Pre-hospital advanced airway management by anaesthetist and nurse anaesthetist critical care teams: a prospective observational study of 2028 pre-hospital tracheal intubations

Background: Pre-hospital tracheal intubation success and complication rates vary considerably among provider categories. The purpose of this study was to estimate the success and complication rates of pre-hospital tracheal intubation performed by physician anaesthetist or nurse anaesthetist pre-hospital critical care teams. Methods: Data were prospectively collected from critical care teams staffed with a physician anaesthetist or a nurse anaesthetist according to the Utstein template for pre-hospital advanced airway management. The patients served by six ambulance helicopters and six rapid response vehicles in Denmark, Finland, Norway, and Sweden from May 2015 to November 2016 were included. Results: The critical care teams attended to 32 007 patients; 2028 (6.3%) required pre-hospital tracheal intubation. The overall success rate of pre-hospital tracheal intubation was 98.7% with a median intubation time of 25 s and an on-scene time of 25 min. The majority (67.0%) of the patients' tracheas were intubated by providers who had performed >2500 tracheal intubations. The success rate of tracheal intubation on the first attempt was 84.5%, and 95.9% of intubations were completed after two attempts. Complications related to pre-hospital tracheal intubation were recorded in 10.9% of the patients. Intubations after rapid sequence induction had a higher success rate compared with intubations without rapid sequence induction (99.4% vs 98.1%; P=0.02). Physicians had a higher tracheal intubation success rate than nurses (99.0% vs 97.6%; P=0.03). Conclusions: When performed by experienced physician anaesthetists and nurse anaesthetists, pre-hospital tracheal intubation was completed rapidly with high success rates and a low incidence of complications.Peer reviewe

Working toward exposure thresholds for blast-induced traumatic brain injury: thoracic and acceleration mechanisms

Research in blast-induced lung injury resulted in exposure thresholds that are useful in understanding and protecting humans from such injury. Because traumatic brain injury (TBI) due to blast exposure has become a prominent medical and military problem, similar thresholds should be identified that can put available research results in context and guide future research toward protecting warfighters as well as diagnosis and treatment. At least three mechanical mechanisms by which the blast wave may result in brain injury have been proposed - a thoracic mechanism, head acceleration and direct cranial transmission. These mechanisms need not be mutually exclusive. In this study, likely regions of interest for the first two mechanisms based on blast characteristics (positive pulse duration and peak effective overpressure) are developed using available data from blast experiments and related studies, including behind-armor blunt trauma and ballistic pressure wave studies. These related studies are appropriate to include because blast-like pressure waves are produced that result in neurological effects like those caused by blast. Results suggest that injury thresholds for each mechanism are dependent on blast conditions, and that under some conditions, more than one mechanism may contribute. There is a subset of blast conditions likely to result in TBI due to head acceleration and/or a thoracic mechanism without concomitant lung injury. These results can be used to guide experimental designs and compare additional data as they become available. Additional data are needed before actual probabilities or severity of TBI for a given exposure can be described.Comment: 11 page

Reporting Helicopter Emergency Medical Services in Major Incidents: A Delphi Study

Peer reviewe

Hemodynamic, respiratory and neorophysiological reactions after high : Velocity behind armor blunt trauma

This thesis is addressing Behind Armor Blunt Trauma (BABT), defined as the nonpenetrating injury resulting from a ballistic impact on personal body armor. The protective vest may impede the projectile, but some of the kinetic energy is transferred to the body, causing effects such as pulmonary contusion, apnea, hypotension and occasionally death. Our aims of these studies have been to investigate physiological responses after highvelocity BABT, including EEG (study I). Furthermore, the safety criterion of 44 mm for protective vests (study II), effects of vagotomy (study III), and fluid resuscitation (study IV) has been evaluated. Anaesthetized pigs, wearing body armor on the right side of thorax, were shot with a standard 7.62 mm assault rifle (velocity approx. 800 m/s). We used body armors corresponding to 28 mm impression in clay placed behind the vest (study I and III), 34 mm and 40 mm (study II), and 42 mm (study IV). Several physiological parameters were thereafter monitored during two hours after the shot. Experimental protocol was similar in all studies, except from study III (in which one group received bilateral cervical vagotomy) and study IV, in which 2 groups received Ringer´s acetate (RA) or hypertonic saline with dextrane (HSD). In all studies we observed an immediate drop of blood pressure, desaturation, increased pressure in the lung circulation, suppressed EEG-pattern and pulmonary contusion. In study II and IV, severe hyperkalemia was seen early after the trauma and several animals had serious arrhythmias. Our observed EEG-changes indicate that high-velocity BABT induces brain dysfunction, for at least a couple of minutes. Based on our results, the safety criteria of 44 mm should be considered insufficient when a vest is exposed to highvelocity bullets. Our results show that apnea after BABT is a vagally mediated reflex, that can be inhibited by vagotomy. Fluid resuscitation has limited effects on physiological parameters in our model, although HSD induces less edema formation and a tendency to improved saturation compared to RA

API:er i den offentliga sektorn : Öppenhet och datatillgänglighet enligt offentlighetsprincipen och PSI-direktivet

