Pub Date : 2024-04-17DOI: 10.1186/s13049-024-01198-x
Samir Ali, Xavier Moors, Hans van Schuppen, Lars Mommers, Ellen Weelink, Christiaan L. Meuwese, Merijn Kant, Judith van den Brule, Carlos Elzo Kraemer, Alexander P. J. Vlaar, Sakir Akin, Annemiek Oude Lansink-Hartgring, Erik Scholten, Luuk Otterspoor, Jesse de Metz, Thijs Delnoij, Esther M. M. van Lieshout, Robert-Jan Houmes, Dennis den Hartog, Diederik Gommers, Dinis Dos Reis Miranda
The likelihood of return of spontaneous circulation with conventional advanced life support is known to have an exponential decline and therefore neurological outcome after 20 min in patients with a cardiac arrest is poor. Initiation of venoarterial ExtraCorporeal Membrane Oxygenation (ECMO) during resuscitation might improve outcomes if used in time and in a selected patient category. However, previous studies have failed to significantly reduce the time from cardiac arrest to ECMO flow to less than 60 min. We hypothesize that the initiation of Extracorporeal Cardiopulmonary Resuscitation (ECPR) by a Helicopter Emergency Medical Services System (HEMS) will reduce the low flow time and improve outcomes in refractory Out of Hospital Cardiac Arrest (OHCA) patients. The ON-SCENE study will use a non-randomised stepped wedge design to implement ECPR in patients with witnessed OHCA between the ages of 18–50 years old, with an initial presentation of shockable rhythm or pulseless electrical activity with a high suspicion of pulmonary embolism, lasting more than 20, but less than 45 min. Patients will be treated by the ambulance crew and HEMS with prehospital ECPR capabilities and will be compared with treatment by ambulance crew and HEMS without prehospital ECPR capabilities. The primary outcome measure will be survival at hospital discharge. The secondary outcome measure will be good neurological outcome defined as a cerebral performance categories scale score of 1 or 2 at 6 and 12 months. The ON-SCENE study focuses on initiating ECPR at the scene of OHCA using HEMS. The current in-hospital ECPR for OHCA obstacles encompassing low survival rates in refractory arrests, extended low-flow durations during transportation, and the critical time sensitivity of initiating ECPR, which could potentially be addressed through the implementation of the HEMS system. When successful, implementing on-scene ECPR could significantly enhance survival rates and minimize neurological impairment. Clinicaltyrials.gov under NCT04620070, registration date 3 November 2020.
{"title":"A national multi centre pre-hospital ECPR stepped wedge study; design and rationale of the ON-SCENE study","authors":"Samir Ali, Xavier Moors, Hans van Schuppen, Lars Mommers, Ellen Weelink, Christiaan L. Meuwese, Merijn Kant, Judith van den Brule, Carlos Elzo Kraemer, Alexander P. J. Vlaar, Sakir Akin, Annemiek Oude Lansink-Hartgring, Erik Scholten, Luuk Otterspoor, Jesse de Metz, Thijs Delnoij, Esther M. M. van Lieshout, Robert-Jan Houmes, Dennis den Hartog, Diederik Gommers, Dinis Dos Reis Miranda","doi":"10.1186/s13049-024-01198-x","DOIUrl":"https://doi.org/10.1186/s13049-024-01198-x","url":null,"abstract":"The likelihood of return of spontaneous circulation with conventional advanced life support is known to have an exponential decline and therefore neurological outcome after 20 min in patients with a cardiac arrest is poor. Initiation of venoarterial ExtraCorporeal Membrane Oxygenation (ECMO) during resuscitation might improve outcomes if used in time and in a selected patient category. However, previous studies have failed to significantly reduce the time from cardiac arrest to ECMO flow to less than 60 min. We hypothesize that the initiation of Extracorporeal Cardiopulmonary Resuscitation (ECPR) by a Helicopter Emergency Medical Services System (HEMS) will reduce the low flow time and improve outcomes in refractory Out of Hospital Cardiac Arrest (OHCA) patients. The ON-SCENE study will use a non-randomised stepped wedge design to implement ECPR in patients with witnessed OHCA between the ages of 18–50 years old, with an initial presentation of shockable rhythm or pulseless electrical activity with a high suspicion of pulmonary embolism, lasting more than 20, but less than 45 min. Patients will be treated by the ambulance crew and HEMS with prehospital ECPR capabilities and will be compared with treatment by ambulance crew and HEMS without prehospital ECPR capabilities. The primary outcome measure will be survival at hospital discharge. The secondary outcome measure will be good neurological outcome defined as a cerebral performance categories scale score of 1 or 2 at 6 and 12 months. The ON-SCENE study focuses on initiating ECPR at the scene of OHCA using HEMS. The current in-hospital ECPR for OHCA obstacles encompassing low survival rates in refractory arrests, extended low-flow durations during transportation, and the critical time sensitivity of initiating ECPR, which could potentially be addressed through the implementation of the HEMS system. When successful, implementing on-scene ECPR could significantly enhance survival rates and minimize neurological impairment. Clinicaltyrials.gov under NCT04620070, registration date 3 November 2020.","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140612461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-16DOI: 10.1186/s13049-024-01202-4
Stian Lande Wekre, Oddvar Uleberg, Lars Eide Næss, Helge Haugland
Helicopter Emergency Medical Services (HEMS) provide rapid and specialized care to critically ill or injured patients. Norwegian HEMS in Central Norway serves an important role in pre-hospital emergency medical care. To grade the severity of patients, HEMS uses the National Advisory Committee for Aeronautics’ (NACA) severity score. The objective of this study was to describe the short- and long term mortality overall and in each NACA-group for patients transported by HEMS Trondheim using linkage of HEMS and hospital data. The study used a retrospective cohort design, aligning with the STROBE recommendations. Patient data from Trondheim HEMS between 01.01.2017 and 31.12.2019 was linked to mortality data from a hospital database and analyzed. Kaplan Meier plots and cumulative mortality rates were calculated for each NACA group at day one, day 30, and one year and three years after the incident. Trondheim HEMS responded to 2224 alarms in the included time period, with 1431 patients meeting inclusion criteria for the study. Overall mortality rates at respective time points were 10.1% at day one, 13.4% at 30 days, 18.5% at one year, and 22.3% at three years. The one-year cumulative mortality rates for each NACA group were as follows: 0% for NACA 1 and 2, 2.9% for NACA 3, 10.1% for NACA 4, 24.7% for NACA 5 and 49.5% for NACA 6. Statistical analysis with a global log-rank test indicated a significant difference in survival outcomes among the groups (p < 2⋅10− 16). Among patients transported by Trondheim HEMS, we observed an incremental rise in mortality rates with increasing NACA scores. The study further suggests that a one-year follow-up may be sufficient for future investigations into HEMS outcomes.
