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Objective Emergency medical personnel are exposed to multiple stressors, including those of psychological etiologies. The aim of this study was to report the prevalence of anxiety, depression, and posttraumatic stress symptoms in Norwegian medical helicopter personnel and to determine to what degree they report personal growth or deprecation due to exposure to work-related events. Methods This was a web-based, cross-sectional survey performed among rescue paramedics and physicians staffing helicopter emergency medical services and search and rescue helicopters between May 5, 2021, and July 5, 2021. Questions included demographic data, the traumatic events exposure index, the Generalized Anxiety Disorder 7 scale, the Patient Health Questionnaire 9 (Depression), the posttraumatic change scale, and the posttraumatic symptom scale. Results Of the 245 eligible participants, 10 declined to take part and 74 failed to answer, producing a response rate of 66% (72 rescue paramedics and 89 physicians). Of the study population, 3.9 % reported manifest posttraumatic stress disorder symptoms, and 1.9% described moderate to severe depression and anxiety. The majority (76%) described posttraumatic emotional growth because of their work experience. Conclusion Despite exposure to several traumatic stressors, participants reported a lower prevalence of posttraumatic stress symptoms, depression, and anxiety compared with a Norwegian adult population. Previous article in issue

To measure and evaluate clinical response to nasal naloxone in opioid overdoses in the pre-hospital environment.Randomised, controlled, double-dummy, blinded, non-inferiority trial, and conducted at two centres.Participants were included by ambulance staff in Oslo and Trondheim, Norway, and treated at the place where the overdose occurred.Men and women age above 18 years with miosis, rate of respiration ≤8/min, and Glasgow Coma Score12/15 were included. Informed consent was obtained through a deferred-consent procedure.A commercially available 1.4 mg/0.1 mL intranasal naloxone was compared with 0.8 mg/2 mL naloxone administered intramuscularly.The primary end-point was restoration of spontaneous respiration of ≥10 breaths/min within 10 minutes. Secondary outcomes included time to restoration of spontaneous respiration, recurrence of overdose within 12 hours and adverse events.In total, 201 participants were analysed in the per-protocol population. Heroin was suspected in 196 cases. With 82% of the participants being men, 105 (97.2%) in the intramuscular group and 74 (79.6%) in the intranasal group returned to adequate spontaneous respiration within 10 minutes after one dose. The estimated risk difference was 17.5% (95% CI, 8.9%-26.1%) in favour of the intramuscular group. The risk of receiving additional naloxone was 19.4% (95% CI, 9.0%-29.7%) higher in the intranasal group. Adverse reactions were evenly distributed, except for drug withdrawal reactions, where the estimated risk difference was 6.8% (95% CI, 0.2%-13%) in favour of the intranasal group in a post hoc analysis.Intranasal naloxone (1.4 mg/0.1 mL) was less efficient than 0.8 mg intramuscular naloxone for return to spontaneous breathing within 10 minutes in overdose patients in the pre-hospital environment when compared head-to-head. Intranasal naloxone at 1.4 mg/0.1 mL restored breathing in 80% of participants after one dose and had few mild adverse reactions.

