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1. Epidemiology and aetiology of impaired level of consciousness in prehospital nontrauma patients in an urban setting

Author

Tom Silfvast, Juhana Hallikainen, Johannes Björkman, and Klaus T. Olkkola

Subjects
Adult, Male, Emergency Medical Services, medicine.medical_specialty, Adolescent, Urban Population, Unconsciousness, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Level of consciousness, Seizures, Epidemiology, medicine, Emergency medical services, Humans, Young adult, Child, Finland, Aged, Aged, 80 and over, Coma, business.industry, Infant, 030208 emergency & critical care medicine, Emergency department, Middle Aged, medicine.disease, Hypoglycemia, Child, Preschool, Emergency medicine, Emergency Medicine, Etiology, Female, Medical emergency, medicine.symptom, business, Alcoholic Intoxication, 030217 neurology & neurosurgery
Abstract

There is little information on the epidemiology and aetiology of nontraumatic loss of consciousness in patients in the Emergency Department, and this high-risk patient group has been poorly characterized in the prehospital setting as well. The aim of this study was to study the epidemiology and aetiology of nontraumatic impaired level of consciousness among the patients treated by an urban Emergency Medical Service (EMS) system in Finland.Data of all emergency calls not related to trauma in an urban EMS system in southern Finland during 2012 were analysed. The inclusion criterion in this study was impaired level of consciousness as identified from the EMS run sheets. Diagnoses made in the receiving facility were cross-checked with the data.During the study period, the EMS was alerted to 22 184 emergency calls. Of these, 306 calls met the inclusion criterion. The included patients could be categorized into four groups: seizures (32%), diabetes (24%), intoxication (17%) and impaired level of consciousness with no other obvious or specific cause (27%). The overall case fatality rate was 8%.Of all EMS calls, patients who presented with an impaired level of consciousness represented 1.4% of all patients, but the fatality rate in those who remained with an impaired level of consciousness during the prehospital phase was considerable. Impaired level of consciousness was associated with a multitude of aetiologies, of which seizures were the most common.