{"title":"Mortality rates in Norwegian HEMS—a retrospective analysis from Central Norway","authors":"Stian Lande Wekre, Oddvar Uleberg, Lars Eide Næss, Helge Haugland","doi":"10.1186/s13049-024-01202-4","DOIUrl":"https://doi.org/10.1186/s13049-024-01202-4","url":null,"abstract":"Helicopter Emergency Medical Services (HEMS) provide rapid and specialized care to critically ill or injured patients. Norwegian HEMS in Central Norway serves an important role in pre-hospital emergency medical care. To grade the severity of patients, HEMS uses the National Advisory Committee for Aeronautics’ (NACA) severity score. The objective of this study was to describe the short- and long term mortality overall and in each NACA-group for patients transported by HEMS Trondheim using linkage of HEMS and hospital data. The study used a retrospective cohort design, aligning with the STROBE recommendations. Patient data from Trondheim HEMS between 01.01.2017 and 31.12.2019 was linked to mortality data from a hospital database and analyzed. Kaplan Meier plots and cumulative mortality rates were calculated for each NACA group at day one, day 30, and one year and three years after the incident. Trondheim HEMS responded to 2224 alarms in the included time period, with 1431 patients meeting inclusion criteria for the study. Overall mortality rates at respective time points were 10.1% at day one, 13.4% at 30 days, 18.5% at one year, and 22.3% at three years. The one-year cumulative mortality rates for each NACA group were as follows: 0% for NACA 1 and 2, 2.9% for NACA 3, 10.1% for NACA 4, 24.7% for NACA 5 and 49.5% for NACA 6. Statistical analysis with a global log-rank test indicated a significant difference in survival outcomes among the groups (p < 2⋅10− 16). Among patients transported by Trondheim HEMS, we observed an incremental rise in mortality rates with increasing NACA scores. The study further suggests that a one-year follow-up may be sufficient for future investigations into HEMS outcomes.","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140591626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-16DOI: 10.1186/s13049-024-01203-3
Pauli Vuorinen, Piritta Setälä, Sanna Hoppu
In Finland, the yearly number of mechanical thrombectomies for acute stroke is increasing and more patients are transported over 100 km to the comprehensive stroke centre (CSC) for definitive care. This leaves the rural townships without immediate emergency medical services (EMS) for hours. In this study we compare the EMS’ estimated return times to own station after the handover of a thrombectomy candidate between two transport methods: (1) using ground transportation with an ambulance to the CSC or (2) using a hydrid strategy starting the transportation with an ambulance and continuing by air with a helicopter emergency medical services unit (HEMS). We reviewed retrospectively all thrombectomy candidates’ transportations from the hospital district of South Ostrobothnia to definitive care at the nearest CSC, Tampere University Hospital from June 2020 to October 2022. The dispatch protocol stated that a thrombectomy candidate’s transport begins immediately with an ambulance and if the local HEMS unit is available the patient is handed over to them at a rendezvous. If not, the patient is transported to the CSC by ground. Transport times and locations of the patient handovers were reviewed from the CSC’s EMS database and the driving time back to ambulance station was estimated using Google maps. The HEMS unit’s pilot’s log was reviewed to assess their mission engagement time. The median distance from the CSC to the ambulances’ stations was 188 km (IQR 149–204 km) and from the rendezvous with the HEMS unit 70 km (IQR 51–91 km, p < 0.001). The estimated median driving time back to station after the patient handover at the CSC was 145 min (IQR 117–153 min) compared to the patient handover to the HEMS unit 53 min (IQR 38–68 min, p < 0.001). The HEMS unit was occupied in thrombectomy candidate’s transport mission for a median of 136 min (IQR 127–148 min). A hybrid strategy to transport thrombectomy candidates with an ambulance and a helicopter reallocates the EMS resources markedly faster back to their own district.