Sverige har länge haft en god kultur av öppenhet i den offentliga sektorn tack vareoffentlighetsprincipen. Men med allt större tekniska framsteg och ökade krav på datatillgängligheträcker den klassiska öppenheten inte längre till. Det finns redan mycket intressant offentlig data iSverige, men i de flesta fall är den antingen sparad i format som är svåra att avläsa digitalt eller fördyr att använda.I denna uppsats undersöks hur ett API kan utvecklas, användas och integreras med andra API:er föratt öppna upp ovan nämnda data på ett bättre sätt och göra den mer tillgänglig för potentiellaanvändare. Vidare undersöks också PSI-direktivets egentliga nytta och hur det tillsammans medoffentlighetsprincipen kan bidra till den nya öppenheten. Med koppling till denna uppsats har ävenen prototyp utvecklats för att ge exempel på hur man kan kombinera olika API:er för att visualiserageografisk data samt hur ett API kan byggas ovanpå visualiseringen för att göra denna data mertillgänglig.Sweden has long had a good tradition of openness in the public sector, thanks to the principle ofpublic access. But due to increasing technological advances and demands on data availability theclassic transparency is no longer sufficient. There are already very interesting public data sets inSweden, but in most cases they are either stored in formats that are difficult to read digitally or it'stoo expensive to use.This thesis examines how an API can be developed, used and integrated with other API:s to open upthe above mentioned data in a better way and make it more accessible to potential users.Furthermore, the real benefits of the PSI directive are examined, and how they along with theprinciple of public access can contribute to the new openness. In connection to this thesis aprototype has also been developed to provide examples of how to combine different API:s for thevisualization of geographic data, and how an API can be built on top of the visualization to makethis data more available

School nurses' experience of the health dialouge - a complex task

Bakgrund: I skolsköterskors uppdrag ingår att stödja eleverna genom hälsofrämjande arbete och ge dem förutsättningar till god hälsa. Genom hälsosamtal kan skolsköterskor få en överblick över elevens hälsa och dennes livsvärld. Hälsosamtalet innefattar även dokumentation av samtalet. Syfte: Att belysa skolsköterskors upplevelse av att främja elevers hälsa genom hälsosamtal och dess tillhörande dokumentation. Metod: Studien var kvalitativ med induktiv ansats och datainsamlingen utfördes med fokusgrupper bestående av skolsköterskor. Insamlad data analyserades med kvalitativ innehållsanalys. Resultat: Tre kategorier framkom: hantera utmaningar i det dagliga arbetet, lyhördhet utifrån person samt möjligheter att stärka god hälsa. Kategorierna utmynnade i temat: En komplex uppgift med utmaningar och möjligheter. Slutsats: Skolsköterskor upplever att hälsosamtalet och dess dokumentation är en komplex uppgift som är otydlig och utan klara riktlinjer. Hälsosamtalet ger endast en ögonblicksbild av eleven och samspelet under samtalet kan också påverka hur det som framkommer tolkas. Kring dokumentationen upplever skolsköterskor att det saknas riktlinjer och önskar att detta ska förtydligas. Samtidigt upplever skolsköterskor att hälsosamtalet ger en möjlighet att främja elevers hälsa. Därmed kan det finnas ett behov av en nationell standard för hälsosamtal.Background: School nurse assignments include supporting pupil through health promotion work and providing them with prerequisites for good health. Through health dialogues, school nurses can gain an overview of the pupils' health and his or her lifeworld. The health dialogues also include documentation of the dialogue. Purpose: To illustrate the school nurse's experience of promoting pupils’ health through health dialogues and documentation. Method: The study was qualitative with inductive approach and the data collection was conducted with focus groups consisting of school nurses. The collected data was analysed with qualitative content analysis. Results: Three categories emerged: deal with challenges in daily work, responsiveness based on person and possibilities to strengthen good health. The categories formed the theme: A complex task with challenges and possibilities. Conclusion: School nurses experience that the health dialogues and its documentation is a complex task that is indistinct without clear guidelines and want this to be clarified. The health dialogues only give an insight of the moment that can affect the possibility to understand emerged information. At the same time, school nurses feel that the health dialogues provide an opportunity to promote pupils' health. Thus, there may be a need for a national standard for health dialogues

Am AI ready? Investigating the impacts of Artificial Intelligence on business within the automotive industry

In today’s world, technology is present everywhere, and it is progressing at such speed that it is increasingly hard for organizations to cope. The disruptive force and power of new technology are especially observable in how they can transform and fundamentally change businesses and their way of generating value. Artificial Intelligence (AI) is one example of such a technology that is believed to have the potential to unleash the next rush of disruption in many industries and the expectations on AI are therefore sky-high. However, from a business perspective, research on the actual impact of AI has lacked focus. Hence this research aims to investigate the impact of AI on business, looking at companies within the automotive industry. This is done by analyzing AI’s specific impact on different components of the business model through the lens of both degrees of impact and time. The insights of the impact are gathered through a qualitative study of companies within the automotive industry or companies with the automotive industry as the primary focus of their business. The findings show that AI is impacting business models within the automotive industry on a broad scale. AI is primarily enabling automotive companies to leverage data about their customer, intensifying the degree to which the companies collaborate with partners, both cross-industry and within the industry. Furthermore, the long-term expectations of the technology are impacting on strategic decisions and positioning made by automotive companies. AI is expected to enable fully autonomous driving which has led companies to reconsider their business models, and the impacts are likely to get even more observable as the technology matures further.MSc in Innovation and Industrial Managemen