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  • 1.
    Larsson, Glenn
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Andersson Hagiwara, Magnus
    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.
    Magnusson, Carl
    Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Characteristics of a trauma population in an ambulance organisation in Sweden: results from an observational study2023In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 31, no 1, article id 33Article in journal (Refereed)
    Abstract [en]

    Background

    Globally, injuries are a major health problem, and in Sweden, injuries are the second most common reason for ambulance dispatch. However, there is a knowledge gap regarding the epidemiology of injuries requiring assessment by emergency medical services (EMS) in Sweden. The aim of the present study was to describe the prehospital population with injuries that have been assessed and treated by EMS.

    Methods

    A randomly selected retrospective sample was collected from 1 January through 31 December 2019 in a region in southwestern Sweden. Data were collected from ambulance and hospital medical records.

    Results

    Among 153,724 primary assignments, 26,697 (17.4%) were caused by injuries. The study cohort consisted of 5,235 patients, of whom 50.5% were men, and the median age was 63 years. The most common cause of injury was low-energy fall (51.4%), and this was the cause in 77.8% of those aged > 63 years and in 26.7% of those aged ≤ 63 years. The injury mechanism was a motor vehicle in 8.0%, a motorcycle in 2.1% and a bicycle in 4.0%. The most common trauma location was the residential area (55.5% overall; 77.9% in the elderly and 34.0% in the younger group). In the prehospital setting, the most frequent clinical sign was a wound (33.2%), a closed fracture were seen in 18.9% and an open fracture in 1.0%. Pain was reported in 74.9% and 42.9% reported severe pain. Medication was given to 42.4% of patients before arrival in the hospital. The most frequent triage colour according to the RETTS was orange (46.7%), whereas only 4.4% were triaged red. Among all patients, 83.6% were transported to the hospital, and 27.8% received fracture treatment after hospital admission. The overall 30-day mortality rate was 3.4%.

    Conclusion

    Among EMS assignments in southwestern Sweden, 17% were caused by injury equally distributed between women and men. More than half of these cases were caused by low-energy falls, and the most common trauma location was a residential area. The majority of the victims had pain upon arrival of the EMS, and a large proportion appeared to have severe pain.

     

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  • 2.
    Larsson, Glenn
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hansson, Peter
    NU Hospital Group (NU), Department of Ambulance Care, SE- 461 85, Trollhättan, Sweden.
    Olsson, Emelie
    NU Hospital Group (NU), Department of Ambulance Care, SE- 461 85, Trollhättan, Sweden.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Prehospital assessment of patients with abdominal pain triaged to self-care at home: an observation study2022In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 22, no 1, article id 92Article in journal (Refereed)
    Abstract [en]

    Background

    Patients who call for emergency medical services (EMS) due to abdominal pain suffer from a broad spectrum of diseases, some of which are time sensitive. As a result of the introduction of the concept of ‘optimal level of care‘, some patients with abdominal pain are triaged to other levels of care than in an emergency department (ED). We hypothesised that it could be challenging in a patient safety perspective.

    Aim

    This study aims to describe consecutive patients who call for EMS due to abdominal pain and are triaged to self-care by EMS clinicians.

    Methods

    This was an observational study performed in an EMS organisation in Western Sweden during 2020. The triage tool Rapid Emergency Triage and Treatment System (RETTS), which included Emergency Signs and Symptom (ESS) codes, was used to find medical records where patients with abdominal pain have been triaged to self-care and 194 patients was included in the study.

    Results

    Of total 48,311 ambulance missions, A total of 1747 patients were labelled with ESS code six (abdominal pain), including 223 (12.8%) who were given the code for self-care and 194 who were further assessed by the research group. Of these patients, 32 (16.3%) had a return visit within 96 hours due to the same symptoms and 11 (5.6%) were hospitalised. In six of these patients, the EMS triage was evaluated retrospectively and assessed as inappropriate. These patients had a final diagnosis of ruptured abdominal aneurysm (n = 1), acute appendicitis with peritonitis (n = 2) and acute pancreatitis (n = 3). All these patients required extensive evaluation and different treatments, including acute surgery, antibiotics and fluid therapy.

    Conclusion

    Amongst the 1747 patients assessed by EMS due to abdominal pain, 223 (12.8%) were triaged to self-care. Of the 194 patients who were further assessed, 16.3% required a return visit to the ED within 96 hours and 5.6% were hospitalised. Six patients had obvious time-sensitive conditions. Our study highlights the difficulties in the early assessment of abdominal pain and the requirement for an accurate decision support tool.

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  • 3.
    Larsson, Glenn
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Dagerhem, Alma
    Emergency Department, Halland Hospital, Halmstad, Sweden.
    Wihlborg, Jonas
    School of Health and Welfare, Dalarna University, Falun, Sweden.
    Rantala, Andreas
    Emergency Department, Helsingborg General Hospital, Helsingborg, Sweden; Department of Health Sciences, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden; Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, Växjö, Sweden.
    Satisfaction among non-conveyed patients and significant others when discharged at the scene by the ambulance service: an exploratory cross-sectional survey2022In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 22, no 1, article id 100Article in journal (Refereed)
    Abstract [en]

    Background

    The ambulance service is facing an increased number of calls and ambulance assignments. Between 12 and 42% of all assignments result in non-conveyance to the Accident and Emergency Department. However, there is limited knowledge regarding satisfaction among patients and significant others when patients are assessed as non-urgent and discharged at the scene. Therefore, the aim of the study was to explore and compare satisfaction with the ambulance service among patients and significant others when the patient was discharged at the scene.

