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Survival from avalanche burial is dependent on time to extraction, breathing ability, air pocket oxygen content, and avoiding rebreathing of carbon dioxide (COA prospective randomized crossover experimental field study enrolled 20 healthy subjects in Hemsedal, Norway in March 2019. Subjects underwent in randomized order two sessions (receiving 2 litres per minute of air in front of mouth/nose into the air pocket or no air) in a simulated avalanche scenario with extensive monitoring serving as their own control.A significant increase comparing Control vs Intervention were documented for minimum and maximum end-tidal COParticipants subject to simulated avalanche burial can maintain physiologic parameters within normal levels for a significantly longer period if they receive supplemental air in front of their mouth/nose into the air pocket. This may extend the time for potential rescue and lead to increased survival.

ObjectivesVideo streaming has recently been introduced as an additional tool for communication between medical dispatchers and caller. Research implies that video streaming may be a useful tool for the dispatchers, but more knowledge is needed. With this study, we wanted to explore how the dispatchers experience using video streaming as an additional tool in medical emergency calls.DesignAn explorative, qualitative study using semi-structured focus group interviews.SettingTwo emergency medical communications centres in Norway where video streaming recently had been introduced. Interviews were conducted during 24 June 2020 and 26 June 2020.ParticipantsWe recruited 25 medical dispatchers, either nurses or emergency medical technicians who worked at the two centres.ResultsThe results are categorised into three themes: (1) change in dispatcher’s perception of the patient and the situation, (2) reassurance for the dispatcher and (3) worries about increased time consumption and the possibility of unpleasant images.ConclusionThe dispatchers experienced that the use of video streaming in medical emergency calls might contribute to a better comprehension of the situation and following more precise resource allocation, as well as greater reassurance for the dispatcher and improved relationship between the dispatcher and the caller. Further research with an aim to measure effects and safety of video streaming during medical emergency calls is needed.

These European Resuscitation Council (ERC) Cardiac Arrest in Special Circumstances guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the modifications required to basic and advanced life support for the prevention and treatment of cardiac arrest in special circumstances; specifically special causes (hypoxia, trauma, anaphylaxis, sepsis, hypo/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), special settings (operating room, cardiac surgery, catheter laboratory, dialysis unit, dental clinics, transportation (in-flight, cruise ships), sport, drowning, mass casualty incidents), and special patient groups (asthma and COPD, neurological disease, obesity, pregnancy).

BackgroundAcutely sick or injured patients depend on ambulance and emergency department personnel performing an accurate initial assessment and prioritisation (triage) to effectively identify patients in need of immediate treatment. Triage also ensures that each patient receives fair initial assessment. To improve the patient safety, quality of care, and communication about a patient’s medical condition, we implemented a new triage tool (the South African Triage Scale Norway (SATS-N) in all the ambulance services and emergency departments in one health region in Norway. This article describes the lessons we learnt during this implementation process.MethodsThe main framework in this quality improvement (QI) work was the plan–do–study–act cycle. Additional process sources were ‘The Institute for Healthcare Improvement Model for improvement’ and the Norwegian Patient Safety Programme.ResultsBased on the QI process as a whole, we defined subjects influencing this work to be successful, such as identifying areas for improvement, establishing multidisciplinary teams, coaching, implementing measurements and securing sustainability. After these subjects were connected to the relevant challenges and desired effects, we described the lessons we learnt during this comprehensive QI process.ConclusionWe learnt the importance of following a structured framework for QI process during the implementation of the SATS-N triage tool. Furthermore, securing anchoring at all levels, from the managements to the medical professionals in direct patient-orientated work, was relevant important. Moreover, establishing multidisciplinary teams with ambulance personnel, emergency department nurses and doctors with various medical specialties provided ownership to the participants. Meanwhile, coaching provided necessary security for the staff directly involved in caring for patients. Keeping the spirit and perseverance high were important factors in completing the implementation. Establishment of the regional network group was found to be important for sustainability and further improvements.

