The evolving security landscape in Europe underscores the crucial importance of disaster preparedness. Emergency Departments’ (EDs) personnel – comprising nurses, nurse assistants and physicians – play a vital role in managing crises during both peacetime and armed conflicts. However, readiness and educational preparation of Emergency Department (ED) personnel are inconsistent; consequently, Sweden’s National Board of Health and Welfare (NBHW) has introduced national recommendations concerning education and training for both peacetime crises and armed conflicts. This study aimed to investigate the extent to which education and training of ED personnel align with NBHW recommendations for peacetime crisis and armed conflict preparedness in Swedish EDs. A descriptive cross-sectional study was conducted among all 70 hospital-based EDs in Sweden. In August 2025, a questionnaire comprising 45 items was distributed, covering topics related to NBHW recommendations, as well as specific aspects of International Humanitarian Law. The findings revealed that EDs provide education and training on how emergency care is organised and managed during disaster situations, as well as how to strengthen their capability to deliver care under such conditions. However, education and training for emergency care during extreme weather events and armed conflicts remain incomplete. The survey also revealed that disaster preparedness education and training were more common among EDs that had a designated employee responsible for overseeing these activities. Finally, this descriptive and exploratory study indicates that EDs are taking steps to enhance ED personnel’s knowledge and skills in organising and managing emergency care during disaster situations, as well as their capacity to deliver care under such conditions. Nevertheless, education and training related to disaster preparedness and patient care during peacetime crises and armed conflicts remain incomplete. Consequently, ED personnel may have inadequate education and training necessary to respond effectively to all-hazard disasters.

Aim: To explore how patients and their relatives perceive and experience emergency care delivered at home by Mobile Emergency Teams (METs). Design: An exploratory qualitative design was used to explore how patients and relatives experienced the care encounter. This approach was appropriate given the exploratory nature of the study. Ethical Considerations: The study was approved by the Swedish Ethical Review Authority (No: 2023–02186-01) and conducted in accordance with the Declaration of Helsinki. Participants provided informed consent, were assured of confidentiality, and were informed of their right to withdraw at any time. Methods: The study was conducted in southwestern Sweden and included 20 semi-structured interviews with patients (n = 11), relatives (n = 4), and joint patient-relative interviews (n = 5) who had recently received care from METs. Interviews were audio-recorded and transcribed verbatim. Data were analyzed using Braun and Clarke's six-phase thematic analysis. Results: The analysis generated two overarching themes: Embraced by a calming environment and A sense of safety and security. Participants described METs' arrival as a turning point that brought calm and clarity to emotionally intense situations. The teams' respectful approach, clear communication and structured assessments contributed to emotional reassurance. Receiving care at home, in a familiar environment and in the presence of loved ones, supported participants' sense of dignity, autonomy and control. However, some participants expressed uncertainty about what would happen after METs' departure, indicating a need for improved follow-up and continuity of care. Limitations: Findings are shaped by a specific Swedish context, joint interviews and purposive sampling, which may limit transferability. Conclusion: Emergency care at home was experienced as emotionally supportive and clinically competent. Attentiveness, clarity and a respectful presence were central to participants' sense of being thoroughly and considerately cared for. 

Introduction

Suicide is a leading cause of death globally and represents a common, resource-intensive duty for police patrol officers (PPOs). Responding to suicidal crises is often traumatic, and PPOs rarely receive comprehensive training, leaving them inadequately prepared. Police authorities frequently assume operational responsibility in such situations, encompassing emotional, legal, tactical and safety considerations.

Aim

This study aimed to explore and describe the competencies required of PPOs when encountering individuals in suicidal crisis.

Method

An exploratory, descriptive design was employed using a modified Delphi technique. Descriptions provided by PPOs of encounters with individuals in suicidal crisis were used to inform the development of items for a two-round questionnaire distributed to an expert panel. Experts were defined as individuals employed by the Swedish Police Authority or a university college, with additional training and/or teaching experience related to managing suicidal crises.

