Involvement in emergency situations by primary care doctors on-call in Norway - a prospective population-based observational study

<p>Abstract</p> <p>Background</p> <p>Primary care doctors on-call in the emergency primary health care services in Norway are, together with the ambulances, the primary resources for handling emergencies outside hospitals. There is a lack of reliable data for Norway on how often the primary care doctors are alerted and on their responses in the most urgent emergency cases. The aim of this study was to investigate how doctors on-call are involved in red responses (highest priority), using three different emergency medical communication centres (EMCC) as catchment area for a prospective population-based study.</p> <p>Methods</p> <p>In the period from October to December 2007 three dispatch centres covering approximately 816 000 inhabitants prospectively recorded all acute emergency cases. Ambulance records, air ambulance records and records from the doctors on-call were collected. NACA score was used to define the severity of the emergencies.</p> <p>Results</p> <p>5 105 cases were classified as red responses during the period. We have complete basic recordings (AMIS forms) from all and resaved ambulance records, air ambulance records and records from doctors on-call in 89% of the cases. Ambulances were alerted in 96% and doctors on-call in 47% of the cases, but there were large differences between the three EMCCs. Doctors on-call responded with call-out in 42% of the alerted cases. 28% of all patients were taken to a casualty clinic, 46% were admitted to hospital by a doctor and 24% were taken directly to hospital by ambulances. In total, primary care doctors on-call took active part in 42% of all red response cases, and together with GPs' daytime activity the primary health care services were involved in 50% of the cases. 29% of the cases were classified as life-threatening. Call-out by doctors on-call were found to be more frequent in life-threatening situations compared with not life-threatening situations.</p> <p>Conclusion</p> <p>Doctors on-call and GPs on daytime were involved in half of all red responses. There were large differences between the EMCCs in the frequency of doctors alerted. The inhabitants in the three EMMCs were thus offered different levels of professional competency in emergency situations outside hospitals.</p

Effect of requiring a general practitioner at scenes of serious injury: A systematic review

This is the peer reviewed version of the following article: Straumann, G.S.H., Austvoll-Dahlgren, A.A., Holte, H. & Wisborg, T.W. (2018). Effect of requiring a general practitioner at scenes of serious injury: A systematic review. Acta Anaesthesiologica Scandinavica, 62(9), 1194-1199, which has been published in final form at https://doi.org/10.1111/aas.13174. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.Background - In Norway, each municipality is responsible for providing first line emergency healthcare, and it is mandatory to have a primary care physician/general practitioner on call continuously. This mandate ensures that a physician can assist patients and ambulance personnel at the site of severe injuries or illnesses. The compulsory presence of the general practitioner at the scene could affect different parts of patient treatment, and it might save resources by obviating resources from secondary healthcare, like pre‐hospital anaesthesiologists and other specialized resources. This systematic review aimed to examine how survival, time spent at the scene, the choice of transport destination, assessment of urgency, the number of admissions, and the number of cancellations of specialized pre‐hospital resources were affected by the presence of a general practitioner at the scene of a suspected severe injury. Methods - We searched for published and planned systematic reviews and primary studies in the Cochrane Library, Medline, Embase, OpenGrey, GreyLit and trial registries. The search was completed in December 2017. Two individuals independently screened the references and assessed the eligibility of all potentially relevant studies. Results - The search for systematic reviews and primary studies identified 5981 articles. However, no studies met the pre‐defined inclusion criteria. Conclusion - No studies met our inclusion criteria; consequently, it remains uncertain how the presence of a general practitioner at the injury scene might affect the selected outcomes

Air ambulance flights in northern Norway 2002-2008. Increased number of secondary fixed wing (FW) operations and more use of rotor wing (RW) transports

Air ambulance service in Norway has been upgraded during the last years. European regulations concerning pilots’ working time and new treatment guidelines/strategies have called for more resources. The objective was to describe and analyse the two supplementary air ambulance [fixed wing (FW) and rotor wing (RW)] alternatives’ activity during the study period (2002-2008). Furthermore we aimed to compare our findings with reports from other north European regions. This is a retrospective analysis. The air ambulance fleet’s activity according to the electronic patient record database of “Luftambulansetjenesten ANS” (LABAS) was analysed. The subject was the fleet’s operations in northern Norway, logistics, and patients handled. Type of flight, distances, frequency, and patients served were the main outcome measures. A significant increase (45%) in the use of RW and a shift in FW operations (less primary and more secondary) were revealed. The shift in FW operations reflected the centralisation of several health care services [i.e. percutaneous cardiac intervention (PCI), trauma, and cancer surgery] during the study period. Cardiovascular disease (CVD) and injuries were the main diagnoses and constituted half of all operations. CVD was the most common cause of FW operations and injuries of the RW ones. The number of air ambulance operations was 16 per 1,000 inhabitants. This was more frequent than in other north European regions. The use of air ambulances and especially RW was significantly increased during the study period. The change in secondary FW operations reflected centralisation of medical care. When health care services are centralised, air ambulance services must be adjusted to the new settings

Air ambulance services in the Arctic 1999-2009 : a Norwegian study.

Air ambulance services in the Arctic have to deal with remote locations, long distances, rough weather conditions and seasonable darkness. Despite these challenges, the people living in the area expect a high quality of specialist health care. The objective of this study was to analyse the air ambulance operations performed in the Norwegian Arctic and study variations in diagnoses and flight patterns around the year. A retrospective analysis. All air ambulance operations performed during the time 1999 – 2009 period were analysed. The subjects were patients transported and flights performed. The primary outcome measures were patients’ diagnoses and task patterns around the year. A total of 345 patients were transported and 321 flights performed. Coronary heart and vascular disease, bone fractures and infections were the most common diagnoses. Most patients (85%) had NACA score 3 or 4. Half of all fractures occurred in April and August. Most patients were males (66%), and one fourth was not Norwegian. The median flying time (one way) was 3 h 33 m. Ten percent of the flights were delayed, and only 14% were performed between midnight and 8.00 AM. The period April to August was the busiest one (58% of operations). Norway has run a safe air ambulance service in the Arctic for the last 11 years. In the future more shipping and polar adventure operations may influence the need for air ambulances, especially during summer and autumn