Source at https://doi.org/10.1080/02813432.2019.1608056. Background: Despite the potential benefits of physician-staffed Helicopter Emergency Medical Service (HEMS), many dispatches to primary HEMS missions in Norway are cancelled before patient encounter. Information is sparse regarding the health consequences when medically indicated HEMS missions are cancelled and the patients are treated by a GP and ambulance staff only. We aimed to estimate the potential loss of life years for patients in these situations. Method: We included all HEMS requests in the period 2010–2013 from Sogn and Fjordane County that were medically indicated but subsequently cancelled. This provided a selection of patients, with the purpose of studying cancellations independently of the patient’s medical status A multidisciplinary expert panel retrospectively assessed each patient’s potential loss of life years due to the lack of helicopter transport and intervention by a HEMS physician. Results: The study included 184 patients from 176 missions. Because of unavailable HEMS, seven patients (4%) were anticipated to have lost a total of 18 life years. Three patients suffered from myocardial infarction, three from stroke and one from abdominal haemorrhage. The main contribution from HEMS care in these seven cases might have been rapid transport to definitive care. The probability of a patient losing life years when in need of HEMS evacuation was found to be 0.2%. Conclusion: During the four years period seven patients lost 18 life years. Lack of rapid transport seems to be the primary cause of lost life years in this specific geographical area. Key Points Knowledge about to what extent HEMS contributes to an increased survival and a better outcome for patients is limited. Compared to similar studies on life years gained the estimated loss of life years was minor when HEMS evacuation was unavailable in this rural area. The findings indicates that lack of rapid HEMS transport was the primary cause of the estimated loss of life years.

Future deep space astronauts must maintain adequate nutrition despite highly stressful, isolated, confined and dangerous environments. The present case-study investigated appetite regulating hormones, nutrition status, and physical and emotional stress in a space analog condition: an explorer conducting a 93-day unsupported solo crossing of Antarctica. Using the dried blood spot (DBS) method, the subject drew samples of his blood on a regular basis during the expedition. The DBSs were later analyzed for the appetite regulating hormones leptin and adiponectin. Energy intake and nutritional status were monitored by analysis of albumin and globulin (including their ratio). Interleukin-6 (IL-6) was also analyzed and used as an energy sensor. The results showed a marked reduction in levels of the appetite-reducing hormone, leptin, and the appetite stimulating hormone, adiponectin, during both extreme physical and psychological strain. Nutrition status showed a variation over the expedition, with below-normal levels during extreme psychological strain and levels abutting the lower bounds of the normal range during a phase dominated by extreme physical hardship. The IL-6 levels varied substantially, with levels above the normal range except during the recovery phase. It was concluded that a daily intake of 5058 to 5931 calories seemed to allow recovery of both appetite and nutritional status between extreme physical and psychological hardship during a long Arctic expedition. Furthermore, IL-6 may be a sensor in the muscle-liver, muscle-fat and muscle-brain crosstalk. These results may help guide nutrition planning for future astronaut crews, mountaineers and others involved in highly demanding missions. publishedVersion

Background Simulation-based education may improve clinical decision-making skills and supplement clinical placement of nursing students to prepare them for real healthcare settings. Exposing students to several simulation sessions could maximise learning, but longitudinal randomised studies are lacking regarding the effects of simulation-based education. Objective In this randomised study, we followed a class of nursing students to assess the effect of multiple simulations on the students' self-reported clinical decision-making skills and self-confidence. Design A randomised controlled trial, collecting data four times throughout a 3-year nursing program; at the beginning of the second semester as baseline and at the end of each of the following academic years. Students experienced either a single (control) or a double (intervention) set of simulation scenarios in four simulation days, including several simulation scenarios for each session. Setting A university in Norway, 2018–2020. Participants The study included 146 baccalaureate nursing students who volunteered to participate. Methods The participants completed two validated instruments, the 24-item Nurse Decision-Making Instrument and the Self-Confidence Scale, and demographic data were collected. Analysis of covariance and linear mixed-effect models were applied to analyse the effect of the double compared to the single scenario simulations. Results Complete data were obtained for 71 participants. The results showed no significant differences between double vs single scenario sessions on clinical decision-making scores (B = −0.2; 95% confidence interval, −2.1 to 1.7; p = 0.806) or self-confidence score (B = −0.1; 95% confidence interval, −0.4 to 0.2; p = 0.467). However, the overall self-confidence scores increased significantly over time. Conclusion In this randomised study, we found no effects of double vs single scenario simulations on clinical decision-making or self-confidence scores among nursing students during their 3-year program.

