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Background - Rural areas have increased injury mortality with a high pre-hospital death rate. Knowledge concerning the impact of psychoactive substances on injury occurrence is lacking for rural arctic Norway. These substances are also known to increase pre-, per- and postoperative risk. The aim was by prospective observational design to investigate the prevalence and characteristics of psychoactive substance use among injured patients in Finnmark county. Methods - From January 2015 to August 2016, patients ≥18 years admitted to hospitals in Finnmark due to injury were approached when competent. Blood was analysed for ethanol, sedatives, opioids, hypnotics and illicit substances in consenting patients, who completed a questionnaire gathering demographic factors, self-reported use/behaviour and incident circumstances. Results - In 684 injured patients who consented to participation (81% consented), psychoactive substances were detected in 35.7%, alcohol being the most prevalent (23%). Patients in whom substances were detected were more often involved in violent incidents (odds ratio 8.92 95% confidence interval 3.24-24.61), indicated harmful use of alcohol (odds ratio 3.56, 95% confidence interval 2.34-5.43), reported the incident being a fall (odds ratio 2.21, 95% confidence interval 1.47-3.33) and presented with a reduced level of consciousness (odds ratio 3.91, 95% confidence interval 1.58-9.67). Subgroup analysis revealed significant associations between testing positive for a psychoactive substance and being diagnosed with a head injury or traumatic brain injury. Conclusion - A significant proportion of injured patients had used psychoactive substances prior to admission. Use was associated with violence, falls, at-risk alcohol consumption, decreased level of consciousness on admittance and head injury.

Introduction: A rural gradient in trauma mortality disfavoring remote inhabitants is well known. Previous studies have shown higher risk of traumatic deaths in rural areas in Norway, combined with a paradoxically decreased prevalence of non-fatal injuries. We investigated the risk of fatal and severe non-fatal injuries among all adults in Norway during 2002–2016. Methods: All traumatic injuries and deaths among persons with a residential address in Norway from 2002–2016 were included. Data were collected from the Norwegian National Cause of Death Registry and the Norwegian Patient Registry. All cases were stratified into six groups of centrality based on Statistics Norway's classification system, from most urban (group one) to least urban/most rural (group six). Mortality and injury rates were calculated per 100,000 inhabitants per year. Results: The mortality rate differed significantly among the centrality groups (p Conclusions: Fatal and non-fatal injury risks increased in parallel with increasing rurality. The lowest risk was in the second most urban region, followed by the most urban (capital) region, yielding a J-shaped risk curve. Transport injuries had the steepest urban–rural gradient.

Source at https://doi.org/10.1186/s13049-017-0457-y . Background: Non-operative management of splenic injuries has become the treatment of choice in hemodynamically stable patients over the last decades. The aim of the study is to describe the incidence, initial treatment and early outcome of patients with splenic injuries on a national level. Methods: All hospitals in Norway admitting trauma patients were invited to participate in the study. The study period was January through December 2013. The hospitals delivered anonymous data on primarily admitted patients with splenic injury. Results: Three of the four regional trauma centers and 26 of the remaining 33 acute care hospitals delivered data on a total of 151 patients with splenic injury indicating an incidence of 4 splenic injuries per 100,000 inhabitants/year, and a median of 4 splenic injuries per hospital per year. A total of 128 (85%) patients were successfully treated non-operatively including 20 patients who underwent an angiographic procedure. The remaining 23 (15%) patients underwent open splenectomy or spleen-preserving surgery. Conclusion: Most patients with splenic injuries are managed non-operatively. Despite the low number of splenic injuries per hospital, the results indicate satisfactory outcome on a national level.

Introduction - Geriatric patients have a high risk of poor outcomes after trauma and is a rapid-increasing group within the trauma population. Given the need to ensure that the trauma system is targeted, efficient, accessible, safe and responsive to all age groups the aim of the present study was to explore the epidemiology and characteristics of the Norwegian geriatric trauma population and assess differences between age groups within a national trauma system. Materials and methods - This retrospective analysis is based on data from the Norwegian Trauma Registry (2015-2018). Injury severity was scaled using the Abbreviated Injury Scale (AIS), and the New Injury Severity Score (NISS). Trauma patients 16 years or older with NISS ≥9 were included, dichotomized into age groups 16–64 years (Group 1, G1) and ≥65 years (Group 2, G2). The groups were compared with respect to differences in demographics, injury characteristics, management and outcome. Descriptive statistics and relevant parametric and non-parametric tests were used. Results - Geriatric patients proved to be at risk of sustaining severe injuries. Low-energy falls predominated in G2, and the AIS body regions ‘Head’ and ‘Pelvis and lower extremities’ were most frequently injured. Crude 30-day mortality was higher in G2 compared to G1 (G1: 2.9 vs. G2: 13.6%, P Conclusion - In this nationwide study comparing adult and geriatric trauma patients, geriatric patients were found to have a higher mortality, receive less frequently advanced prehospital treatment and transportation, and a lower TTA rate. This is surprising in the setting of a Nordic country with free access to publicly funded emergency services, a nationally implemented trauma system with requirements to pre- and in-hospital services and a national trauma registry with high individual level coverage from all trauma-receiving hospitals. Further exploration and a deeper understanding of these differences is warranted.