{"title":"Optimizing remote and rural prehospital resources using air transport of thrombectomy candidates","authors":"Pauli Vuorinen, Piritta Setälä, Sanna Hoppu","doi":"10.1186/s13049-024-01203-3","DOIUrl":"https://doi.org/10.1186/s13049-024-01203-3","url":null,"abstract":"In Finland, the yearly number of mechanical thrombectomies for acute stroke is increasing and more patients are transported over 100 km to the comprehensive stroke centre (CSC) for definitive care. This leaves the rural townships without immediate emergency medical services (EMS) for hours. In this study we compare the EMS’ estimated return times to own station after the handover of a thrombectomy candidate between two transport methods: (1) using ground transportation with an ambulance to the CSC or (2) using a hydrid strategy starting the transportation with an ambulance and continuing by air with a helicopter emergency medical services unit (HEMS). We reviewed retrospectively all thrombectomy candidates’ transportations from the hospital district of South Ostrobothnia to definitive care at the nearest CSC, Tampere University Hospital from June 2020 to October 2022. The dispatch protocol stated that a thrombectomy candidate’s transport begins immediately with an ambulance and if the local HEMS unit is available the patient is handed over to them at a rendezvous. If not, the patient is transported to the CSC by ground. Transport times and locations of the patient handovers were reviewed from the CSC’s EMS database and the driving time back to ambulance station was estimated using Google maps. The HEMS unit’s pilot’s log was reviewed to assess their mission engagement time. The median distance from the CSC to the ambulances’ stations was 188 km (IQR 149–204 km) and from the rendezvous with the HEMS unit 70 km (IQR 51–91 km, p < 0.001). The estimated median driving time back to station after the patient handover at the CSC was 145 min (IQR 117–153 min) compared to the patient handover to the HEMS unit 53 min (IQR 38–68 min, p < 0.001). The HEMS unit was occupied in thrombectomy candidate’s transport mission for a median of 136 min (IQR 127–148 min). A hybrid strategy to transport thrombectomy candidates with an ambulance and a helicopter reallocates the EMS resources markedly faster back to their own district.","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140591835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-12DOI: 10.1186/s13049-024-01201-5
Léo Charrin, Nicolas Romain-Scelle, Christian Di-Filippo, Eric Mercier, Frederic Balen, Karim Tazarourte, Axel Benhamed
Shortness of breath is a common complaint among individuals contacting emergency communication center (EMCCs). In some prehospital system, emergency medical services include an advanced life support (ALS)-capable team. Whether such team should be dispatched during the phone call or delayed until the BLS-capable paramedic team reports from the scene is unclear. We aimed to evaluate the impact of delayed MMT dispatch until receiving the paramedic review compared to immediate dispatch at the time of the call on patient outcomes. A cross-sectional study conducted in Lyon, France, using data obtained from the departmental EMCC during the period from January to December 2019. We included consecutive calls related to adult patients experiencing acute respiratory distress. Patients from the two groups (immediate mobile medical team (MMT) dispatch or delayed MMT dispatch) were matched on a propensity score, and a conditional weighted logistic regression assessed the adjusted odds ratios (ORs) for each outcome (mortality on days 0, 7 and 30). A total of 870 calls (median age 72 [57–84], male 466 53.6%) were sought for analysis [614 (70.6%) “immediate MMT dispatch” and 256 (29.4%) “delayed MMT” groups]. The median time before MMT dispatch was 25.1 min longer in the delayed MMT group (30.7 [26.4–36.1] vs. 5.6 [3.9–8.8] min, p < 0.001). Patients subjected to a delayed MMT intervention were older (median age 78 [66–87] vs. 69 [53–83], p < 0.001) and more frequently highly dependent (16.3% vs. 8.6%, p < 0.001). A higher proportion of patients in the delayed MMT group required bag valve mask ventilation (47.3% vs. 39.1%, p = 0.03), noninvasive ventilation (24.6% vs. 20.0%, p = 0.13), endotracheal intubation (7.0% vs. 4.1%, p = 0.07) and catecholamine infusion (3.9% vs. 1.3%, p = 0.01). After propensity score matching, mortality at day 0 was higher in the delayed MMT group (9.8% vs. 4.2%, p = 0.002). Immediate MMT dispatch at the call was associated with a lower risk of mortality on day 0 (0.60 [0.38;0.82], p < 0.001) day 7 (0.50 [0.27;0.72], p < 0.001) and day 30 (0.56 [0.35;0.78], p < 0.001) This study suggests that the deployment of an MMT at call in patients in acute respiratory distress may result in decreased short to medium-term mortality compared to a delayed MMT following initial first aid assessment.
