Prehospital therapeutic hypothermia after cardiac arrest - from current concepts to a future standard

Therapeutic hypothermia has been shown to improve survival and neurological outcome after prehospital cardiac arrest. Existing experimental and clinical evidence supports the notion that delayed cooling results in lesser benefit compared to early induction of mild hypothermia soon after return of spontaneous circulation. Therefore a practical approach would be to initiate cooling already in the prehospital setting

Imagining the World: The Significance of Religious Worldviews for Science Education

This paper begins by examining whether ‘science’ and ‘religion’ can better be seen as distinct or related worldviews, focusing particularly on scientific and religious understandings of biodiversity. I then explore how people can see the natural world, depending on their worldview, by looking at two contrasting treatments of penguin behaviour, namely that provided in the film March of the Penguins and in the children’s book And Tango Makes Three. I end by drawing some initial conclusions as to what might and what might not be included about religion in school science lessons. Science educators and teachers need to take account of religious worldviews if some students are better to understand the compass of scientific thinking and some of science’s key conclusions. It is perfectly possible for a science teacher to be respectful of the worldviews that students occupy, even if these are scientifically limited, while clearly and non-apologetically helping them to understand the scientific worldview on a particular issue

Post resuscitation care of out-of-hospital cardiac arrest patients in the Nordic countries : a questionnaire study

Background: Aim of this study was to compare post resuscitation care of out-of-hospital cardiac arrest (OHCA) patients in Nordic (Denmark, Finland, Iceland, Norway, Sweden) intensive care units (ICUs). Methods: An online questionnaire was sent to Nordic ICUs in 2012 and was complemented by an additional one in 2014. Results: The first questionnaire was sent to 188 and the second one to 184 ICUs. Response rates were 51 % and 46 %. In 2012, 37 % of the ICUs treated all patients resuscitated from OHCA with targeted temperature management (TTM) at 33 degrees C. All OHCA patients admitted to the ICU were treated with TTM at 33 degrees C more often in Norway (69 %) compared to Finland (20 %) and Sweden (25 %), p 0.02 and 0.014. In 2014, 63 % of the ICUs still use TTM at 33 degrees C, but 33 % use TTM at 36 degrees C. Early coronary angiography (CAG) and possible percutaneous coronary intervention (PCI) was routinely provided for all survivors of OHCA in 39 % of the hospitals in 2012 and in 28 % of the hospitals in 2014. Routine CAG for all actively treated victims of OHCA was performed more frequently in Sweden (51 %) and in Norway (54 %) compared to Finland (13 %), p 0.014 and 0.042. Conclusions: Since 2012, TTM at 36 degrees C has been implemented in some ICUs, but TTM at 33 degrees C is used in majority of the ICUs. TTM at 33 or 36 degrees C and primary CAG are not routinely provided for all OHCA survivors and the criteria for these and ICU admission are variable. Best practices as a uniform approach to the optimal care of the resuscitated patient should be sought in the Nordic Countries.Peer reviewe

Alcohol use in the prehospital setting: a diagnostic challenge in patients treated by a physician staffed mobile intensive care unit

BACKGROUND: Alcohol use among emergency patients has been studied earlier, but the data regarding alcohol use especially among critically ill and injured patients treated in the prehospital setting is scarce. The aim of this study was to evaluate the incidence of alcohol use and the characteristics of cases attended by a physician staffed mobile intensive care unit (MICU). FINDINGS: During a 2 month period, exhaled air alcohol concentration-measured as a part of routine patient examination in all adolescent and adult patients treated by the MICU-was recorded. The MICU encountered 258 patients, of which 82 could be tested for alcohol use. Of the tested patients 43 % gave a positive breath test result. Proportion of male patients providing a positive result in the breath test did not differ significantly those of women. The primary reason for not to test the patient was a decreased level of consciousness in one-fifth of the initial 258 patients. CONCLUSIONS: A significant proportion (47 %) of the encountered patients could not be tested due to their critical condition. Alcohol use was observed in 43 % of those capable of providing a breath test sample. The rate of positive tests seemed to be higher than those reported from emergency departments. Novel diagnostic methods to detect alcohol consumption in non-cooperative patients are warranted

The first seven years of nationally organized helicopter emergency medical services in Finland - the data from quality registry

Background: Helicopter Emergency Medical Services (HEMS) play an important role in prehospital care of the critically ill. Differences in funding, crew composition, dispatch criteria and mission profile make comparison between systems challenging. Several systems incorporate databases for quality control, performance evaluation and scientific purposes. FinnHEMS database was incorporated for such purposes following the national organization of HEMS in Finland 2012. The aims of this study are to describe information recorded in the database, data collection, and operational characteristics of Finnish HEMS during 2012-2018. Methods: All dispatches of the six Finnish HEMS units recorded in the national database from 2012 to 2018 were included in this observational registry study. Five of the units are physician staffed, and all are on call 24/7. The database follows a template for uniform reporting in physician staffed pre-hospital services, exceeding the recommended variables of relevant guidelines. Results: The study included 100,482 dispatches, resulting in 33,844 (34%) patient contacts. Variables were recorded with little or no missing data. A total of 16,045 patients (16%) were escorted by HEMS to hospital, of which 2239 (2%) by helicopter. Of encountered patients 4195 (4%) were declared deceased on scene. The number of denied or cancelled dispatches was 66,638 (66%). The majority of patients were male (21,185, 63%), and the median age was 57.7 years. The median American Society of Anesthesiologists Physical Scale classification was 2 and Eastern Cooperative Oncology Group performance class 0. The most common reason for response was trauma representing 26% (8897) of the patients, followed by out-of-hospital cardiac arrest 20% (6900), acute neurological reason excluding stroke 13% (4366) and intoxication and related psychiatric conditions 10% (3318). Blunt trauma (86%, 7653) predominated in the trauma classification. Conclusions: Gathering detailed and comprehensive data nationally on all HEMS missions is feasible. A national database provides valuable insights into where the operation of HEMS could be improved. We observed a high number of cancelled or denied missions and a low percentage of patients transported by helicopter. The medical problem of encountered patients also differs from comparable systems.Peer reviewe

