Patients' use of Danish emergency medical services before and during the COVID-19 pandemic: a register-based study.

Background: During the COVID-19 pandemic, disturbing images of ambulances unable to respond to the demands for prehospital assistance appeared from several parts of the world. In Denmark, however, a notion occurred that the demands for emergency medical assistance declined. The purpose of this study was to compare the patients' use of the Danish Emergency Medical Services (EMS) before and during the COVID-19 pandemic.

Emergency Call versus General Practitioner Requested Ambulances - Patient Mortality, Disease Severity and Pattern.

Introduction: Ambulance requests by general practitioners for primary care patients (GP-requested) are often omitted in studies on increased demand within emergency care but may comprise a substantial patient group. We aimed to assess acute severity, intensive care unit (ICU) admission, and diagnostic pattern, including comorbidity, and mortality among GP-requested ambulance patients, compared to emergency call ambulance patients. Our hypothesis was that emergency call patients had more severe health issues than GP-requested ambulance patients.

Development and inter-rater reliability of a simple prehospital mobility score for use in emergency patients.

Background: Mobility assessment enhances the ability of vital sign-based early warning scores to predict risk. Currently mobility is not routinely assessed in a standardized manner in Denmark during the ambulance transfer of unselected emergency patients. The aim of this study was to develop and test the inter-rater reliability of a simple prehospital mobility score for pre-hospital use in ambulances and to test its inter-rater reliability.

A classification system for identifying patients dead on ambulance arrival: a prehospital medical record review.

Background: Patients dead before arrival of the ambulance or before arrival at hospital may be in- or excluded in mortality analyses, making comparison of mortality difficult. Often only physicians are allowed to declare death, thereby impeding uniform registration of prehospital death. Many studies do not report detailed definitions of prehospital mortality.

Critically deviating vital signs among patients with non-specific diagnoses-A register-based historic cohort study.

Background: One third of ambulance patients receive non-specific diagnoses in hospital. Mortality is 3-4%, however due to the high patient volume this group accounts for 20% of all deaths at day 30. Non-specific diagnoses do not provide much information on causes for death.

Prehospital Early Warning Scores to Predict Mortality in Patients Using Ambulances.

Importance: Early warning scores (EWSs) are designed for in-hospital use but are widely used in the prehospital field, especially in select groups of patients potentially at high risk. To be useful for paramedics in daily prehospital clinical practice, evaluations are needed of the predictive value of EWSs based on first measured vital signs on scene in large cohorts covering unselected patients using ambulance services.

Objective: To validate EWSs' ability to predict mortality and intensive care unit (ICU) stay in an unselected cohort of adult patients who used ambulances.

Decision on non-conveyance of patients suspected of COVID-19 in a novel arrangement with assessment visits by paramedics at home.

Background: During the first weeks of the outbreak of the coronavirus disease 2019 (COVID-19), the North Denmark emergency medical services authorised paramedics to assess patients suspected of COVID-19 at home, and then decide if conveyance to a hospital was required. The aim of this study was to describe the cohort of patients who were assessed at home and their outcomes in terms of subsequent hospital visits and short-term mortality.

Methods: This was a historical cohort study in the North Denmark Region with consecutive inclusion of patients suspected of COVID-19 who were referred to a paramedic's assessment visit by their general practitioner or an out-of-hours general practitioner.

More emergency patients presenting with chest pain.

Introduction: Throughout recent years the demand for prehospital emergency care has increased significantly. Non-traumatic chest pain is one of the most frequent complaints. Our aim was to investigate the trend in frequency of the most urgent ambulance patients with chest pain, subsequent acute myocardial infarction (AMI) diagnoses, and 48-hour and 30-day mortality of both groups.

Prevalence and mortality among patients with COPD hospitalised by ambulance in the 2007-2018 period.

Introduction: Severe exacerbations in chronic obstructive pulmonary disease (COPD) may require acute medical attention by calling the emergency medical services (EMS) for an ambulance. The 30-day mortality for EMS patients with respiratory diseases appears to have stagnated, which may be due to changes in age, comorbidity or disease severity. We examined trends of occurrence, severity and mortality for EMS patients with COPD.

How Patients Who Are Transported by Ambulance Experience Dyspnea and the Use of a Dyspnea Scale: A Qualitative Study.

Approximately 7% of all dispatched ambulances in Denmark are for patients for whom breathing difficulties are the main cause for using ambulance services. Objective measurements are routinely carried out in the ambulances, but little is known of the patients' subjective experience of dyspnea. The purpose of this study was to investigate how patients with acute dyspnea, transported to hospital by ambulance, experience their situation, along with their experience of the use of a dyspnea scale.

Prehospital Release of Patients After Treatment in an Anesthesiologist-Staffed Mobile Emergency Care Unit.

Importance: Prehospital treatment and release of patients may reduce unnecessary transports to the hospital and may improve patient satisfaction. However, the safety of patients should be paramount.