Simulation-based learning (SBL) is becoming an accepted part of health education. Providing high-quality simulation-based education depends more on skilled facilitators than on elaborate simulator equipment. In the last six years, a cross-professional facilitator course has been developed to train interprofessional staff and faculty from health educational institutions in Bergen. The course starts with two days of traditional simulation theory and practice followed by a third day five weeks later. During the third day, participants present their own experiences from practising as facilitators in their own workplaces. In this paper, we present the course content and the participants' evaluation of the course based on the qualitative content analysis of their answers to open-ended questions. The main findings were that the course format and primary focus on practice were appreciated and that the follow-up day was especially useful to broaden the learning experience.

ObjectivesFew studies have described evacuations due to medical emergencies from the offshore installations in the North Sea, though efficient medical service is essential for the industrial activities in this area. The major oil- and gas-producing companies’ search and rescue (SAR) service is responsible for medical evacuations. Using a prospective approach, we describe the characteristics of patients evacuated by SAR.Design and settingA prospective observational study of the offshore primary care provided by SAR in the North Sea.MethodsPatients were identified by linking flight information from air transport services in 2015/2016 and the company’s medical record system. Standardised forms filled out by SAR nurses during the evacuation were also analysed. In-hospital information was obtained retrospectively from Haukeland University Hospital’s information system.ResultsA total of 381 persons (88% men) were evacuated during the study period. Twenty-seven per cent of missions were due to chest pain and 18% due to trauma. The mean age was 46.0 years. Severity scores were higher for cases due to medical conditions compared with trauma, but the scores were relatively low compared with onshore emergency missions. The busiest months were May, July and December. Weekends were the busiest days.ConclusionThree times as many evacuations from offshore installations are performed due to acute illness than trauma, and cardiac problems are the most common. Although most patients are not severely physiologically deranged, the study documents a need for competent SAR services 24 hours a day year-round. Training and certification should be tailored for the SAR service, as the offshore health service structure and geography differs from the structure onshore.

Aim The aim of this study was to examine and describe predictors of self-confidence among nursing students attending multiple simulation-based education sessions during a bachelor program. Design This was a randomized controlled longitudinal study. Methods Participants (n = 146) were randomly assigned to a single or double set of acute care scenarios in each session. Participants attended 4 days of simulation sessions throughout a 3-year bachelor program. At four separate time points, both groups answered a survey including the Self-confidence scale and The Kolb Learning Style Inventory version 3.1. Descriptive statistics, cross‐tabulations and linear models were employed to analyze the data. Results No significant interaction effects were found between the students’ self-confidence at the end of the educational program and predictive factors favoring a double set of simulation scenarios. Most third-year students (n = 52, 85%) preferred a concrete learning mode at baseline. Conclusions No significant predictive factors increasing self-confidence in favor of a double set of simulation scenarios could be demonstrated in this study. Hence, the continuous search for how to effectively implement SBE is of major importance for the development of SBE as a pedagogical method and remains a challenge.