Background A debate regarding the potential harmful effects of rigid neck collar and backboard usage among prehospital and hospital care providers in Norway provoked the development of an evidence-based guideline. “The Norwegian guideline for the prehospital management of adult trauma patients with potential spinal injury” was developed with rigorous scientific methods and published in 2016. An e-learning course was developed in parallel. The aim of this study is to explore whether emergency medical services personnel in Norway have implemented the guideline, and to what extent the e-learning course was applied during the implementation process. Method An electronic survey was distributed individually to registered prehospital personnel in Norway 18 months after publication of the guideline. Results In all, 938 of 5500 (17%) EMS personnel responded to the survey. More than one-half confirmed knowledge of the guideline; among these, 56% claimed that the guideline was implemented in the service they work. Not having responded to trauma cases in real life was the main reason for not having executed the guideline. The e-learning course had been completed by 18% of respondents. Conclusion Although the guideline has not been authorized or made compulsory by national authorities, one-half of respondents with knowledge of the guideline reported it as implemented. E-learning did not seem to have affected the implementation. The guideline was developed based on perceived needs among care providers, and this probably facilitated implementation of the guideline. Electronic supplementary material The online version of this article (10.1186/s13049-019-0660-0) contains supplementary material, which is available to authorized users.

Previous studies have shown a high occurrence of injuries and deaths related to the use of snowmobiles and other off-road vehicles in Northern Norway. No public statistics are available to permit monitoring of these findings over time. The objective of our study was to provide new figures for the prevalence of injuries and deaths from the use of snowmobiles and other off-road vehicles, and assess the consistency between different sources of data.Information on registered deaths and personal injuries requiring hospitalisation in Northern Norway in the period 1 January 2013-31 December 2014 was collected from the police and hospitals. We also searched through open online sources.We found 7 deaths and 87 personal injuries requiring hospitalisation: 13 incidents with ATVs and 81 involving snowmobiles. Median age was 31.5 years, and 41 (44 %) victims were below 30 years of age. All the fatalities and 66 (76 %) of those injured were men. Altogether 42 (45 %) of the incidents had occurred in Finnmark county. Of the seven fatalities, the police found six in their records and the hospitals found two. In searching through open online sources we found one further ATV-related and three snowmobile-related fatalities in the same region and period.No reliable records of fatalities and personal injuries resulting from the use of snowmobiles and ATVs are available. The findings of this study may serve as a reference point for preventive efforts by the police and health services and for purposes of further study.

The aim of the present study was to assess potential long-term reduction in health-related quality of life (HRQOL) in adult trauma patients 2-7 years after discharge from an intensive care unit (ICU), and to study possible determinants of the HRQOL reduction.Follow-up study of a cohort of 341 trauma patients admitted to the ICU of a university hospital during 1998-2003. Of the 228 eligible patients, 210 (92%) completed the study. A telephone interview using the EuroQol 5-D (EQ-5D) was conducted. Patients reported their HRQOL both at present and before trauma.Before trauma 88% reported in retrospect no problem in any EQ-5D dimension, compared with 20% at follow-up. After trauma (median 4.0 years) 58% suffered pain/discomfort, 44% reported alterations in usual activities, 40% reduced mobility, 35% anxiety/depression, and 15% limited autonomy. A total of 74% experienced reduction in HRQOL. Severe problems were reported by 16%. Women experienced more anxiety/depression than men. Simplified Acute Physiology Score (SAPS) II and Injury Severity Score (ISS) were significantly associated with impaired HRQOL, while age was not. Patients with severe head injury reported better HRQOL than those without severe head injury.More than 2 years post-injury, 74% reported impaired HRQOL but only 16% had severe problems. The majority still suffered pain/discomfort, indicating that pain management is a key factor in improving long-term outcome after severe trauma.

Background - Finnmark, Northern Norway, had a mortality rate for paediatric injury in 1998‐2007 that was more than twice the national average. We investigated whether this rate had decreased in 2008‐2015 after improvements in emergency care. We also compared the mortality rate to rates of non‐fatal injury and trauma team activation both regionally and in Norway. Methods - The study was based on 4 national registries. Mortality and injury rates were calculated per 100 000 persons per year. The study population was divided into age groups; 0‐5, 6‐10, 11‐15 and 16‐17 years. Results - Between 1998‐2007 and 2008‐2015 there was an overall decrease in paediatric mortality rate due to external causes in Norway in total from 7.1 to 4.0. Despite this, in 2008‐2015, the mortality rate remained 2.5 times higher in Finnmark than in Norway (9.7, RR = 2.5 CI 1.4‐4.3, P = 0.001), similar to findings for 1998‐2007. Finnmark had half the rate of non‐fatal injuries in 1999‐2007 (5052, RR = 0.6, 95% CI 0.6‐0.7, P < 0.001) and in 2008‐2015 (3893, RR = 0.5, 95% CI 0.5‐0.6, P < 0.001) as in Norway. The rate of trauma team activation was similar in Finnmark and Norway. Conclusions - The risk of injury‐related death remained significantly higher, while the overall risk of non‐fatal injury was significantly reduced for children in rural Northern Norway. Thus, injuries in this rural area seem to be less frequent but more severe. There is a need for detailed examination of each death to determine possible preventive measures.

ObjectivesExplore the function of three specific modes of talk (discourse types) in decision-making processes.DesignTen real-life admissions of patients with critical illness were audio/video recorded and transcribed. Activity-type analysis (a qualitative discourse analytical method) was applied.SettingInterdisciplinary emergency teams admitting patients with critical illness in a Norwegian university hospital emergency department (ED).ParticipantsAll emergency teams consisted of at least two internal medicine physicians, two ED nurses, one anaesthetist and one nurse anaesthetist. The number of healthcare professionals involved in each emergency team varied between 11 and 20, and some individuals were involved with more than one team.ResultsThe three discourse types played significant roles in team decision-making processes when negotiating meaning. Online commentaries (ONC) and metacommentaries (MC) created progression while offline commentaries (OFC) temporarily placed decisions on hold. Both ONC and MC triggered action and distributed tasks, resources and responsibility in the team. OFC sought mutual understanding and created a broader base for decisions.ConclusionA discourse analytical perspective on team talk in medical emergencies illuminates both the dynamics and complexity of teamwork. Here, we draw attention to the way specific modes of talk function in negotiating mutual understanding and distributing tasks and responsibilities in non-algorithm-driven activities. The analysis uncovers a need for an enhanced focus on how language can trigger safe team practice and integrate this knowledge in teamwork training to improve communication skills in ad hoc emergency teams.

