Stine Thorhauge Zwisler

Outcome following physician supervised prehospital resuscitation: a retrospective study

Background Prehospital care provided by specially trained, physician-based emergency services (P-EMS) is an integrated part of the emergency medical systems in many developed countries. To what extent P-EMS increases survival and favourable outcomes is still unclear. The aim of the study was thus to investigate ambulance runs initially assigned ‘life-saving missions’ with emphasis on long-term outcome in patients treated by the Mobile Emergency Care Unit (MECU) in Odense, Denmark Methods All MECU runs are registered in a database by the attending physician, stating, among other parameters, the treatment given, outcome of the treatment and the patients diagnosis. Over a period of 80u2005months from May 1 2006 to December 31 2012, all missions in which the outcome of the treatment was registered as ‘life saving’ were scrutinised. Initial outcome, level of competence of the caretaker and diagnosis of each patient were manually established in each case in a combined audit of the prehospital database, the discharge summary of the MECU and the medical records from the hospital. Outcome parameters were final outcome, the aetiology of the life-threatening condition and the level of competences necessary to treat the patient. Results Of 25u2005647 patients treated by the MECU, 701 (2.7%) received prehospital ‘life saving treatment’. In 596 (2.3%) patients this treatment exceeded the competences of the attending emergency medical technician or paramedic. Of these patients, 225 (0.9%) were ultimately discharged to their own home. Conclusions The present study demonstrates that anaesthesiologist administrated prehospital therapy increases the level of treatment modalities leading to an increased survival in relation to a prehospital system consisting of emergency medical technicians and paramedics alone and thus supports the concept of applying specialists in anaesthesiology in the prehospital setting especially when treating patients with cardiac arrest, patients in need of respiratory support and trauma patients.

Opioid prescriptions before and after high-energy trauma.

OBJECTIVEnTo describe the legal use of opioids in adult patients before and after high-energy trauma.nnnDESIGNnThe study was a retrospective database study.nnnSETTINGnClinical care outside hospitals.nnnPATIENTSnAll patients who suffered high-energy trauma and were brought to Odense University Hospital (OUH), Denmark, in 2007 and 2008 were retrieved from the trauma database. These patients were linked with data on opioid use from the regional prescription database. In all, 938 patients were included.nnnMAIN OUTCOME MEASUREnRedemption of opioid prescription during the 6 months prior to a multitrauma or redemption of two or more prescriptions for opioids 6 months or later after a multitrauma.nnnRESULTSnOf the 938 patients brought to OUH with severe trauma within the study period, 61 patients died (7 percent) and six of these had redeemed prescriptions for opioids within 6 months prior to the trauma (10 percent) compared to 65 patients of the 877 survivors (7 percent) (odds ratio 1.4, nonsignificant). In all, 62 patients (7 percent) redeemed opioid prescriptions later than 6 months after their trauma and in a multivariable analysis, severe injury itself and severe injuries of the lower extremities were associated with redemption of opioid prescription after the trauma.nnnCONCLUSIONSnThe authors did not find any correlation between death by trauma and redemption of opioid prescriptions within the 6 months before the trauma. More severe traumas and especially severe traumas to the lower extremities were associated with redemption of opioid prescriptions after multitrauma.

