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Abstract: Background: The importance of circulation during cardiopulmonary resuscitation has led to efforts to decrease time without chest compressions (“no-flow time”). The no-flow time from the interruption of chest compressions until defibrillation is referred to as the “pre-shock pause”. A shorter pre-shock pause increases the chance of successful defibrillation. It is unclear whether drug administration affects the length of the pre-shock pause. Our study compares pre-shock pause with and without drug administration in a full-scale simulation. Methods: This was an observational study in an ambulance including 72 junior physicians and a cardiac arrest scenario. Data were extracted by reviewing video recordings of the resuscitation. Sequences including defibrillation and/or drug administration were identified and assigned to one out of four categories: Defibrillation only (DC-only) and drug administration just prior to defibrillation (Drug+DC) for which the pre-shock pause was calculated, and drug administration alone (Drug-only) for which pre-drug time was calculated. Results: DC-only sequences were identified in 68/72 simulations, Drug+DC in 24/72, and Drug-only in 33/72. Median pre-shock pauses were 18s (DC-only) and 32 (Drug+DC), and median pre-drug pause 6. The variation between pauses was statistically significant (p ≪0.001). DC-only and Drug+DC sequences was found in 22/72 simulations. A statistically significant difference of 8s was found between the median pre-shock pauses: 17s (DC-only) and 25 (Drug+DC) (p ≪0.001). For un-paired observations, the pre-shock pause increased with 78% and for paired observations 47%. Conclusions: Drug administration prior to defibrillation was associated with significant increases in pre-shock pauses in this full-scale simulation study. [Copyright &y& Elsevier]

Abstract: Introduction: Physicians are expected to manage their role as teamleader during resuscitation. During inter-hospital transfer the physician has the highest medical credentials on a small team. The aim of this study was to describe physician behaviour as teamleaders in a simulated cardiac arrest during inter-hospital transfer. Our goal was to pinpoint deficits in knowledge and skill integration and make recommendations for improvements in education. Method: An ambulance was the framework for the simulation; the scenario a patient with acute coronary syndrome suffering ventricular fibrillation during transportation. Physicians (graduation age ≤5 years) working in internal medicine departments in Denmark were studied. The ambulance crew was instructed to be passive to clarify the behaviour of the physicians. Results: 72 physicians were studied. Chest compressions were initiated in 71 cases, ventilation and defibrillation in 72. The median times for arrival of the driver in the patient cabin, initiation of ventilation and chest compressions, and first defibrillation were all less than 1min. Medication was administered in 63/72 simulations (88%), after a median time of 210s. Adrenaline was the preferred initial drug administered (58/63, 92%). Tasks delegated were ventilations, chest compressions, defibrillation, and administration of medication (97%, 92%, 42%, and 10% of cases, respectively). Discussion and conclusion: Junior physicians performed well with respect to the treatment given and the delegation of tasks. However, variations in the time of initiation it took for each treatment indicated lack of leadership skills. It is imperative that the education of physicians includes training in leadership. [Copyright &y& Elsevier]

A recent publication demonstrated the possibility of erroneous operation of 2 widely used monitor-defibrillators and observed that the design of user interfaces might contribute to error during operation. During an ambulance simulation training exercise for 72 junior internal medicine physicians that called for defibrillation in the management of cardiac arrest, we observed that in 5 of 192 defibrillation attempts by the physicians, the monitor-defibrillator was inadvertently powered off. When the device is inadvertently powered off, recognition and subsequent steps to defibrillate delayed defibrillation an average of 24 seconds (range 14 to 32 seconds). Our analysis of the controls of this monitor-defibrillator found that the device could be powered off even if fully charged and ready to shock. Redesign of the equipment might prevent this inadvertent event. [Copyright &y& Elsevier]

Emergency patients are frequently assigned nonspecific diagnoses. Nonspecific diagnoses describe observations or symptoms and are found in chapters R and Z of the International Classification of Diseases, 10th edition (ICD-10). Patients with such diagnoses have relatively low mortality, but due to patient volume, the absolute number of deaths is substantial. However, information on cause of short-term mortality is limited. To investigate whether death could be expected for ambulance patients brought to the emergency department (ED) after a 1-1-2 call, released with a nonspecific ICD-10 diagnosis within 24 h, and who subsequently died within 30 days. Retrospective medical record review of adult 1-1-2 emergency ambulance patients brought to an ED in the North Denmark Region during 2017–2021. Patients were divided into three categories: unexpected death, expected death (terminal illness), and miscellaneous. Charlson Comorbidity Index (CCI) was assessed. We included 492 patients. Mortality was distributed as follows: Unexpected death 59.2% (n = 291), expected death (terminal illness) 25.8% (n = 127), and miscellaneous 15.0% (n = 74). Patients who died unexpectedly were old (median age of 82 years) and had CCI 1–2 (58.1%); 43.0% used at least five daily prescription drugs, and they were severely acutely ill upon arrival (24.7% with red triage, 60.1% died within 24 h). More than half of ambulance patients released within 24 h from the ED with nonspecific diagnoses, and who subsequently died within 30 days, died unexpectedly. One-fourth died from a pre-existing terminal illness. Patients dying unexpectedly were old, treated with polypharmacy, and often life-threateningly sick at arrival. [ABSTRACT FROM AUTHOR]

Study Objective: Emergency medical services (EMS) provides out-of-hospital care to patients with life-threatening conditions, but the long-term outcomes of EMS patients are unknown. We seek to determine the long-term mortality of EMS patients in Denmark.Methods: We analyzed linked EMS, hospital, and vital status data from 3 of 5 geographic regions in Denmark. We included events from July 1, 2011, to December 31, 2012. We classified EMS events according to primary dispatch category (unconsciousness/cardiac arrest, accidents/trauma, chest pain, dyspnea, neurologic symptoms, and other EMS patients). The primary outcome was 1-year mortality adjusted for age, sex, and Charlson comorbidity index.Results: Among 142,125 EMS events, primary dispatch categories were unconsciousness or cardiac arrest 5,563 (3.9%), accidents or trauma 40,784 (28.7%), chest pain 20,945 (14.7%), dyspnea 9,607 (6.8%), neurologic symptoms 17,804 (12.5%), and other EMS patients 47,422 (33.4%). One-year mortality rates were unconscious or cardiac arrest 54.7% (95% confidence interval [CI] 53.4% to 56.1%), accidents or trauma 7.8 (95% CI 7.5% to 8.1%), chest pain 8.5% (95% CI 8.1% to 9.0%), dyspnea 27.7% (95% CI 26.7% to 28.7%), neurologic symptoms 14.1% (95% CI 13.6% to 14.7%), and other EMS patients 11.1% (95% CI 10.8% to 11.4%). Compared with other EMS conditions, adjusted 1-year mortality was higher in unconsciousness or cardiac arrest (risk ratio [RR] 2.6; 95% CI 2.5 to 2.7), dyspnea (RR 1.5; 95% CI 1.4 to 1.5), and in neurologic symptoms (RR 1.1; 95% CI 1.0 to 1.1), but lower in chest pain (RR 0.6; 95% CI 0.6 to 0.7) and accidents or trauma (RR 0.8; 95% CI 0.8 to 0.8).Conclusion: EMS patients with unconsciousness or cardiac arrest, dyspnea, and neurologic symptoms are at highest risk of long-term mortality. Our results suggest a potential for outcome improvement in these patients. [ABSTRACT FROM AUTHOR]