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  • 1.
    Andersson, Elin
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bohlin, Linda
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sundler, Annelie Johansson
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Fekete, Zoltán
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Prehospital Identification of Patients with a Final Hospital Diagnosis of Stroke.2018In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Introduction the early phase of stroke, minutes are critical. Since the majority of patients with stroke are transported by the Emergency Medical Service (EMS), the early handling and decision making by the EMS clinician is important. Problem The study aim was to evaluate the frequency of a documented suspicion of stroke by the EMS nurse, and to investigate differences in the clinical signs of stroke and clinical assessment in the prehospital setting among patients with regard to if there was a documented suspicion of stroke on EMS arrival or not, in patients with a final hospital diagnosis of stroke.

    METHODS: The study had a retrospective observational design. Data were collected from reports on patients who were transported by the EMS and had a final diagnosis of stroke at a single hospital in western Sweden (630 beds) in 2015. The data sources were hospital and prehospital medical journals.

    RESULTS: In total, 454 patients were included. Among them, the EMS clinician suspected stroke in 52%. The findings and documentation on patients with a suspected stroke differed from the remaining patients as follows: a) More frequently documented symptoms from the face, legs/arms, and speech; b) More frequently assessments of neurology, face, arms/legs, speech, and eyes; c) More frequently addressed the major complaint with regard to time and place of onset, duration, localization, and radiation; d) Less frequently documented symptoms of headache, vertigo, and nausea; and e) More frequently had an electrocardiogram (ECG) recorded and plasma glucose sampled. In addition to the 52% of patients who had a documented initial suspicion of stroke, seven percent of the patients had an initial suspicion of transitory ischemic attack (TIA) by the EMS clinician, and a neurologist was approached in another 10%.

    CONCLUSION: Among 454 patients with a final diagnosis of stroke who were transported by the EMS, an initial suspicion of stroke was not documented in one-half of the cases. These patients differed from those in whom a suspicion of stroke was documented in terms of limited clinical signs of stroke, a less extensive clinical assessment, and fewer clinical investigations. Andersson E , Bohlin L , Herlitz J , Sundler AJ , Fekete Z , Andersson Hagiwara M . Prehospital identification of patients with a final hospital diagnosis of stroke.

  • 2. Andrews, RA
    et al.
    Austin, C
    Brown, R
    Chen, YZ
    Engindeniz, Z
    Girouard, R
    Leaman, P
    Masellis, M
    Nakayama, S
    Polentsov, YO
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Sharing international experiences in disasters: summary and action plan2001In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 16, no 1, p. 42-45Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The discussions in this theme provided an opportunity to share specific experiences with disasters that occurred outside of the Asia-Pacific Rim. METHODS: Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Since the findings from the Theme 7 and Theme 3 groups were similar, the chairs of both groups presided over one workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates. RESULTS: The main points developed during the presentations and discussion included: (1) disaster response planning, (2) predetermined command and organizational structure, (3) rapid response capability, (4) mitigation, and (5) communications and alternatives. DISCUSSION: The action plans presented are in common with those presented by Theme 3, and include: (1) plan disaster responses including the different types, identification of hazards, training based on experiences, and provision of public education; (2) improving coordination and control; (3) maintaining communications assuming infrastructure breakdown; (4) maximizing mitigation through standardized evaluations, creation of a legal framework, and recognition of advocacy and public participation; and (5) providing resources and knowledge through access to existing therapies, using the media, and increasing decentralization of hospital inventories. CONCLUSIONS: Most of the problems that occurred outside the Asia-Pacific rim relative to disaster management are similar to those experienced within it. They should be addressed in common with the rest of the world.

  • 3.
    Axelsson, Christer
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Karlsson, Anders
    Sjöberg, Henrik
    Jiménez-Herrera, Maria
    Bång, Angela
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson, Henrik
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Gellerstedt, Martin
    Ljungström, Lars
    The Early Chain of Care in Patients with Bacteraemia with the Emphasis on the Prehospital Setting2016In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 31, no 3, p. 1-6Article in journal (Refereed)
    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.