Published
2016

2. EuReCa ONE⿿27 Nations, ONE Europe, ONE Registry

Author

Jan-Thorsten Gräsner, Rolf Lefering, Rudolph W. Koster, Siobhán Masterson, Bernd W. Böttiger, Johan Herlitz, Jan Wnent, Ingvild B.M. Tjelmeland, Fernando Rosell Ortiz, Holger Maurer, Michael Baubin, Pierre Mols, Irzal HadžibegoviĿ, Marios Ioannides, Roman Škulec, Mads Wissenberg, Ari Salo, Hervé Hubert, Nikolaos I. Nikolaou, Gerda Lóczi, Hildigunnur Svavarsdóttir, Federico Semeraro, Peter J. Wright, Carlo Clarens, Ruud Pijls, Grzegorz Cebula, Vitor Gouveia Correia, Diana Cimpoesu, Violetta Raffay, Stefan Trenkler, Andrej Markota, Anneli Strömsöe, Roman Burkart, Gavin D. Perkins, Leo L. Bossaert, Marc Kaufmann, Markus Thaler, Martin Maier, Gerhard Prause, Helmut Trimmel, Diane de Longueville, Thierry Preseau, Dominique Biarent, Christian Melot, Nicolas Mpotos, Koen Monsieurs, Patrick Van de Voorde, Marie Vanhove, Pascale Lievens, Mathias Faniel, Slobodanka Keleuva, Milan Lazarevic, Radmila Majhen Ujevic, Mato Devcic, Branka Bardak, Fabijan Barisic, Silvija Hunyadi Anticevic, Marios Georgiou, Anatolij Truhláſ, Jiſí Knor, Eva Smržová, Roman Sviták, Robin Šín, Petr Mokrejš, Freddy K. Lippert, Juhana Hallikainen, Marko Hoikka, Timo Iirola, Timo Jama, Helena Jäntti, Raimo Jokisalo, Milla Jousi, Hetti Kirves, Markku Kuisma, Jukka Laine, Sami Länkimäki, Petri Loikas, Vesa Lund, Teuvo Määttä, Heini Nal, Heimo Niemelä, Petra Portaankorva, Marko Pylkkänen, Marko Sainio, Piritta Setälä, Jerry Tervo, Taneli Väyrynen, Davy Murgue, Anne Champenois, Marc Fournier, Daniel Meyran, Romain Tabary, Aurélie Avondo, Gelin Gelin, Bruno Simonnet, Marc Joly, Isabelle Megy-Michoux, Xavier Paringaux, Yves Duffait, Michael Vial, Julien Segard, Sophie Narcisse, David Hamban, Jonathan Hennache, Sylvain Thiriez, Mathieu Doukhan, Carine Vanderstraeten, Jean-Charles Morel, Gilles Majour, Corinne Michenet, Laurent Tritsch, Marc Dubesset, Olivier Peguet, David Pinero, Fréderic Guillaumee, Patrick Fuster, Jean-François Ciacala, Benoît Jardel, Jean-Yves Letarnec, Frank Goes, Pierre Gosset, Muriel Vergne, Christian Bar, Fabienne Branche, Stevens Prineau, Steven Lagadec, Carole Cornaglia, Cécile Ursat, Philippe Bertrand, Jean-Marc Agostinucci, Pierre Nadiras, Géraldine Gonzales de Linares, Line Jacob, François Revaux, Thomas Pernot, Nathalie Roudiak, Agnès Ricard-Hibon, Laurent Villain-Coquet, Stefan Beckers, Thomas Hanff, Bernd Strickmann, Nicolai Wiegand, Petra Wilke, Harald Sues, Stefan Bogatzki, Wolfgang Baumeier, Kai Pohl, Bert Werner, Hans Fischer, Torsten Zeng, Erik Popp, Andreas Günther, Andreas Hochberg, Alex Lechleuthner, Jens-Christian Schewe, Hans Lemke, Erich Wranze-Bielefeld, Andreas Bohn, Markus Roessler, Frank Naujoks, Frank Sensen, Torben Esser, Matthias Fischer, Martin Messelken, Christopher Rose, Gabriele Schlüter, Wolfgang Lotz, Michael Corzilius, Claus-Martin Muth, Christian Diepenseifen, Björn Tauchmann, Torsten Birkholz, Andreas Flemming, Stefanie Herrmann, Uwe Kreimeier, Clemens Kill, Frank Marx, Ralph Schröder, Wolfgang Lenz, Glykeria Botini, Barakos Grigorios, Nikolaos Giannakoudakis, Michail Zervopoulos, Dimitrios Papangelis, Sofia Petropoulou-Papanastasiou, Themistoklis Liaskos, Spyridon Papanikolaou, Andreas Karabinis, Attila Zentay, Hólmgeir ÿorsteinsson, Anna Gilsdóttir, Svavar A. Birgisson, Fjölnir Freyr Guðmundsson, Hallgrímur Hreiðarsson, Björgvin ÿrnason, Hermann Hermannsson, Gísli Björnsson, Brynjar ÿór Friðriksson, Gunnar Baldursson, ÿrmann Höskuldsson, Jórunn Valgarðsdottir, Matthildur ÿsmundardóttir, Guðmundur Guðmundsson, Hjörtur Kristjánsson, Eyþór Rúnar ÿórarinsson, Jón Guðlaugsson, Sigurður Skarphéðinsson, Alberto Peratoner, Andrea Santarelli, Cesare Sabetta, Giovanni Gordini, Giovanni Sesana, Riccardo Giudici, Simone Savastano, Tommaso Pellis, Jean Beissel, Jean Uhrig, Tom Manderscheid, Marco Klop, Pascal Stammet, Marc Koch, Philippe Welter, Robert Schuman, Wendy Bruins, Hesam Amin, Nina Braa, Staale Bratland, Eirik Alnes Buanes, Tomas Draegni, Knut Roar Johnsen, Wenche Torunn Mathisen, Terje Oedegaarden, Marie Oppedal, Alf Stolt-Nielsen Reksten, Mats Eirik Roedsand, Jon Erik Steen-Hansen, Marta Dyrda, Anna Frejlich, Sſawomir MaciĿg, Sonia Osadnik, Ireneusz Weryk, Eugénio Mendonça, Carlos Freitas, Pinto Cruz, Carmo Caldeira, José Barros, Luis Vale, António Brazão, Nuno Jardim, Fernanda Rocha, Ricardo Duarte, Nicodemos Fernandes, Pedro Ramos, Margarida Jardim, Miguel Reis, Romulo Ribeiro, Sérgio Zenha, Jorge Fernandes, Juan Francisco, David Assis, Fernanda Abreu, Dinarte Freitas, Leonardo Ribeiro, Paulo Azevedo, Débora Calafatinho, Rui Jardim, Aleixo Pestana, Rui Faria, Bogdan Oprita, Alis Grasu, Paul Nedelea, Sorina Sovar, Florin Agapi, Aleksandar KliĿkoviĿ, Aleksandra LaziĿ, Bogdan NikoliĿ, Bogdan Zivanovic, Branislav MartinoviĿ, Dušan MilenkoviĿ, HuseinoviĿ Damir, Jovanka Koprivica, Kornelija Horvat JakšiĿ, Margit Pajor, Saša MiliĿ, Mirko VidoviĿ, Radojka Petrovic Glamoclija, Sladjana Andjelic, Vlajovic Sladjana, Zlatko BabiĿ, Zlatko Fišer, Peter Androvic, Lubica Bajerovska, Miroslav Chabron, Viliam Dobias, Eva Havlikova, Bozena Horanova, Renata Kratochvilova, Dana Kubova, Jan Murgas, Juraj Patras, Ladislav Simak, Vladimir Snarskij, Zuzana Zaviaticova, Marcela Zuffova, Francesc Escalada Roig, Luis Sánchez Santos, Alfredo Echarri Sucunza, Juan A. Cordero Torres, Guadalupe Inza Muñoz, Marta Martínez del Valle, Isabel Ceniceros Rozalen, Enrique Martín Sánchez, María Victoria Raúl Canabal Berlanga, Karlos Ibarguren Olalde, José I. Ruiz Azpiazu, María José García-Ochoa, Rafael Zoyo López-Navarro, José M. Adsuar Quesada, José A. Cortés Ramas, Francisco J. Mellado Vergel, Juan B. López Messa, Patricia Fernández del Valle, Luciano Anselmi, Breganzona Claudio Benvenuti, Nigel Batey, Yorkshire Ambulance, Scott Booth, Patricia Bucher, Charles D. Deakin, Jay Duckett, Chen Ji, Nancy Loughlin, Jenny Lumley-Holmes, Jessica Lynde, Frank Mersom, Carly Ramsey, Clare Robinson, Robert Spaight, Sukhdeep Dosanjh, Gurkamal Virdi, and Andrew Whittington