Background Appropriate dispatch criteria and helicopter emergency medical service (HEMS) crew decisions are crucial for avoiding over-triage and reducing the number of concurrencies. The aim of the present study was to compare patient outcomes after completed HEMS missions and missions cancelled by the HEMS due to concurrencies. Methods Missions cancelled due to concurrencies (AMB group) and completed HEMS missions (HEMS group) in Western Norway from 2004 to 2013 were assessed. Outcomes were survival to hospital discharge, physiology score in the emergency department, emergency interventions in the hospital, type of department for patient admittance, and length of hospital stay. Results Survival to discharge was similar in the two groups. One-third of the primary missions in the HEMS group and 13% in the AMB group were patients with pre-hospital conditions posing an acute threat to life. In a sub group analysis of these patients, HEMS patients were younger, more often admitted to an intensive care unit, and had an increased survival to discharge. In addition, the HEMS group had a greater proportion of patients with deranged physiology in the emergency department according to an early warning score. Conclusion Patients in the HEMS group seemed to be critically ill more often and received more emergency interventions, but the two groups had similar in-hospital mortality. Patients with pre-hospital signs of acute threat to life were younger and presented increased survival in the HEMS group.

Introduction On 22 July 2011, Norway suffered a devastating terrorist attack targeting a political youth camp on a remote island. Within a few hours, 35 injured terrorist victims were admitted to the local Ringerike community hospital. All victims survived. The local emergency medical service (EMS), despite limited resources, was evaluated by three external bodies as successful in handling this crisis. This study investigates the determinants for the success of that EMS as a model for quality improvement in healthcare. Methods We performed focus group interviews using the critical incident technique with 30 healthcare professionals involved in the care of the attack victims to establish determinants of the EMS’ success. Two independent teams of professional experts classified and validated the identified determinants. Results Our findings suggest a combination of four elements essential for the success of the EMS: (1) major emergency preparedness and competence based on continuous planning, training and learning; (2) crisis management based on knowledge, trust and data collection; (3) empowerment through multiprofessional networks; and (4) the ability to improvise based on acquired structure and competence. The informants reported the successful response was specifically based on multiprofessional trauma education, team training, and prehospital and in-hospital networking including mental healthcare. The powerful combination of preparedness, competence and crisis management built on empowerment enabled the healthcare workers to trust themselves and each other to make professional decisions and creative improvisations in an unpredictable situation. Conclusion The determinants for success derived from this qualitative study (preparedness, management, networking, ability to improvise) may be universally applicable to understanding the conditions for resilient and safe healthcare services, and of general interest for quality improvement in healthcare.

Background: The estimated number of in-hospitals deaths due to adverse events is often different when using data from deceased patients compared with that of a population experiencing adverse events. Methods: The study was conducted at three hospitals in the Bergen Hospital Trust, including a 950-bed university hospital. The objective was to study the reported deaths and investigate the probable number of deaths caused by adverse events. Information about all patients who died in the hospitals during 2011 was retrieved from the electronic patient data management system and the medical records. All deaths were classified into two groups according to Norwegian law based on whether or not the death was sudden and/or unexpected. The cause of death in the latter group was further classified as being due to either natural or unnatural causes according to national requirements. An expert review panel screened the patient records for information regarding adverse events and possible (≥ 50%) preventability. Age, length of hospital stay, and Charlson Comorbidity Index were also registered. Results: There were 59,605 unique patients admitted in 2011 and 1185 registered deaths (1.98%). The mean and median ages of the deceased were 73,8 and 78 years, respectively, and the median length of stay was 5.6 days (range). Of these deaths, 290 (24.5%) were considered sudden and/or unexpected and 218 were considered to be due to natural causes. Of the 72 unnatural deaths, 16 (1.4%) were classified as preventable or probably preventable. For 18 deaths (%) it was impossible to confirm or rule out preventability. Conclusions: Using this method, we identified a small proportion of hospital deaths that could be classified as unnatural. Furthermore, there was a ≥ 50% chance or more that 34 deaths (2.9%) were due to causes that could have been prevented. publishedVersion