  • 4.
    Axelsson, Christer
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Karlsson, Thomas
    Pande, Katarina
    Wigertz, Kristin
    Örtenwall, Per
    Nordanstig, Joakim
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    A description of the prehospital phase of aortic dissection in terms of early suspicion and treatment.2015In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 30, no 2Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Aortic dissection is difficult to detect in the early phase due to a variety of symptoms. This report describes the prehospital setting of aortic dissection in terms of symptoms, treatment, and suspicion by the Emergency Medical Service (EMS) staff.

    BASIC PROCEDURES: All patients in the Municipality of Gothenburg, Sweden, who, in 2010 and 2011, had a hospital discharge diagnosis of aortic dissection (international classification of disease (ICD) I 71,0) were included. The exclusion criteria were: age<18 years of age and having a planned operation. This was a retrospective, descriptive study based on patient records. In the statistical analyses, Fisher's exact test and the Mann-Whitney U test were used for analyses of dichotomous and continuous/ordered variables.

    MAIN FINDINGS: Of 92 patients, 78% were transported to the hospital by the EMS. The most common symptom was pain (94%). Pain was intensive or very intensive in 89% of patients, with no significant difference in relation to the use of the EMS. Only 47% of those using the EMS were given pain relief with narcotic analgesics. Only 12% were free from pain on admission to the hospital. A suspicion of aortic dissection was reported by the EMS staff in only 17% of cases. The most common preliminary diagnosis at the dispatch center (31%) and by EMS clinicians (52%) was chest pain or angina pectoris. In all, 79% of patients were discharged alive from the hospital (75% of those that used the EMS and 95% of those that did not).

    CONCLUSION: Among patients who were hospitalized due to aortic dissection in Gothenburg, 78% used the EMS. Despite severe pain in the majority of patients, fewer than half received narcotic analgesics, and only 12% were free from pain on admission to the hospital. In fewer than one-in-five patients was a suspicion of aortic dissection reported by the EMS staff.

  • 5.
    Bremer, Anders
    et al.
    University of Borås, School of Health Science.
    Dahlberg, Karin
    Sandman, Lars
    University of Borås, School of Health Science.
    Balancing between closeness and distance: emergency medical services personnel's experiences of caring for families at out-of-hospital cardiac arrest and sudden death2012In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 27, no 1, p. 42-52Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) is a lethal health problem that affects between 236,000 and 325,000 people in the United States each year. As resuscitation attempts are unsuccessful in 70-98% of OHCA cases, Emergency Medical Services (EMS) personnel often face the needs of bereaved family members. PROBLEM: Decisions to continue or terminate resuscitation at OHCA are influenced by factors other than patient clinical characteristics, such as EMS personnel's knowledge, attitudes, and beliefs regarding family emotional preparedness. However, there is little research exploring how EMS personnel care for bereaved family members, or how they are affected by family dynamics and the emotional contexts. The aim of this study is to analyze EMS personnel's experiences of caring for families when patients suffer cardiac arrest and sudden death. METHODS: The study is based on a hermeneutic lifeworld approach. Qualitative interviews were conducted with 10 EMS personnel from an EMS agency in southern Sweden. RESULTS: The EMS personnel interviewed felt responsible for both patient care and family care, and sometimes failed to prioritize these responsibilities as a result of their own perceptions, feelings and reactions. Moving from patient care to family care implied a movement from well-structured guidance to a situational response, where the personnel were forced to balance between interpretive reasoning and a more direct emotional response, at their own discretion. With such affective responses in decision-making, the personnel risked erroneous conclusions and care relationships with elements of dishonesty, misguided benevolence and false hopes. The ability to recognize and respond to people's existential questions and needs was essential. It was dependent on the EMS personnel's balance between closeness and distance, and on their courage in facing the emotional expressions of the families, as well as the personnel's own vulnerability. The presence of family members placed great demands on mobility (moving from patient care to family care) in the decision-making process, invoking a need for ethical competence. CONCLUSION: Ethical caring competence is needed in the care of bereaved family members to avoid additional suffering. Opportunities to reflect on these situations within a framework of care ethics, continuous moral education, and clinical ethics training are needed. Support in dealing with personal discomfort and clear guidelines on family support could benefit EMS personnel.

