Potentially Severe Incidents During Interhospital Transport of Critically Ill Patients, Frequently Occurring But Rarely Reported: A Prospective Study

Objectives The out-of-hospital environment can pose significant challenges to the quality and safety of interhospital transport of critically ill patients. Because we lack knowledge of the occurrence of incidents, their potential consequences, and whether they are actually reported, this study was initiated. Methods Two different services in Norway were asked to self-report incidents after every interhospital transport of critically ill patients. Sampling lasted for 12 and 8 months, respectively. An expert group evaluated each incident for severity and demand for reporting into the hospital’s electronic incident reporting system. One year later, the hospital’s reporting system was scrutinized to determine the number of incidents actually reported. Results A total of 455 transports of critically ill patients were performed, resulting in 294 unique incidents reported: medical (15%), technical (25%), missing equipment (17%), and personal failures and communication difficulties (42%). Only 3 (1%) of the 294 unique incidents were actually reported in the hospital’s electronic incident reporting system. The experts were inconsistent in which incidents should have been reported and to what degree checklists, standard operating procedures, simulation, and training could have prevented the incidents. Conclusions This study of interhospital transports of critically ill patients reveals a very high number of incidents. Despite this fact, these incidents are severely underreported in the hospital’s electronic incident reporting system. This suggests that learning is lost and errors with predominant probability are repeated. These results emphasize the existing challenges in regard to the quality and safety of interhospital transport of critically ill patients.publishedVersio

Häusliche Gewalt gegen Männer - der blinde Fleck der Geschlechterforschung?

"Es scheint normal, dass Frauen Opfer und Männer Täter sind" (Schwithal 2004:1). Permanent wird der akute Schutzbedarf von Frauen breitflächig thematisiert. Die Medien liefern täglich erschütterndes Material von Frauen, die Gewalt erfahren. In diesem Fall sind Hilfs- und Beratungsangebote leicht zu finden, Frauenhäuser sind in der breiten Masse der Bevölkerung bekannt und sensible Handlungsleitfäden für Betroffene und Angehörige liegen in Arztpraxen oder Supermärkten aus. Gegenstand ist überwiegend häusliche Gewalt1 - die Gewalt welche hinter verschlossenen Türen und von der Öffentlichkeit abgeschnitten geschieht und der Frauen hilflos ausgeliefert sind. TV-Spots, die Opfer dazu aufrufen nicht länger in der missbräuchlichen Situation zu verharren, richten sich ausschließlich an Frauen. Der quälende, schreiende und schmerzverursachende Mann – oft nur als dunkler Schatten, geballte Faust oder bedrohliche Stimme dargestellt – verharrt in der Täterrolle. ..

Ab Initio Studies of Molecules

The goal of this thesis has been to develop from scratch an ab initio computer program for calculating the electronic structure and properties of molecules. In order to obtain a good compromise between accuracy and computational cost, we decided to create a Hartree-Fock solver using Gaussian basis functions, as well as an implementation of Møller-Plesset perturbation theory up to third order. The thesis consists of three parts. Part I discusses the fundamentals of many-body quantum mechanics and derives the restricted andunrestricted Hartree-Fock equations. An optimised scheme for computing the one- and two-particle integrals needed for the calculation of the Fock matrix is described in detail. Finally, the Møller-Plesset perturbation theory up to third order is derived. Part II describes how we have implemented the methods in the C++ programming language, and the code is validated by reproducing a selection of published results. In part III we present and discuss results from calculations on various molecular systems. Both closed and open shell molecules are considered. Special attention is payed to the correlation energy and the problem of dissociation

Time Course of Hoist Operations by the Search and Rescue Helicopter Service in Southeast Norway