Objective: To determine the extent of unplanned emergency department (ED) contacts, short-term mortality, and diagnostic patterns in patients treated and released by a prehospital anesthesiologist supervising a mobile emergency care unit (MECU).

Assessed and discharged - diagnosis, mortality and revisits in short-term emergency department contacts.

Background: Emergency departments (EDs) experience an increasing number of patients. High patient flow are incentives for short duration of ED stay which may pose a challenge for patient diagnostics and care implying risk of ED revisits or increased mortality. Four hours are often used as a target time to decide whether to admit or discharge a patient.

Which symptoms pose the highest risk in patients calling for an ambulance? A population-based cohort study from Denmark.

Background: Emergency medical service patients are a vulnerable population and the risk of mortality is considerable. In Denmark, healthcare professionals receive 112-emergency calls and assess the main reason for calling. The main aim was to investigate which of these reasons, i.

Understanding the Effect of Electronic Prehospital Medical Records in Ambulances: A Qualitative Observational Study in a Prehospital Setting.

Little is known of ambulance professionals' work practices regarding the use of medical records, their communication with patients, before and during hand over to Emergency Departments (ED). An electronic Prehospital Medical Record (ePMR) has been implemented in all Danish ambulances since 2015. Our aim was to investigate the use of ePMR and whether it affected the ambulance professionals' clinical practice.

Predicting outcome for ambulance patients with dyspnea: a prospective cohort study.

Objective: To validate the discrimination and classification accuracy of a novel acute dyspnea scale for identifying outcomes of out-of-hospital patients with acute dyspnea.

Methods: Prospective observational population-based study in the North Denmark Region. We included patients from July 1, 2017 to September 24, 2019 assessed as having acute dyspnea by the emergency dispatcher or by emergency medical services (EMS) personnel.

Patient experience of severe acute dyspnoea and relief during treatment in ambulances: a prospective observational study.

Background: Acute dyspnoea is common among ambulance patients, but little is known of the patients' experience of symptom. We aimed to investigate ambulance patients initial perceived intensity of acute dyspnoea, and whether they experienced relief during prehospital treatment. Furthermore, to investigate the validity and feasibility of using a subjective dyspnoea score in the ambulance, and its association with objectively measured vital signs.

Completeness in the recording of vital signs in ambulances increases over time.

Introduction: In 2006, the North Denmark Region implemented the electronic prehospital patient medical record (PPR), amPHI, in the region's prehospital emergency medical service. In 2015, a new nationwide version was implemented. Our aim was to investigate the completeness and correctness of registrations of vital sign data in the PPR after the initial introduction and after the implementation of the new PPR version.

The Danish prehospital emergency healthcare system and research possibilities.

The emergency medical healthcare system outside hospital varies greatly across the globe - even within the western world. Within the last ten years, the demand for emergency medical service systems has increased, and the Danish emergency medical service system has undergone major changes.Therefore, we aimed to provide an updated description of the current Danish prehospital medical healthcare system.

Symptom, diagnosis and mortality among respiratory emergency medical service patients.

Objective: Breathing difficulties and respiratory diseases have been under-reported in Emergency Medical Services research, despite these conditions being prevalent with substantial mortality. Our aim was two-fold; 1) to investigate the diagnostic pattern and mortality among EMS patients to whom an ambulance was dispatched due to difficulty breathing, and 2) to investigate the initial symptoms and mortality for EMS patients diagnosed with respiratory diseases in hospital.

Methods: Population-based historic cohort study in the North Denmark Region 2012-2015.

Diagnosis and mortality of emergency department patients in the North Denmark region.

Background: Emergency departments handle a large proportion of acute patients. In 2007, it was recommended centralizing the Danish healthcare system and establishing emergency departments as the main common entrance for emergency patients. Since this reorganization, few studies describing the emergency patient population in this new setting have been carried out and none describing diagnoses and mortality.

Trends in diagnostic patterns and mortality in emergency ambulance service patients in 2007-2014: a population-based cohort study from the North Denmark Region.

Objective: Demand for ambulances is growing. Nevertheless, knowledge is limited regarding diagnoses and outcomes in patients receiving emergency ambulances. This study aims to examine time trends in diagnoses and mortality among patients transported with emergency ambulance to hospital.

Cuff Algometry for Estimation of Hyperalgesia and Pain Summation.

Objective: Cuff algometry is useful to assess pain sensitivity mechanisms, but effects of cuff position and stimulation pattern are not clear.

Methods: In 20 healthy volunteers, cuff pain detection threshold (PDT) and pain tolerance (PTT) were recorded with cuffs accommodating two individual chambers at four locations (eight positions) along the leg, using ramp inflation (1 kPa/s) until subjects indicated PDT and PTT. Repeated stimulations (1-s stimulation, 4-s break) with a staircase increase in stimulus intensity (5 kPa/step) were used to assess PDT and PTT on a single location.