  • 6.
    Hagiwara, Magnus
    et al.
    University of Borås, School of Health Science.
    Henricson, M
    Jonsson, Anders
    University of Borås, School of Health Science.
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Decision-Support Tool in Prehospital Care:A Systematic Review of Randomized Trials2011In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 26, no 4, p. 1-11Article in journal (Refereed)
    Abstract [en]

    Objective: The objective of this study was to evaluate the effects of the decision support tool (DST) on the assessment of the acutely ill or injured out-of-hospital patient. Methods: This study included systematic reviews of randomized controlled trials (RCT) where the DST was compared to usual care in and out of the hospital setting. The databases scanned include: (1) Cochrane Reviews (up to January 2010); (2) Cochrane Controlled Clinical Trials (1979 to January 2010); (3) Cinahl (1986 to January 2010); and (4) Pubmed/ Medline (1926 to January 2010). In addition, information was gathered from related magazines, prehospital home pages, databases for theses, conferences, grey literature and ongoing trials. Results: Use of the DST in prehospital care may have the possibility to decrease “time to definitive care” and improve diagnostic accuracy among prehospital personnel, but more studies are needed. Conclusions: The amount of data in this review is too small to be able to draw any reliable conclusions about the impact of the use of the DST on prehospital care. The research in this review indicates that there are very few RCTs that evaluate the use of the DST in prehospital care.

  • 7.
    Jonsson, Anders
    et al.
    University of Borås, School of Health Science.
    Karlsson, K
    Niemelä, P
    Heart rate as a marker of stress in ambulancepersonnel: a pilot study of body's response to the ambulance alarm2011In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 26, no 1, p. 21-26Article in journal (Refereed)
    Abstract [en]

    Introduction: Studies have demonstrated the presence of stress and post-traumatic stress among ambulance personnel, but no previous research has focused on the body’s reaction in the form of the change in heart rate of ambulance staff in association with specific occupational stress. Hypothesis: The purpose of this study is to investigate whether work as an ambulance professional generates prolonged physiological arousal that can be measured by heart rate in different situations. Methods: Twenty participants carried a pulse-meter in the form of a wristwatch, which continuously measured and stored their heart rate 24 hours per day for a period of seven days. All ambulance alarms that occurred during the test period were recorded in journals, and the participants completed diaries and a questionnaire describing their experiences. The alarms were divided into different phases. Correlations between heart rate in the different phases were computed. Results: Analysis of study data indicated a significant rise of heart rate unrelated to physical effort during an emergency alarm and response. This increased heart rate was noticed throughout the mission and it was not related to the length of experience the staff had in the ambulance profession. In addition, a non-significant trend suggested that alarms involving acutely ill children lead to an even higher increase in heart rate. In addition, this research showed that constant tension existed during sleep, while available for an emergency, indicated by a noticeable increase in heart rate during sleep at work compared to sleeping at home. Conclusions: A rise in heart rate was experienced during all acute emergency missions, regardless of a subject’s experience, education, and gender. Missions by themselves generated a rate increase that did not seem to correlate with physical effort required during an emergency response. This study shows that working on an ambulance that responds to medical emergencies is associated with a prolonged physiological arousal.

  • 8.
    Jonsson, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Segesten, Kerstin
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Daily stress and conception of self in Swedish ambulance personnel2004In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 19, no 3, p. 226-234Article, review/survey (Refereed)
  • 9.
    Silverplats, Katarina
    et al.
    Göteborgs Universitet.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lundberg, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Training methods for the control of catastrophic hemorrhage in the military environment2013In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 28, no 1Article, review/survey (Refereed)
  • 10.
    Suserud, Björn-Ove
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Backlund, Anna
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Patients comfort in prehospital emergency care2009In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 24, no 2, p. 10-10Article, review/survey (Refereed)
  • 11.
    Suserud, B-O
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Photo Documentation on the Scene of an Accident: A Complement to the Ordinary Documentation2001In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 16, no S1, p. S74-Article, review/survey (Refereed)
  • 12.
    Tärnqvist, Julia
    et al.
    The Ambulance Service in Skaraborg, Lidköping, Sweden.
    Dahlén, Erik
    The Ambulance Service in Skaraborg, Lidköping, Sweden.
    Magnusson, Carl
    Sahlgrenska Univ Hospital.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Strömsöe, Anneli
    University of Dalarna.
    Norberg, Gabriella
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Sahlgrenska University Hospital.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    On-Scene and Final Assessments and Their Interrelationship Among Patients Who Use the EMS on Multiple Occasions2017In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 32, no 5, p. 528-535Article in journal (Refereed)
    Abstract [en]

