76 years and 52% were men. Of all patients, 308 (44%) had been in contact with the EMS and/or the emergency department (ED). Of these 308 patients, 232 (75%) were transported by the EMS and 188 (61%) had “true pathogens” in blood cultures. Patients who were transported by the EMS were older, included more men, and suffered from more severe symptoms  and signs.The EMS nurse  suspected sepsis in only six percent of the cases. These patients had a delay from arrival at hospital until the start of antibiotics of one hour and 19 minutes  versus three hours and 21 minutes among the remaining patients (P = .0006). The corresponding figures for cases with “true pathogens” were one hour and19 minutes  versus three hours and 15 minutes  (P = .009).

Conclusion:  Among patients with bacteraemia, 75% used the EMS, and these patients were older, included more men, and suffered from more severe symptoms  and signs. The EMS nurse  suspected sepsis in six percent of cases. Regardless  of whether or not patients with true pathogens  were isolated,  a suspicion of sepsis by the EMS clinician at thescene was associated with a shorter delay to the start of antibiotic treatment.

Keywords
bacteremia; Emergency Medical Services; prehospital phase; sepsis
National Category
Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-9562 (URN)10.1017/S1049023X16000339 (DOI)000376655700008 ()27026077 (PubMedID)2-s2.0-84961879870 (Scopus ID)
Available from: 2016-04-08 Created: 2016-04-08 Last updated: 2018-12-07Bibliographically approved
Bremer, A. & Bång, A. (2016). Vårdvetenskaplig analys (2ed.). In: Björn-Ove Suserud & Lars Lundberg (Ed.), Prehospital akutsjukvård: (pp. 318-321). Stockholm: Liber
Open this publication in new window or tab >>Vårdvetenskaplig analys
2016 (Swedish)In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud & Lars Lundberg, Stockholm: Liber , 2016, 2, p. 318-321Chapter in book (Other academic)
Place, publisher, year, edition, pages
Stockholm: Liber, 2016 Edition: 2
Keywords
Bröstsmärtor, ångest, vårdande
National Category
Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-9331 (URN)978-91-47-11474-0 (ISBN)
Available from: 2016-03-08 Created: 2016-03-08 Last updated: 2017-05-04Bibliographically approved
Axelsson, C., Herrera, M. J. & Bång, A. (2015). How the context of ambulance care influences learning to become a specialist ambulance nurse a Swedish perspective.. Nurse Education Today
Open this publication in new window or tab >>How the context of ambulance care influences learning to become a specialist ambulance nurse a Swedish perspective.
2015 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: Ambulance emergency care is multifaceted with extraordinary challenges to implement accurate assessment and care. A clinical learning environment providing opportunities for mastering these essential skills is a key component in ensuring that prehospital emergency nurse (PEN) students acquire the necessary clinical competence.

AIM: The aim is to understand how PEN students experience their clinically based training, focusing on their learning process.

METHOD: We applied content analysis with its qualitative method to our material that consisted of three reflections each by 28 PEN students over their learning process during their 8weeks of clinical ambulance practice. The research was carried out at the Center for Prehospital Care, University of Borås, Sweden.

RESULTS: The broad spectrum of ambulance assignments seems to awaken great uncertainty and excessive respect in the students. Student vulnerability appears to decrease when the clinical supervisor behaves calmly, knowledgeably, confidently and reflectively. Early traumatic incidents on the other hand may increase the students' anxiety. Each student is offered a unique opportunity to learn how to approach patients and relatives in their own environments, and likewise an opportunity to gather information for assessment. Infrequency of missions seems to make PEN students less active in their student role, thereby preventing them from availing themselves of potential learning situations. Fatigue and hunger due to lack of breaks or long periods of transportation also inhibit learning mode.

CONCLUSION: Our findings suggest the need for appraisal of the significance of the clinical supervisor, the ambulance environment, and student vulnerability. The broad spectrum of conditions in combination with infrequent assignments make simulation necessary. However, the unique possibilities provided for meeting patients and relatives in their own environments offer the PEN student excellent opportunities for learning how to make assessments.

Keywords
Ambulances, Clinical competence, Emergency medical service, Learning, Students, Nursing
National Category
Learning Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-8465 (URN)10.1016/j.nedt.2015.10.029 (DOI)000371098300003 ()26596850 (PubMedID)2-s2.0-84947333227 (Scopus ID)
Available from: 2016-01-13 Created: 2016-01-13 Last updated: 2018-12-21Bibliographically approved
Lingsarve, J., Bång, A., Claesson, A., Wireklint Sundström, B., Abelsson, A., Svensson, A., . . . Bremer, A. (2015). Kompetens i ambulansen ger en säker akutsjukvård. Dagens Medicin
Open this publication in new window or tab >>Kompetens i ambulansen ger en säker akutsjukvård
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2015 (Swedish)In: Dagens Medicin, ISSN 1104-7488Article in journal, News item (Other (popular science, discussion, etc.)) Published
Keywords
Kompetens, ambulanssjukvård, patientsäkerhet, ambulanssjuksköterska
National Category
Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-8718 (URN)
Note

Debattinlägg från 05-06-2015

Available from: 2016-01-30 Created: 2016-01-30 Last updated: 2018-04-18Bibliographically approved
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