Comparison of three different prehospital wrapping methods for preventing hypothermia - a crossover study in humans

<p>Abstract</p> <p>Background</p> <p>Accidental hypothermia increases mortality and morbidity in trauma patients. Various methods for insulating and wrapping hypothermic patients are used worldwide. The aim of this study was to compare the thermal insulating effects and comfort of bubble wrap, ambulance blankets / quilts, and Hibler's method, a low-cost method combining a plastic outer layer with an insulating layer.</p> <p>Methods</p> <p>Eight volunteers were dressed in moistened clothing, exposed to a cold and windy environment then wrapped using one of the three different insulation methods in random order on three different days. They were rested quietly on their back for 60 minutes in a cold climatic chamber. Skin temperature, rectal temperature, oxygen consumption were measured, and metabolic heat production was calculated. A questionnaire was used for a subjective evaluation of comfort, thermal sensation, and shivering.</p> <p>Results</p> <p>Skin temperature was significantly higher 15 minutes after wrapping using Hibler's method compared with wrapping with ambulance blankets / quilts or bubble wrap. There were no differences in core temperature between the three insulating methods. The subjects reported more shivering, they felt colder, were more uncomfortable, and had an increased heat production when using bubble wrap compared with the other two methods. Hibler's method was the volunteers preferred method for preventing hypothermia. Bubble wrap was the least effective insulating method, and seemed to require significantly higher heat production to compensate for increased heat loss.</p> <p>Conclusions</p> <p>This study demonstrated that a combination of vapour tight layer and an additional dry insulating layer (Hibler's method) is the most efficient wrapping method to prevent heat loss, as shown by increased skin temperatures, lower metabolic rate and better thermal comfort. This should then be the method of choice when wrapping a wet patient at risk of developing hypothermia in prehospital environments.</p

Collecting core data in physician-staffed pre-hospital helicopter emergency medical services using a consensus-based template: international multicentre feasibility study in Finland and Norway

Background Comparison of services and identification of factors important for favourable patient outcomes in emergency medical services (EMS) is challenging due to different organization and quality of data. The purpose of the present study was to evaluate the feasibility of physician-staffed EMS (p-EMS) to collect patient and system level data by using a consensus-based template. Methods The study was an international multicentre observational study. Data were collected according to a template for uniform reporting of data from p-EMS using two different data collection methods; a standard and a focused data collection method. For the standard data collection, data were extracted retrospectively for one year from all FinnHEMS bases and for the focused data collection, data were collected prospectively for six weeks from four selected Norwegian p-EMS bases. Completeness rates for the two data collection methods were then compared and factors affecting completeness rates and template feasibility were evaluated. Standard Chi-Square, Fisher’s Exact Test and Mann-Whitney U Test were used for group comparison of categorical and continuous data, respectively, and Kolomogorov-Smirnov test for comparison of distributional properties. Results All missions with patient encounters were included, leaving 4437 Finnish and 128 Norwegian missions eligible for analysis. Variable completeness rates indicated that physiological variables were least documented. Information on pain and respiratory rate were the most frequently missing variables with a standard data collection method and systolic blood pressure was the most missing variable with a focused data collection method. Completeness rates were similar or higher when patients were considered severely ill or injured but were lower for missions with short patient encounter. When a focused data collection method was used, completeness rates were higher compared to a standard data collection method. Conclusions We found that a focused data collection method increased data capture compared to a standard data collection method. The concept of using a template for documentation of p-EMS data is feasible in physician-staffed services in Finland and Norway. The greatest deficiencies in completeness rates were evident for physiological parameters. Short missions were associated with lower completeness rates whereas severe illness or injury did not result in reduced data capture.publishedVersio

Benefit and risk assessment of breastmilk for infant health in Norway: Opinion of the Steering Committee of the Norwegian Scientific Committee for Food Safety

Source at https://vkm.no/english/riskassessments/allpublications/benefitandriskassessmentofbreastmilkforinfanthealthinnorway.4.27ef9ca915e07938c3b2a6df.html.Breastmilk covers all the nutritional needs of the infant the first months of life, with the exception of vitamin D. In addition, breastmilk has a number of protective properties. However, as humans are exposed to polluting chemicals through food, air, water and skin contact, breastmilk also contains contaminants. Taking the present-day levels of contaminants in Norwegian breastmilk and the long duration of breastfeeding (12 months) in Norway into account, the Norwegian Scientific Committee for Food Safety concludes that contaminants poses a low risk to Norwegian infants, and that the benefits of breastmilk to Norwegian infants clearly outweigh the risk presented by contaminants

Helicopter-based Emergency Medical Service: dispatches, decisions and patient outcome

