The lateral trauma position: What do we know about it and how do we use it? A cross-sectional survey of all Norwegian emergency medical services

<p>Abstract</p> <p>Background</p> <p>Trauma patients are customarily transported in the supine position to protect the spine. The Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) principles clearly give priority to airways. In Norway, the lateral trauma position (LTP) was introduced in 2005. We investigated the implementation and current use of LTP in Norwegian Emergency Medical Services (EMS).</p> <p>Methods</p> <p>All ground and air EMS bases in Norway were included. Interviews were performed with ground and air EMS supervisors. Questionnaires were distributed to ground EMS personnel.</p> <p>Results</p> <p>Of 206 ground EMS supervisors, 201 answered; 75% reported that LTP is used. In services using LTP, written protocols were present in 67% and 73% had provided training in LTP use. Questionnaires were distributed to 3,025 ground EMS personnel. We received 1,395 (46%) valid questionnaires. LTP was known to 89% of respondents, but only 59% stated that they use it. Of the respondents using LTP, 77% reported access to written protocols. Flexing of the top knee was reported by 78%, 20% flexed the bottom knee, 81% used under head padding. Of 24 air EMS supervisors, 23 participated. LTP is used by 52% of the services, one of these has a written protocol and three arrange training.</p> <p>Conclusions</p> <p>LTP is implemented and used in the majority of Norwegian EMS, despite little evidence as to its possible benefits and harms. How the patient is positioned in the LTP differs. More research on LTP is needed to confirm that its use is based on evidence that it is safe and effective.</p

Методика поиска и отбора документов личного происхождения в деятельности архива образовательного учреждения

Erratum The original article [1] contains an error whereby all authors’ names were mistakenly interchanged. The original article has now been corrected to present the authors’ names correctly

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

Peer reviewe

Systematic reporting of pre-hospital major incident medical management - identifying needs, a suggested solution and assessing implementation

Storulykker er krevende for prehospitale medisinske tjenester over hele verden. Vi vet at de samme problemene viser seg gang på gang. Hvordan kan de prehospitale tjenestene lære av tidligere erfaringer? På grunn av storulykkers (engelsk: major incidents) omfattende betydning for menneskeliv og samfunn er det nødvendig å standardisere rapporteringen fra hendelsene. Dette kan muliggjøre analyser som sammenlikner hendelsene og identifiserer læringsmomenter. Tilsvarende innsats for å standardisere helseregistre på andre områder har tilrettelagt for sammenligningsstudier, samt gjort det mulig å identifisere forbedringspunkter. Vi antar at det samme vil gjelde for storulykker. Målet med denne avhandlingen var å tilrettelegge for systematisk innsamling av standardiserte data fra den prehospitale medisinske håndteringen av storulykker. Dette vil kunne øke kvaliteten på forskning og erfaringsformidling vedrørende prehospital innsats ved storulykker og potensielt forbedre kvaliteten på redningsarbeidet. Ved å standardisere data og tilrettelegge for analyser kan man redusere skadevirkningene av fremtidige hendelser, og den prehospitale medisinske responsen kan forbedres. Fire studier inngår i avhandlingen. Vi gjennomført en systematisk litteraturgjennomgang for å identifisere innhold i eksisterende rapporteringsmaler for storulykker. Fordi det ikke fantes en egnet rapporteringsmal gjennomførte vi en konsensusprosess for å konstruere en slik mal. Etter implementering av denne, gjennomførte vi en pilotstudie for å undersøke hvor anvendelig malen var til å registrere de ønskede data. Malen ble så revidert på bakgrunn av funnene. En egen mal for rapportering av luftambulanserespons i storulykker ble senere utviklet ved hjelp av konsensusmetodologi. Begge rapporteringsmal er fritt tilgjengelig på www.majorincidentreporting.net. Avhandlingen viser hvordan systematisk litteraturgjennomgang kan være nyttig for å identifisere eksisterende kunnskap og vurdere behovet for et nytt forskningsprosjekt. Avhandlingen fant at det var nødvendig å lage en konsensusbasert mal for å rapportere den prehospitale medisinske responsen ved en storulykke. Det var mulig å oppnå konsensus, lage en rapporteringsdatabase og å få fagfolk til å bruke rapporteringsmalen. Hovedutfordringene har vært at et lavt antall fagpersoner foreløpig har rapportert fra hendelser, og derfor deltok få respondenter i studien som så på anvendbarheten. Det lave antallet rapporter er også en utfordring når det skal gjøres analyser som sammenlikner data fra hendelsene. Gitt den relativt korte tiden som rapporteringsmalene har vært tilgjengelig, er det likevel grunn til optimisme med hensyn til mulighetene for å få gjennomført slike studier i fremtiden

Implementing a template for major incident reporting: experiences from the first year

This is an open access article originally published in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine under a Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.Major incidents are resource-demanding situations that require urgent and effective medical management. The possibility to extract learning from them is therefore important. Comparative analysis of information based on uniform data collection from previous incidents may facilitate learning. The Major Incident Reporting Collaborators have developed a template for reporting of the medical pre-hospital response to major incidents. The template is accompanied by an open access webpage (www.majorincidentreporting.org) for online reporting and access to published reports. This commentary presents the experiences from the first year of implementing the template including a presentation of the five published reports

Utilisation of helicopter emergency medical services in the early medical response to major incidents: A systematic literature review