    Introduction The use of Emergency Medical Services (EMS) is increasing. A number of patients call repeatedly for EMS. Early studies of frequent callers show that they form a heterogenous group. Problem There is a lack of research on frequent EMS callers. There is furthermore a lack of knowledge about characteristics and the prehospital assessment of the patients who call for EMS on several occasions. Finally, there is a general lack of knowledge with regard to the association between the prehospital assessment by health care providers and the final diagnosis. Method Patients in Skaraborg in Western Sweden, who used the EMS at least four times in 2014, were included, excluding transport between hospitals. Information on the prehospital assessment on-scene and the final diagnosis was collected from the EMS and hospital case records. Results In all, 339 individual patients who used the EMS on 1,855 occasions were included, accounting for five percent of all missions. Fifty percent were women. The age range was 10-98 years, but more than 50.0% were in the age range of 70-89 years. The most common emergency signs and symptoms (ESS) codes on the scene were dyspnea, chest pain, and abdominal pain. The most common final diagnosis was chronic obstructive pulmonary disease (eight percent). Thirteen percent of all cases had a final diagnosis defined as a potentially life-threatening condition. Among these, 22.0% of prehospital assessments were retrospectively judged as potentially inappropriate. Forty-nine percent had a defined final diagnosis not fulfilling the criteria for a potentially life-threatening condition. Among these cases, 30.0% of prehospital assessments were retrospectively judged as potentially inappropriate. Conclusion: Among patients who used EMS on multiple occasions, the most common symptoms on-scene were dyspnea, chest pain, and abdominal pain. The most common final diagnosis was chronic obstructive pulmonary disease. In 13.0%, the final diagnosis of a potentially life-threatening condition was indicated. In a minority of these cases, the assessment on-scene was judged as potentially inappropriate. Tärnqvist J , Dahlén E , Norberg G , Magnusson C , Herlitz J , Strömsöe A , Axelsson C , Andersson Hagiwara M . On-Scene and Final Assessments and Their Interrelationship Among Patients Who Use the EMS on Multiple Occasions. Prehosp Disaster Med. 2017;32(5):1–8.

  • 13. Waage, A
    et al.
    Hamberger, B
    Lundin, T
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Riddez, L
    KAMEDO report no 84: Terrorist attacks against the World Trader Center, 11 september 20012006In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 21, no 2, p. 129-131Article in journal (Refereed)
    Abstract [en]

    On 11 September 2001, two hijacked airplanes collided with the World Trade Center in New York. Both towers collapsed, spreading smoke and debris for miles. Rescue personnel arrived rapidly, but the collapse of the towers made the scene too dangerous for these teams to rescue all those trapped inside. Although this collapse was impossible to predict, fires occurring in skyscrapers can cause the structures to collapse.When a fire erupts in the upper levels of the building, it is even more difficult for those trapped inside to escape. Communications systems were shut down. In future incidents with large numbers of injured victims, the injured should be transported to hospitals by non-traditional medical transport vehicles (taxis, cars, etc.). If future disasters occur in the vicinity of a hospital, the most severely injured victims should go to the hospital instead of congregating at assembly points. These victims often are already at hospitals before substantial aid arrives at the assembly points. On-scene care must be documented, and easy-to-read triage tags should be used. Reserve power supplies in major cities should be maintained in preparation for emergencies. Both victims and rescue personnel are susceptible to post-traumatic, psychosocial reactions.

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