Introduction: Although Norway has one of the most developed air ambulance services in the world, its helicopter emergency medical service (HEMS) capacity is limited. Few studies have assessed the medical decisions involved with Norway’s HEMS, and little is known about the selection of missions and medical priorities on-scene. The aim of this work was to increase knowledge about HEMS use, HEMS physicians’ medical priorities among patients, and factors influencing on-scene time. Method: Extensive mission data from 42,500 dispatches of HEMS in Førde, Bergen, and Stavanger during 2004–2013 were analysed to assess mission profiles, identify variations in on-scene time and compare patient survival after transport by either ground ambulances or HEMS. Results: The annual number of dispatches to primary missions was stable during the 10-year period. Summer, weekends, and daytime were the busiest times. More than one third of all dispatches were cancelled, with lower proportions cancelled in summer and during daytime. In 95% of the completed emergency missions, patients were reached within 45 minutes, and response and on-scene times in helicopter missions were short (24 and 11 min, respectively). There was a 2-minute decrease in on-scene time during the last five years of the study period. However, if HEMS performed endotracheal intubation of the patient, this increased on-scene time by almost 10 minutes. Basic treatment prior to HEMS arrival reduced on-scene time in patients suffering from acute myocardial infarction by almost 2 minutes. Trauma was the most common condition among the patients encountered in primary missions, followed by cardiac arrest and chest pain. One third of the HEMS patients were severely ill or injured and more than two thirds of this group received advanced interventions. When concurrent HEMS missions occurred, more of the patients prioritized by HEMS seemed to be critically ill compared with patients transported by ground ambulance, although survival was similar. Conclusion: HEMS cancellation rates were rather low, and response and on-scene times in primary missions were short. One third of the patients were seriously ill or injured, and more than two thirds of this group received advanced interventions. When concurrent missions occurred, HEMS seemed to select the missions that may have the most impact. Prehospital data should be automatically registered to improve future research quality in the provision of both HEMS and ground ambulance services

Kitesurfing and snowkiting injuries in Norway: a retrospective study

Abstract Background Kiteboarding (kitesurfing on water and snowkiting) is a fairly new sport and is defined as a high-risk sport. The injury rate has been reported to be between 6 and 9 per 1000 h. The aim of the study was to identify and describe kiteboarding-related injuries in Norway over a five-year period. Methods We used “snowball sampling” to identify kiteboarding accidents in a retrospective study. In addition, we conducted structural searches in the National Air Ambulance Service and Search and Rescue Helicopter patient record databases. All included informants were interviewed. Descriptive methods were used to characterise the sample. Results Twenty-nine kiteboarders were included, with a total of 33 injuries. One half of the injuries to head, face and neck were cerebral concussions (n = 12). The most common type of injury was bone fractures (n = 28), followed by soft tissue injuries (n = 24). Most injuries were of moderate severity (51%) and falling from less than 5 m was the most common mechanism of injury. Operator error and lack of experience were the most frequently reported causes of accidents (82%). Conclusions Serious injuries occured during kiteboarding. The majority of kiteboarders reported operator error or lack of experience as the cause of their accident. Prior to kiteboarding, a course highlighting the importance in using helmet for snowkiting and both helmet and life vest in kitesurfing, should be mandatory

Helicopter-based emergency medical services for a sparsely populated region: A study of 42,500 dispatches

Background: The Helicopter Emergency Medical Service (HEMS) in Norway is operated day and night, despite challenging geography and weather. In Western Norway, three ambulance helicopters, with a rapid response car as an alternative, cover close to 1 million inhabitants in an area of 45,000 km2. Our objective was to assess patterns of emergency medical problems and treatments in HEMS in a geographically large, but sparsely populated region. Methods: Data from all HEMS dispatches during 2004–2013 were assessed retrospectively. Information was analyzed with respect to patient treatment and characteristics, in addition to variations in services use during the day, week, and seasons. Results: A total of 42,456 dispatches were analyzed. One third of the patients encountered were severely ill or injured, and two thirds of these received advanced treatment. Median activation time and on-scene time in primary helicopter missions were 5 and 11 min, respectively. Most patients (95%) were reached within 45 min by helicopter or rapid response car. Patterns of use did not change. More than one third of all dispatches were declined or aborted, mostly due to no longer medical indication, bad weather conditions, or competing missions. Conclusion: One third of the patients encountered were severely ill or injured, and more than two thirds of these received advanced treatment. HEMS use did not change over the 10-year period, however HEMS use peaked during daytime, weekends, and the summer. More than one third of all dispatches were declined or aborted

General practitioners not available – out-of-hospital emergency patients handled by anaesthesiologist in a large Norwegian municipality