Results

Of the 50 experts invited, 43 completed both rounds, yielding a response rate of 86%. Consensus was achieved on 50 items, categorised into knowledge (n = 14), skills (n = 22) and attitudes (n = 14).

Background: Persons living with dementia (PLWD) are at an increased risk of going missing, with an elevated risk of harm. In Sweden, thousands of PLWD go missing annually, and the police are responsible for locating them. However, there is limited knowledge about the key factors that contribute to effective search efforts. Therefore, this study aimed to identify these key factors as expressed by police experts. Method: Using the Delphi technique, this exploratory study sought consensus among 43 Swedish police search experts over three rounds. The consensus was set at ≥70%. Results: Of the initial 73 items described by individual police experts, 53 reached consensus among the expert group. Five categories were identified: Information, Search Management, Search Tactics, Knowledge, and Collaboration. Discussion/conclusion: Limited situational awareness and lack of structure can hamper police search efforts when PLWD go missing. Knowing the person, critical partners, and the terrain all enhance search effectiveness.

Police Patrol Officers (PPOs) increasingly encounter individuals experiencing severe mental ill health who may pose a risk to themselves or others. In such situations, PPOs may act either independently or in collaboration with healthcare professionals, navigating a complex interplay between legal duties, safety considerations, and ethical responsibilities. This qualitative study aiming to explore PPOs’ ethical competence in such situations employed focus group interviews (n = 5) with PPOs (n = 32) and applied a deductive qualitative content analysis based on Lechasseur et al.’s framework of ethical competence, comprising ethical sensitivity, ethical knowledge, ethical reflection, ethical decision-making, ethical action, and ethical behaviour. The findings suggest that PPOs demonstrate several dimensions of ethical competence yet describe challenges related to emotional detachment, managing uncertainty, and balancing caregiving and law-enforcement responsibilities. Ethical competence was mainly articulated in relation to professional duty, harm reduction, and efforts to balance safety, autonomy, and support. The findings indicate a need for continued ethics education, structured opportunities for reflection, and strengthened interprofessional collaboration to support ethically grounded practice in encounters involving individuals experiencing severe mental ill health. 

Responding to people in suicidal crisis is a significant part of the work of Swedish police patrol officers (PPOs). PPOs can prevent suicide and provide the person in crisis with support, but their presence can also have unintended effects, like escalation of the situation and stigma. The aim of this study was to describe PPOs’ experiences and actions when they encounter people in suicidal crisis. The study was performed with an inductive and descriptive qualitative design using the critical incident technique (CIT). A total of 26 PPOs were interviewed. Their experiences could be grouped under the main areas Navigating on the edge of chaos, The stakes are high and A split objective, and their actions under the main categories Striving for control, Pursuing adaptation and Engaging in collaboration. The results give us insights in the balancing acts PPOs perform when confronting people in suicidal crisis, as they must weigh providing safety and control against being present, adapting to suffering, and the specific needs of the situation and the individual.

Background

People living with mental illness form a significant component of individuals presenting to emergency care services. Ambulance care embraces the care and treatment given to people of all ages who have suffered a sudden illness or injury and is carried out twenty-four-seven, regardless of setting and organizational belonging.

Aim

The aim was to explore ambulance clinicians’ competence requirements in caring for people living with mental illness.

Method

The study had a deductive and explorative design. A Delphi method was adopted using a group of experienced individuals recruited from the emergency care chain and non-governmental organizations (N = 15). An initial open-ended questionnaire was distributed covering three questions about; (1) knowledge, (2) skills and (3) attitudes that ambulance clinicians need to care for people living with mental illness. The informants’ answers were analysed using a manifest content analysis ending up in statements designed into a questionnaire that was sent out digitally in two rounds.

Results

The 57 statements that reached consensus could be categorised as referring to knowledge (n = 26), skills (n = 13) and attitude (n = 18).

Conclusion

Ambulance clinicians are expected to manage a range of incidents involving people living with mental illness, demanding knowledge of mental illness and the skills of mental health assessment, to ensure ambulance clinicians have the ability and non-judgmental attitude to make appropriate decisions within a caring encounter.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44192-025-00140-6.