Background Posttraumatic stress disorder (PTSD) has been shown to be elevated among first responders (Emergency Medical Services, fire service, police force) compared to the general population. Examining the prevalence of mental health issues in a work force with an elevated occupational risk is fundamental towards ensuring their wellbeing and implementing safeguard measures. The goal of this study is therefore to report the prevalence of depression, anxiety, posttraumatic development, and PTSD in Norwegian ambulance personnel. Methods This study is a cross-sectional, anonymous, web-based survey (Questback®), performed among operative personnel employed in the Emergency Medical Services in the Regional Health Trust of Central Norway between 18. February and 9. April 2021. The study was sent to 1052 eligible participants. Questions reported demographic data, a traumatic events exposure index, Patient Health Questionnaire-9 (Depression), Generalized Anxiety Disorder-7 scale, Posttraumatic symptom scale (PTSD) and Posttraumatic change scale. Results The response rate in this study was 45.5% (n = 479/1052). The mean age of respondents was 37.1 years (std. 11.1) and 52.8% (n = 253) were male. Of the respondents, 80.6% (n = 386) were married or had a partner, and 91.6% (n = 439) reported having access to a peer support programme, with 34.9% (n = 167) reporting that they had utilized peer support. In this study, 5% (n = 24) showed a prevalence of manifest posttraumatic stress disorder symptoms, while 8.6% (n = 41) reported moderate to severe depression and 2.9% (n = 14) presented moderate to severe symptoms of general anxiety. Of the respondents, 77.2% (n = 370) reported personal growth because of their work experiences. Conclusions This study indicates that Norwegian ambulance personnel report a prevalence of posttraumatic stress symptoms and depression, which is slightly higher for men, and lower for the female proportion in this study, when compared to an adult Norwegian population. The vast majority of respondents reported personal growth because of their work experience, and both the degree of peer support and having a partner seem to influence levels of posttraumatic stress and -development.

The change of rescue helicopter type from the Sea King to the SAR Queen has been controversial. Some hospitals can no longer receive rescue helicopters because of the stronger rotor downwash from the SAR Queen. For the same reason, it has been unclear whether the SAR Queen would be able to land near patients for air ambulance missions. The objective of the study was to investigate whether the change of helicopter type has changed the rescue service's mission profile.Mission data from the first eight months with the SAR Queen at Ørland Air Base (14 May 2021-14 January 2022) were compared with the last equivalent period with the Sea King (14 May 2020-14 January 2021).The number of requests increased from 249 to 349 (40 %) after the introduction of the new rescue helicopter. Response time increased from 11 to 13 minutes (18 %), while the on-scene time remained unchanged at 10 minutes for primary missions and search and rescue missions. The patients' average degree of severity, assessed by NACA scores, remained unchanged at 3.7. The proportion of missions where hoisting of a rescue paramedic or a doctor was required to gain access to the patient remained unchanged.The study showed that the use of the rescue helicopter at Ørland Air Base increased after the phasing-in of the SAR Queen. The service's mission profile remained the same. The unchanged proportion of missions that involved hoisting indicates that suitable landing sites close to the patients were found to the same extent as with the Sea King.

Bakgrunn: Fokus på høyere legefaglig kompetanse i akuttmottakene har økt de siste årene, og i mange norske akuttmottak er det nå fast ansatte leger i klinisk virksomhet. Det finnes ingen norske studier som viser effekter av akuttleger i akuttmottak. Vi ønsket å evaluere effekter av å introdusere akuttlege ved et mellomstort norsk akuttmottak. Materiale og metode: Vi har samlet logistiske pasientdata fra 22 ukedager (i perioden kl 8-15) med akuttlege tilstede i akuttmottaket og sammenliknet med tilsvarende antall ukedager før og etter perioden. I tillegg ble det gjennomført spørreundersøkelse for vaktgående leger og sykepleiere. Resultater: Gjennomsnittlig oppholdstid for pasienter gikk ned med 57 minutter i akuttlegeperioden sammenliknet med perioden før (3t 21min versus 2t 24min, 28 %, p

We propose new recommendations for the emergency treatment of low-voltage electric injuries (1 000 volts). A large proportion of these patients can be treated as outpatients.

