European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The Trondheim region's (315 km2, population 154,000) emergency medical service (EMS) provides advanced cardiac life support (ACLS) with combined paramedic and physician response. This EMS system is commonly employed in Norway, yet no population based study of outcome in cardiac arrest has been published to date. This retrospective study reports incidence and outcome from every attempted out-of-hospital cardiopulmonary resuscitation (CPR) during 1990 through 1994 according to the Utstein template. ⋯ Most patients made a favourable cerebral outcome, although nine were severely disabled. This is the first population-based Norwegian study of outcome from out-of-hospital cardiac arrest in this combined paramedic/physician staffed EMS. Incidence, survival and neurological outcome are comparable with results obtained in other EMS systems.
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Road traffic accidents (RTAs) with entrapment are perceived as a challenge to emergency systems because of the severity of the ensuing traumas and the inherent complexity of the rescue procedures. To clarify these two aspects this prospective cohort study enrolling 244 entrapped trauma patients was conducted by a Regional Medical Helicopter Service. Forty-six victims (18.9%) were found dead, 101 (51%) of the 198 patients who reached the hospital alive had an injury severity score (ISS) > or = 16. ⋯ Fourteen patients (13.9%) died during hospitalization. These data demonstrate that a high percentage of entrapped patients require advanced life support (ALS), including on scene intubation and chest decompression. Aggressive field resuscitation and immediate transport to a level 1 trauma centre is associated with a mortality lower than that predicted by TRISS in spite of the prolonged prehospital time.
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During the extrication process the trauma victim is at high risk for additional injuries or aggravation of existing lesions. Improper handling during extrication with poor concern and knowledge of the ongoing resuscitation process may increase the time spent at the scene and expose the patient to unnecessary risks. Earlier studies report a significant number of neurological injuries that appear to be a result of the extrication process, or of inadequate immobilization during transport. ⋯ The complexity of the scenarios increases throughout the course and different extrication techniques and strategies are practised. Both the times to extrication and on-scene times were reduced during the 3-day course. Therapeutic interventions and handling of the patient were also improved, in terms of early recognition of medical and technical risks and reduction of the time of no therapy.
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The quality of the treatment by emergency physicians of patients with abdominal complaints, who visited the emergency department (ED) of a city hospital (OLVG), Amsterdam, The Netherlands, was evaluated in a prospective observational study. During 6 months 1853 patients with abdominal complaints visited the emergency department of the OLVG hospital, 1221 patients (66%) without referral by a general practitioner (GP). Of these 1221 patients, 933 (76%) were treated by the emergency physician without consulting a specialist. ⋯ It is concluded that most patients with abdominal complaints visit the ED of this hospital without referral by their GP. Of these patients, the emergency physician can treat 76% without further specialist consultation. In seven patients (1.1%) the diagnosis was missed.