This is the peer reviewed version of the following article: Straumann, G.S.H., Austvoll-Dahlgren, A.A., Holte, H. & Wisborg, T.W. (2018). Effect of requiring a general practitioner at scenes of serious injury: A systematic review. Acta Anaesthesiologica Scandinavica, 62(9), 1194-1199, which has been published in final form at https://doi.org/10.1111/aas.13174. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. Background - In Norway, each municipality is responsible for providing first line emergency healthcare, and it is mandatory to have a primary care physician/general practitioner on call continuously. This mandate ensures that a physician can assist patients and ambulance personnel at the site of severe injuries or illnesses. The compulsory presence of the general practitioner at the scene could affect different parts of patient treatment, and it might save resources by obviating resources from secondary healthcare, like pre‐hospital anaesthesiologists and other specialized resources. This systematic review aimed to examine how survival, time spent at the scene, the choice of transport destination, assessment of urgency, the number of admissions, and the number of cancellations of specialized pre‐hospital resources were affected by the presence of a general practitioner at the scene of a suspected severe injury. Methods - We searched for published and planned systematic reviews and primary studies in the Cochrane Library, Medline, Embase, OpenGrey, GreyLit and trial registries. The search was completed in December 2017. Two individuals independently screened the references and assessed the eligibility of all potentially relevant studies. Results - The search for systematic reviews and primary studies identified 5981 articles. However, no studies met the pre‐defined inclusion criteria. Conclusion - No studies met our inclusion criteria; consequently, it remains uncertain how the presence of a general practitioner at the injury scene might affect the selected outcomes.

Source at https://doi.org/10.1111/aas.12931. Background: Studies of severely injured patients suggest that advanced pre‐hospital care and/or rapid transportation provides a survival benefit. This benefit depends on the disposition of resources to patients with the greatest need. Norway has 19 Emergency Helicopters (HEMS) staffed by anaesthesiologists on duty 24/7/365. National regulations describe indications for their use, and the use of the national emergency medical dispatch guideline is recommended. We assessed whether severely injured patients had been treated or transported by advanced resources on a national scale. Methods: A national survey was conducted collecting data for 2013 from local trauma registries at all hospitals caring for severely injured patients. Patients were analysed according to hospital level; trauma centres or acute care hospitals with trauma functions. Patients with an Injury Severity Score (ISS) > 15 were considered severely injured. Results: Three trauma centres (75%) and 17 acute care hospitals (53%) had data for trauma patients from 2013, a total of 3535 trauma registry entries (primary admissions only), including 604 victims with an ISS > 15. Of these 604 victims, advanced resources were treating and/or transporting 51%. Sixty percent of the severely injured admitted directly to trauma centres received advanced services, while only 37% of the severely injured admitted primarily to acute care hospitals received these services. Conclusion: A highly developed and widely distributed HEMS system reached only half of severely injured trauma victims in Norway in 2013.

Background Death after injury with low energy has gained increasing focus lately, and seems to constitute a significant amount of trauma-related death. The aim of this study was to describe the epidemiology of deaths from low-energy trauma in a rural Norwegian cohort. Methods All deaths from external causes in Finnmark County, Norway, from 1995 to 2004 were identified retrospectively through the Norwegian Cause of Death Registry. Deaths caused by hanging, drowning, suffocation, poisoning, and electrocution were excluded. Trauma was categorised as high energy or low energy based on mechanism of injury. All low-energy trauma deaths were then reviewed. Results There were 262 cases of trauma death during the period. Low-energy trauma counted for 43% of the trauma deaths, with an annual crude death rate of 13 per 100,000 inhabitants. Low falls accounted for 99% of the injuries. Fractures were sustained in 89% of cases and head injuries in 11%. Ninety per cent of patients had pre-existing medical conditions, and the median age was 82 years. Death was caused by a medical condition in 85% of cases. Fifty-two per cent of the patients died after discharge from the hospital. Conclusion In this cohort, low-energy trauma was a significant contributor to trauma related death, especially among elderly and patients with pre-existing medical conditions.

Accepted manuscript version. Published version is available at http://dx.doi.org/10.1016/j.amj.2013.08.004 Introduction: Flight nurses in the Norwegian National Air Ambulance Service are specialist nurse anesthetists or intensive care nursing specialists. For air ambulance bases far from hospitals, these nurses represent otherwise unavailable competencies. This study reports a 6-year experience with flight nurse participation in local emergencies beyond the transportation phase. Methods: The fixed-wing air ambulance base in Alta, Northern Norway (20,000 inhabitants), with two aircraft and two on-call teams, is 150 km by road from the nearest hospital. We did a prospective registration of all emergency non-flight missions near the air ambulance base through January 1, 2005, to December 31, 2010. Results: The 217 completed missions corresponded to three missions per month, half during daytime. Twentythree percent of patients were under age 18, injury rate was high (36%), and 63% had potentially or manifest life-threatening conditions while 11% died during treatment. One third of all missions (67 of 217) resulted in an air ambulance flight to the hospital. Conclusion: Mission frequency did not significantly reduce flight availability, and precision in case selection for this special service was good. The use of flight nurses in the local community promotes equal access to advanced medical services for populations far from hospitals.