Pulseless electrical activity and successful out-of-hospital resuscitation - long-term survival and quality of life: an observational cohort study

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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

Well-being at work among helicopter emergency medical service personnel in Finland

Personnel engaged in emergency medical services (EMS) and in helicopter emergency medical services (HEMS) perform challenging missions 24/7. This underlines the importance of overall well-being at work among these personnel. Only healthy personnel can successfully perform challenging HEMS missions in the long run. Fatigue due to an imbalance between overall strain and recovery is an occupational hazard that may compromise both well-being at work and operational and patient safety in HEMS settings. However, there are no evidence-based recommendations available on how to mitigate fatigue at HEMS work. For this reason, it is important to create a comprehensive picture of HEMS personnel’s overall well-being at work, including on-duty fatigue, at the national level. The research aim of the present study was to assess the overall well-being at work among HEMS personnel in Finland, with the main emphasis on fatigue and the balance between strain and recovery. To make the results as useful as possible for development actions, different occupational groups, duties, and task load levels were considered in the assessment. The development aim of the present study was to a) identify the main development needs to promote the overall balance between strain and recovery in HEMS professionals and b) introduce a future improvement plan to achieve this goal

Valtakunnallinen selvitys ensihoitopalvelun toiminnasta : Väliraportti 2

Sosiaali- ja terveysministeriön päätöksellä käynnistettiin valtakunnallinen selvitys ensihoitopalvelun tehtävistä. Selvityksen perustana on maan kaikki hätäkeskuksista tulleet ensihoitotehtävät viiden vuoden ajalta. Tällä hetkellä emme pysty kansallisesti tuottamaan ensihoitopalvelun toiminnan keskeisiä tun-nuslukuja, eikä järjestelmässä tapahtuneiden muutosten vaikuttavuutta voida siten myöskään luotettavasti arvioida. On välttämätöntä luoda kansallinen ensihoitopalvelun tietovaranto, jotta pystymme suunnittelemaan ja ohjaamaan resurssien käyttöä tarkoituksenmukaisesti ja reaaliaikaisesti. Siihen tulee kerätä sekä ensihoitopalvelua kuvaavat kansalliset operatiiviset tiedot (hätäkeskustietojärjestelmä, viranomaisten kenttäjärjestelmä) että niihin yhdistettyinä kansallisesti kerätyt potilastiedot (kansallinen ensihoitokertomus, Potilastiedon arkisto). Ensihoitopalvelun suunnittelussa tulee huomioida sekä tehtävävolyymin muuttuminen pelkäs-tään hätätilapotilaista kohti laajempaa päivystyspotilaiden kirjoa että nykyistä paremmin verkottumisesta muihin sosiaali- ja terveydenhuollon lähipalveluihin. Hätäkeskusten toiminta on päivystyksellisten potilasvirtojen ohjauspaikkana aliarvioitu. Sosiaali- ja terveystoimen rakenneuudistuksen yhteydessä tulee uudelleen arvioida hätäkeskusten rajapinnassa oleva toiminta. Tehtävien riskinarviointi ja tarkoituksenmukainen resurssien käyttö edellyttävät sosiaali- ja terveystoimen päivystystoiminnan johto- ja koordinaatiokeskusten perustamista. Näihin keskuksiin keskitettäisiin myös kansallinen kansalaisten terveydenhuollon puhelinneuvonta ja -ohjaus

Advising and limiting medical treatment during phone consultation : a prospective multicentre study in HEMS settings

Background We investigated paramedic-initiated consultation calls and advice given via telephone by Helicopter Emergency Medical Service (HEMS) physicians focusing on limitations of medical treatment (LOMT). Methods A prospective multicentre study was conducted on four physician-staffed HEMS bases in Finland during a 6-month period. Results Of all 6115 (mean 8.4/base/day) paramedic-initiated consultation calls, 478 (7.8%) consultation calls involving LOMTs were included: 268 (4.4%) cases with a pre-existing LOMT, 165 (2.7%) cases where the HEMS physician issued a new LOMT and 45 (0.7%) cases where the patient already had an LOMT and the physician further issued another LOMT. The most common new limitation was a do-not-attempt cardiopulmonary resuscitation (DNACPR) order (n = 122/210, 58%) and/or 'not eligible for intensive care' (n = 96/210, 46%). In 49 (23%) calls involving a new LOMT, termination of an initiated resuscitation attempt was the only newly issued LOMT. The most frequent reasons for issuing an LOMT during consultations were futility of the overall situation (71%), poor baseline functional status (56%), multiple/severe comorbidities (56%) and old age (49%). In the majority of cases (65%) in which the HEMS physician issued a new LOMT for a patient without any pre-existing LOMT, the physician felt that the patient should have already had an LOMT. The patient was in a health care facility or a nursing home in half (49%) of the calls that involved issuing a new LOMT. Access to medical records was reported in 29% of the calls in which a new LOMT was issued by an HEMS physician. Conclusion Consultation calls with HEMS physicians involving patients with LOMT decisions were common. HEMS physicians considered end-of-life questions on the phone and issued a new LOMT in 3.4% of consultations calls. These decisions mainly concerned termination of resuscitation, DNACPR, intubation and initiation of intensive care.Peer reviewe