    Methods

    The present study was designed as a cross-sectional exploratory survey with a consecutive sample employing the Consumer Emergency Care Satisfaction Scale questionnaire on patients and significant others.

    Results

    A total of 162 questionnaires were analysed, 87 patients and 75 significant others. Overall, satisfaction was high with no significant difference between patients and significant others, although 17-19% were dissatisfied with the discharge information.

    Conclusions

    Generally, patients and significant others are satisfied with the care provided by the Ambulance Service when discharged at the scene and thus not conveyed the Accident and Emergency Department. The participants were especially satisfied with Specialist Ambulance Nurses’ interpersonal skills, e.g., making time and providing thorough information. Guidelines for assignments involving non-conveyance, as well as information, instructions and what to expect when discharged at the scene can be improved. 

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  • 4.
    Magnusson, Carl
    et al.
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-405 30, Gothenburg, Sweden; Department of Prehospital Emergency Care , Sahlgrenska University Hospital, SE-411 04, Gothenburg, Sweden.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Norberg-Boysen, Gabriella
    Kauppi, Wivica
    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.
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Prehospital Emergency Care , Sahlgrenska University Hospital, SE-411 04, Gothenburg, Sweden.
    Packendorff, Niclas
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Larsson, Glenn
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Wibring, Kristoffer
    Suboptimal prehospital decision- making for referral to alternative levels of care – frequency, measurement, acceptance rate and room for improvement2022In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 22, no 1, article id 89Article in journal (Refereed)
    Abstract [en]

    Background

    The emergency medical services (EMS) have undergone dramatic changes during the past few decades. Increased utilisation, changes in care-seeking behaviour and competence among EMS clinicians have given rise to a shift in EMS strategies in many countries. From transport to the emergency department to at the scene deciding on the most appropriate level of care and mode of transport. Among the non-conveyed patients some may suffer from “time-sensitive conditions” delaying diagnosis and treatment. Thus, four questions arise:

    1) How often are time-sensitive cases referred to primary care or self-care advice?

    2) How can we measure and define the level of inappropriate clinical decision-making?

    3) What is acceptable?

    4) How to increase patient safety?

    Main text

    To what extent time-sensitive cases are non-conveyed varies. About 5–25% of referred patients visit the emergency department within 72 hours, 5% are hospitalised, 1–3% are reported to have a time-sensitive condition and seven-day mortality rates range from 0.3 to 6%.

    The level of inappropriate clinical decision-making can be measured using surrogate measures such as emergency department attendances, hospitalisation and short-term mortality. These measures do not reveal time-sensitive conditions. Defining a scoring system may be one alternative, where misclassifications of time-sensitive cases are rated based on how severely they affected patient outcome.

    In terms of what is acceptable there is no general agreement. Although a zero-vision approach does not seem to be realistic unless under-triage is split into different levels of severity with zero-vision in the most severe categories.

    There are several ways to reduce the risk of misclassifications. Implementation of support systems for decision-making using machine learning to improve the initial assessment is one approach. Using a trigger tool to identify adverse events is another.

    Conclusion

    A substantial number of patients are non-conveyed, including a small portion with time-sensitive conditions. This poses a threat to patient safety. No general agreement on how to define and measure the extent of such EMS referrals and no agreement of what is acceptable exists, but we conclude an overall zero-vision is not realistic. Developing specific tools supporting decision making regarding EMS referral may be one way to reduce misclassification rates.

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  • 5.
    Herlitz, Johan
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Magnusson, Carl
    Sahlgrenska universitetssjukhuset, Göteborg.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lundgren, Peter
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Larsson, Glenn
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Rawshani, Araz
    Sahlgrenska universitetssjukhuset, Göteborg.
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Den prehospitala akutsjukvården i Sverige har stora utmaningar2021In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, article id 21119Article, review/survey (Refereed)
  • 6.
    Wennberg, Pär
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
    Hillberg Hörnfeldt, Thea
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Stål, Susanna
    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.
    Björås, Joakim
    SU Ambulance, Sahlgrenska University Hospital, Department of Prehospital Emergency Care, Gothenburg, Sweden.
    Larsson, Glenn
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. SU Ambulance, Sahlgrenska University Hospital, Department of Prehospital Emergency Care, Gothenburg, Sweden.
    Fascia iliaca compartment block (FICB) as pain treatment in older persons with suspected hip fractures in prehospital emergency care – A comparative pilot study2021In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 57, article id 101012Article in journal (Refereed)
    Abstract [en]

    Background 

    Older persons with a suspected hip fracture and suffering considerable pain are common patients in the emergency medical services (EMS). Pain treatment needs to be improved and fascia iliaca compartment block (FICB) can be one option. The purpose of this paper was to analyse prehospital pain in patients with a suspected hip fracture under EMS care and to compare standard treatment and FICB. 

      

    Methods 

    An evaluation of a retrospective case-control study comprising 135 patients from a pilot project with FICB in an EMS organisation in Sweden. The control patients were matched with FICB patients. Pain was assessed on the arrival of the EMS and on arrival in hospital. 

     

    Results 

    In all, 27 patients received FICB and 108 had standard pain treatment. There was a significant reduction in pain in both groups. However, there was a more marked reduction in pain among patients who received FICB than in the control group. So, for static pain, 56% experienced a reduction in pain in the FICB group versus 30% among controls (p < 0.01). The corresponding values for dynamic pain were 85% and 59% (p < 0.01). 

      

    Conclusion 

    FICB can be a good supplement to standard prehospital pain treatment in patients with suspected hip fractures. 

     

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