Chest compression devices are useful during mountain rescue but may cause a delay in transport if not immediately available. The aims of this prospective observational study were to compare manual and mechanical cardiopulmonary resuscitation (CPR) during transport on a sledge connected to a snowmobile with a non-moving setting and to compare CPR quality between manual and two mechanical chest compression devices.Sixteen healthcare providers simulated four different combined CPR scenarios on a sledge in a non-moving setting and during transport and two mechanical chest compression devices during transport on the sledge. The study was conducted in May 2015 in a mountain in Norway. The primary outcome measures were compression rate (compressions per minute), compression depth in millimetres, leaning (incomplete chest wall release after compression in millimetres) and chest compression fraction (fraction of total time were compression were performed). The results were analysed by descriptive and graphical methods and paired t-tests were used to compare the differences between techniques.We did not observe a significant difference between moving and non-moving conditions with respect to manual compression rate (p=0.34), compression depth (p=0.50) or leaning (p=0.92). However, both the manual compression depth (p0.001) and the leaning (p=0.04) showed a significantly larger variance during the moving runs.Manual chest compression is possible on a snowmobile during transport even in challenging terrain. This experimental study shows that high-quality chest compressions and manual ventilation can be performed in an intubated patient during a short-term transportation on a sledge.

Trening av tverrprofesjonelle team med bruk av simulering brukes særlig ved forberedelse til akuttmedisinske situasjoner. Det foreligger nå god dokumentasjon for at slik trening har betydning for pasientene. 27. mars 1977 skjedde verdens hittil verste flykatastrofe, der 583 personer omkom på Tenerife etter at to jumbojeter kolliderte på flyplassen i tett tåke. Granskningen etter katastrofen avdekket mangelfull kommunikasjon og misforståelser som sannsynlige hovedårsaker til hendelsen (1). Fortsatt, den dag i dag, er det vanskelig å forstå at dette kunne forekomme med så mange tekniske hjelpemidler tilgjengelig. En økende forståelse av hvordan feil og uønskede hendelser oppstår, viser at vi må fokusere mer på menneskene i systemene og på hvordan vi forholder oss til hverandre og overfor risiko enn å stole blindt på tekniske systemer.

Introduction and Aims Opioid overdose fatalities are a significant concern globally. Non-fatal overdoses have been described as a strong predictor for future overdoses, and are often attended by the ambulance services. This paper explores characteristics associated with non-fatal overdoses and aims to identify possible trends among these events in an urban area in Norway. Design and Methods This is a retrospective analysis of non-fatal overdoses from Bergen ambulance services from 2012 to 2013. Demographic, temporal and geographic data were explored. Results During the two years, 463 non-fatal opioid overdoses were attended by ambulance services. Ambulance call-outs occurred primarily during the late afternoon and evening hours of weekdays. Summer months had more overdoses than other seasons, with a peak in August. Overdoses were nearly twice as likely to occur in a public location in August (risk ratio 1.92, P = 0.042). Ambulance response times were more likely to be longer to private locations, and these victims were more likely to be treated and left at the scene. There was no difference in arrival time for drug-related and non-drug related dispatch. Discussion and Conclusions The temporal patterns suggest that non-fatal overdoses occur during non-recreational time periods. The longer ambulance response time and disposition for private addresses indicate potential opportunities for peer interventions. Our analysis describes circumstances surrounding non-fatal overdoses and can be useful in guiding relevant, targeted prevention interventions. [Madah-Amiri D, Clausen T, Myrmel L, Brattebo G, Lobmaier P. Circumstances surrounding non-fatal opioid overdoses attended by ambulance services. Drug Alcohol Rev 2017;36:288-294]