{"title":"Impact of delayed mobile medical team dispatch for respiratory distress calls: a propensity score matched study from a French emergency communication center","authors":"Léo Charrin, Nicolas Romain-Scelle, Christian Di-Filippo, Eric Mercier, Frederic Balen, Karim Tazarourte, Axel Benhamed","doi":"10.1186/s13049-024-01201-5","DOIUrl":"https://doi.org/10.1186/s13049-024-01201-5","url":null,"abstract":"Shortness of breath is a common complaint among individuals contacting emergency communication center (EMCCs). In some prehospital system, emergency medical services include an advanced life support (ALS)-capable team. Whether such team should be dispatched during the phone call or delayed until the BLS-capable paramedic team reports from the scene is unclear. We aimed to evaluate the impact of delayed MMT dispatch until receiving the paramedic review compared to immediate dispatch at the time of the call on patient outcomes. A cross-sectional study conducted in Lyon, France, using data obtained from the departmental EMCC during the period from January to December 2019. We included consecutive calls related to adult patients experiencing acute respiratory distress. Patients from the two groups (immediate mobile medical team (MMT) dispatch or delayed MMT dispatch) were matched on a propensity score, and a conditional weighted logistic regression assessed the adjusted odds ratios (ORs) for each outcome (mortality on days 0, 7 and 30). A total of 870 calls (median age 72 [57–84], male 466 53.6%) were sought for analysis [614 (70.6%) “immediate MMT dispatch” and 256 (29.4%) “delayed MMT” groups]. The median time before MMT dispatch was 25.1 min longer in the delayed MMT group (30.7 [26.4–36.1] vs. 5.6 [3.9–8.8] min, p < 0.001). Patients subjected to a delayed MMT intervention were older (median age 78 [66–87] vs. 69 [53–83], p < 0.001) and more frequently highly dependent (16.3% vs. 8.6%, p < 0.001). A higher proportion of patients in the delayed MMT group required bag valve mask ventilation (47.3% vs. 39.1%, p = 0.03), noninvasive ventilation (24.6% vs. 20.0%, p = 0.13), endotracheal intubation (7.0% vs. 4.1%, p = 0.07) and catecholamine infusion (3.9% vs. 1.3%, p = 0.01). After propensity score matching, mortality at day 0 was higher in the delayed MMT group (9.8% vs. 4.2%, p = 0.002). Immediate MMT dispatch at the call was associated with a lower risk of mortality on day 0 (0.60 [0.38;0.82], p < 0.001) day 7 (0.50 [0.27;0.72], p < 0.001) and day 30 (0.56 [0.35;0.78], p < 0.001) This study suggests that the deployment of an MMT at call in patients in acute respiratory distress may result in decreased short to medium-term mortality compared to a delayed MMT following initial first aid assessment.","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140591831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-09DOI: 10.1186/s13049-024-01200-6
Hadi Mirfazaelian
Dear Editor,
I read the study published by Nikula et al. [1] with interest. As provided by the authors, “the objective of this study was to evaluate whether intranasal dexmedetomidine could provide more effective analgesia and sedation during a painful procedure than intranasal ketamine” [1]. As depicted in the statistical analysis section, it is a superiority trial and hence the null (H0) hypothesis should be “dexmedetomidine is not superior to esketaime”. By conducting this study, the investigators tried to reject the null hypothesis and conclude that it is superior to ketamine (H1 hypothesis).
In the conclusion, they stated that “This study was underpowered and did not show any difference between intranasal dexmedetomidine and intranasal esketamine for procedural sedation and analgesia in young children.“ [1]. I have 2 arguments; first, although early stoppage of a trial would generally reduce the power [2, 3], this can be stated only after post-hoc power analysis. Second, the inability to reject the null hypothesis should lead to a conclusion that the study failed to demonstrate the superiority of dexmedetomidine over esketamine. As a result, it is more accurate for conclusion to be read as “the results failed to show that Dexmedetomidine was superior to the esketamine” or “reduction in pain as per FLACC, was not statistically significant”. In my view, the conclusions drawn by the authors do not accurately reflect the statistical findings, potentially leading to misinterpretation of the study’s implications.
Sincerely yours,
Hadi Mirfazaelian MSc, MD.
Nikula A, Lundeberg S, Ryd Rinder M, Lääperi M, Sandholm K, Castrén M, Kurland L. A randomized double-blind trial of intranasal dexmedetomidine versus intranasal esketamine for procedural sedation and analgesia in young children. Scandinavian Journal of Trauma.
Moher D, Dulberg CS, Wells GA. Statistical Power, Sample Size, and Their Reporting in Randomized Controlled Trials. JAMA. 1994;272:122–124.
Nayak BK. Understanding the relevance of sample size calculation. Vol 58: Medknow; 2010:469–470.
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Authors and Affiliations
Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran
Hadi Mirfazaelian
Prehospital and Hospital Emergency Research Center, Tehran, Iran
Hadi Mirfazaelian
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Correspondence