BAKGRUNN Pasienter utsatt for strøm henvises ofte til akuttmottaket, men det er ulike retningslinjer for hvordan disse bør håndteres. Vi beskriver her pasienter med strømgjennomgang fra lavspenning i akuttmottaket ved St. Olavs hospital. METODE OG MATERIALE Retrospektive data fra pasienter henvist til akuttmottaket etter strømgjennomgang fra lavspenning (< 1 000 volt) i perioden 1.1.2012–31.12.2017 (N = 210) ble inkludert. RESULTATER Median alder var 26 år og 186/210 (89 %) var menn. 165/210 (79 %) hadde symptomer etter strømgjennomgangen. Lokal smerte og ubehag i brystet forekom hos henholdsvis 84/165 (51 %) og 57/165 (35 %). Det var normale EKG-funn hos 168/209 (80 %), og ingen pasienter hadde behandlingstrengende arytmier eller økning i troponin T eller kreatinkinase. Ingen pasienter hadde alvorlige komplikasjoner eller døde. FORTOLKNING Strømgjennomgang fra lavspenning gav verken alvorlige arytmier eller forhøyet nivå av troponin T eller kreatinkinase. Asymptomatiske pasienter med normale funn ved klinisk undersøkelse og på EKG bør kunne håndteres utenfor sykehus, uten at pasientsikkerheten reduseres.

Introduction Intranasal naloxone is widely used to treat opioid overdoses. The advantage of nasal administration compared to injection lies in its suitability for administration by lay people as it is needless. Approved formulations of nasal naloxone with bioavailability of approximately 50% have only undergone trials in healthy volunteers, while off-label nasal sprays with low bioavailability have been studied in patients. Randomised clinical trials are needed to investigate efficacy and safety of approved intranasal naloxone in patients suffering overdose. This study investigates whether the administration of 1.4 mg naloxone in 0.1 millilitres per dose is non- inferior to 0.8 mg intramuscular injection in patients treated for opioid overdose. Methods and analysis Sponsor is the Norwegian University of Science and Technology. The study has been developed in collaboration with user representatives. The primary endpoint is the restoration of spontaneous respiration ≥10 breaths/minute based on a sample of 200 opioid overdose cases. Double-dummy design ensures blinding, which will be maintained until the database is locked. Ethics and dissemination The study was approved by the Norwegian Medicines Agency and Regional Ethics Committees (REC: 2016/2000). It adheres to the Good Clinical Practice guidelines as set out by The International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use. Informed consent will be sought through a differentiated model. This allows for deferred consent after inclusion for patients who have regained the ability to consent. Patients who are unable to consent prior to discharge by emergency services are given written information and can withdraw at a later date in line with user recommendations. Metadata will be published in the NTNU Open repository. De-identified individual participant data will be made available to recipients conditional of data processor agreement being entered. Trial registrations: EudraCT number: 2016-004072-22 and Clinicaltrials.gov NCT03518021 © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

The Emergency Department in Trondheim has prepared for a large influx of patients infected with the SARS-CoV-2 virus. We conducted a study comparing patients in the Emergency Department in the first weeks of the pandemic in Norway (weeks 11 and 12) with the average number of patient visits.Data from patients at the Emergency Department of St Olav's Hospital in the period 6 January 2020-22 March 2020 were retrieved from the Emergency Department's database. Logistical patient data concerning patient numbers, chief complaints, length of stay in the Emergency Department, acuity level, isolation status, and treatment level were analysed.In week 12, 331 patients were referred to the Emergency Department, a reduction of 39 % compared with the average of 541 patients in weeks 2-10. There was a general reduction in all patient groups, but particularly those discharged from the Emergency Department. In week 12 there were 56 more patients isolated with suspected/potentially infectious disease (187 %) compared with the average for weeks 2-10, and these patients spent almost two hours longer in the Emergency Department than other patients.There was a reduction in patient visits to the Emergency Department in the first weeks of the pandemic. The percentage of patients isolated for infection control increased, and the time spent in the Emergency Department for these patients was greater than for other patients. The reduction in the inflow of patients is expected to be temporary, and the Emergency Department at St Olav's Hospital expects a large influx of patients with suspected COVID-19 disease.

