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.

Immediate Paramedic Tactical Response Unit in a Civilian Emergency Medical Service: The First Year Experience.

Purpose: An immediate paramedic tactical response unit was implemented into a civilian emergency medical services (EMS) system. This was compared with the preexisting traditional tactical EMS support (TEMS). The primary aim of the study was to evaluate the effect on tasking frequencies.

Prehospital administration of blood products: experiences from a Finnish physician-staffed helicopter emergency medical service.

Background: Massive infusions of crystalloids into bleeding hypotensive patients can worsen the outcome. Military experience suggests avoiding crystalloids using early damage control resuscitation with blood components in out of hospital setting. Civilian emergency medical services have since followed this idea.

Limiting treatment in pre-hospital care: A prospective, observational multicentre study.

Background: Data are scarce on the withdrawal of life-sustaining therapies and limitation of care orders (LCOs) during physician-staffed Helicopter Emergency Medical Service (HEMS) missions. We investigated LCOs and the quality of information available when physicians made treatment decisions in pre-hospital care.

Methods: A prospective, nationwide, multicentre study including all Finnish physician-staffed HEMS bases during a 6-month study period.

Spontaneous trigger words associated with confirmed out-of-hospital cardiac arrest: a descriptive pilot study of emergency calls.

Background: According to the International Liaison Committee on Resuscitation (ILCOR), the trigger words used by callers that are associated with cardiac arrest constitute a scientific knowledge gap. This study was designed to find hypothetical trigger words in emergency calls in order to improve the specificity of out-of-hospital cardiac arrest recognition.

Methods: In this descriptive pilot study conducted in a Finnish hospital district, linguistic contents of 80 emergency calls of dispatcher-suspected or EMS-encountered out-of-hospital cardiac arrests between January 1, 2017 and May 31, 2017 were analysed.

Limitation of treatment in prehospital care - the experiences of helicopter emergency medical service physicians in a nationwide multicentre survey.

Background: Making ethically sound treatment limitations in prehospital care is a complex topic. Helicopter Emergency Medical Service (HEMS) physicians were surveyed on their experiences with limitations of care orders in the prehospital setting, including situations where they are dispatched to healthcare facilities or nursing homes.

Methods: A nationwide multicentre study was conducted among all HEMS physicians in Finland in 2017 using a questionnaire with closed five-point Likert-scale questions and open questions.

Professional firefighter and trained volunteer first-responding units in emergency medical service.

Background: Although widely dispatched to out-of-hospital cardiac arrests, the performance of prehospital first-responding units in other medical emergencies is unknown.

Methods: In this retrospective, descriptive study, the general performance of 44 first-responding units in Pirkanmaa County, Finland, were examined. A subgroup analysis compared the first-responding units made up of professional firefighters and trained volunteers.

End-tidal carbon dioxide output in manual cardiopulmonary resuscitation versus active compression-decompression device during prehospital quality controlled resuscitation: a case series study.

Background: Active compression-decompression (ACD) devices have enhanced end-tidal carbon dioxide (ETCO) output in experimental cardiopulmonary resuscitation (CPR) studies. However, the results in out-of-hospital cardiac arrest (OHCA) patients have shown inconsistent outcomes, and earlier studies lacked quality control of CPR attempts. We compared manual CPR with ACD-CPR by measuring ETCO output using an audiovisual feedback defibrillator to ensure continuous high quality resuscitation attempts.

Physician-staffed helicopter emergency medical service has a beneficial impact on the incidence of prehospital hypoxia and secured airways on patients with severe traumatic brain injury.

Background: After traumatic brain injury (TBI), hypotension, hypoxia and hypercapnia have been shown to result in secondary brain injury that can lead to increased mortality and disability. Effective prehospital assessment and treatment by emergency medical service (EMS) is considered essential for favourable outcome. The aim of this study was to evaluate the effect of a physician-staffed helicopter emergency medical service (HEMS) in the treatment of TBI patients.

A survey of front-line paramedics examining the professional relationship between paramedics and physician medical oversight.

Objective: Paramedicine is often dependent on physician medical directors and their associated programs for direction and oversight. A positive relationship between paramedics and their oversight physicians promotes safety and quality care while a strained or ineffective one may threaten these goals. The objective of this study was to explore and understand the professional relationship between paramedics and physician medical oversight as viewed by front-line paramedics.

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.

Pre-hospital severe traumatic brain injury - comparison of outcome in paramedic versus physician staffed emergency medical services.

Background: Traumatic brain injury (TBI) is one of the leading causes of death and permanent disability. Emergency Medical Services (EMS) personnel are often the first healthcare providers attending patients with TBI. The level of available care varies, which may have an impact on the patient's outcome.

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.

