When disaster strikes: staff recall and the use of staff recall systems during mass patient influx at Norwegian emergency primary health care centers - a cross-sectional study

BackgroundIn Norway, planning for disasters has been specifically emphasized since the incidents on July 22(nd,) 2011. Every municipality is now legislated to have a contingency plan that includes plans for staff recall during situations with mass influx of patients. Whether the primary health care services in Norway are prepared for mass influx of patients remains unclear.Aims of the studyThe aims of this study were (1) to assess the experiences of head doctors at emergency primary health care centers (EPHCC) in Norway with mass influx of patients, (2) to explore mass influx and staff recall procedures in use, (3) to assess head doctors experiences with staff recall systems, and (4) to assess their perspective on automatized staff recall systems. We also wanted to assess whether there were differences between small and large EPHCCs regarding whether they had plans in place.MethodsThe study had a cross-sectional, multicenter design, using a self-developed questionnaire. The questionnaire was developed utilizing recommendations from the Delphi technique, including an expert group and piloting. A purposive sampling strategy was used, including head doctors from Norwegian EPHCCs (n = 169). Data were analyzed using the Statistical Package for the Social Sciences, and included descriptive statistics, Chi-Square tests and Shapiro-Wilks. Free-text answers were analyzed by content analysis.ResultsA total of 64 head doctors responded to the questionnaire. The results show that 25% of the head doctors had experienced mass influx of patients at their EPHCC. In total 54.7% of Norwegian EPHCCs did not have disaster plans that consider mass influx situations. The majority of EPHCCs plan to recall staff one by one (60.3%) or through Short-Message-Systems (34.4%). Most EPHCCs had available telephone "alarm" lists (81.4%), that are updated regularly (60.9%). However, only 17.2% had plans that consider loss of mobile phone connection or internet. In total, 67,2% of the head doctors reported to have little experience with automatized staff recall systems, and 59,7% reported to have little knowledge about such systems. There were no significant difference between small and large EPHCCs in having plans or not.ConclusionEven though our results show that few EPHCCs experience mass influx of patients, it is important to be prepared when such incidents do occur. Our results indicate that it is still potential for improvement regarding plans for staff recall and implementation of staff recall systems at Norwegian EPHCCs. Involving national disaster medicine experts in the process of generating tools or checklists could aid when constructing disaster plans. Education and implementation of training for mass influx situations at all levels should always be highlighted

Long-term effects of restriction of intravenous fluid in adult ICU patients with septic shock

PURPOSE To assess long-term outcomes of restrictive versus standard intravenous (IV) fluid therapy in adult intensive care unit (ICU) patients with septic shock included in the European Conservative versus Liberal Approach to Fluid Therapy in Septic Shock in Intensive Care (CLASSIC) trial. METHODS We conducted the pre-planned analyses of mortality, health-related quality of life (HRQoL) using EuroQol (EQ)-5D-5L index values and EQ visual analogue scale (VAS), and cognitive function using Mini Montreal Cognitive Assessment (Mini MoCA) test at 1 year. Deceased patients were assigned numerical zero for HRQoL as a state equal to death and zero for cognitive function outcomes as worst possible score, and we used multiple imputation for missing data on HRQoL and cognitive function. RESULTS Among 1554 randomized patients, we obtained 1-year data on mortality in 97.9% of patients, HRQoL in 91.3%, and cognitive function in 86.3%. One-year mortality was 385/746 (51.3%) in the restrictive-fluid group versus 383/767 (49.9%) in the standard-fluid group, absolute risk difference 1.5%-points [99% confidence interval (CI) - 4.8 to 7.8]. Mean differences were 0.00 (99% CI - 0.06 to 0.05) for EQ-5D-5L index values, - 0.65 for EQ VAS (- 5.40 to 4.08), and - 0.14 for Mini MoCA (- 1.59 to 1.14) for the restrictive-fluid group versus the standard-fluid group. The results for survivors only were similar in both groups. CONCLUSIONS Among adult ICU patients with septic shock, restrictive versus standard IV fluid therapy resulted in similar survival, HRQoL, and cognitive function at 1 year, but clinically important differences could not be ruled out