Development and internal validation of an algorithm for estimating mortality in patients encountered by physician-staffed helicopter emergency medical services.

Background: Severity of illness scoring systems are used in intensive care units to enable the calculation of adjusted outcomes for audit and benchmarking purposes. Similar tools are lacking for pre-hospital emergency medicine. Therefore, using a national helicopter emergency medical services database, we developed and internally validated a mortality prediction algorithm.

User Needs and Factors Associated With the Acceptability of Audiovisual Feedback Devices for Chest Compression Monitoring in Cardiopulmonary Resuscitation.

The use of audiovisual feedback devices to guide the quality of chest compressions during cardiopulmonary resuscitation has increased in recent years. Audiovisual feedback devices can be classified as integrated (eg, Zoll AED Plus defibrillator) or standalone (eg, CPRmeter). This study aimed to explore users' needs and factors affecting the acceptability of audiovisual feedback devices.

The effect of standalone audio-visual feedback devices on the quality of chest compressions during laypersons' cardiopulmonary resuscitation training: a systematic review and meta-analysis.

Aims: Individual studies that investigated the effect of standalone audio-visual feedback (AVF) devices during laypersons' cardiopulmonary resuscitation (CPR) training have yielded conflicting results. This review aimed to evaluate the effect of standalone AVF devices on the quality of chest compressions during laypersons' CPR training.

Method And Result: Randomized controlled trials of simulation studies recruiting participants without actual patient CPR experience were included.

Intubation first-pass success in a high performing pre-hospital critical care system is not associated with 30-day mortality: a registry study of 4496 intubation attempts.

Background: Lower intubation first-pass success (FPS) rate is associated with physiological deterioration, and FPS is widely used as a quality indicator of the airway management of a critically ill patient. However, data on FPS's association with survival is limited. We aimed to investigate if the FPS rate is associated with 30-day mortality or physiological complications in a pre-hospital setting.

Randomized controlled trial comparing pit crew resuscitation model against standard advanced life support training.

Objectives: Pit crew models are designed to improve teamwork in critical medical situations, like advanced life support (ALS). We investigated if a pit crew model training improves performance assessment and ALS skills retention when compared to standard ALS education.

Methods: This was a prospective, blinded, randomized, and controlled, parallel-group trial.

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.

Standardised data collection in prehospital critical care: a comparison of medical problem categories and discharge diagnoses.

Background: Prehospital medical problem reporting is essential in the management of helicopter emergency medical services (HEMS) operations. The consensus-based template for reporting and documenting in physician-staffed prehospital services exists and the classification of medical problems presented in the template is widely used in research and quality improvement. However, validation of the reported prehospital medical problem is lacking.

Cerebral oxygen desaturation events during and functional outcomes after prehospital anaesthesia: A prospective pilot study.

Background: During prehospital anaesthesia, oxygen delivery to the brain might be inadequate to match the oxygen consumption, with unknown long-term functional outcomes. We aimed to evaluate the feasibility of monitoring cerebral oxygenation during prehospital anaesthesia and determining the long-term outcomes.

Methods: We performed a prospective observational feasibility study in two helicopter emergency medical services units.

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.

The accuracy of preliminary diagnoses made by paramedics - a cross-sectional comparative study.

Background: Clinical decision-making skills of paramedics have been emphasized because of the growing complexity of emergency medicine nursing. A preliminary diagnosis made by a paramedic has an essential role in directing the subsequent care. An accurate preliminary diagnosis improves the patient's outcome.

Exploring Unsupervised Query Paraphrasing to Identify Relevant Search Phrases for a Literature Review.

Literature databases have multifaceted search options, but emerging research areas do not have an established terminology and therefore it is difficult to find relevant literature when conducting a review. This study aimed to explore if an unsupervised paraphrasing approach is useful in identifying relevant search phrases for a literature review on an emerging research topic - situational leadership in critical care. Using an initial set of 12 search phrases, the system was used to propose additional phrases, which were manually classified and further used in an expanded PubMed database search.

An observational study of technical and non-technical skills in advanced life support in the clinical setting.

Objective: Technical skills (TS) and non-technical skills (NTS) are the primary elements ensuring patient safety during advanced life support (ALS) and effective crisis resource management (CRM). Both skills are needed to perform high-quality ALS, though they are traditionally practiced separately. The evidence of the association between NTS and TS in high-quality ALS performance is insufficient.

Reliability of prehospital patient classification in helicopter emergency medical service missions.