Larger student groups and pressure on limited faculty time have raised the question of the learning value of merely observing simulation training in emergency medicine, instead of active team participation. The purpose of this study was to examine observers and hands-on participants' self-reported learning outcomes during simulation-based interprofessional team training regarding non-technical skills. In addition, we compared the learning outcomes for different professions and investigated team performance relative to the number of simulations in which they participated. A concurrent mixed-method design was chosen to evaluate the study, using questionnaires, observations, and focus group interviews. Participants included a total of 262 postgraduate and bachelor nursing students and medical students, organised into 44 interprofessional teams. The quantitative data showed that observers and participants had similar results in three of six predefined learning outcomes. The qualitative data emphasised the importance of participating in different roles, training several times, and training interprofessionally to enhance realism. Observing simulation training can be a valuable learning experience, but the students' preferred hands-on participation and learning by doing. For this reason, one can legitimise the observer role, given the large student groups and limited faculty time, as long as the students are also given some opportunity for hands-on participation in order to become more confident in their professional roles.

Background: The Helicopter Emergency Medical Service (HEMS) in Norway is operated day and night, despite challenging geography and weather. In Western Norway, three ambulance helicopters, with a rapid response car as an alternative, cover close to 1 million inhabitants in an area of 45,000 km2. Our objective was to assess patterns of emergency medical problems and treatments in HEMS in a geographically large, but sparsely populated region. Methods: Data from all HEMS dispatches during 2004–2013 were assessed retrospectively. Information was analyzed with respect to patient treatment and characteristics, in addition to variations in services use during the day, week, and seasons. Results: A total of 42,456 dispatches were analyzed. One third of the patients encountered were severely ill or injured, and two thirds of these received advanced treatment. Median activation time and on-scene time in primary helicopter missions were 5 and 11 min, respectively. Most patients (95%) were reached within 45 min by helicopter or rapid response car. Patterns of use did not change. More than one third of all dispatches were declined or aborted, mostly due to no longer medical indication, bad weather conditions, or competing missions. Conclusion: One third of the patients encountered were severely ill or injured, and more than two thirds of these received advanced treatment. HEMS use did not change over the 10-year period, however HEMS use peaked during daytime, weekends, and the summer. More than one third of all dispatches were declined or aborted. publishedVersion

