An analysis of prehospital critical care events and management patterns from 97 539 emergency helicopter medical service missions : A retrospective registry-based study

BACKGROUND It is largely unknown how often physicians in emergency helicopter medical services (HEMS) encounter various critical care events and if HEMS exposure is associated with particular practice patterns or outcomes. OBJECTIVES This study aimed: to describe the frequency and distribution of critical care events; to investigate whether HEMS exposure is associated with differences in practice patterns and determine if HEMS exposure factors are associated with mortality. DESIGN A retrospective registry-based study. SETTING Physician-staffed HEMS in Finland between January 2012 and August 2019. PARTICIPANTS Ninety-four physicians who worked at least 6 months in the HEMS during the study period. Physicians with undeterminable HEMS exposure were excluded from practice pattern comparisons and mortality analysis, leaving 80 physicians. MAIN OUTCOME MEASURES The primary outcome measure was a physician's average annual frequencies for operational events and clinical interventions. Our secondary outcomes were the proportion of missions cancelled or denied, time onsite (OST) and proportion of unconscious patients intubated. Our tertiary outcome was adjusted 30-day mortality of patients. RESULTS The physicians encountered 62 [33 to 98], escorted 31 [17 to 41] and transported by helicopter 2.1 [1.3 to 3.5] patients annually, given as median [interquartile range; IQR]. Rapid sequence intubation was performed 11 [6.2 to 16] times per year. Physicians were involved in out-of-hospital cardiac arrest (OHCA) 10 [5.9 to 14] and postresuscitation care 5.5 [3.1 to 8.1] times per year. Physicians with longer patient intervals had shorter times onsite. Proportionally, they cancelled more missions and intubated fewer unconscious patients. A short patient interval [odds ratio (OR); 95% confidence interval (CI)] was associated with decreased mortality (0.87; 95% CI, 0.76 to1.00), whereas no association was observed between mortality and HEMS career length. CONCLUSION Prehospital exposure is distributed unevenly, and some physicians receive limited exposure to prehospital critical care. This seems to be associated with differences in practice patterns. Rare HEMS patient contacts may be associated with increased mortality.Peer reviewe

Gamma Hydroxybutyric Acid (GHB) for the Treatment of Alcohol Dependence: A Review

Gamma-hydroxybutyric acid (GHB) is a short-chain fatty acid structurally similar to the inhibitory neurotransmitter γ-aminobutyric acid. Clinical trials have demonstrated that 50–100 mg/kg of GHB fractioned into three or six daily doses is able to suppress alcohol withdrawal symptoms and facilitates the maintenance of abstinence from alcohol. These studies have also shown that GHB craving episodes are a very limited phenomenon (about 10–15%). Thus, physicians with access should consider the clinical efficacy of GHB as a valid pharmacological tool for the treatment of alcohol addiction

CITY AUTOMATED TRANSPORT SYSTEM (CATS): THE LEGACY OF AN INNOVATIVE EUROPEAN PROJECT

CATS is a collaborative European project promoting driverless vehicles that ended in December 2014. This contribution explains how the project evolved, including the handling of unexpected events and concentrating on lessons learned. The constructor and vehicle had to be changed for economic reasons in the middle of the project timeline. A second constructor went bankrupt, although access to his vehicles could be secured. For security and legal reasons, part of the final demonstration was relocated at short notice to the EPFL campus in Lausanne, Switzerland, where around 1600 people were transported during 16 days of vehicle operation. Reactions to the driverless vehicle concept were overwhelmingly positive. Implications for the acceptability of driverless vehicles in Europe and elsewhere are discussed

Cytoarchitectural and metabolic adaptations in muscles with mitochondrial and cytosolic creatine kinase deficiencies

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