Airway management by physician-staffed Helicopter Emergency Medical Services - a prospective, multicentre, observational study of 2,327 patients.

Background: Despite numerous studies on prehospital airway management, results are difficult to compare due to inconsistent or heterogeneous data. The objective of this study was to assess advanced airway management from international physician-staffed helicopter emergency medical services.

Methods: We collected airway data from 21 helicopter emergency medical services in Australia, England, Finland, Hungary, Norway and Switzerland over a 12-month period.

Real-time audiovisual feedback system in a physician-staffed helicopter emergency medical service in Finland: the quality results and barriers to implementation.

Objectives: To evaluate the quality of cardiopulmonary resuscitation (CPR) in a physician staffed helicopter emergency medical service (HEMS) using a monitor-defibrillator with a quality analysis feature. As a post hoc analysis, the potential barriers to implementation were surveyed.

Methods: The quality of CPR performed by the HEMS from November 2008 to April 2010 was analysed.

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

Background: The aim of the study was to evaluate the long-term outcome of patients successfully resuscitated from pre-hospital cardiac arrest with initial pulseless electrical activity (PEA), because the long-term outcome of these patients is unknown. Survival, neurological status one year after cardiac arrest and self-perceived quality of life after five years were assessed.

Methods: This retrospective study included adult patients resuscitated from PEA between August 2001 and March 2003 in three urban areas in southern Finland.

Evaluation of the effects of low temperature on performance of standard non-electric medical equipment at -21.5°C (-6.7°F) - a descriptive study on a real life challenge in the prehospital setting.

Aim Of The Study: To our knowledge, there are no previous reports on the performance of medical equipment in cold conditions. The aim of this study was to evaluate the performance of several plastic, single-use medical equipment exposed to cold outdoor temperature.

Methods: Medical equipment such as endotracheal tubes, suction catheters and intravenous lines were exposed to outdoor temperature of -21.

[Out-of-hospital cardiac arrest].

Cardiac arrest as the first symptom of coronary artery disease is not uncommon. Some of previously healthy people with sudden cardiac arrest may be saved by effective resuscitation and post-resuscitative therapy. The majority of cardiac arrest patients experience the cardiac arrest outside of the hospital, in which case early recognition of lifelessness, commencement of basic life support and entry to professional care without delay are the prerequisites for recovery.

Quality controlled manual chest compressions and cerebral oxygenation during in-hospital cardiac arrest.

Aim: The quality of cardiopulmonary resuscitation (CPR) is associated with the rate of return of spontaneous circulation (ROSC) during human cardiac arrest. Current advances in defibrillator technology enable measurement of CPR quality during resuscitation, but it is not known whether this is directly reflected in cerebral oxygenation. In this descriptive study we aimed to evaluate whether the quality of feedback-monitored CPR during in-hospital cardiac arrest is reflected in near infrared frontal cerebral spectroscopy (NIRS).

Conduct of emergency research in patients unable to give consent--experiences and perceptions of patients, their consent providing next of kin, and treating physicians following a prehospital resuscitation trial.

Objective: According to a directive of the European Parliament, informed consent is required to conduct a clinical trial also in emergencies when the patient is unable to provide consent. In these cases surrogate consent can be obtained from the patient's next of kin. There are no reports describing how patients and their next of kin perceive this policy.

Therapeutic hypothermia after cardiac arrest - cerebral perfusion and metabolism during upper and lower threshold normocapnia.

Background: During cardiac arrest and after successful resuscitation a continuum of ischaemia-reperfusion injury develops. Mild hypothermia exerts protective effects in the postresuscitation phase but also alters CO₂ production and solubility, which may lead to deleterious effects if overlooked when adjusting the ventilation of the resuscitated patient. Using a multimodality approach, the effects of different carbaemic states on cerebral perfusion and metabolism were evaluated during therapeutic hypothermia.

Out-of-hospital cardiac arrests in children.

Prehospital pediatric cardiac arrest is a rare event compared with adult cardiac arrest. Despite the recent advancements in postresuscitation care improving the outcome of adult patients, similar evidence is lacking in pediatric victims of cardiac arrest. In this brief article, the current data on pediatric cardiac arrest occurring in the prehospital setting are reviewed.

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.

Incidence of iatrogenic dyscarbia during mild therapeutic hypothermia after successful resuscitation from out-of-hospital cardiac arrest.

To investigate the incidence of iatrogenic dyscarbia in survivors of out-of-hospital cardiac arrest treated with induced mild hypothermia.We performed a retrospective cohort study of the ventilatory management based on blood gas analyses of patients resuscitated from prehospital cardiac arrest. In the pilot phase, we assessed the ventilatory management in the patients treated in one university hospital during a 4-year study period.