| 1. |
- Axelsson, Christer, et al.
(författare)
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The Early Chain of Care in Patients with Bacteraemia with the Emphasis on the Prehospital Setting
- 2016
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Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 31:3, s. 272-277
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Tidskriftsartikel (refereegranskat)abstract
- There is a lack of knowledge about the early phase of severe infection. This report describes the early chain of care in bacteraemia as follows: (a) compare patients who were and were not transported by the Emergency Medical Services (EMS); (b) describe various aspects of the EMS chain; and (c) describe factors of importance for the delay to the start of intravenous antibiotics. It was hypothesized that, for patients with suspected sepsis judged by the EMS clinician, the delay until the onset of antibiotic treatment would be shorter.All patients in the Municipality of Gothenburg (Sweden) with a positive blood culture, when assessed at the Laboratory of Bacteriology in the Municipality of Gothenburg, from February 1 through April 30, 2012 took part in the survey.In all, 696 patients fulfilled the inclusion criteria. Their mean age was 76 years and 52% were men. Of all patients, 308 (44%) had been in contact with the EMS and/or the emergency department (ED). Of these 308 patients, 232 (75%) were transported by the EMS and 188 (61%) had “true pathogens” in blood cultures. Patients who were transported by the EMS were older, included more men, and suffered from more severe symptoms and signs.The EMS nurse suspected sepsis in only six percent of the cases. These patients had a delay from arrival at hospital until the start of antibiotics of one hour and 19 minutes versus three hours and 21 minutes among the remaining patients (P =.0006). The corresponding figures for cases with “true pathogens” were one hour and 19 minutes versus three hours and 15 minutes (P =.009).Among patients with bacteraemia, 75% used the EMS, and these patients were older, included more men, and suffered from more severe symptoms and signs. The EMS nurse suspected sepsis in six percent of cases. Regardless of whether or not patients with true pathogens were isolated, a suspicion of sepsis by the EMS clinician at the scene was associated with a shorter delay to the start of antibiotic treatment.
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| 2. |
- Berntsson, Tommy, et al.
(författare)
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Ambulanssjukvården måste bli jämlik
- 2013
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Ingår i: Helsingborgs Dagblad. - Helsingborg : Helsingborgs Dagblad. - 1103-9388. ; 2013-06-17
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Skiftande vårdkvalité hotar patientsäkerheten inom ambulanssjukvården. Nu måste regeringen och Socialstyrelsen skapa nationella riktlinjer, skriver Nätverket för utbildning av ambulanssjuksköterskor .
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| 3. |
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| 4. |
- Herlitz, Johan, et al.
(författare)
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Suspicion and treatment of severe sepsis : An overview of the prehospital chain of care
- 2012
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BioMed Central. - 1757-7241. ; 20:42
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundSepsis is a life-threatening condition where the risk of death has been reported to be even higher than that associated with the major complications of atherosclerosis, i.e. myocardial infarction and stroke. In all three conditions, early treatment could limit organ dysfunction and thereby improve the prognosis.AimTo describe what has been published in the literature a/ with regard to the association between delay until start of treatment and outcome in sepsis with the emphasis on the pre-hospital phase and b/ to present published data and the opportunity to improve various links in the pre-hospital chain of care in sepsis.MethodsA literature search was performed on the PubMed, Embase (Ovid SP) and Cochrane Library databases.ResultsIn overall terms, we found a small number of articles (n=12 of 1,162 unique hits) which addressed the prehospital phase. For each hour of delay until the start of antibiotics, the prognosis appeared to become worse. However, there was no evidence that prehospital treatment improved the prognosis.Studies indicated that about half of the patients with severe sepsis used the emergency medical service (EMS) for transport to hospital. Patients who used the EMS experienced a shorter delay to treatment with antibiotics and the start of early goal-directed therapy (EGDT). Among EMS-transported patients, those in whom the EMS staff already suspected sepsis at the scene had a shorter delay to treatment with antibiotics and the start of EGDT.There are insufficient data on other links in the prehospital chain of care, i.e. patients, bystanders and dispatchers.ConclusionSevere sepsis is a life-threatening condition. Previous studies suggest that, with every hour of delay until the start of antibiotics, the prognosis deteriorates. About half of the patients use the EMS. We need to know more about the present situation with regard to the different links in the prehospital chain of care in sepsis.
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| 5. |
- Andersson, Henrik, 1968-, et al.
(författare)
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The early chain of care in bacteraemia patients: Early suspicion, treatment and survival in prehospital emergency care
- 2018
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Ingår i: American Journal of Emergency Medicine. - : Elsevier BV. - 0735-6757 .- 1532-8171. ; 36:12, s. 2211-2218
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Bacteraemia is a first stage for patients risking conditions such as septic shock. The primary aim of this study is to describe factors in the early chain of care in bacteraemia, factors associated with increased chance of survival during the subsequent 28 days after admission to hospital. Furthermore, the long-term outcome was assessed. Methods: This study has a quantitative design based on data from Emergency Medical Services (EMS) and hospital records. Results: In all, 961 patients were included in the study. Of these patients, 13.5% died during the first 28 days. The EMS was more frequently used by non-survivors. Among patients who used the EMS, the suspicion of sepsis already on scene was more frequent in survivors. Similarly, EMS personnel noted the ESS code "fever, infection" more frequently for survivors upon arriving on scene. The delay time from call to the EMS and admission to hospital until start of antibiotics was similar in survivors and non-survivors. The five-year mortality rate was 50.8%. Five-year mortality was 62.6% among those who used the EMS and 29.5% among those who did not (p < 0.0001). Conclusion: This study shows that among patients with bacteraemia who used the EMS, an early suspicion of sepsis or fever/infection was associated with improved early survival whereas the delay time from call to the EMS and admission to hospital until start of treatment with antibiotics was not. 50.8% of all patients were dead after five years. (C) 2018 Elsevier Inc. All rights reserved.