Assessment of acute pain in trauma—A retrospective prehospital evaluation

OBJECTIVEnTo elucidate pain treatment with analgesics in a prehospital trauma population.nnnDESIGNnRetrospective database study.nnnSETTINGnPrehospital data from the anesthesiologist-manned Mobile Emergency Care Unit (MECU) in Odense, Denmark, were extracted and subjected to analysis.nnnPATIENTSnDuring the period of January 1, 2013 to December 31, 2014, patients with the diagnoses unspecified multiple injuries, examination and observation following traffic accident, examination and observation following other accident, and commotio cerebri were included in the analysis.nnnMAIN OUTCOME MEASURESnEvaluation of the application of the pain scale Numeric Rating Scale (NRS). Furthermore, the authors performed a characterization of the patients with mild pain and severe pain according to specific parameters such as pharmacological interventions, opioid consumption, intubation, and others.nnnRESULTSnNine hundred eighty-five cases were analyzed. NRS was documented only in one case. In all, 787 patients experienced no pain or mild pain (no pain, n = 242; mild pain, n = 545) and 168 patients severe pain or worse (severe pain, n = 155; intolerable pain, n = 13). In the severe pain group, 138 were treated with opioid analgesics or S-ketamine, while no pharmacological intervention was documented in 30 cases. Eight of the 138 cases with severe pain needed endotracheal intubation, whereas nine cases in the patients with mild or no pain needed endotracheal intubation; odds ratio (OR) 4.3 (p = 0.003).nnnCONCLUSIONSnEffect was only documented in one patient after administering opioids in a patient with trauma population, where approximately 17 percent of patients experienced severe pain. Severe pain was correlated to male gender, respiratory intervention, opioid administration, and the diagnosis unspecified multiple injuries.

Paediatric medical emergency calls to a Danish Emergency Medical Dispatch Centre: a retrospective, observational study

BackgroundLittle is known regarding paediatric medical emergency calls to Danish Emergency Medical Dispatch Centres (EMDC). This study aimed to investigate these calls, specifically the medical issues leading to them and the pre-hospital units dispatched to the paediatric emergencies.MethodsWe performed a retrospective, observational study on paediatric medical emergency calls managed by the EMDC in the Region of Southern Denmark in February 2016. We reviewed audio recordings of emergency calls and ambulance records to identify calls concerning patients ≤u200915xa0years. We examined EMDC dispatch records to establish how the medical issues leading to these calls were classified and which pre-hospital units were dispatched to the paediatric emergencies. We analysed the data using descriptive statistics.ResultsOf a total of 7052 emergency calls in February 2016, 485 (6.9%) concerned patients ≤u200915xa0years. We excluded 19 and analysed the remaining 466. The reported medical issues were commonly classified as: “seizures” (22.1%), “sick child” (18.9%) and “unclear problem” (12.9%). The overall most common pre-hospital response was immediate dispatch of an ambulance with sirens and lights with a supporting physician-manned mobile emergency care unit (56.4%). The classification of medical issues and the dispatched pre-hospital units varied with patient age.DiscussionWe believe our results might help focus the paediatric training received by emergency medical dispatch staff on commonly encountered medical issues, such as the symptoms and conditions pertaining to the symptom categories “seizures” and “sick child”. Furthermore, the results could prove useful in hypothesis generation for future studies examining paediatric medical emergency calls.ConclusionAlmost 7% of all calls concerned patients ≤u200915xa0years. Medical issues pertaining to the symptom categories “seizures”, “sick child” and “unclear problem” were common and the calls commonly resulted in urgent pre-hospital responses.

Noise exposure during prehospital emergency physicians work on Mobile Emergency Care Units and Helicopter Emergency Medical Services