Introduction Optimal dispatch of emergency medical services relies on accurate time estimates of the various prehospital stages. Hoist rescue work time intervals performed by the search and rescue (SAR) helicopter service in Norway have not been studied to date. We aimed to describe the epidemiologic, operational, and medical aspects of the SAR service in southeast Norway. To complement the prehospital timeline, we performed simulated hoist operations. Methods We reviewed time and patient descriptors and medical interventions in hoist operations performed at a SAR base over 5 y. In addition, a simulation study measuring hoist rescue time intervals was performed. Data are presented as mean±SD, except National Advisory Committee for Aeronautics (NACA) scores, which are presented as modes. Results There were 148 hoist operations performed during the study period, involving 180 patients. Time to take-off was 13±7 min. There were 88 patients (49%) who were injured; 53 (29%) had a medical condition, and 39 (22%) were evacuees. The mode of the NACA score was 3. Forty-five patients (25%) had an NACA score of 4 to 6. Medical interventions were performed on 77 patients (43%) in 73 operations (49%). Nine patients (5%) were endotracheally intubated, and 1 thoracostomy was performed. The simulated rescuer access time was 4±2 min, the simulated anesthesiologist access time was 6±2 min, and the simulated hoist extrication time was 13±2 min. Conclusions Hoist rescue was performed in 10% (n=148) of the SAR operations. New information about hoist extrication time intervals can improve rescue helicopter dispatch accuracy.publishedVersio

Interhospital transport of critically ill patients: experiences and challenges, a qualitative study

Background No consensus based national standard for interhospital transports of critically ill patients exists in Norway. The local hospitals are responsible for funding, organizing and performing these transports, resulting in potentially different level of care for the critically ill patients depending on local hospital resources and not the level of severity in the patient’s condition. The aim of this study was to examine how these transports are executed and to discover challenges during transports and potentials of improvement. Methods A qualitative study with 20 semi-structured interviews of doctors, nurses and ambulance personnel representing a wide range in experience and formal education, reflecting the different compositions of crews performing interhospital transports was conducted. A systematic text condensation of the interviews was performed to describe personal experiences and values. Results Few interviewees reported special adverse events when asked. Instead they chose to describe more general characteristics of the working environment, their own positive emotions or fears and the strengths and weaknesses of the organizational system. The prehospital working environment was described as different from the in-hospital environment. The personnel experienced being on their own during transports, lack of procedures and checklists and often no systematic education or demanded preparedness for participating. The resident doctors described pressure from elderly colleagues to participate in the transports. At the same time, all interviewees reported a self-interest in participating in these transports. Conclusions Safe interhospital transports of the critically ill patients are challenged by the characteristics of the out of hospital environment. The transports are described as potentially unsafe for both patients and personnel. Systematic education is warranted, highlighting the use of checklists and special educational programs in prehospital critical care medicine. The strong personal interest to participate in these transports may serve as a barrier against changing todays system. To ensure the right level of competence and safety for each unique patient, it is imperative to standardize the interhospital transports on a national level, built on consensus from experienced prehospital personnel. Trial registration The trial is approved and registered by the local representative for the Norwegian Data Protection Authority as trial 13–7751

Potentially Severe Incidents During Interhospital Transport of Critically Ill Patients, Frequently Occurring But Rarely Reported: A Prospective Study

Objectives The out-of-hospital environment can pose significant challenges to the quality and safety of interhospital transport of critically ill patients. Because we lack knowledge of the occurrence of incidents, their potential consequences, and whether they are actually reported, this study was initiated. Methods Two different services in Norway were asked to self-report incidents after every interhospital transport of critically ill patients. Sampling lasted for 12 and 8 months, respectively. An expert group evaluated each incident for severity and demand for reporting into the hospital’s electronic incident reporting system. One year later, the hospital’s reporting system was scrutinized to determine the number of incidents actually reported. Results A total of 455 transports of critically ill patients were performed, resulting in 294 unique incidents reported: medical (15%), technical (25%), missing equipment (17%), and personal failures and communication difficulties (42%). Only 3 (1%) of the 294 unique incidents were actually reported in the hospital’s electronic incident reporting system. The experts were inconsistent in which incidents should have been reported and to what degree checklists, standard operating procedures, simulation, and training could have prevented the incidents. Conclusions This study of interhospital transports of critically ill patients reveals a very high number of incidents. Despite this fact, these incidents are severely underreported in the hospital’s electronic incident reporting system. This suggests that learning is lost and errors with predominant probability are repeated. These results emphasize the existing challenges in regard to the quality and safety of interhospital transport of critically ill patients