Summary of changes since 2010 Guidelines The main changes in the ERC Guidelines 2015 in comparison with the Guidelines 20101are summarised below:Special causes•Survival after an asphyxia-induced cardiac arrest is rare and survivors often have severe neurological impairment. During CPR, early effective ventilation of the lungs with supplementary oxy-gen is essential.•A high degree of clinical suspicion and aggressive treatment can prevent cardiac arrest from electrolyte abnormalities. The new algorithm provides clinical guidance to emergency treatment of life-threatening hyperkalaemia.•Hypothermic patients without signs of cardiac instability(systolic blood pressure ≥90 mmHg, absence of ventricular arrhythmias or core temperature ≥28◦C) can be rewarmed externally using minimally invasive techniques (e.g. with warm forced air and warm intravenous fluid). Patients with signs of cardiac instability should be transferred directly to a centre capable of extracorporeal life support (ECLS).•Early recognition and immediate treatment with intramuscular adrenaline remains the mainstay of emergency treatment for anaphylaxis.•The mortality from traumatic cardiac arrest (TCA) is very high.The most common cause of death is haemorrhage. It is recognised that most survivors do not have hypovolaemia, but instead have other reversible causes (hypoxia, tension pneumothorax, cardiac tamponade) that must be immediately treated. The new treatment algorithm for TCA was developed to prioritise the sequence of life- saving measures. Chest compressions should not delay the treatment of reversible causes. Cardiac arrests of non-traumatic origin leading to a secondary traumatic event should be recog- nised and treated with standard algorithms.•There is limited evidence for recommending the routine trans-port of patients with continuing CPR after out-of-hospital cardiac arrest (OHCA) of suspected cardiac origin. Transport may be beneficial in selected patients where there is immediate hospital access to the catheterisation laboratory and an infrastructure providing prehospital and in- hospital teams experienced in mechanical or haemodynamic support and percutaneous coronary intervention (PCI) with ongoing CPR.•Recommendations for administration of fibrinolytics when pulmonary embolism is the suspected cause of cardiac arrest remain unchanged. Routine use of surgical embolectomy or mechanical thrombectomy when pulmonary embolism is the suspected cause of cardiac arrest is not recommended. Consider these methods only when there is a known diagnosis of pulmonary embolism.•Routine use of gastric lavage for gastrointestinal decontamination in poisoning is no longer recommended. Reduced emphasis is placed on hyperbaric oxygen therapy in carbon monoxide poisoning.Special environments•The special environments section includes recommendations for treatment of cardiac arrest occurring in specific locations. These locations are specialised healthcare facilities (e.g. operating theatre, cardiac surgery, catheterisation laboratory, dialysis unit, dental surgery), commercial airplanes or air ambulances, field of play, outside environment (e.g. drowning, difficult terrain, high altitude, avalanche burial, lightning strike and electrical injuries)or the scene of a mass casualty incident.•Patients undergoing surgical procedures involving general anaes- thesia, particularly in emergencies, are at risk from perioperative cardiac arrest. A new section covers the common causes and relevant modification to resuscitative procedures in this group of patients.•Cardiac arrest following major cardiac surgery is relatively common in the immediate post-operative phase. Key to successful resuscitation is recognition of the need to perform emergency resternotomy, especially in the context of tamponade or hae- morrhage, where external chest compressions may be ineffective. Resternotomy should be performed within 5 min if other interventions have failed.•Cardiac arrest from shockable rhythms (Ventricular Fibrillation(VF) or pulseless Ventricular Tachycardia (pVT)) during cardiac catheterisation should immediately be treated with up to three stacked shocks before starting chest compressions. Use of mechanical chest compression devices during angiography is recommended to ensure high-quality chest compressions and reduce the radiation burden to personnel during angiography with ongoing CPR.•In dental surgery, do not move the patient from the dental chair in order to start CPR. Quickly recline the dental chair into a hor- izontal position and place a stool under the head of the chair to increase its stability during CPR.•The in-flight use of AEDs aboard commercial airplanes can result in up to 50% survival to hospital discharge. AEDs and appropriate CPR equipment should be mandatory on board of all commercial aircraft in Europe, including regional and low-cost carriers.Consider an over-the-head technique of CPR if restricted access precludes a conventional method, e.g. in the aisle.•The incidence of cardiac arrest on board helicopter emergency medical services (HEMS) and air ambulances is low. Importance of preflight preparation and use of mechanical chest compression devices are emphasised.•Sudden and unexpected collapse of an athlete on the field of play is likely to be cardiac in origin and requires rapid recognition and early defibrillation.•The duration of submersion is a key determinant of outcome from drowning. Submersion exceeding 10 min is associated with poor outcome. Bystanders play a critical role in early rescue and resuscitation. Resuscitation strategies for those in respiratory or cardiac arrest continue to prioritise oxygenation and ventilation.•The chances of good outcome from cardiac arrest in difficult terrain or mountains may be reduced because of delayed access and prolonged transport. There is a recognised role of air rescue and availability of AEDs in remote but often-visited locations.•The cut-off criteria for prolonged CPR and extracorporeal rewarming of avalanche victims in cardiac arrest are more stringent to reduce the number of futile cases treated with extra-corpoereal life support (ECLS). ECLS is indicated if the duration of burial is >60 min (instead of >35 min), core temperature at extrication is

This executive summary provides the essential treatment algorithms for the resuscitation of children and adults and highlights the main guideline changes since 2010. Detailed guidance is provided in each of the ten sections, which are published as individual papers within this issue of Resuscitation. The sections of the ERC Guidelines 2015 are

