Ohje ensihoitopalvelujen palvelutasopäätöksen laatimiseksi

Terveydenhuoltolaki (1326/2010) velvoittaa erikoissairaanhoidon järjestämisestä vastaavaa sairaanhoitopiirin kuntayhtymää tekemään alueensa ensihoitopalvelun palvelutasopäätöksen. Terveydenhuoltolain nojalla annetussa uudistetussa sosiaali- ja terveysministeriön asetuksessa ensihoitopalvelusta säädetään yksityiskohtaisemmin palvelutasopäätöksen laatimisesta. Tässä julkaisussa kuvataan ensihoitopalvelun palvelutasopäätöksen tausta, tavoitteet, sisältö ja raportointitavat. Ensihoitopalvelun suunnittelun lähtökohtana tulee olla samantasoisten palvelujen tarjoaminen riskeiltään ja palvelutarpeiltaan samanlaisilla alueilla. Sairaanhoitopiirit käyttävät tässä julkaisussa kuvattua valtakunnallista mallia palvelutasopäätöksen tekemisessä ja palvelutason seuraamisess

Feasibility of LMA Supreme for airway management in unconscious patients by ALS paramedics

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EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety?

Background: The safety of the Emergency Medical Service's (EMS's) non-conveyance decision was evaluated by EMS re-contacts, primary health care or emergency department (ED) visits, and hospitalization within 48 h. The secondary outcome was 28-day mortality.Methods: This cohort study used prospectively collected data on non-conveyed EMS patients from three different regions in Finland between June 1 and November 30, 2018. The Adjusted International Classification of Primary Care (ICPC2) as the reason for care was compared to hospital discharge diagnoses (ICD10). Multivariable logistic regressions were used to determine factors that were independently associated with adverse outcomes. Results are presented with adjusted odds ratios (aORs) together with 95% confidence intervals (CIs). Data regarding deceased patients were reviewed by the study group.Results: Of the non-conveyed EMS patients (n = 11,861), 6.3% re-contacted the EMS, 8.3% attended a primary health care facility, 4.2% went to the ED, 1.6% were hospitalized, and 0.1% died 0-24 h after the EMS mission. The 0-24 h adverse event rate was higher than 24-48 h. After non-conveyance, 32 (0.3%) patients were admitted to an intensive care unit within 24 h. Primary non-urgent EMS mission (aOR 1.49; 95% CI 1.25 to 1.77), EMS arrival at night (aOR 1.82; 95% CI 1.58 to 2.09), ALS unit type vs BLS (aOR 1.43; 95% CI 1.16 to 1.77), rural area (aOR 1.74; 95% CI 1.51 to 1.99), and older patient age (aOR 1.41; 95% CI 1.20 to 1.66) were associated with subsequent primary health care visits (0-24 h).Conclusions: Four in five non-conveyed patients did not have any re-contact in follow-up period. EMS non-conveyance seems to be a relatively safe method of focusing ED resources and avoiding ED crowding.</p

Effect of levosimendan in experimental verapamil- induced myocardial depression

Background: Calcium antagonist overdose can cause severe deterioration of hemodynamics unresponsible to treatment with beta adrenergic inotropes. The aim of the study was to evaluate in an experimental model the effects of levosimendan during severe calcium antagonist intoxication. Methods: Twelve landrace-pigs were intoxicated with intravenous verapamil at escalating infusion rates. The infusion containing 2.5 mg/ml verapamil was used aiming to a reduction of cardiac output by 40 % from the baseline value. Intoxicated pigs were randomized into two groups: control (saline) and levosimendan (intravenous bolus). Inotropic effect was measured as a change in a maximum of the positive slope of the left ventricular pressure (LV dP/dt). The survival and hemodynamics of the animals were followed for 120 min after the targeted reduction of cardiac output. Results: In the control group, five out of six pigs died during the experiment. In the levosimendan group, one pig died before completion of the experiment (p = 0.04). In the levosimendan group a change in LV dP/dt was positive in four out of six pigs compared to one out of six pigs in the control group (p = ns). Conclusions: In this experimental model, the use of levosimendan was associated with improved survival. Background In the year 2004 more than 10000 toxic exposures to calciu

A consensus-based template for documenting and reporting in physician-staffed pre-hospital services

Background: Physician-staffed pre-hospital units are employed in many Western emergency medical services (EMS) systems. Although these services usually integrate well within their EMS, little is known about the quality of care delivered, the precision of dispatch, and whether the services deliver a higher quality of care to pre-hospital patients. There is no common data set collected to document the activity of physician pre-hospital activity which makes shared research efforts difficult. The aim of this study was to develop a core data set for routine documentation and reporting in physician-staffed pre-hospital services in Europe. Methods: Using predefined criteria, we recruited sixteen European experts in the field of pre-hospital care. These experts were guided through a four-step modified nominal group technique. The process was carried out using both e-mail-based communication and a plenary meeting in Stavanger, Norway. Results: The core data set was divided into 5 sections: “fixed system variables”, “event operational descriptors”, “ patient descriptors”, “process mapping”, and “outcome measures and quality indicators”. After the initial round, a total of 361 variables were proposed by the experts. Subsequent rounds reduced the number of core variables to 45. These constituted the final core data set. Emphasis was placed on the standardisation of reporting time variables, chief complaints and diagnostic and therapeutic procedures. Conclusions: Using a modified nominal group technique, we have established a core data set for documenting and reporting in physician-staffed pre-hospital services. We believe that this template could facilitate future studies within the field and facilitate standardised reporting and future shared research efforts in advanced prehospital care.publishedVersio

Feasibility of written instructions in airway management training of laryngeal tube

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Airway management in out-of-hospital cardiac arrest in Finland : current practices and outcomes

Background: Though airway management methods during out-of-hospital cardiac arrest (OHCA) remain controversial, no studies on the topic from Finland have examined adherence to OHCA recommendations in real life. In response, the aim of this study was to document the interventions, success rates, and adverse events in airway management processes in OHCA, as well as to analyse survival at hospital discharge and at follow-up a year later. Methods: During a 6-month study period in 2010, data regarding all patients with OHCA and attempted resuscitation in southern and eastern Finland were prospectively collected. Emergency medical services (EMS) documented the airway techniques used and all adverse events related to the process. Study endpoints included the frequency of different techniques used, their success rates, methods used to verify the correct placement of the endotracheal tube, overall adverse events, and survival at hospital discharge and at follow-up a year later. Results: A total of 614 patients were included in the study. The incidence of EMS-attempted resuscitation was determined to be 51/100,000 inhabitants per year. The final airway technique was endotracheal intubation (ETI) in 413 patients (67.3 %) and supraglottic airway device (SAD) in 188 patients (30.2 %). The overall success rate of ETI was 92.5 %, whereas that of SAD was 85.0 %. Adverse events were reported in 167 of the patients (27.2 %). Having a prehospital EMS physician on the scene (p Conclusions: This study showed acceptable ETI and SAD success rates among Finnish patients with OHCA. Adverse events related to airway management were observed in more than 25 % of patients, and overall survival was 17.8 % at hospital discharge and 14.0 % after 1 year.Peer reviewe

Regional variation and outcome of out-of-hospital cardiac arrest (ohca) in Finland - the Finnresusci study

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