Background: Several scores and codes are used in prehospital clinical quality registries but little is known of their reliability. The aim of this study is to evaluate the inter-rater reliability of the American Society of Anesthesiologists physical status (ASA-PS) classification system, HEMS benefit score (HBS), International Classification of Primary Care, second edition (ICPC-2) and Eastern Cooperative Oncology Group (ECOG) performance status in a helicopter emergency medical service (HEMS) clinical quality registry (CQR).

Methods: All physicians and paramedics working in HEMS in Finland and responsible for patient registration were asked to participate in this study.

The reliability and accuracy of operational system data in a nationwide helicopter emergency medical services mission database.

Aim: The aim of this study was to evaluate the reliability and accuracy of documentation in FinnHEMS database, which is a nationwide helicopter emergency service (HEMS) clinical quality registry.

Methods: This is a nationwide study based on written fictional clinical scenarios. Study subjects were HEMS physicians and paramedics, who filled in the clinical quality registry based on the clinical scenarios.

Development of an instrument for the evaluation of advanced life support performance.

Background: Assessing advanced life support (ALS) competence requires validated instruments. Existing instruments include aspects of technical skills (TS), non-technical skills (NTS) or both, but one instrument for detailed assessment that suits all resuscitation situations is lacking. This study aimed to develop an instrument for the evaluation of the overall ALS performance of the whole team.

Two cases of low birth weight infant survival by prehospital emergency hysterotomy.

Background: During maternal cardiac arrest, emergency hysterotomy (EH) is recommended after four minutes of resuscitation, if no signs of spontaneous circulation are detected. This extreme procedure is believed to be potentially beneficial for both the mother and the infant. Both maternal and neonatal survivals seem to be associated to the time delay between the cardiac arrest and the delivery and in-hospital resuscitation location.

Evaluating helicopter emergency medical missions: a reliability study of the HEMS benefit and NACA scores.

Background: The benefits of the Helicopter Emergency Medical Service (HEMS) and dispatch accuracy are continuously debated, and a widely accepted score to measure the benefits of the mission is lacking. The HEMS Benefit Score (HBS) has been used in Finnish helicopter emergency medical services, but studies are lacking. The National Advisory Committee for Aeronautics (NACA) score is widely used to measure the severity of illness or injury in the pre-hospital setting, but it has many critics due to its subjectivity.

Hemoglobin expression in rat experimental granulation tissue.

The general opinion that hemoglobin is only a carrier protein for oxygen and carbon dioxide has been challenged by several recent studies showing hemoglobin expression in other cells than those of the erythroid series, for example, in macrophages. We discovered β-globin expression in rat experimental granulation tissue induced by subcutaneously implanted cellulose sponges. Closer investigation revealed also α-globin expression.

Hydroxyapatite coating of cellulose sponges attracts bone-marrow-derived stem cells in rat subcutaneous tissue.

The presence of bone-marrow-derived stem cells was investigated in a wound-healing model where subcutaneously implanted cellulose sponges were used to induce granulation tissue formation. When cellulose was coated with hydroxyapatite (HA), the sponges attracted circulating haemopoietic and mesenchymal progenitor cells more efficiently than uncoated cellulose. We hypothesized that the giant cells/macrophages of HA-coated sponges recognize HA as foreign material, phagocyte or hydrolyse it and release calcium ions, which are recognized by the calcium-sensing receptors (CaRs) expressed on many cells including haemopoietic progenitors.

Bioactive glass-derived hydroxyapatite-coating promotes granulation tissue growth in subcutaneous cellulose implants in rats.

Granulation tissue was induced in hydroxyapatite-coated cellulose sponges with subcutaneous implantation in rats. A massive inflammatory reaction with an intense foreign body reaction and an increased invasion of fibrovascular tissue was observed by days 1-3 post-operation, whereas tissue growth into the uncoated control implants was much slower and took place mainly on their surfaces. The foreign body reaction in apatite-coated sponges declined after post-operative day 14, and no obvious differences were seen between the two cellulose sponges from 1 month up to 1 year after implantation.

Hydroxyapatite coating of cellulose sponge does not improve its osteogenic potency in rat bone.

Regenerated cellulose sponges were coated biomimetically with hydroxyapatite to increase their osteogenic properties. Induction of apatite precipitation was carried out with bioactive glass in simulated body fluid (SBF) for 24 h and the final coating was carried out in 1.5 x concentrated SBF for 14 days.