Subjects
medicine.medical_specialty, resuscitation outcomes, resuscitation, united-states, education, cardiac arrest, 030204 cardiovascular system & hematology, Emergency Nursing, survival, Out of hospital cardiac arrest, resuscitation registry, 03 medical and health sciences, 0302 clinical medicine, Epidemiology, medicine, cpr, success, business.industry, sweden, Incidence (epidemiology), association, emergency medicine, europe, 030208 emergency & critical care medicine, defibrillation, 3. Good health, quality, Emergency, Emergency medicine, Emergency Medicine, epidemiology, Cardiology and Cardiovascular Medicine, business, management
Abstract

INTRODUCTION: The aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.METHODS: This was an international, pr ...

Published
2016

3. Cutting the Prehospital On-Scene Time of Stroke Thrombolysis in Helsinki

Author

Tuukka Puolakka, Sami Länkimäki, Perttu J. Lindsberg, Markku Kuisma, Kirsi Rantanen, Juhana Hallikainen, and Jyrki Puolakka

Subjects
Male, Emergency Medical Services, medicine.medical_specialty, Time Factors, Ambulances, 03 medical and health sciences, 0302 clinical medicine, Emergency medical services, Humans, Medicine, Thrombolytic Therapy, Prospective Studies, Stroke, Acute ischemic stroke, Finland, Aged, Aged, 80 and over, Advanced and Specialized Nursing, business.industry, 030208 emergency & critical care medicine, Middle Aged, medicine.disease, Emergency Medical Technicians, Emergency medicine, Stroke thrombolysis, Female, Neurology (clinical), Medical emergency, Emergency Service, Hospital, Cardiology and Cardiovascular Medicine, business, Training program, 030217 neurology & neurosurgery, Program Evaluation
Abstract

Background and Purpose— Significant portion of the prehospital delay consists of minutes spent on the scene with the patient. We implemented a training program for the emergency medical services personnel with the aim to optimize the on-scene time (OST) and to study the impact of different elements of prehospital practice to the OST duration. Methods— In this prospective interventional study, key operational emergency medical service performance variables were analyzed from all thrombolysis candidates transported to the Helsinki University Hospital emergency department. The catchment period was 4 months before and 4 months after the implementation. Results— One hundred and forty-one patients were managed as thrombolysis candidates before and 148 patients after the training program implementation. The OST duration for the groups was 25 (20.5–31) and 22.5 (18–28.5) minutes, respectively ( P Conclusions— Implementation of the emergency medical services training program successfully decreased the OST of thrombolysis candidates by 10%. Higher expertise level of the ambulance crew was associated with shorter OST, and decisions to consult a physician via telephone were reflected by longer OST.

