Background Mental illness is prevalent worldwide, creating a demand for Emergency Medical Service (EMS)assessments in mental illness, yet research on the epidemiology of patients with mental illness in the EMS is lackingin Sweden. This study aims to describe the patients presenting with symptoms of mental illness in the EMS and howthey are assessed in the prehospital setting.

Method A retrospective observational study was conducted to identify patients assessed for symptoms of mentalillness in the EMS in 2023. A total of 1,304 records met the inclusion criteria and were included in the study: [1]assessed in the EMS due to symptoms of mental illness and [2] over 13 years old. The data were analysed using IBMSPSS Statistic 28.

Results More females (54.3%) than men (45.7%) were assessed for mental illness (p=<0.01). The median age was 39years, with an interquartile range (IQR) of 32 years (p=<0.01) and a total range of 13–91. Most patients were assessedonce, with a range of 1 to 37 times. The initial priority of the patients was mainly Priority 1 (45.6%) or Priority 2 (49.9%). However, this shifted after the EMS assessment where most patients either recieved a lower priority or No priority[due to not being transported] (39.7%). The most common triage colour was Orange (21.4%), indicating the needfor acute care, but four out of ten patients did not recieve a triage color (40.4%). The most frequent patients assessedby the EMS were suicide threats/attempts (45.2%) and intoxications (48.8%) with intoxication cases most likely to behospitalised. The length of the stay in the hospital varied from 0 to 67 days but most patients were discharged within24 h (6.8%) or admitted for 24 h (6.4%).

ConclusionPatients with mental illness are frequently assessed in the EMS, primarily for suicide threats/attempts andintoxication. However, few are admitted to the hospital, and many are not triaged, suggesting difficulties in referringpatients with mental illness to the right level of care. The result may inform future studies assessing patients withmental illness in the EMS.

This qualitative article explores how simulation and training in tactical emergency care can contribute to police professionals’ ability to provide specialized care to colleagues and civilians in mass casualty events, such as an active shooter situation. Using an ethnographic approach, two simulations of tactical prehospital emergency care were observed and analyzed. The observations took place in Western Sweden during November and December 2023, and each simulation featured different scenarios. The first scenario was a final exercise for medics in the regional task force, while the second involved an exercise with the regional task force, ambulances, an ambulance helicopter, and a Coast Guard helicopter.

Through the analysis, five themes emerged, identified as factors that could both facilitate and hinder the ability to provide tactical emergency care. The results suggest that simulations of tactical emergency care should also include training in communication and cooperation to avoid diffusion of responsibility.

Objective: This study aims to advance the On Scene Injury Severity Prediction (OSISP), an Artificial Intelligence(AI)-based model, as a Clinical Decision Support System (CDSS) that supports Emergency Medical Service (EMS) personnel during on-scene assessment of adult trauma patients. The objectives are to explore the integration of OSISP with theprehospital trauma workflow and to refine the User Interface (UI) that communicates the predictions.Methods: Workflow integration was studied in a workshop by analysis of a customer journey map created by personnelwith experience of working in the EMS setting (n=8). Literature reviews were conducted to identify key factors enablingefficient human–AI collaboration and implementation options. Identified UI components derived from workshop and literature review findings were then evaluated and selected to refine the OSISP UI.Results: The workshop derived that OSISP is a service to be used on portable IT platforms as a second opinion, supportfor prioritization, and support during patient assessment. The literature reviews identified key content, characteristics,and goals of communicating predictions to users. The refined UI consisted of eight information components (prediction,entered predictors, missing predictors, and model details), and four functions (notification, exploration mode, and filtering of top three entered and missing predictors), to communicate the OSISP prediction.Conclusions: The refined OSISP UI has potential to integrate well into the clinical workflow during patient assessment,as well as enhance human–AI collaboration through customizable information when communicating predictions.However, usability testing of the OSISP UI is needed to ensure clinical utility

Background

Despite breathlessness (dyspnoea) being a common and serious symptom that often necessitates ambulance care, there is still a limited understanding of how ambulance clinicians (ACs) experience and manage these situations in the pre-hospital setting. Given the potential severity and complexity of breathlessness, as well as its impact on patient outcomes, a deeper insight into ACs’ perspectives is essential. This study aimed to explore ACs experiences of caring for patients with breathlessness within ambulance services.

Methods

An inductive qualitative design was employed. Data were collected through dyadic interviews with 16 ACs from two ambulance organizations in southwestern Sweden during two days in May and June 2021. The data were analyzed using qualitative content analysis.

Results

The ACs experienced several challenges in caring for patients with breathlessness, which is captured in three generic categories: navigating patients’ experiences during breathlessness, navigating relatives and their involvement, and navigating one’s own capability in care. ACs highlighted challenges of identifying and addressing patients’ individual needs, emphasizing the crucial role of trust-building. While ACs relied on their clinical expertise, assessing a patient’s condition remained challenging in certain situations. Furthermore, their ability to manage stress and emotional demands were essential for providing quality care.

Conclusions

This study underscores the challenges of caring for patients with breathlessness, with ACs employing strategies to manage stress and establish a safe environment. Clinical experience and ongoing training and education are strategies to strengthen clinical reasoning and decision-making. Pairing less experienced ACs with seasoned colleagues could also improve care quality and support the development of professional competence.

Background

Abdominal pain is a common symptom encountered by emergency medical services (EMS) in Sweden. EMS nurses follow a structured process involving clinical history, physical examination, and final assessment, as guided by regional protocols. However, little is known about EMS nurses' adherence to these guidelines.

Objective

This study aims to evaluate adherence to regional guidelines for managing abdominal pain in EMS and explore whether EMS nurses' educational level is associated with adherence.