ObjectiveThe transfer of experiences gained after prehospital medical responses to major incidents has largely been nonsystematic, and better-structured reporting methods have been advocated. A consensus-based template was recently created and implemented as an open-access website. This qualitative study assessed the feasibility of using the template and reporting site.MethodsInformants who had used or who had been asked to use the template were interviewed. The semi-structured interviews were transcribed verbatim, and the transcripts were analyzed by using an inductive approach based on grounded theory methodology.ResultsThe major theme identified was a need for “defining purpose” as explained by the minor themes “relevance,” “scope,” “resources,” and “usefulness.” Informants reported that the template content needed to be revised and that the scope and rationale behind each question should be conveyed to the user. Resources necessary for reporting and clarity regarding the aim and outcome also need to be communicated to users and policy-makers. The interface between informants and the template is critical.ConclusionsInformants considered the template and website useful but reported that the workload exceeded their expectations. Despite pilot testing of the template before implementation, early revision of the template is recommended. (Disaster Med Public Health Preparedness. 2017;11:403–406)

The geography of Norway has led to an initiative to train teams from rural hospitals in damage control surgery using a team-oriented approach based on Crew Resource Management. Our aim was to evaluate this approach and its impact on trauma care in rural hospitals across Norway.Thirty-eight teams from 21 hospitals participated in 10 courses (during the years 2003-2006) where providers from the same hospital trained as a team. Each course consisted of interactive lecture modules and operative sessions on live porcine models that emphasize communication, collaboration and team-based problem solving. The data collection tools were a postcourse questionnaire and a phone survey of participating hospitals.Teams consisted of surgeons (34%), operating room nurses (35%), and anesthesiology staff (31%). Almost all course participants (N = 228, 99%) reported a dramatic increase in their proficiency with damage control techniques. There was a mean increase of 2.3 points in proficiency with extraperitoneal pelvic packing and 1.5 points with emergency thoracotomy on a 5-step Likert scale. The team approach was perceived as crucial by 218 (94%) of participants. The phone survey revealed 12 cases of lifesaving rural damage control operations by course participants in the past 3 years (estimated cost: $15,075 per life saved). Of the 18 hospitals surveyed, 17 modified their trauma protocols as a result of the course.Teaching damage control surgery using a team-oriented approach is an innovative educational method for rural hospitals.

Because the hospitals in Norway are mostly rural community hospitals that see life-threatening trauma only infrequently, we developed a course in damage control surgery based on a live porcine model in 1999. The course also focuses on teamwork and leadership training based on crew resource management principles. The aim of this study was to evaluate the direct educational benefit from the course and whether participants had used the damage control techniques in their subsequent daily practice.A total of 103 participants completed 2 questionnaires about the self-efficacy for damage control surgery, the first at completion of the course and the second at least 6 months after the course.There was a significant increase in the number of trauma team members who felt comfortable performing damage control surgery (from 17% before the course to 62% at followup; p0.001). Almost half the surgeons and operating room nurses reported using damage control techniques in their subsequent practice. Participants considered the focus on team-oriented training important. Four of every five participants thought this course had improved their ability to handle severely injured patients.This study shows that a team-oriented operative trauma course is not only beneficial in the short term, but the principles and techniques learned are subsequently applied by the graduates in their daily practice. Course content and structure, particularly the emphasis on integral operating room teams working together, is especially suitable for the rural setting.

Background Bystander first aid and basic life support can likely improve victim survival in trauma. In contrast to bystander first aid and out-of-hospital cardiac arrest, little is known about the role of bystanders in trauma response. Our aim was to determine how frequently first aid is given to trauma victims by bystanders, the quality of this aid, the professional background of first-aid providers, and whether previous first-aid training affects aid quality. Methods We conducted a prospective 18-month study in two mixed urban–rural Norwegian counties. The personnel on the first ambulance responding to trauma calls assessed and documented first aid performed by bystanders using a standard form. Results A total of 330 trauma calls were included, with bystanders present in 97% of cases. Securing an open airway was correctly performed for 76% of the 43 patients in need of this first-aid measure. Bleeding control was provided correctly for 81% of 63 patients for whom this measure was indicated, and prevention of hypothermia for 62% of 204 patients. Among the first-aid providers studied, 35% had some training in first aid. Bystanders with documented first-aid training gave better first aid than those where first-aid training status was unknown. Conclusions A majority of the trauma patients studied received correct pre-hospital first aid, but still there is need for considerable improvement, particularly hypothermia prevention. Previous first-aid training seems to improve the quality of first aid provided. The effect on patient survival needs to be investigated.

Several earlier studies have shown that doctors in local out-of-hours emergency primary health care participate in call-outs to varying degrees. It is the out-of-hours doctor who decides whether to respond with a call-out. We wished to study the assessments that form the basis of this decision.We interviewed the out-of-hours doctors in the county of Hordaland who had been alerted about an emergency incident on the health radio network during an evening or night shift, apart from at weekends. The interview period lasted from July to October 2012 and was linked directly to specific alarm calls.There were 252 relevant incidents, 72 of which were investigated. A total of 47 of the 95 doctors contacted were interviewed (49%). The doctor responded with a call-out in 65 % of the incidents. Normally it was the content of the message about the patient's medical condition that was critical for the doctor's decision to respond with a call-out, while it was most often practical aspects that meant that she/he did not respond in this way. When the doctor responded with a call-out, and later assessed the call-out as necessary, the patient's need for medical expertise was the most important reason given.In the incidents studied, the decision on whether or not to respond with a call-out was based on a balanced consideration of the patient's needs and what was practically possible for the doctor. The out-of-hours doctors experienced a need for medical expertise in many emergency medical situations.