Chest pain is one of the most frequent chief complaints in patients admitted to the emergency department (ED). No study has evaluated this patient population in Norway. The aim of the present study was to describe the diagnoses and logistics of chest pain patients admitted to the ED at a Norwegian university hospital.Data were collected from all patients referred to the ED at St. Olav's Hospital-Trondheim University Hospital in 2015. Patients presenting at the ED with a chief complaint of chest pain based on the Rapid Emergency Triage and Treatment System were included in this study.In the study period, 22,403 patients were admitted to the ED. Chest pain was the second most common chief complaint (11%), only exceeded by acute abdominal pain (18%). Among the chest pain patients, 12% had acute coronary syndrome (ACS) and 37% were diagnosed with non-specific chest pain. Gastrointestinal, musculoskeletal, and pulmonary conditions were less common, affecting 6%, 4%, and 4% of the patients, respectively. In total, 90% of the ED chest pain patients were handled by the Clinic of Cardiology.Chest pain was the second most common chief complaint among patients admitted to the ED, and most patients were handled by the Clinic of Cardiology. More than one-third of the patients received a cardiac diagnosis, but the largest group of patients was discharged with a diagnosis of non-specific chest pain. Other conditions managed by non-cardiac medical specialties were less common.

Background The Emergency Department in Trondheim has prepared for a large influx of patients infected with the SARS-CoV-2 virus. We conducted a study comparing patients in the Emergency Department in the first weeks of the pandemic in Norway (weeks 11 and 12) with the average number of patient visits. Material and method Data from patients at the Emergency Department of St Olav's Hospital in the period 6 January 2020-22 March 2020 were retrieved from the Emergency Department's database. Logistical patient data concerning patient numbers, chief complaints, length of stay in the Emergency Department, acuity level, isolation status, and treatment level were analysed. Results In week 12, 331 patients were referred to the Emergency Department, a reduction of 39 % compared with the average of 541 patients in weeks 2-10. There was a general reduction in all patient groups, but particularly those discharged from the Emergency Department. In week 12 there were 56 more patients isolated with suspected/potentially infectious disease (187 %) compared with the average for weeks 2-10, and these patients spent almost two hours longer in the Emergency Department than other patients. Interpretation There was a reduction in patient visits to the Emergency Department in the first weeks of the pandemic. The percentage of patients isolated for infection control increased, and the time spent in the Emergency Department for these patients was greater than for other patients. The reduction in the inflow of patients is expected to be temporary, and the Emergency Department at St Olav's Hospital expects a large influx of patients with suspected COVID-19 disease.

Background: Crowding in emergency departments (EDs) is a challenge globally. To counteract crowding in day-to-day operations, better tools to improve monitoring of the patient flow in the ED is needed. The objective of this study was the development of a continuously updated monitoring system to forecast emergency department (ED)arrivals on a short time-horizon incorporating data from prehospital services. Methods: Time of notification and ED arrival was obtained for all 191,939 arrivals at the ED of a Norwegian university hospital from 2010 to 2018. An arrival notification was an automatically captured time stamp which indicated the first time the ED was notified of an arriving patient, typically by a call from an ambulance to the emergency service communication center. A Poisson time-series regression model for forecasting the number of arrivals on a 1-, 2- and 3-h horizon with continuous weekly and yearly cyclic effects was implemented. We incorporated time of arrival notification by modelling time to arrival as a time varying hazard function. We validated the model on the last full year of data. Results: In our data, 20% of the arrivals had been notified more than 1 hour prior to arrival. By incorporating time of notification into the forecasting model, we saw a substantial improvement in forecasting accuracy, especially on a one-hour horizon. In terms of mean absolute prediction error, we observed around a six percentage-point decrease compared to a simplified prediction model. The increase in accuracy was particularly large for periods with large inflow. Conclusions: The proposed model shows increased predictability in ED patient inflow when incorporating data on patient notifications. This approach to forecasting arrivals can be a valuable tool for logistic, decision making and ED resource management. © The Author(s). 2019Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