Methods

A retrospective, descriptive review of EMS case records for patients with ESS Code 6 (abdominal pain) was conducted. Data were analyzed to compare adherence to guidelines between EMS nurses with and without specialized education.

Results

A total of 600 cases were reviewed. Guideline adherence was suboptimal in several areas, such as pain intensity documented in only 36 % of cases, and abdominal palpation performed in 70 %. EMS nurses with specialized education were more likely to administer pain relief, perform abdominal palpation, and measure blood glucose.

Conclusion

Adherence to guidelines for managing abdominal pain in EMS was limited, particularly in documenting pain intensity. The findings suggest that a higher level of education among EMS nurses may improve compliance with assessment and treatment protocols.

Purpose

In stroke, time and choice of treatment are critical. In ischemic stroke current options are thrombolysis or thrombectomy, with the latter as preferred choice in LVO (Large Vessel Occlusion)– but also only available at selected hospitals. If direct transport in suspected LVO can be decided with good precision in the ambulance, valuable time to treatment can be saved. Today this decision is far from obvious. Phone calls to stroke consultants and/or prehospital assessment scales are what´s commonly available. However, these introduce a risk of uncertainty and unfamiliarity in the assessments. With ViPHS (Video support in PreHospital Care) the purpose is to propose and test a telemedicine solution utilizing video streaming to increase precision in prehospital decisions regarding LVO cases. The paper presents the bearing clinical as well as technical principles and arguments in ViPHS, together with experiences gained from realistic full scale simulations and operational clinical pilots.

Method

The project followed a clinical process innovation model developed by the project team. This four-step model involves analysis of present care processes and proposals regarding alternative care process and technology, stepwise prototyping leading into full-scale realistic simulations, and finally a limited and an extended pilot.

Results

ViPHS has been tested in simulations and pilots. The results show that streamed video in the ViPHS telemedicine care model enables stroke experts to remotely make neurological assessments according to the NIHSS (National Institute of Health Stroke Scale) protocol.

Conclusions

Streamed video and remote NIHSS assessment using ViPHS care model can contribute to shortening vital time to thrombectomy through more informed transport and care decisions for suspected LVO cases. The remote NIHSS assessment can also shorten time for other patients on arrival to any hospital with stroke handling capabilities like thrombolysis. Therefore, ViPHS constitutes an important addition to present acute regional stroke care. ViPHS may also be deployed outside ambulance settings, for instance at smaller care facilities, but also in non-stroke applications if customized care processes and on-call routines are designed accordingly.

I det vardagliga samtalet kan teori och praktik ibland upplevas som varandras motsatser - men vi vill påstå att teori och praktik snarare är beroende av varandra. Blåljusorganisationer ingår i dag i ett akademiskt sammanhang och att arbeta inom blåljus ses som en semi-profession, med behov av reflekterande praktiker. I ditt kommande eller nuvarande yrke behöver du därför förhålla dig till och verka inom gränslandet mellan teori och praktik.

Du som läser denna bok har kanske precis börjat en metodkurs, står inför uppgiften att skriva en uppsats eller deltar i ett utvecklingsprojekt på din arbetsplats. I boken får du hjälp och guidning genom de frågor som kan uppstå i ditt arbete. Här presenterar och introducerar vi en översikt av metodval som har förankring i och relevans för blåljusyrken.

Vetenskaplig metod för blåljuspersonal vänder sig till studenter som kommer att jobba inom blåljusorganisationer, eller personer som redan gör det. Tanken är att hjälpa och guida dig igenom olika typer av frågor som kan uppstå när du ska närma dig, förstå och genomföra en vetenskaplig studie.

Background

The emergency medical service (EMS) addresses all chief complaints across all ages in various contexts. Children in EMS present a particular challenge due to their unique anatomical and physical properties, which require specific training that EMS clinicians often report lacking. This combination exposes children to incidents threatening patient safety. The most common method to highlight incidents is the incident reporting system. Studies have shown underreporting of such incidents, highlighting the need for multiple methods to measure and enhance patient safety in EMS for children. Thus, the aim of this study was to modify and adapt the current Ambulance TT for road-based EMS (ATT) to a pediatric version (pATT) with a guide containing definitions of triggers.

Methods

The adaption of the ambulance trigger tool to a version suitable for children followed a stepwise manner, including (1) a review of previous literature to pinpoint areas of risk regarding patient safety among children in EMS. (2) Three sessions of expert panel discussions via video meetings were held to evaluate each trigger of the ATT in terms of clinical relevance, comprehensibility, language and areas of risk regarding patient safety among children in EMS. (3) Clinical use of the pATT along with Retrospective Record Review (RRR). (4) Calculation of Item-level validity index and positive predictive value (PPV) for each trigger. (5) calculate inter-rater reliability between two independent record reviewers.

Results

MethodsThe adaption of the ambulance trigger tool to a version suitable for children followed a stepwise manner, including (1) a review of previous literature to pinpoint areas of risk regarding patient safety among children in EMS. (2) Three sessions of expert panel discussions via video meetings were held to evaluate each trigger of the ATT in terms of clinical relevance, comprehensibility, language and areas of risk regarding patient safety among children in EMS. (3) Clinical use of the pATT along with Retrospective Record Review (RRR). (4) Calculation of Item-level validity index and positive predictive value (PPV) for each trigger. (5) calculate inter-rater reliability between two independent record reviewers.

Conclusion

This study demonstrates the adaptation of an existing trigger tool (ATT) to one suitable for children. It also shows that the trigger tool, along with retrospective record review, is a feasible method to evaluate patient safety in EMS, thus complementing existing methods.