Background Until autumn 2018 the GPs in Bergen Municipality did not attend emergency patients outside the emergency primary care centre. The ambulance staff handled emergencies on their own or were assisted by an anaesthesiologist from the helicopter emergency medical service (HEMS). The aim of this study was to investigate procedures performed by the HEMS anaesthesiologist and to assess the level of skills needed to perform these procedures. Methods This study was a retrospective assessment of data from the period 2011 to 2013 on all emergency missions in which patients were dealt with by HEMS, using a rapid-response car in Bergen Municipality. All emergency missions were sorted into three categories: No intervention, Basic or Advanced intervention. This list was made by a research group with anaesthesiologists working for Bergen HEMS and GPs with OOH experience. The list is based on curriculum found in acute medicine courses. Results HEMS responded to 716 (2.3%) out of a total of 31,696 emergencies in Bergen Municipality during the three years. In more than two-thirds (71%) of these missions, no intervention or only a basic intervention was performed. Most advanced procedures were performed in patients with cardiac arrest. Conclusion By retrospective evaluation of HEMS missions by car in Bergen municipality, we found that nearly one-third of the patients received advanced procedures. Cardiac arrest was the medical condition in which the most advanced procedures were performed. More research is needed to evaluate procedures and the importance of clinical evaluation and physicians’ experience in treating these patient groups. KEY POINTS Both HEMS and on-call GPs are needed in emergency care, and more knowledge will be useful to highlight the level of practical skills needed in these missions. There is a need for better prioritization of when to use HEMS resources and when to use on-call GPs in emergency missions. More than two-thirds of the patients involved in emergency missions received no intervention or just a basic intervention when dealt with by HEMS. This raises the issue of whether an on-call GP could have adequately treated many of the patients in this study in terms of practical skills.publishedVersio

A prospective observational study of why people are medically evacuated from offshore installations in the North Sea

Objectives Few studies have described evacuations due to medical emergencies from the offshore installations in the North Sea, though efficient medical service is essential for the industrial activities in this area. The major oil- and gas-producing companies’ search and rescue (SAR) service is responsible for medical evacuations. Using a prospective approach, we describe the characteristics of patients evacuated by SAR. Design and setting A prospective observational study of the offshore primary care provided by SAR in the North Sea. Methods Patients were identified by linking flight information from air transport services in 2015/2016 and the company’s medical record system. Standardised forms filled out by SAR nurses during the evacuation were also analysed. In-hospital information was obtained retrospectively from Haukeland University Hospital’s information system. Results A total of 381 persons (88% men) were evacuated during the study period. Twenty-seven per cent of missions were due to chest pain and 18% due to trauma. The mean age was 46.0 years. Severity scores were higher for cases due to medical conditions compared with trauma, but the scores were relatively low compared with onshore emergency missions. The busiest months were May, July and December. Weekends were the busiest days. Conclusion Three times as many evacuations from offshore installations are performed due to acute illness than trauma, and cardiac problems are the most common. Although most patients are not severely physiologically deranged, the study documents a need for competent SAR services 24 hours a day year-round. Training and certification should be tailored for the SAR service, as the offshore health service structure and geography differs from the structure onshore

A prospective observational study of why people are medically evacuated from offshore installations in the North Sea

Objectives - Few studies have described evacuations due to medical emergencies from the offshore installations in the North Sea, though efficient medical service is essential for the industrial activities in this area. The major oil- and gas-producing companies’ search and rescue (SAR) service is responsible for medical evacuations. Using a prospective approach, we describe the characteristics of patients evacuated by SAR. Design and setting - A prospective observational study of the offshore primary care provided by SAR in the North Sea. Methods - Patients were identified by linking flight information from air transport services in 2015/2016 and the company’s medical record system. Standardised forms filled out by SAR nurses during the evacuation were also analysed. In-hospital information was obtained retrospectively from Haukeland University Hospital’s information system. Results - A total of 381 persons (88% men) were evacuated during the study period. Twenty-seven per cent of missions were due to chest pain and 18% due to trauma. The mean age was 46.0 years. Severity scores were higher for cases due to medical conditions compared with trauma, but the scores were relatively low compared with onshore emergency missions. The busiest months were May, July and December. Weekends were the busiest days. Conclusion - Three times as many evacuations from offshore installations are performed due to acute illness than trauma, and cardiac problems are the most common. Although most patients are not severely physiologically deranged, the study documents a need for competent SAR services 24 hours a day year-round. Training and certification should be tailored for the SAR service, as the offshore health service structure and geography differs from the structure onshore

Is There a Trade-Off Between Maximum Jumping and Throwing Capability in the Handball Jump Throw?

This study examined the potential trade-off in performance between maximum physical capabilities in the handball jump throw, a fundamental skill comprised of two mechanically independent tasks. Elite handball players performed jump throw actions from a force plate for each of three instructions: jump at maximum capability, throw at maximum capability, and jump and throw at maximum capability simultaneously. Jump height and throwing velocity were derived from motion capture data. When jumping and throwing at maximum capability simultaneously, no trade-off between jump height and throwing velocity was present, but rather a concurrent decline from their respective maximums. This decline could be explained by mechanical factors related to movement execution; magnitudes of directional impulses favored vertical movement for jumping and horizontal movement for throwing. However, no explanation for differences in total magnitude of impulse between instructions was evident. Due to the expertise of the participants, information processing should not be a limiting factor, leaving movement strategy as the most likely explanation for the present findings