CONTEXT & OBJECTIVE: Norwegian hospitals' trauma teams are seldom exposed to severely injured patients. We developed and implemented a one-day multi-professional training course for hospital trauma teams in order to improve communication, cooperation and leadership. METHODS: Training courses were held in 28 Norwegian hospitals with learning objectives: improved team work, common understanding of treatment priorities and principles, communication skills, and threats to efficient communication. Two trauma teams in each hospital had two consecutive simulations in their hospital's own emergency room, as part of the course. Simulation was based on real cases, with a low-fidelity mannequin as patient. Participants completed questionnaires before and after the training course. RESULTS: A total of 2,860 trauma team members participated in the courses, of which 1,237 took part in the simulation. Independent of hospital size, the participants reported leadership and communication to be major obstacles during their last real trauma team participation. Immediately after the training, all participants reported highly fulfilled educational expectations and a high perception of learning, and taking part in the practical simulation improved the evaluation. Nurses scored their outcome significantly higher than physicians. Participants from minor hospitals reported as great a benefit from the training as personnel from major hospitals. CONCLUSIONS: Local team training is a feasible approach and team simulation offers an excellent opportunity to practise demanding and infrequent challenges. The simulation format makes it possible to integrate training on interpersonal skills as well as communication and leadership under stress. Continued requests for such training in Norway support this conclusion.

Background Trauma systems have improved outcomes for injured patients, but might be challenging to implement. We assessed the implementation of a trauma system in Norway after recommendations for a national trauma system were published in 2007, with a focus on elements in acute care hospitals. Methods All hospitals in Norway, except for the four regional trauma centres, admitting injured patients at the time of the study were included in a telephone survey. The questionnaire was administered during May 2013 by the regional trauma coordinators who interviewed the local trauma coordinator and/or the local doctor responsible for trauma care in all the acute care hospitals. The main categories were availability of the trauma team and team training, written procedures, preparedness and training of personnel. The compliance to a set of 17 predefined trauma system criteria was evaluated at each institution. Results Of the 35 acute care hospitals in Norway admitting trauma patients at the time of the survey, all were included. The median number of fulfilled criteria was 14. Major deficiencies were found in fulfilling competence criteria, maintaining a local trauma registry, and trauma audits. The number of fulfilled criteria correlated strongly with the size of the hospital and the frequency of trauma team activation. Conclusions Shortcomings in requirements for lower-level trauma care hospitals correlate to hospital size and frequency with which the trauma team is activated. In order to fulfill the minimum requirements, smaller hospitals should receive more attention.

Background: Medical emergencies and major trauma require optimal team function. Leadership, co-operation and communication are the most essential issues. Due to low caseloads such emergencies occur rarely in most Norwegian hospitals. Team training of personnel between real emergencies is expected to improve performance in comparable settings. Most hospitals have cardiac arrest teams, but it is known that the training of such multiprofessional teams varies widely. We wanted to know if this also was the case for trauma teams and resuscitation teams for newborns. Methods: A telephone survey of training practices in all the Norwegian hospitals with acute cover was conducted in 2002. Information was obtained on whether trauma teams and neonatal resuscitation teams had participated in practical multiprofessional training during the previous 6 or 12 months. Results: Information was obtained from all 50 hospitals. Of the acute care hospitals, 30% had trained their trauma teams during the previous 6 months, and an additional 18% when considering the previous year, while 38% of neonatal wards had multiprofessional training during the previous 6 months, and additionally 13% had had training during the previous year. Additionally four neonatal wards had had regular training of nurses only. More than 80% of all respondents judged regular team training to be achievable, and none considered this training impossible. Conclusion: Only half the Norwegian acute care hospitals reported at least yearly training of trauma and neonatal resuscitation teams. Regular team training represents an underused potential to improve handling of low-frequency emergencies.

Background The treatment of trauma victims is a complex multi-professional task in a stressful environment. We previously found that trauma team members perceive leadership as the most important human factor. The aim of the present study was to assess the experience and education of Norwegian trauma team leaders, and allow them to describe their perceived educational needs. Methods We conducted an anonymous descriptive study using a point prevalence methodology based on written questionnaires. All 45 hospitals in Norway receiving severely injured trauma victims were contacted on a randomly selected weeknight during November 2009. Team leaders were asked to specify what trauma related training programs they had participated in, how much experience they had, and what further training they wished, if any. Results Response rate was 82%. Slightly more than half of the team leaders were residents. The median working experience as a surgeon among team leaders was 7.5 years. Sixty-eight percent had participated in multi-professional training in non-technical skills, while 54% had passed the advanced trauma life support(ATLS) course. Fifty-one percent were trained in damage control surgery. A median of one course per team leader was needed to comply with the new proposed national standards. Team leaders considered training in damage control surgery the most needed educational objective. Conclusions Level of experience among team leaders was highly variable and their educational background insufficient according to international and proposed national standards. Proposed national standards should be urgently implemented to ensure equal access to high quality trauma care.