Published
2016

4. Meeting abstracts from the first European Emergency Medical Services congress (EMS2016)

Author

Alexander White, Han Xian Ng, Wai Yee Ng, Eileen Kai Xin Ng, Stephanie Fook-Chong, Phek Hui Jade Kua, Marcus Eng Hock Ong, Alvilda Thougaard Steensberg, Lars Bredevang Andersen, Mette Mølby Eriksen, Ole Mazur Hendriksen, Thomas Thougaard, Andreas Claesson, J. Lennartsson, L. Svensson, M. Ringh, J. Hollenberg, P. Nordberg, M. Rosenqvist, T. Djarv, S. Österberg, D. Fredman, Y. Ban, Anne-Sophie Löwe, Jacob Nielsen, Martin Zimling, Jakob Schmidt, Freddy Lippert, Annette K. Ersbøll, Thea Palsgaard Møller, Mikkel D. Jørgensen, Annika Hamilton, Jacob Steinmetz, Mads Wissenberg, Christian Torp-Pedersen, Lars Hove, Nicolai Lohse, Bodil Thorsager, Hanne Bonde, Maria Birkvad Rasmussen, Doris Østergaard, Camilla Schade Hansen, Mikkel Brabrand, Annmarie Lassen, Cilia Kjer, Mathias Holgersen, Sandra Viggers, Claus Kjær Pedersen, Morten Thingemann Bøtker, Ingunn Skogstad Riddervold, Christian Juhl Terkelsen, Dag S. Nystøyl, S. Hunskaar, E. Zakariassen, David Fredman, Leif Svensson, Yifang Ban, Martin Jonsson, Jacob Hollenberg, Per Nordberg, Mattias Ringh, Mårten Rosenqvist, Margareta Lundén, Jan Haas, Filipe Ribeiro, Mark Newton, Paulo Freitas, Dario Rocha, Emilio Leal, Nuno Santos, Tania Cortez, Stephanie Allmark, Janet Marsden, Gitte Linderoth, Grethe Thomas, Anne Møller Nielsen, Gertrud Øllgaard, Hideo Inaba, Akira Yamashita, Testuo Maeda, Håkon Kvåle Bakke, Tine Steinvik, Johan Angell, Torben Wisborg, Håkon Ruud, Ingunn Anda Haug, Tonje S. Birkenes, Helge Myklebust, Jo Kramer-Johansen, Kamilia S. Funder, Lars S. Rasmussen, Rasmus Hesselfeldt, Volkert Siersma, Asger Sonne, Sandra Wulffeld, amilia S. Funde, Frants Pedersen, Ole M. Hendriksen, Freddy K. Lippert, Kim Sol-A, Sand Do Shin, Kyungwon Lee, Eui Jung Lee, Young Sun Ro, Ki Jeong Hong, Yu Jin Kim, Joo Jeong, Park Jeong Ho, Lars Grassmé Binderup, Søren Mikkelsen, Caroline Schaffalitzky de Muckadell, Hans Morten Lossius, Palle Toft, Annmarie Touborg Lassen, Lee Thompson, Michael Hill, Maren Ranhoff Hov, Thomas Lindner, Eirik Franer, Andreas Monstad, Christian G. Lund, Martin Betzer, Rasmus Malmberg Lyngby, Milla Jousi, Jouni Nurmi, Nanna Kruse, Charlotte Barfod, Nikolaj Raaber, Morten T. Bøtker, Sophie-Charlott Seidenfaden, Ingunn S. Riddervold, Paul Simpson, Liz Thyer, Ben van Nugteren, Hans Kirkegaard, Niels Juul, T. Zwisler, Camilla Rønnov, Hanne B. Mieritz, Gitte Jørgensen, Susanne Ångerman-Haasmaa, Sami Länkimäki, Søren Viereck, Josephine Philip Rothman, Fredrik Folke, Teodora Filipescu, Alasdair Gray, Teresa A Williams, Kwok M. Ho, Hideo Tohira, Daniel Fatovich, Deon Brink, Paul Bailey, Gavin D. Perkins, Judith Finn, Annette Kjær Ersbøll, Thora Majlund Kjærulff, Janne Shurmann Tolstrup, Jon Trærup Andersen, Jerry Overton, Theo Walther Jensen, Jens Roland, Jens Flensted Lassen, Tuukka Puolakka, Jyrki Puolakka, Juhana Hallikainen, Kirsi Rantanen, and Markku Kuisma

Subjects
medicine.medical_specialty, business.industry, 030208 emergency & critical care medicine, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Family medicine, Emergency Medicine, medicine, Helicopter emergency medical service, Emergency medical services, 030212 general & internal medicine, Meeting Abstracts, business
Published
2017

5. Teaching anaesthesia induction to medical students: comparison between full-scale simulation and supervised teaching in the operating theatre