There is a lack of knowledge of the emergency department (ED) population in Norway; hence, the aim of this study was to describe the ED patient population at a Norwegian University Hospital.Prospective data of all ED patients admitted to the main ED over a period of 2 months were collected. The patients' presenting complaint was registered using the International Classification of Primary Care-2 (ICPC-2).A total of 3163 patients arrived in the ED during the study period. The majority (71%) of patients presented with a complaint that was defined as a symptom in ICPC-2. The most common symptoms were abdominal pain (13%), chest pain (13%), and dyspnea (9%). The complaints of the remaining patients (29%) were primarily traumas, infections, and other diagnoses.ED patients have a diverse spectrum of presenting complaints and the majority of patients present with symptoms rather than a defined medical diagnosis.

A series of experiments with thixotropic fluids composed of polymers and salt, with various temperatures and in circulation was carried out to examine how it influenced the current polymers decompositioning. The results indicated that salt would increase the time a polymer, in relatively high concentrations, would maintain its initial rheological characteristics. Exposing a polymer solution to shear stress has revealed that the polymer undergoes viscoelastic creep where the polymer fails under stress and decreases in viscosity rapidly the first 24 hours, 2 cP in 2%PAC and 10 cP in 4%PAC, before flattening out. The rapid early decrease was enhanced when the temperature was increased from 25℃ to 50℃ in both a 2%PAC solution and a 4%PAC solution with respectively 4 cP and 17 cP (Plastic viscosity). The polymer xanthan gum appears to be more reactive to small changes in temperature and shear stress when dissolved in water than polyanionic cellulose.

Background The patient visits to Norwegian emergency departments (EDs) have increased significantly over the last few years. A national evaluation revealed a lack of systematic activity control, resource management and quality improvement. This paper describes some variables in patient visits to an urban Norwegian university hospital. Methods The retrospective data were collected from a database (Akuttdatabasen) and included all patients admitted to the main ED at the St. Olav9s University Hospital between 1 December 2010 and 1 December 2011. Results ED visits have increased by 44% over the last decade and show considerable timely variations. Almost 50% of the patients are older than 65 years of age. The rate of patients triaged with the highest acuity level was 11%, but only 1.3% of the patients were admitted to the Intensive Care Unit (ICU). The total admission rate was 89%. Conclusions The increase in ED visits to the St. Olav9s Hospital in recent years follows the same trend as in other countries. The authors see a slightly higher percentage of high level acuity patients compared with international studies due the general practitioner9s intended ‘gatekeeper’ function. The authors also found a high total admission rate and a low ICU admission rate compared with other countries. These differences cannot be explained solely by differences in the healthcare system in Norway. The cultural and traditional organisation of the Norwegian Health Care System needs to change and this creates an excellent opportunity to improve the competence by establishing emergency medicine as a specialty in Norway.

Background Although pain management is a fundamental aspect of care in emergency departments (EDs), inadequate treatment of pain is unfortunately common. There are multiple local protocols for pain assessment in the ED. This study evaluated whether the initial assessment and treatment of pain in the ED are in accordance with the in-hospital protocol of the ED at a Norwegian University Hospital. Materials and methods Prospective data on pain assessment and initial treatment in the ED were collected from nursing and physician documentation. The patients’ perceptions of subjective pain were recorded using a numerical rating scale (NRS) that ranged from 0 to 10. Results Seventy-seven percent of the 764 enrolled patients were evaluated for pain at arrival. Female patients had a higher probability of not being asked about pain, but there was no difference in the percentage of patients asked about pain with respect to age. Additionally, patients with low oxygen saturation and systolic blood pressure were less likely to be asked about pain. Of those with moderate and severe pain (58 %), only 14 % received pain relief. Discussion Assessment and treatment of pain in the ED are inadequate and not in line with the local protocols. A focus on strategies to improve pain treatment in the ED is a necessary aspect of developing optimal acute patient care in Norway in the future.