亲爱的编辑，我饶有兴趣地阅读了尼库拉等人发表的研究报告[1]。根据作者提供的信息，"本研究的目的是评估鼻内注射右美托咪定是否能比鼻内注射氯胺酮在疼痛手术中提供更有效的镇痛和镇静"[1]。如统计分析部分所述，这是一项优越性试验，因此零假设（H0）应为 "右美托咪定不优于氯胺酮"。在结论中，他们指出："这项研究的力量不足，没有显示出鼻内右美托咪定和鼻内艾司氯胺酮在幼儿手术镇静和镇痛方面存在任何差异"。[1].我有两个论点：第一，虽然试验的提前终止通常会降低功率[2, 3]，但这只能在事后功率分析后才能说明。其次，如果无法拒绝零假设，就应该得出结论：该研究未能证明右美托咪定优于艾司氯胺酮。因此，更准确的结论应该是 "结果未能显示右美托咪定优于艾司氯胺酮 "或 "根据 FLACC，疼痛减轻在统计学上并不显著"。Nikula A, Lundeberg S, Ryd Rinder M, Lääperi M, Sandholm K, Castrén M, Kurland L. A randomized double-blind trial of intranasal dexmedetomidine versus intranasal esketamine for procedural sedation and analgesia in young children.Scandinavian Journal of Trauma.Moher D, Dulberg CS, Wells GA.随机对照试验中的统计功率、样本大小及其报告。美国医学会杂志》。1994;272:122-124.Nayak BK.了解样本量计算的相关性》。下载参考文献不适用。作者和工作单位伊朗德黑兰医学科学大学急诊医学系伊朗德黑兰Hadi Mirfazaelian医院和医院急诊研究中心伊朗德黑兰Hadi Mirfazaelian作者Hadi Mirfazaelian查看作者发表的文章您也可以在PubMed Google Scholar中搜索该作者通讯作者Hadi Mirfazaelian.Conflict of interest不适用。开放获取本文采用知识共享署名 4.0 国际许可协议进行许可，该协议允许以任何媒介或格式使用、共享、改编、分发和复制，只要您适当注明原作者和来源，提供知识共享许可协议的链接，并说明是否进行了修改。本文中的图片或其他第三方材料均包含在文章的知识共享许可协议中，除非在材料的署名栏中另有说明。如果材料未包含在文章的知识共享许可协议中，且您打算使用的材料不符合法律规定或超出许可使用范围，则您需要直接从版权所有者处获得许可。如需查看该许可的副本，请访问 http://creativecommons.org/licenses/by/4.0/。创意共享公共领域专用免责声明(http://creativecommons.org/publicdomain/zero/1.0/)适用于本文提供的数据，除非在数据的信用行中另有说明。转载与许可引用本文Mirfazaelian, H. A wrong conclusion.Scand J Trauma Resusc Emerg Med 32, 26 (2024). https://doi.org/10.1186/s13049-024-01200-6Download citationReceived：25 March 2024Accepted: 27 March 2024Published: 09 April 2024DOI: https://doi.org/10.1186/s13049-024-01200-6Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative
{"title":"A wrong conclusion","authors":"Hadi Mirfazaelian","doi":"10.1186/s13049-024-01200-6","DOIUrl":"https://doi.org/10.1186/s13049-024-01200-6","url":null,"abstract":"<p>Dear Editor,</p><p>I read the study published by Nikula et al. [1] with interest. As provided by the authors, “the objective of this study was to evaluate whether intranasal dexmedetomidine could provide more effective analgesia and sedation during a painful procedure than intranasal ketamine” [1]. As depicted in the statistical analysis section, it is a superiority trial and hence the null (H0) hypothesis should be “dexmedetomidine is not superior to esketaime”. By conducting this study, the investigators tried to reject the null hypothesis and conclude that it is superior to ketamine (H1 hypothesis).</p><p>In the conclusion, they stated that “This study was underpowered and did not show any difference between intranasal dexmedetomidine and intranasal esketamine for procedural sedation and analgesia in young children.“ [1]. I have 2 arguments; first, although early stoppage of a trial would generally reduce the power [2, 3], this can be stated only after post-hoc power analysis. Second, the inability to reject the null hypothesis should lead to a conclusion that the study failed to demonstrate the superiority of dexmedetomidine over esketamine. As a result, it is more accurate for conclusion to be read as “the results failed to show that Dexmedetomidine was superior to the esketamine” or “reduction in pain as per FLACC, was not statistically significant”. In my view, the conclusions drawn by the authors do not accurately reflect the statistical findings, potentially leading to misinterpretation of the study’s implications.</p><p>Sincerely yours,</p><p>Hadi Mirfazaelian MSc, MD.</p><ol data-track-component=\"outbound reference\"><li data-counter=\"1.\"><p>Nikula A, Lundeberg S, Ryd Rinder M, Lääperi M, Sandholm K, Castrén M, Kurland L. A randomized double-blind trial of intranasal dexmedetomidine versus intranasal esketamine for procedural sedation and analgesia in young children. <i>Scandinavian Journal of Trauma</i>.</p></li><li data-counter=\"2.\"><p>Moher D, Dulberg CS, Wells GA. Statistical Power, Sample Size, and Their Reporting in Randomized Controlled Trials. <i>JAMA.</i> 1994;272:122–124.</p></li><li data-counter=\"3.\"><p>Nayak BK. Understanding the relevance of sample size calculation. Vol 58: Medknow; 2010:469–470.</p></li></ol><p>Download references<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><p>Not applicable.</p><h3>Authors and Affiliations</h3><ol><li><p>Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran</p><p>Hadi Mirfazaelian</p></li><li><p>Prehospital and Hospital Emergency Research Center, Tehran, Iran</p><p>Hadi Mirfazaelian</p></li></ol><span>Authors</span><ol><li><span>Hadi Mirfazaelian</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li></ol><h3>Corresponding author</h3><p>Correspondence ","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140591624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-02DOI: 10.1186/s13049-024-01197-y
Anja Westman, Lisa Kurland, Karin Hugelius
There is no universal agreement on what competence in disaster medicine is, nor what competences and personal attributes add value for disaster responders. Some studies suggest that disaster responders need not only technical skills but also non-technical skills. Consensus of which non-technical skills are needed and how training for these can be provided is lacking, and little is known about how to apply knowledge of non-technical skills in the recruitment of disaster responders. Therefore, this scoping review aimed to identify the non-technical skills required for the disaster medicine response. A scooping review using the Arksey & O´Malley framework was performed. Structured searches in the databases PuBMed, CINAHL Full Plus, Web of Science, PsycInfo and Scopus was conducted. Thereafter, data were structured and analyzed. From an initial search result of 6447 articles, 34 articles were included in the study. These covered both quantitative and qualitative studies and different contexts, including real events and training. The most often studied real event were responses following earthquakes. Four non-technical skills stood out as most frequently mentioned: communication skills; situational awareness; knowledge of human resources and organization and coordination skills; decision-making, critical-thinking and problem-solving skills. The review also showed a significant lack of uniform use of terms like skills or competence in the reviewed articles. Non-technical skills are skills that disaster responders need. Which non-technical skills are most needed, how to train and measure non-technical skills, and how to implement non-technical skills in disaster medicine need further studies.