Background. Guidelines for sedation, ventilator weaning, and delirium screening are helpful to avoid too deep sedation and to identify signs of delirium in the intensive care unit (ICU). Methods. National ICU registry members (n=37) were surveyed regarding use of scoring instruments and guidelines for sedation and ventilator weaning, choice of drugs, and daily sedation interruption practices. Results were merged with registry data on ventilator time and length of stay for ICU patients ventilated >24 hours (7.075 ICU stays). Results. Eighty-five percent of the 33 responding ICUs used sedation scales and 39% and 55% had sedation and weaning protocols, respectively. An association was found between using protocols and longer mean ventilator time and mean length of ICU stay. Thirty three percent (11/33) practiced daily sedation interruption. Regular delirium assessment was associated with significantly shorter mean ventilator time and mean length of ICU stay but used by few. Conclusion. More ICUs had guidelines for weaning than for sedation. The ventilator time and length of ICU stay compared well with other studies. Although having guidelines was associated with longer ventilator time and ICU stay, the differences were rather small. Daily sedation interruption was seldom used. Few units used delirium scoring instruments.

Background Overdoses from so-called “club drugs” (GHB/GBL) have become a more frequent cause of overdoses attended by ambulance services. Given its availability, affordability, and lack of awareness of risks, there is a common misconception among users that the drug is relatively safe. Methods This study reviewed ambulance records in Bergen, Norway between 2009 and 2015 for cases of acute poisonings, particularly from suspected GHB/GBL intoxication. Results In total, 1112 cases of GHB and GBL poisoning were identified. GHB was suspected for 995 (89%) of the patients. Men made up the majority of the cases (n = 752, 67.6%) with a median age of 27 years old. Temporal trends for GHB/GBL overdoses displayed a late-night, weekend pattern. The most frequent initial symptoms reported were unconsciousness, or reduced consciousness. Most of the patients required further treatment and transport. During the period from 2009 to 2015, there was a nearly 50% decrease in GHB/GBL overdoses from 2013 to 2014. Discussion The characteristics of GHB/GBL overdose victims shed light on this patient group. The decrease in incidence over the years may be partly due to a legal ban on GBL in Norway, declared in 2010. It may also be due to an increase in the use of MDMA/ecstasy. Conclusion The review of ambulance records on the prehospital treatment of overdoses can be beneficial in monitoring, preparing, and prevention efforts aimed to benefit this vulnerable group.

Background Critically ill patients need to be immediately identified, properly managed, and rapidly transported to definitive care. Extensive prehospital times may increase mortality in selected patient groups. The on-scene time is a part of the prehospital interval that can be decreased, as transport times are determined mostly by the distance to the hospital. Identifying factors that affect on-scene time can improve training, protocols, and decision making. Our objectives were to assess on-scene time in the Helicopter Emergency Medical Service (HEMS) in our region and selected factors that may affect it in specific and severe conditions. Methods This retrospective cohort study evaluated on-scene time and factors that may affect it for 9757 emergency primary missions by the three HEMSs in western Norway between 2009 and 2013, using graphics and descriptive statistics. Results The overall median on-scene time was 10 minutes (IQR 5–16). The median on-scene time in patients with penetrating torso injuries was 5 minutes (IQR 3–10), whereas in cardiac arrest patients it was 20 minutes (IQR 13–28). Based on multivariate linear regression analysis, the severity of the patient’s condition, advanced interventions performed, mode of transport, and trauma missions increased the on-scene time. Endotracheal intubation increased the OST by almost 10 minutes. Treatment prior to HEMS arrival reduced the on-scene time in patients suffering from acute myocardial infarction. Discussion We found a short OST in preselected conditions compared to other studies. For the various patient subgroups, the strength of association between factors and OST varied. The time spent on-scene and its influencing factors were dependent on the patient’s condition. Our results provide a basis for efforts to improve decision making and reduce OST for selected patient groups. Conclusions The most important factors associated with increased on-scene time were the severity of the patient’s condition, the need for intubation or intravenous analgesic, helicopter transport, and trauma missions. Electronic supplementary material The online version of this article (10.1186/s13049-017-0442-5) contains supplementary material, which is available to authorized users.