Background Trauma patients are customarily transported in the supine position to protect the spine. The Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) principles clearly give priority to airways. In Norway, the lateral trauma position (LTP) was introduced in 2005. We investigated the implementation and current use of LTP in Norwegian Emergency Medical Services (EMS). Methods All ground and air EMS bases in Norway were included. Interviews were performed with ground and air EMS supervisors. Questionnaires were distributed to ground EMS personnel. Results Of 206 ground EMS supervisors, 201 answered; 75% reported that LTP is used. In services using LTP, written protocols were present in 67% and 73% had provided training in LTP use. Questionnaires were distributed to 3,025 ground EMS personnel. We received 1,395 (46%) valid questionnaires. LTP was known to 89% of respondents, but only 59% stated that they use it. Of the respondents using LTP, 77% reported access to written protocols. Flexing of the top knee was reported by 78%, 20% flexed the bottom knee, 81% used under head padding. Of 24 air EMS supervisors, 23 participated. LTP is used by 52% of the services, one of these has a written protocol and three arrange training. Conclusions LTP is implemented and used in the majority of Norwegian EMS, despite little evidence as to its possible benefits and harms. How the patient is positioned in the LTP differs. More research on LTP is needed to confirm that its use is based on evidence that it is safe and effective.

Background Trauma is the leading cause of death for young people in Norway. Studies indicate that several of these deaths are avoidable if the patient receives correct initial treatment. The trauma team is responsible for initial hospital treatment of traumatized patients, and team members have previously reported that non-technical skills as communication, leadership and cooperation are the major challenges. Better team function could improve patient outcome. The aim of this study was to obtain a deeper understanding of which non-technical skills are important to members of the trauma team during initial examination and treatment of trauma patients. Methods Twelve semi-structured interviews were conducted at four different hospitals of various sizes and with different trauma load. At each hospital a nurse, an anaesthesiologist and a team leader (surgeon) were interviewed. The conversations were transcribed and analyzed using systematic text condensation according to the principles of Giorgi's phenomenological analysis as modified by Malterud. Results and conclusion Leadership was perceived as an essential component in trauma management. The ideal leader should be an experienced surgeon, have extensive knowledge of trauma care, communicate clearly and radiate confidence. Team leaders were reported to have little trauma experience, and the team leaders interviewed requested more guidance and supervision. The need for better training of trauma teams and especially team leaders requires further investigation and action.

Norway has 50 trauma hospitals serving a geographically disperse population (4.6 million) and many have low trauma case loads. We showed that personnel find functioning as a team especially challenging, and developed a 1-day training course, arranged locally at each hospital, focused on team training in communication, leadership, and cooperation during simulated patient treatment. This study evaluates the effects of training on participants' knowledge, confidence, and perceived trauma team performance, controlling for hospital size and the participants' previous experience.Anonymous, written questionnaires were answered by 4,203 participants (28% physicians, 55% nurses) in 44 hospitals before and immediately after training courses, and by 1,368 trauma team members in 26 of the hospitals 6 months after their last training course. Outcome measures were knowledge and confidence concerning the respondent's own role, and evaluation of trauma team performance in live trauma resuscitations.There was a significant increase in self-reported knowledge and confidence among all participants. Community hospitals and participants without recent trauma experience had the lowest preintervention scores, but reached levels comparable to participants at the other hospitals after training. The effects increased after 6 months, with trauma team performance evaluated as having improved, even by team members who had not participated in the training.Practical team training in hospitals improved the participants' perceived knowledge and confidence, which continued to increase for 6 months after training independent of participants' experience level, suggesting that small hospitals may reach levels comparable to major hospitals.

Most Norwegian hospitals have systematically trained trauma teams in cooperation with the BEST Foundation: Bettersystematic trauma care. A group of general practitioners, ambulance personnel and primary care nurses have modified this training concept for use in general practise, with the aim to strengthen acute medical competence within Norwegian primary health care. This study describes experience gained with a training method for dealing with receival and stabilisation of victims of injury in multiprofessional teams in primary health care.Multiprofessional training courses were held in 10 municipalities in Finnmark county in northern Norway. The course consisted of two hours of lectures on handling of critically injured patients in the primary care setting, followed by practical training with simulated patients. Communication, leadership and cooperation was emphasised during the training. The simulation sessions with dolls were video recorded and evaluated after each session. Individual questionnaires were distributed before and after training.Most municipalities that we contacted responded positively. Training was arranged for 22 teams and 145 participants completed questionnaires. The participants reported a significantly improved confidence in their own role and the correct order of necessary procedures. 91% would recommend the course to a colleague.This group of different health professionals reported a great need for training and a high outcome after the intervention. The findings support further dissemination of this training method in Norwegian primary health care.

Despite recent developments in trauma care, it is estimated that 10 to 15% of deaths after injury are avoidable and caused by errors in the initial hospital phase of treatment. In 2000 it was found that a number of Norwegian hospitals lacked procedures and protocols. The situation in all hospitals delivering trauma care in Norway was reassessed.In autumn of 2004, all 50 Norwegian trauma care hospitals were surveyed. Response was obtained from all.Trauma teams were found in 88% of all hospitals, compared to 52% in 2000. A parallel improvement was found in the use of paging criteria for trauma teams, use of trauma manuals and protocols, and designated patient charts. Targeted training of teams was done in 88% of the hospitals and 54 % had arranged practical drills of trauma teams in the six months prior to the survey. Only minor differences were found between hospitals at different levels. Systematic audits were performed in only 27% of hospitals.A major improvement has taken place during four years, and it is now possible to implement national trauma care guidelines. There is still a need for improved use of audits and team training.