关于什么是灾害医学方面的能力，以及什么能力和个人特质能为救灾人员带来附加值，并没有达成普遍一致的意见。一些研究表明，救灾人员不仅需要技术技能，还需要非技术技能。对于需要哪些非技术性技能以及如何提供这方面的培训，目前还缺乏共识，而对于如何在招聘救灾人员时应用非技术性技能的知识也知之甚少。因此，本次范围界定审查旨在确定灾难医学响应所需的非技术性技能。我们采用 Arksey & O´Malley 框架进行了范围界定研究。在 PuBMed、CINAHL Full Plus、Web of Science、PsycInfo 和 Scopus 等数据库中进行了结构化检索。之后，对数据进行了结构化处理和分析。初步搜索结果为 6447 篇文章，其中 34 篇文章被纳入研究范围。这些文章涵盖了定量和定性研究以及不同的背景，包括真实事件和培训。研究最多的真实事件是地震后的应对措施。有四种非技术性技能最常被提及：沟通技能；情景意识；人力资源知识和组织协调技能；决策、批判性思维和解决问题的技能。审查还显示，在所审查的文章中，技能或能力等术语的使用严重不统一。非技术技能是救灾人员需要的技能。哪些非技术技能是最需要的，如何培训和衡量非技术技能，以及如何在灾难医学中实施非技术技能，这些都需要进一步研究。
{"title":"Non-technical skills needed by medical disaster responders– a scoping review","authors":"Anja Westman, Lisa Kurland, Karin Hugelius","doi":"10.1186/s13049-024-01197-y","DOIUrl":"https://doi.org/10.1186/s13049-024-01197-y","url":null,"abstract":"There is no universal agreement on what competence in disaster medicine is, nor what competences and personal attributes add value for disaster responders. Some studies suggest that disaster responders need not only technical skills but also non-technical skills. Consensus of which non-technical skills are needed and how training for these can be provided is lacking, and little is known about how to apply knowledge of non-technical skills in the recruitment of disaster responders. Therefore, this scoping review aimed to identify the non-technical skills required for the disaster medicine response. A scooping review using the Arksey & O´Malley framework was performed. Structured searches in the databases PuBMed, CINAHL Full Plus, Web of Science, PsycInfo and Scopus was conducted. Thereafter, data were structured and analyzed. From an initial search result of 6447 articles, 34 articles were included in the study. These covered both quantitative and qualitative studies and different contexts, including real events and training. The most often studied real event were responses following earthquakes. Four non-technical skills stood out as most frequently mentioned: communication skills; situational awareness; knowledge of human resources and organization and coordination skills; decision-making, critical-thinking and problem-solving skills. The review also showed a significant lack of uniform use of terms like skills or competence in the reviewed articles. Non-technical skills are skills that disaster responders need. Which non-technical skills are most needed, how to train and measure non-technical skills, and how to implement non-technical skills in disaster medicine need further studies.","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140591832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-19DOI: 10.1186/s13049-024-01194-1
Erik Westnes, Magnus Hjortdahl
Rescue operations are in Norway defined as situations where patients are difficult to access or that more resources are needed than the health services alone possess and can put in operation (Bull A, Redningshåndboken er endelig her! [Internet]. Hovedredningssentralen. 2018 [cited 2023 May 15]. Available from: https://www.hovedredningssentralen.no/redningshandboken-er-endelig-her/ ). Rescue operations after large incidents may include civil protection, military forces, non-governmental organizations and other resources, but the initial rescue effort must be performed by the emergency services as time often is of essence. The central area of an accident where special training and personal protection equipment is necessary or mandatory is called the Hot Zone. This study examines Urban Search And Rescue (USAR) firefighters and police officers reported experiences from ambulance personnel’s contribution in the Hot Zone. We conducted five focus group interviews with USAR-trained firefighters and police officers. The interviewees were those on duty on the agreed dates. The interviews were taped, transcribed, and analysed using thematic analysis as described by Braun & Clarke. Three themes were identified; Feeling safe during missions, Building USAR capacity, and Trust-building within USAR-teams. The firefighters and police officers reported their and the patients’ safety are best managed by EMS-personnel, whose presence strongly contributes to their own feeling of safety in a dangerous area. When EMS handles victims and injured emergency workers, firefighters and police officers can focus on their own primary tasks. Indeed, interviewees reported that building a USAR capacity depends on having USAR-trained EMS-personnel in the Hot Zone. The interviewees have clear and consistent opinions on how to establish an interagency USAR capacity effectively. Trust is paramount to the interviewees, and they express a high degree of trust within USAR Oslo. Firefighters and police officers regard USAR-trained EMS-personnel as a natural and integrated part in urban search and rescue teams. EMS-personnel in the dangerous area deliver safety and medical professional assistance to both rescue workers and patients. Informants in this study had clear opinions on how to establish and maintain such a service.