Author

Tarja Randell, Leila Niemi-Murola, Juhana Hallikainen, P. Tarkkila, Olli Väisänen, and Per H. Rosenberg

Subjects
Male, Medical education, Students, Medical, Education, Medical, business.industry, Anesthetics, General, education, MEDLINE, 3. Good health, Patient Simulation, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, Humans, Medicine, Female, General anaesthesia, 030212 general & internal medicine, Anaesthesia induction, business, Patient simulation
Abstract

The aim of the study was to compare the effectiveness of teaching of general anaesthesia induction to medical students using either full-scale simulation or traditional supervised teaching with patients in the operating theatre.Forty-six fourth year students attending their course in anaesthesiology were enrolled. The students were randomly assigned to two groups. The simulation group received training in the simulator. The traditional training group was supervised by a senior consultant anaesthetist. After the training sessions all students were tested in the simulator setting. The test was assessed using a 40-item evaluation list.Thirty-three per cent of students in the traditional group and 87% of the students in the simulation group passed the test. Statistically significant differences were: request of glycopyrrolate (P0.001), Sp(O2) monitoring (P0.001), used gloves when placing an intravenous cannula (P = 0.012), intubation attempt within 30 s (P0.04), anaesthesia gas set at MAC at least 1 (P0.04), instructed anaesthetic nurse to keep Sp(O2) at least 95% (P0.05), keep MAP at least 60 mmHg (P0.05), keep heart rate more than 50 beats per minute (P0.002), keep end-tidal p(CO2) 4-5.5 kPa (P0.002).The simulation group performed better in 25% of the tasks and similarly in the others compared with the traditional teaching group. With the same time and amount of teaching personnel we trained five or six students in the simulator compared with one student in the operating theatre. Further research will reveal whether these promising results with simulation may be applied more generally in anaesthesiology teaching to medical students.

Published
2009

6. Interprofessional education of medical students and paramedics in emergency medicine

Author

Tom Silfvast, Leila Niemi-Murola, Juhana Hallikainen, Per H. Rosenberg, and O. Väisänen

Subjects
Program evaluation, medicine.medical_specialty, Students, Medical, 020205 medical informatics, media_common.quotation_subject, education, MEDLINE, 02 engineering and technology, Transfer system, 03 medical and health sciences, 0302 clinical medicine, Nursing, Surveys and Questionnaires, 0202 electrical engineering, electronic engineering, information engineering, Medicine, Humans, 030212 general & internal medicine, Curriculum, Finland, media_common, Teamwork, business.industry, 4. Education, General Medicine, Interprofessional education, Competency-Based Education, 3. Good health, Advanced life support, Emergency Medical Technicians, Anesthesiology and Pain Medicine, Life support, Family medicine, Emergency medicine, Emergency Medicine, business, Program Evaluation
Abstract

Background: Emergency medicine is team work from the field to the hospital and therefore it is also important for physicians to understand the work of paramedics, and vice versa. Interprofessional emergency medicine education for medical and paramedic students in Helsinki was started in 2001. It consisted of a 15 European credit transfer system (ECTS) credits programme combining 22 students in 2001. In 2005, the number of students had increased to 25. The programme consisted of three parts: acute illness in childhood and adults (AI), advanced life support (ALS) and trauma life support (TLS). In this paper, we describe the concept of interprofessional education of medical students and paramedics in emergency medicine. Methods: After finishing the programmes in 2001 and in 2005, the students’ opinions regarding the education were collected using a standardized questionnaire. Results: There were good ratings for the courses in AI (2001 vs. 2005, whole group; 4.3 ± 0.7 vs. 4.2 ± 0.4, P= 0.44) ALS (4.7 ± 0.5 vs. 4.4 ± 0.5, P= 0.06) and TLS (3.9 ± 0.7 vs. 4.4 ± 0.5, P= 0.01) in both years. Most of the medical students considered that this kind of co-education should be arranged for all medical students (2001 vs. 2005; 4.8 ± 0.6 vs. 4.4 ± 0.5, P= 0.02) and should be obligatory (3.5 ± 1.5 vs. 3.1 ± 1.3, P= 0.35). Conclusions: Co-education was well received and determined by the students as an effective way of improving their knowledge of emergency medicine and medical skills. The programme was rated as very useful and it should be included in the educational curriculum of both student groups.

Published
2007

8. Reply to ?Interprofessional education?

Author

Juhana Hallikainen

Subjects
Anesthesiology and Pain Medicine, Nursing, business.industry, Medicine, General Medicine, Interprofessional education, business
Published
2007

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