Snowmobiles are increasingly popular. In Western Finnmark, Norway, there is now one snowmobile per five inhabitants, in the rest of Norway only one for each 110 inhabitants. Our clinical impression was that the frequency of injuries had increased. The aim of this study was to describe frequency and severity of snowmobile-related injuries through two winter seasons by the use of an existing injury registry.Prospectively registered data from the injury registry at Hammerfest Hospital for the winter seasons 2002/2003 and 2003/2004 were analysed.Sixty-seven patients were registered with snowmobile-related injuries, mainly men between 15 and 35. The large majority of injuries were caused during recreational snowmobile driving, after sunset, and outside trails. Admission to hospital was necessary for 45 patients. The grading of severity was serious to critical in 13 victims; 2 persons were killed. The mechanism of injury was mainly loss of control over the vehicle. We have no reliable data concerning driving under the influence of ethanol. The rate of serious injuries per snowmobile was unchanged as compared to 1988-9, but the number of vehicles had increased by 30%.Injuries related to snowmobiles are increasing in number and severity. They are mainly related to recreational use, especially in weekends and after sunset. The use of helmets, compulsory training, and expanded trails have not decreased the rate of accidents per vehicle. There is an urgent need for preventive measures.

Goals for the programme were recruitment of specialists and lowering turnover among them, generating new knowledge, quality assurance and professional development. Close to NOK 25 million were spent on this research programme in regional non-university hospitals over the 1992-2001 period.78 projects were funded, 77 responded to our questionnaire.36 (47%) of respondents claim to have completed their projects, 5 (7%) have not, whereas 36 (47%) have ongoing projects. 70% of the projects have led to publications, 39% as part of doctoral theses, 61% have been done locally and 43 % also had other funding. In relation to the aims of the programme, those responding were very positive and 75 out of 77 suggested that a low-threshold, supportive programme of this type should be continued.We conclude that the programme has had positive effects beyond the generation of new knowledge.

This study reports the experience gained in prehospital thrombolysis in acute myocardial infarction in a sparsely inhabited remote area of northern Norway. The study was retrospective from 1992 to 1999. The area covered was 49 000 km2, with a population of 75 000. During the study period only one out of 19 municipalities offered prehospital thrombolysis by general practitioners. Treatment was therefore accomplished by the use of an existing anaesthesiologist-manned rescue helicopter in the absence of available alternatives. The objectives were to evaluate whether prehospital thrombolysis was feasible, and if this approach improved access to early thrombolysis. A total of 272 patients with cardiac-related diagnoses were treated; 91 were considered prehospitally to have an acute myocardial infarction. The median delay from the onset of chest pain until first contact with the health system was 4 hours and 6 minutes or 4 hours and 10 minutes. A total of 23 patients were thrombolysed by the rescue anaesthesiologist prehospitally and four by general practitioners, whereas 58 had contraindications, mainly the duration of chest pain being greater than 6 h (24). Twelve of the 23 patients experienced hypotension and arrhythmia after the administration of streptokinase. Prehospital thrombolysis was feasible, but in order to improve access for patients, all general practitioners or ambulance personnel should administer treatment prehospitally. The public should be urged further to make early contact in cases of chest pain.

(2001). Confidence and experience in emergency medicine procedures. Norwegian general practitioners. Scandinavian Journal of Primary Health Care: Vol. 19, No. 2, pp. 99-100.

Spinal anaesthesia has been used in day-care surgery for a long time, but the fear of past dural puncture headache has limited its use in younger patients. A survey was conducted in order to assess the extent to which spinal anaesthesia is used for day-care surgery, and the routines governing the present practice in Norwegian anaesthetic departments. Information was obtained on the use of spinal anaesthesia for day-care surgery. In half of the anaesthetic departments spinal anaesthesia was used regularly. A large proportion of the departments worked with a lower age limit over 30 years of age for use of spinal anaesthesia. This does not seem to be justified on the basis of the scientific evidence. A prospective patient study revealed that out of 120 day-care patients aged 15 to 45 years who were given spinal anaesthesia, 93% would accept the same kind of anaesthetic again. Based on recent studies, the fear of post dural puncture headache should not preclude the use of spinal anaesthesia as a good alternative to general anaesthesia in day-care surgery.

Up to now, thrombolytic treatment in myocardial infarction has been restricted to coronary care departments in Norwegian hospitals. Owing to the highly significant impact of the time elapsing between onset of symptoms and thrombolytic treatment, it has been a challenge to offer patients in remote areas early treatment. The rescue helicopter in Northern Norway is manned by an anaesthesiologist. By taking advantage of this, in combination with strict diagnostic criteria, prehospital treatment with streptokinase is now offered in addition to pain relief, oxygen, nitrates and aspirin, and observation against arrhythmia. By these means, patients in remote areas can receive thrombolytic treatment without the delay caused by transportation and in-hospital examination, and a high level of safety is maintained. It still remains, however, to shorten the patients' and the doctors' delay in notifying the helicopter. It is suggested, that all anaesthesiologist-manned air ambulances implement this technique after consulting local general practitioners and cardiologists.

The Norwegian Medical Association has been delegated responsibility for suggesting guidelines to monitor the quality and capacity of postgraduate specialist training. In every specialty, a committee for specialist training has to monitor the availability of specialists in their field on behalf of the Association. The authors describe a systematic approach to monitoring, in which available information was carefully matched with selected survey data, to enable prognostications. The method was then applied to anaesthesia, and revealed a need for higher production of specialists in this field. More than 10% of the 309 consultant anaesthetist positions were vacant, owing to lack of applicants, and another 36 consultants are needed to ascertain a minimum of three specialists in every hospital providing emergency services. 15% of the certified specialists did not work as anaesthesiologists. It was estimated that ten persons would leave annually, either to do research or take up another specialty, and that 15 would retire. Based on the findings, it is suggested that the present specialist production of about 20 per year should be increased to secure the nation's future need of anaesthesiologists.