{"title":"Firefighters and police search dog handlers’ experiences working closely with paramedics in urban search and rescue incidents: a qualitative focus group study from Oslo","authors":"Erik Westnes, Magnus Hjortdahl","doi":"10.1186/s13049-024-01194-1","DOIUrl":"https://doi.org/10.1186/s13049-024-01194-1","url":null,"abstract":"Rescue operations are in Norway defined as situations where patients are difficult to access or that more resources are needed than the health services alone possess and can put in operation (Bull A, Redningshåndboken er endelig her! [Internet]. Hovedredningssentralen. 2018 [cited 2023 May 15]. Available from: https://www.hovedredningssentralen.no/redningshandboken-er-endelig-her/ ). Rescue operations after large incidents may include civil protection, military forces, non-governmental organizations and other resources, but the initial rescue effort must be performed by the emergency services as time often is of essence. The central area of an accident where special training and personal protection equipment is necessary or mandatory is called the Hot Zone. This study examines Urban Search And Rescue (USAR) firefighters and police officers reported experiences from ambulance personnel’s contribution in the Hot Zone. We conducted five focus group interviews with USAR-trained firefighters and police officers. The interviewees were those on duty on the agreed dates. The interviews were taped, transcribed, and analysed using thematic analysis as described by Braun & Clarke. Three themes were identified; Feeling safe during missions, Building USAR capacity, and Trust-building within USAR-teams. The firefighters and police officers reported their and the patients’ safety are best managed by EMS-personnel, whose presence strongly contributes to their own feeling of safety in a dangerous area. When EMS handles victims and injured emergency workers, firefighters and police officers can focus on their own primary tasks. Indeed, interviewees reported that building a USAR capacity depends on having USAR-trained EMS-personnel in the Hot Zone. The interviewees have clear and consistent opinions on how to establish an interagency USAR capacity effectively. Trust is paramount to the interviewees, and they express a high degree of trust within USAR Oslo. Firefighters and police officers regard USAR-trained EMS-personnel as a natural and integrated part in urban search and rescue teams. EMS-personnel in the dangerous area deliver safety and medical professional assistance to both rescue workers and patients. Informants in this study had clear opinions on how to establish and maintain such a service.","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140172629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recently, the Norwegian Helicopter Emergency Medical Service (HEMS) has developed a procedure for a special type of static rope rescue operation, referred to as the offset technique. In this technique, the helicopter is offset from the accident site, and the HEMS technical crew member uses an offset throw line to gain access to the scene. Today, there is little practical experience of such operations, and a need has been identified for more knowledge on the potential hazards encountered during this type of operation. Such knowledge is of importance for further development of the procedure for the offset technique. To identify potential hazards for helicopter rescue operations using the static rope offset technique and, thereby, to improve the procedure for such operations. This may lead to improved safety for patients and crew members during offset rescue operations. A Safe Job Analysis was used to identify the hazards of offset rescue operations. Such operations are divided into tasks and sub-tasks. For each sub-task, we identified potential hazards and suggested ways of preventing these. Through the Safe Job Analysis, we suggest some changes in the existing procedure for the offset technique, to make it more robust against potential hazards. We have demonstrated the value of Safe Job Analysis for improving the static rope offset evacuation procedure. Our analysis has led to some changes in the procedure for offset rescue operations. This is the importance of having two throw lines and focusing on “why” in the procedure.
{"title":"Evaluation of the offset static rope evacuation procedure: insights from a safe job analysis","authors":"Eirik Bjorheim Abrahamsen, Håvard Mattingsdal, Håkon Bjorheim Abrahamsen","doi":"10.1186/s13049-024-01186-1","DOIUrl":"https://doi.org/10.1186/s13049-024-01186-1","url":null,"abstract":"Recently, the Norwegian Helicopter Emergency Medical Service (HEMS) has developed a procedure for a special type of static rope rescue operation, referred to as the offset technique. In this technique, the helicopter is offset from the accident site, and the HEMS technical crew member uses an offset throw line to gain access to the scene. Today, there is little practical experience of such operations, and a need has been identified for more knowledge on the potential hazards encountered during this type of operation. Such knowledge is of importance for further development of the procedure for the offset technique. To identify potential hazards for helicopter rescue operations using the static rope offset technique and, thereby, to improve the procedure for such operations. This may lead to improved safety for patients and crew members during offset rescue operations. A Safe Job Analysis was used to identify the hazards of offset rescue operations. Such operations are divided into tasks and sub-tasks. For each sub-task, we identified potential hazards and suggested ways of preventing these. Through the Safe Job Analysis, we suggest some changes in the existing procedure for the offset technique, to make it more robust against potential hazards. We have demonstrated the value of Safe Job Analysis for improving the static rope offset evacuation procedure. Our analysis has led to some changes in the procedure for offset rescue operations. This is the importance of having two throw lines and focusing on “why” in the procedure.","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140146919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-11DOI: 10.1186/s13049-024-01192-3
Virginia Zarama, María Camila Arango-Granados, Ramiro Manzano-Nunez, James P. Sheppard, Nia Roberts, Annette Plüddemann
Chest pain is responsible for millions of visits to the emergency department (ED) annually. Cardiac ultrasound can detect ischemic changes, but varying accuracy estimates have been reported in previous studies. We synthetized the available evidence to yield more precise estimates of the accuracy of cardiac ultrasound for acute myocardial ischemia in patients with chest pain in the ED and to assess the effect of different clinical characteristics on test accuracy. A systematic search for studies assessing the diagnostic accuracy of cardiac ultrasound for myocardial ischemia in the ED was conducted in MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, Web of Science, two trial registries and supplementary methods, from inception to December 6th, 2022. Prospective cohort, cross-sectional, case–control studies and randomized controlled trials (RCTs) that included data on diagnostic accuracy were included. Risk of bias was assessed with the QUADAS-2 tool and a bivariate hierarchical model was used for meta-analysis with paired Forest and SROC plots used to present the results. Subgroup analyses was conducted on clinically relevant factors. Twenty-nine studies were included, with 5043 patients. The overall summary sensitivity was 79.3% (95%CI 69.0–86.8%) and specificity was 87.3% (95%CI 79.9–92.2%), with substantial heterogeneity. Subgroup analyses showed increased sensitivity in studies where ultrasound was conducted at ED admission and increased specificity in studies that excluded patients with previous heart disease, when the target condition was acute coronary syndrome, or when final chart review was used as the reference standard. There was very low certainty in the results based on serious risk of bias and indirectness in most studies. Cardiac ultrasound may have a potential role in the diagnostic pathway of myocardial ischemia in the ED; however, a pooled accuracy must be interpreted cautiously given substantial heterogeneity and that important patient and test characteristics affect its diagnostic performance. Protocol Registration: PROSPERO (CRD42023392058).
