Perceived competency requirements for emergency medical services field supervisors in managing chemical and explosive incidents - qualitative interview study.

Background: Chemical, biological, radiological, nuclear, and explosive (CBRNE) incidents present rare and complex challenges for Emergency Medical Services (EMS), necessitating effective incident command to manage occupational and patient safety risks. EMS incident commanders must make quick decisions under pressure, coordinating medical responses and ensuring personnel's safety. This study examined the perceived competence requirements of Finnish EMS field supervisors in managing C and E incidents.

The experiences of patients not conveyed after evaluation by emergency medical services in Southwest Finland - A qualitative survey study.

Background: The amount of non-critical Emergency Medical Services missions has been increasing. After examination and treatment, paramedics can decide, based on guidelines, not to convey the patient to a healthcare facility. This study aimed to investigate patients' experiences in non-conveyance situations in Southwest Finland.

Patient experience of non-conveyance in the EMS of Southwest Finland: a descriptive survey study.

Background: Emergency Medical Services are dispatched more frequently than before. However, many non-urgent patients do not need ambulance transportation to a healthcare facility after evaluation and treatment on scene. This study explored the experiences of non-conveyed patients.

Rethinking non-urgent EMS conveyance to ED during night-time - a pilot study in Southwest Finland.

Background: The amount of emergency medical service missions has increased internationally in recent years, and emergency departments are overcrowded globally. Previous evidence has shown that patients arriving at the emergency department during nighttime (20 - 08) have to wait longer, are more likely to leave without being seen, and often have non-urgent conditions compared to patients arriving during the day. The objective of this pilot study was to examine what kind of patient groups are conveyed as non-urgent to the hospital by emergency medical service during nighttime and what kind of diagnostic tests and medical interventions those patients receive before morning to identify patient groups that could be non-conveyed or directed to alternative points of care.

The role of emergency medical services in the management of in-hospital emergencies: Causes and outcomes of emergency calls - A descriptive retrospective register-based study.

Background: Medical emergency teams (METs) are in place in some hospitals in Finland to respond to critical emergency events. However, in hospitals without dedicated METs, staff are instructed to call emergency medical services (EMS) to deal with emergencies. This study examined the reasons for calling EMS to hospitals and the outcomes of these calls.

The effect of time of measurement on the discriminant ability for mortality in trauma of a pre-hospital shock index multiplied by age and divided by the Glasgow Coma Score: a registry study.

Background: The shock index (SI) and its derivatives have been shown to predict mortality in severely injured patients, both in pre-hospital and in-hospital settings. However, the impact of the time of measurement on the discriminative ability of the pre-hospital SI is unknown. The aim of this study was to evaluate whether the time of measurement influences the discriminative ability of the SI multiplied by age (SIA) and divided by the Glasgow Coma Score (SIA/G).

Predictive value of shock index variants on 30-day mortality of trauma patients in helicopter emergency medical services: a nationwide observational retrospective multicenter study.

The original shock index (SI) has been further developed to increase its prognostic value. We aimed to evaluate the predictive value of different SI variants on 30-day mortality among severely injured trauma patients in pre-hospital critical care settings. Adult trauma patients in the national Helicopter Emergency Medical Services (HEMS) registry were evaluated based on the primary outcome of 30-day mortality.

Using machine learning to predict subsequent events after EMS non-conveyance decisions.

Background: Predictors of subsequent events after Emergency Medical Services (EMS) non-conveyance decisions are still unclear, though patient safety is the priority in prehospital emergency care. The aim of this study was to find out whether machine learning can be used in this context and to identify the predictors of subsequent events based on narrative texts of electronic patient care records (ePCR).

Methods: This was a prospective cohort study of EMS patients in Finland.

Accuracy of prehospital clinicians' perceived prognostication of long-term survival in critically ill patients: a nationwide retrospective cohort study on helicopter emergency service patients.

Objectives: Prehospital critical care physicians regularly attend to patients with poor prognosis and may limit the advanced therapies. The aim of this study was to evaluate the accuracy of poor prognosis given by prehospital critical care clinicians.

Design: Cohort study.

The development of emergency medical services benefit score: a European Delphi study.