BackgroundPrehospital personnel are at risk of occupational hearing loss due to high noise exposure. The aim of the study was to establish an overview of noise exposure during emergency responses in Mobile Emergency Care Units (MECU), ambulances and Helicopter Emergency Medical Services (HEMS). A second objective was to identify any occupational hearing loss amongst prehospital personnel.MethodsNoise exposure during work in the MECU and HEMS was measured using miniature microphones worn laterally to the auditory canals or within the earmuffs of the helmet. All recorded sounds were analysed in proportion to a known tone of 94 dB. Before and after episodes of noise exposure, the physicians underwent a hearing test indicating whether the noise had had any impact on the function of the outer sensory hair cells. This was accomplished by measuring the amplitude level shifts of the Distortion Product Otoacoustic Emissions. Furthermore, the prehospital personnels’ hearing was investigated using pure-tone audiometry to reveal any occupational hearing loss. All prehospital personnel were compared to ten in-hospital controls.ResultsOur results indicate high-noise exposure levels of ≥80 dB(A) during use of sirens on the MECU and during HEMS operations compared to in-hospital controls (70 dB(A)). We measured an exposure up to ≥90 dB(A) under the helmet for HEMS crew. No occupational hearing loss was identified with audiometry. A significant level shift of the Distortion Product Otoacoustic Emissions at 4 kHz for HEMS crew compared to MECU physicians was found indicating that noise affected the outer hair cell function of the inner ear, thus potentially reducing the hearing ability of the HEMS crew.DiscussionFurther initiatives to prevent noise exposure should be taken, such as active noise reduction or custom-made in-ear protection with communication system for HEMS personnel. Furthermore, better insulation of MECU and ambulances is warranted.ConclusionWe found that the exposure levels exceeded the recommendations described in the European Regulative for Noise, which requires further protective initiatives. Although no hearing loss was demonstrated in the personnel of the ground-based units, a reduced function of the outer sensory hair cells was found in the HEMS group following missions.

Use of Infrared Thermography in Diagnosing Necrotizing Fasciitis in the Emergency Department: A Case Study

Objective Necrotizing fasciitis is a difficult diagnosis with a very high mortality. However, thermal imaging has the potential to identify increasing skin temperature and rapid progression. Materials and methods We used repeat photographs taken with a thermal camera to visualize changes in skin temperature over time. Results An unstable male patient presented at the emergency department. Thermal imaging showed increased skin temperature of his left foot with a rapid increase and progression in extent within 1 hour. Necrotizing fasciitis was suspected and later confirmed. Conclusions We believe thermal imaging could be an important adjunct for the diagnosis of suspected necrotizing fasciitis. LEARNING POINTS Necrotizing fasciitis is a difficult diagnosis to make. Thermal imaging can visualize skin temperature and thus show increased temperature and extent. Rapid identification of necrotizing fasciitis is vital for patient survival.

Changes in severity of traffic related trauma aged 18+ admitted to a local level 2 trauma centre after the introduction of the Mobile Emergency Care Unit at Southern Funen. A pilot study

Background Centralizing and specializing in Danish health care is ongoing. Around the country Mobile Emergency Care Units (MECU) are introduced during the past years. Pre-hospital triage is important to evaluate at which trauma level the severely injured patients must be received. The aim of our study was to evaluate changes in the severity in 18+ traffic related trauma admitted to a level 2 centre at Odense University Hospital, Svendborg Hospital (OUH, SH) after the introduction of a local MECU.

Lipothymia and Syncope—Aetiology and Outcome in a Prehospital Setting: A Retrospective Study

Background. A firm aetiology of lipothymia or syncope can be difficult to establish prehospitally. The aim of the study was to investigate patients initially assigned the diagnosis of lipothymia or syncope prehospitally and establish the aetiology of their condition either based on prehospital or in-hospital medical records. Methods. From May 1, 2006 to April 30, 2010, all patients receiving the diagnosis of lipothymia or syncope by the MECU were investigated. If admitted to hospital, the patients’ medical records were investigated to confirm the prehospital diagnosis. Results. Within 17980 MECU runs registered, 678 were assignments in which the patients were diagnosed with lipothymia or syncope (3.8%). 578 patients (85%) were admitted to hospital. 278 of the patients were discharged directly from the emergency department, while 271 were admitted to a ward. 112 patients refused treatment offered by the MECU or at the emergency department, died, or were left at the scene following treatment. 17 were lost to followup. Of all patients investigated, 299 were discharged with the diagnosis of lipothymia or syncope. 250 patients were discharged with other diagnoses. Conclusions. In 44% of the patients presenting with lipothymia or syncope, no other diagnosis was established at the hospital, and no explanatory aetiology was found.