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| 6. |
- Axelsson, Christer, et al.
(författare)
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Nationella regler krävs för ambulanssjukvård
- 2011
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Ingår i: Svenska Dagbladet. - 1101-2412.
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Ambulanssjukvården i Sverige saknar nationella riktlinjer. En konsekvens av detta är brister i tillgängligheten vilket fått allvarliga konsekvenser för flera personer under den senaste tiden. En av dem är Maximilian och hans mamma som blev påkörda på trottoaren av en 23-årig förare som hade tappat kontrollen över sin bil. Det tog nästan en timme innan pojken flögs till sjukhus med helikopter från olycksplatsen på Tjörn utanför Stenungsund. Maximilian blev bara tio veckor.
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| 7. |
- Axelsson, Christer, et al.
(författare)
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Nationella regler krävs för ambulanssjukvård
- 2011
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Ingår i: Svenska Dagbladet. - 1101-2412. ; :2011-11-15
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- I Sverige är det upp till varje landsting att bestämma hur snabbt en ambulans ska vara på plats. I stället borde det finnas nationella riktlinjer kring hur tillgängligheten ska se ut, skriver flera ambulanssjuksköterskor.
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| 8. |
- Bremer, Anders, 1957-, et al.
(författare)
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Ethical values in emergency medical services : A pilot study
- 2015
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Ingår i: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 22:8, s. 928-942
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Tidskriftsartikel (refereegranskat)abstract
- Background: Ambulance professionals often address conflicts between ethical values. As individuals’values represent basic convictions of what is right or good and motivate behaviour, research is neededto understand their value profiles.Objectives: To translate and adapt the Managerial Values Profile to Spanish and Swedish, and measure thepresence of utilitarianism, moral rights and/or social justice in ambulance professionals’ value profiles inSpain and Sweden.Methods: The instrument was translated and culturally adapted. A content validity index was calculated.Pilot tests were carried out with 46 participants.Ethical considerations: This study conforms to the ethical principles for research involving humansubjects and adheres to national laws and regulations concerning informed consent and confidentiality.Findings: Spanish professionals favoured justice and Swedish professionals’ rights in their ambulanceorganizations. Both countries favoured utilitarianism least. Gender differences across countries showedthat males favoured rights. Spanish female professionals favoured justice most strongly of all.Discussion: Swedes favour rights while Spaniards favour justice. Both contexts scored low onutilitarianism focusing on total population effect, preferring the opposite, individualized approach of therights and justice perspectives. Organizational investment in a utilitarian perspective might jeopardizeambulance professionals’ moral right to make individual assessments based on the needs of the patientat hand. Utilitarianism and a caring ethos appear as stark opposites. However, a caring ethos in its turn might well involve unreasonable demands on the individual carer’s professional role. Since both the justiceand rights perspectives portrayed in the survey mainly concern relationship to the organization and peerswithin the organization, this relationship might at worst be given priority over the equal treatment andmoral rights of the patient.Conclusion: A balanced view on ethical perspectives is needed to make professionals observant and readyto act optimally – especially if these perspectives are used in patient care. Research is needed to clarify howjustice and rights are prioritized by ambulance services and whether or not these organization-related valuesare also implemented in patient care.
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| 9. |
- Claesson, Andreas, et al.
(författare)
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Defibrillation before EMS arrival in western Sweden
- 2017
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Ingår i: American Journal of Emergency Medicine. - : Elsevier. - 0735-6757 .- 1532-8171. ; 35:8, s. 1043-1048
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Bystanders play a vital role in public access defibrillation (PAD) in out-of-hospital cardiac arrest (OHCA). Dual dispatch of first responders (FR) alongside emergency medical services (EMS) can reduce time to first defibrillation. The aim of this study was to describe the use of automated external defibrillators (AEDs) in OHCAs before EMS arrival.METHODS: All OHCA cases with a shockable rhythm in which an AED was used prior to the arrival of EMS between 2008 and 2015 in western Sweden were eligible for inclusion. Data from the Swedish Register for Cardiopulmonary Resuscitation (SRCR) were used for analysis, on-site bystander and FR defibrillation were compared with EMS defibrillation in the final analysis.RESULTS: Of the reported 6675 cases, 24% suffered ventricular fibrillation (VF), 162 patients (15%) of all VF cases were defibrillated before EMS arrival, 46% with a public AED on site. The proportion of cases defibrillated before EMS arrival increased from 5% in 2008 to 20% in 2015 (p<0.001). During this period, 30-day survival increased in patients with VF from 22% to 28% (p=0.04) and was highest when an AED was used on site (68%), with a median delay of 6.5min from collapse to defibrillation. Adjusted odds ratio for on-site defibrillation versus dispatched defibrillation for 30-day survival was 2.45 (95% CI: 1.02-5.95).CONCLUSIONS: The use of AEDs before the arrival of EMS increased over time. This was associated with an increased 30-day survival among patients with VF. Thirty-day survival was highest when an AED was used on site before EMS arrival.
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| 10. |
- Herlitz, Johan, et al.
(författare)
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Så skapas världens bästa ambulanssjukvård
- 2011
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Ingår i: Göteborgsposten. - 1103-9345. ; :2011-05-14
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Tiden från larm till dess att ambulans kommer har ökat dramatiskt de senaste tio åren i Västra Götaland. Samtidigt bedöms allt fler i behov av snabb utryckning. Kompetens finns att råda bot på detta – om den tillåts styra utvecklingen, skriver bland andra professor Johan Herlitz.
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