Background: The helicopter emergency services (HEMS) Benefit Score (HBS) is a nine-level scoring system developed to evaluate the benefits of HEMS missions. The HBS has been in clinical use for two decades in its original form. Advances in prehospital care, however, have produced demand for a revision of the HBS.

EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety?

Background: The safety of the Emergency Medical Service's (EMS's) non-conveyance decision was evaluated by EMS re-contacts, primary health care or emergency department (ED) visits, and hospitalization within 48 h. The secondary outcome was 28-day mortality.

Methods: This cohort study used prospectively collected data on non-conveyed EMS patients from three different regions in Finland between June 1 and November 30, 2018.

The first seven years of nationally organized helicopter emergency medical services in Finland - the data from quality registry.

Background: Helicopter Emergency Medical Services (HEMS) play an important role in prehospital care of the critically ill. Differences in funding, crew composition, dispatch criteria and mission profile make comparison between systems challenging. Several systems incorporate databases for quality control, performance evaluation and scientific purposes.

Changing role of EMS -analyses of non-conveyed and conveyed patients in Finland.

Background: Emergency Medical Services (EMS) and Emergency Departments (ED) have seen increasing attendance rates in the last decades. Currently, EMS are increasingly assessing and treating patients without the need to convey patients to health care facility. The aim of this study was to describe and compare the patient case-mix between conveyed and non-conveyed patients and to analyze factors related to non-conveyance decision making.

Mechanism-based population pharmacokinetic and pharmacodynamic modeling of intravenous and intranasal dexmedetomidine in healthy subjects.

Purpose: Dexmedetomidine is an α2-adrenoceptor agonist used for perioperative and intensive care sedation. This study develops mechanism-based population pharmacokinetic-pharmacodynamic models for the cardiovascular and central nervous system (CNS) effects of intravenously (IV) and intranasally (IN) administered dexmedetomidine in healthy subjects.

Method: Single doses of 84 μg of dexmedetomidine were given once IV and once IN to six healthy men.

Pharmacokinetics of prolonged infusion of high-dose dexmedetomidine in critically ill patients.

Introduction: Only limited information exists on the pharmacokinetics of prolonged (> 24 hours) and high-dose dexmedetomidine infusions in critically ill patients. The aim of this study was to characterize the pharmacokinetics of long dexmedetomidine infusions and to assess the dose linearity of high doses. Additionally, we wanted to quantify for the first time in humans the concentrations of H-3, a practically inactive metabolite of dexmedetomidine.

Bioavailability of dexmedetomidine after intranasal administration.

Purpose: The aim of this proof-of-concept study was to characterize the pharmacokinetics and pharmacodynamics of intranasal dexmedetomidine compared with its intravenous administration in a small number of healthy volunteers.

Methods: Single doses of 84 μg of dexmedetomidine were given once intravenously and once intranasally to seven healthy men. Plasma dexmedetomidine concentrations were measured for 10 h, and pharmacokinetic variables were calculated with standard noncompartmental methods.

Is advanced life support better than basic life support in prehospital care? A systematic review.

Background: Prehospital care is classified into ALS- (advanced life support) and BLS- (basic life support) levels according to the methods used. ALS-level prehospital care uses invasive methods, such as intravenous fluids, medications and intubation. However, the effectiveness of ALS care compared to BLS has been questionable.

Highly variable pharmacokinetics of dexmedetomidine during intensive care: a case report.

Introduction: Dexmedetomidine is a selective and potent alpha2-adrenoceptor agonist licensed for use in the sedation of patients initially ventilated in intensive care units at a maximum dose rate of 0.7 mug/kg/h administered for up to 24 hours. Higher dose rates and longer infusion periods are sometimes required to achieve sufficient sedation.

Effect of physician-staffed helicopter emergency medical service on blunt trauma patient survival and prehospital care.

Objective: The aim of the study was to assess the immediate and long-term effect of a helicopter emergency physician giving advanced life support on-scene compared with conventional load and go principle in urban and rural settings in treating blunt trauma patients.

Methods: In a retrospective study, 81 blunt trauma patients treated prehospitally by a physician-staffed helicopter emergency medical service were compared with 77 patients treated before the era of the helicopter emergency medical service. The data were collected in the prehospital and hospital files and a questionnaire was sent to the survivors 3 years after the trauma.