Maintaining a clear airway and sufficient ventilation is vital in emergency medicine, but junior doctors and medical students rarely get sufficient training in the relevant techniques. These can be taught on mannequins, anaesthetised patients, or on recently deceased patients. The Norwegian and British medical associations recently banned the use of dead patients for intubation training for ethical reasons. A telephone survey of a random sample of 1,050 persons revealed that 69% would allow themselves to be practised on if they were anaesthetised, while 58% would accept that a close relative who had just died in hospital be used. Most of those who would not give their consent or who were unsure feared being injured, or the idea upset them. These results challenge previous assumptions about the attitude of the general public, and the medical associations' stand on the issue may have to be reconsidered for the sake of improving the teaching of vital skills.

A high autopsy rate is a requirement for confirming or correcting clinical diagnoses and for providing opportunities for medical education on pre- and postgraduate level. A telephone survey was conducted to obtain information about the opinion of the Norwegian public on this matter. A randomised sample of 1,050 persons over 15 years of age were asked whether they would consent to autopsy if a close family member died in a hospital. Of the 954 (91%) who agreed to answer, 86% (95% CI 84-89) would consent, while 14% (95% CI 11-16) were unsure or would object. Demographical background variables did not significantly influence the response. When asked if they would give prior consent to an autopsy on themselves, should they die in a hospital, 84% (95% CI 82-87) said they would agree, while 16% (95% CI 13-18) were unsure or would object. Age between 31-50 years, male sex and married civil status significantly increased the likelihood of a positive attitude towards autopsy. The survey revealed a generally favourable attitude in the population towards autopsy. This positive confidence has to be maintained through careful talks with relatives about autopsy, and arrangements for relatives to be informed of the result of an autopsy.

The need for medical personnel to be able to perform certain emergency medical procedures, such as endotracheal intubation, intravascular acess, defibrillation, and tracheotomy cannot be questioned. However, it is difficult to practise these techniques on patients and mannequins. Using newly deceased persons is an alternative which allows the procedures to be performed under nearly realistic circumstances, but this educational approach could raise certain ethical objections among staff who are not adequately informed about the educational objectives. A survey of the ten largest Norwegian hospitals revealed that only two had adopted this practice. The rest had considered it, but had decided not to start this routine. None of the hospitals had refrained from it after thoroughly analysing the ethical issues involved. Six hospitals used cadavers for other instruction. The practice represents a unique opportunity for training, and the ethical implications are justifiable provided that the training is conducted with respect and compassion for the deceased.

The attitude of health personnel towards the human immunodeficiency virus (HIV) has a great influence on public opinion. Thus appropriate knowledge about HIV and its routes of transmission, plus safe and professional behaviour are crucial. A survey of 359 Norwegian health workers (75% response) revealed that factual knowledge was good. Fear of occupational transmission was substantial, but was not reflected in behaviour: 25–50% of the personnel reported not using gloves when exposed to blood. No relationship was found between knowledge and behaviour. A majority (79%) of the sample held the view that every hospital patient should be routinely tested on admission. Seventy-four per cent advocated preoperative screening, with special precautions if the results are positive. Knowledge did not seem to influence these attitudes. It is concluded that the behaviour of health personnel in relation to occupational risks is unrelated to factual knowledge, and further studies are needed to uncover behavioral determinants.

Knowledge about routes of HIV transmission and attitudes to HIV antibody testing was studied in a group of Norwegian dentists. Personal protection by gloves was also recorded. Eighty-three of 120 (69%) dentists in Bergen (private practitioners) completed a postal questionnaire. More than half of these considered themselves to be in potentially infectious situations daily. Overall knowledge was good, although one fifth gave wrong answers about the relation between antibody status and infectivity. About half the respondents had attitudes to antibody testing not consistent with Centers for Disease Control (CDC) guidelines. These dentists scored significantly lower on the knowledge questions. Seventy-five (92%) reported consequent use of gloves. A low knowledge score was found among non-users. The present study indicates that lack of knowledge is related to non-recommended attitudes and behavior. The study underlines the need for continuous education and information about HIV.

Background Bystander first aid can improve survival following out-of-hospital cardiac arrest or trauma. Thus, providing first aid education to laypersons may lead to better outcomes. In this study, we aimed to establish the prevalence and distribution of first aid training in the populace, how often first aid skills are needed, and self-reported helping behaviour. Methods We conducted a telephone survey of 1000 respondents who were representative of the Norwegian population. Respondents were asked where and when they had first aid training, if they had ever encountered situations where first aid was necessary, and stratified by occupation. First aid included cardio-pulmonary resuscitation (CPR) and basic life support (BLS). To test theoretical first aid knowledge, respondents were subjected to two hypothetical first aid scenarios. Results Among the respondents, 90% had received first aid training, and 54% had undergone first aid training within the last 5 years. The workplace was the most common source of first aid training. Of the 43% who had been in a situation requiring first aid, 89% had provided first aid in that situation. There were considerable variations among different occupations in first aid training, and exposure to situations requiring first aid. Theoretical first aid knowledge was not as good as expected in light of the high share who had first aid training. In the presented scenarios 42% of respondent would initiate CPR in an unconscious patient not breathing normally, and 46% would provide an open airway to an unconscious road traffic victim. First aid training was correlated with better theoretical knowledge, but time since first aid training was not. Conclusions A high proportion of the Norwegian population had first aid training, and interviewees reported high willingness to provide first aid. Theoretical first aid knowledge was worse than expected. While first aid is part of national school curriculum, few have listed school as the source for their first aid training. Electronic supplementary material The online version of this article (doi:10.1186/s12873-017-0116-7) contains supplementary material, which is available to authorized users.