Objective: This systematic review identifies, describes and appraises the literature describing the utilisation of helicopter emergency medical services (HEMS) in the early medical response to major incidents. Setting: Early prehospital phase of a major incident. Design: Systematic literature review performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Web of Science, PsycINFO, Scopus, Cinahl, Bibsys Ask, Norart, Svemed and UpToDate were searched using phrases that combined HEMS and ‘major incidents’ to identify when and how HEMS was utilised. The identified studies were subjected to data extraction and appraisal. Results: The database search identified 4948 articles. Based on the title and abstract, the full text of 96 articles was obtained; of these, 37 articles were included in the review, and an additional five were identified by searching the reference lists of the 37 articles. HEMS was used to transport medical and rescue personnel to the incident and to transport patients to the hospital, especially when the infrastructure was damaged. Insufficient air traffic control, weather conditions, inadequate landing sites and failing communication were described as challenging in some incidents. Conclusions: HEMS was used mainly for patient treatment and to transport patients, personnel and equipment in the early medical management of major incidents, but the optimal utilisation of this specialised resource remains unclear. This review identified operational areas with improvement potential. A lack of systematic indexing, heterogeneous data reporting and weak methodological design, complicated the identification and comparison of incidents, and more systematic reporting is needed

Implementing a template for major incident reporting: experiences from the first year

Major incidents are resource-demanding situations that require urgent and effective medical management. The possibility to extract learning from them is therefore important. Comparative analysis of information based on uniform data collection from previous incidents may facilitate learning. The Major Incident Reporting Collaborators have developed a template for reporting of the medical pre-hospital response to major incidents. The template is accompanied by an open access webpage (www.majorincidentreporting.org) for online reporting and access to published reports. This commentary presents the experiences from the first year of implementing the template including a presentation of the five published reports

A consensus based template for reporting of pre-hospital major incident medical management

After the publication of our article “A consensus based template for reporting of pre-hospital major incident medical management” Scand J Trauma Resusc Emerg Med 2013, 22:5, we noticed that The Major Incident Reporting Collaborators were not included as authors. They have now been added at the end of the author list. The group consists of Gareth Davies, Michel Debacker, Erik Frischknecht Christensen, Juhana Hallikainen, Troels Martin Hansen, Jorine Juffermans, Per Kulling, Vidar Magnusson, Jannicke Mellin-Olsen, Kai Milke, Anders Ruter, Stephen JM Sollid, Wolfgang Voelckel.Background: Structured reporting of major incidents has been advocated to improve the care provided at future incidents. A systematic review identified ten existing templates for reporting major incident medical management, but these templates are not in widespread use. We aimed to address this challenge by designing an open access template for uniform reporting of data from pre-hospital major incident medical management that will be tested for feasibility. Methods: An expert group of thirteen European major incident practitioners, planners or academics participated in a four stage modified nominal group technique consensus process to design a novel reporting template. Initially, each expert proposed 30 variables. Secondly, these proposals were combined and each expert prioritized 45 variables from the total of 270. Thirdly, the expert group met in Norway to develop the template. Lastly, revisions to the final template were agreed via e-mail. Results: The consensus process resulted in a template consisting of 48 variables divided into six categories;pre-incident data, Emergency Medical Service (EMS) background, incident characteristics, EMS response, patient characteristics and key lessons. Conclusions: The expert group reached consensus on a set of key variables to report the medical management of pre-hospital major incidents and developed a novel reporting template. The template will be freely available for downloading and reporting on www.majorincidentreporting.org. This is the first global open access database for pre-hospital major incident reporting. The use of a uniform dataset will allow comparative analysis and has potential to identify areas of improvement for future responses

Rapid extrication of entrapped victims in motor vehicle wreckage using a Norwegian chain method – cross-sectional and feasibility study

This article was originally published in BMC Emergency Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.Background Road traffic injury (RTI) is a global problem causing some 1,2 million deaths annually and another 20–50 million people sustain non-fatal injuries. Pre-hospital entrapment is a risk factor for complications and delays transport to the hospital. The Rapid Extrication (RE) method combines winching and cutting of both front poles and utilising two larger vehicles to pull car wreckage apart to extricate patients. A previous study indicates that RE is an efficient alternative to previously existing methods. Methods All Fire Departments in Norway were questioned on: background, frequency of training, use and implementation of the method, protocol and equipment. Times used for extrication from motor vehicle wreckage were measured at the National Championship in RE. Questionnaires presented to participants asked about frequency of training, inter-disciplinary cooperation and self-perceived safety for both providers and patients on a 1–7 Likert scale (1 - worst and 7 - best). Results Participating Fire Departments use RE in 95% of cases on passenger cars and 77% of cases on larger vehicles. Teams participating in the National Championship scored self-perceived security of crew as median 7 and IQR (6, 7), patient safety 7 (6, 7), communication between personnel 7 (6, 7), teamwork 7 (6, 7), and how well the technique functioned 7 (6, 7). All teams had extricated and transported the patient into the ambulance within 20 minutes. Conclusion Interdisciplinary and regular training of RE can lead to safe extrication of a critically injured patient in less than 20 minutes and may be life saving

Impact of helicopter emergency medical services in major incidents: systematic literature review

Introduction: Helicopter emergency medical services (HEMS) aim to bring highly specialised crews to the major incident for triage, treatment and transport. When the site is difficult to access, HEMS may be the only mode of transportation of both personnel and patients. This systematic review will identify, describe and appraise literature regarding the role of HEMS in medical response to major incidents. We aim to improve knowledge on HEMS role in a major incident and provide a basis for future research. Methods and analysis: A systematic literature review will be conducted with search phrases that combine HEMS and major incidents to identify when and how HEMS have been used. Included literature will be subject to quality appraisal and data extraction. Ethics: No ethical approval is sought because this is a literature review. It will be submitted to a peer-reviewed journal and the PRISMA guidelines will be followed