Background: Shared decision-­ making aims to ensure that healthcare professionals and patients jointly make decisions regarding the patient's care. However, professionals often find it challenging to implement shared decision-­ making with older patients who have cognitive impairments or diminished decision-­making capacity. Research indicates a significant gap in the understanding of how decision-­ making processes unfold in prehospital settings.

Aim: The objective of this scoping review was to explore how decision-­making involving older patients in acute prehospital situations is characterized.

Design and Method: This scoping review is based on the Joanna Briggs Institute's guidelines for scoping reviews and is reportedusing the Preferred Reporting Items for Systematic Reviews and Meta-­Analyses extension for Scoping Review (PRISMA-­ScR).

Data Sources: CINAHL, PubMed, Scopus, PsychINFO and Web of Science were searched to identify relevant studies published between the years 2000 and 2024.

Results: The results are based on 26 studies and indicate that decision-­making among older patients is a conditional process,characterised by collaborative support involving the patient, significant others and healthcare professionals. Barriers to this process include hierarchical dynamics, fear of reprisals and uncertainty regarding the risk–benefit ratio. Factors that support decision-­making include situationally relevant competence, organisational resources and the presence of specific symptoms and signs.

Conclusion: Shared decision-­making with older patients in acute prehospital settings is conditional, often resulting in decisions being made primarily by healthcare professionals. There is considerable room for improvement in how this process is systematically approached. A structured approach is needed—one that assesses the older patient's decision-­ making capacity, considers the perspectives of family members, and incorporates input from individuals who know the patient well, all while minimizing hierarchical barriers.

Background

The number of persons living with dementia is increasing globally, including in Sweden, and these persons are at heightened risk of going missing and coming to harm. When they do go missing, the police get involved. There is a dearth of knowledge surrounding the prevalence and outcomes of harm in these instances in many countries, including Sweden, which affects our understanding of the associated risks and necessary interventions. Therefore, the aim of this study was to describe incidents of missing people and explore factors associated with harm in persons living with dementia as reported to the Swedish Police.

Methods

Data on background characteristics, the missing incidents, and police response was collected from a nationwide police registry. The missing incidents were analysed using descriptive statistics and logistic regression was used to explore factors associated with harm.

Results

A total of 1,041 missing person case reports concerning persons living with dementia were identified. In 61 (6%) of these reports, the missing person was harmed. The level of harm varied from lacerations to death. Male sex, no prior missing incidents, cold season, time since last contact, delayed reporting, and prolonged duration of police search effort were significantly associated with an increased probability of harm.

Conclusions

Persons living with dementia constituted a substantial proportion of all missing persons case reports submitted to the Swedish Police during the study period. Persons living with dementia were also at considerable risk of harm when missing, as even minor injuries can lead to substantial consequences. Furthermore, time was a critical factor, emerging as the strongest predictor of harm in the study. This calls for the development of collaborative routines between the police and professional caregivers caring for persons living with dementia.

Background

Emergency care faces increasing pressure, with extended waiting times and strained resources. Medical Emergency Teams (METs) combine expertise from emergency departments and ambulance services to deliver coordinated emergency care in patients’ homes. This study explores nurses’ and physicians’ experiences and actions when providing such care.

Method

This qualitative study used the Critical Incident Technique with an inductive approach. Seventeen individual interviews were conducted with nurses and physicians from two METs in southwestern Sweden. All 22 clinicians were eligible and invited to participate, and no exclusion criteria were applied. Data were collected between November 2023 and January 2024 and analyzed using content analysis.

Results

Participants reported that collaboration within MET was sometimes insufficient, limiting the full use of team skills. However, in time-critical situations, teamwork became more cohesive. Actions included understanding patients situations and preferences and fostering collaboration with other care providers. Experience over time helped clinicians identify which patients could safely remain at home.

Conclusion

Delivering emergency care at home allows clinicians to gain deeper insight into patients’ everyday lives and provide more comprehensive care. This shift may reduce care fragmentation and help identify contextual risks often overlooked in hospital-based settings.