{"title":"The diagnostic accuracy of cardiac ultrasound for acute myocardial ischemia in the emergency department: a systematic review and meta-analysis","authors":"Virginia Zarama, María Camila Arango-Granados, Ramiro Manzano-Nunez, James P. Sheppard, Nia Roberts, Annette Plüddemann","doi":"10.1186/s13049-024-01192-3","DOIUrl":"https://doi.org/10.1186/s13049-024-01192-3","url":null,"abstract":"Chest pain is responsible for millions of visits to the emergency department (ED) annually. Cardiac ultrasound can detect ischemic changes, but varying accuracy estimates have been reported in previous studies. We synthetized the available evidence to yield more precise estimates of the accuracy of cardiac ultrasound for acute myocardial ischemia in patients with chest pain in the ED and to assess the effect of different clinical characteristics on test accuracy. A systematic search for studies assessing the diagnostic accuracy of cardiac ultrasound for myocardial ischemia in the ED was conducted in MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, Web of Science, two trial registries and supplementary methods, from inception to December 6th, 2022. Prospective cohort, cross-sectional, case–control studies and randomized controlled trials (RCTs) that included data on diagnostic accuracy were included. Risk of bias was assessed with the QUADAS-2 tool and a bivariate hierarchical model was used for meta-analysis with paired Forest and SROC plots used to present the results. Subgroup analyses was conducted on clinically relevant factors. Twenty-nine studies were included, with 5043 patients. The overall summary sensitivity was 79.3% (95%CI 69.0–86.8%) and specificity was 87.3% (95%CI 79.9–92.2%), with substantial heterogeneity. Subgroup analyses showed increased sensitivity in studies where ultrasound was conducted at ED admission and increased specificity in studies that excluded patients with previous heart disease, when the target condition was acute coronary syndrome, or when final chart review was used as the reference standard. There was very low certainty in the results based on serious risk of bias and indirectness in most studies. Cardiac ultrasound may have a potential role in the diagnostic pathway of myocardial ischemia in the ED; however, a pooled accuracy must be interpreted cautiously given substantial heterogeneity and that important patient and test characteristics affect its diagnostic performance. Protocol Registration: PROSPERO (CRD42023392058).","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140099501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-06DOI: 10.1186/s13049-024-01189-y
Niklas Breindahl, Signe A. Wolthers, Thea P. Møller, Stig N. F. Blomberg, Jacob Steinmetz, Helle C. Christensen
Improving oxygenation and ventilation in drowning patients early in the field is critical and may be lifesaving. The critical care interventions performed by physicians in drowning management are poorly described. The aim was to describe patient characteristics and critical care interventions with 30-day mortality as the primary outcome in drowning patients treated by the Danish Air Ambulance. This retrospective cohort study with 30-day follow-up identified drowning patients treated by the Danish Air Ambulance from January 1, 2016, through December 31, 2021. Drowning patients were identified using a text-search algorithm (Danish Drowning Formula) followed by manual review and validation. Operational and medical data were extracted from the Danish Air Ambulance database. Descriptive analyses were performed comparing non-fatal and fatal drowning incidents with 30-day mortality as the primary outcome. Of 16,841 dispatches resulting in a patient encounter in the six years, the Danish Drowning Formula identified 138 potential drowning patients. After manual validation, 98 drowning patients were included in the analyses, and 82 completed 30-day follow-up. The prehospital and 30-day mortality rates were 33% and 67%, respectively. The National Advisory Committee for Aeronautics severity scores from 4 to 7, indicating a critical emergency, were observed in 90% of the total population. They were significantly higher in the fatal versus non-fatal group (p < 0.01). At least one critical care intervention was performed in 68% of all drowning patients, with endotracheal intubation (60%), use of an automated chest compression device (39%), and intraosseous cannulation (38%) as the most frequently performed interventions. More interventions were generally performed in the fatal group (p = 0.01), including intraosseous cannulation and automated chest compressions. The Danish Air Ambulance rarely treated drowning patients, but those treated were severely ill, with a 30-day mortality rate of 67% and frequently required critical care interventions. The most frequent interventions were endotracheal intubation, automated chest compressions, and intraosseous cannulation.
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