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- Ambjörnsson, Joakim, et al.
(författare)
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Prehospital suspicion and identification of adult septic patients : Experiences of a screening tool
- 2016
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Ingår i: 2nd Global Conference on Emergency Nursing and Trauma Care, Melia Sitges, September 22-24, 2016.
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Konferensbidrag (refereegranskat)abstract
- Introduction: Sepsis is life threatening and requires urgent healthcare to reduce suffering and death. Therefore it is important that septic patients are identified early to enable treatment. Aim: To investigate to what extent EMS personnel identified patients with sepsis using the “BAS 90-30-90” model, and to describe assessments and medical procedures that were undertaken by the personnel.Methods: This was a retrospective study where 185 EMS medical records were reviewed. The inclusion was based on patients who were later diagnosed with sepsis in the hospital. Results: A physician assessed the patients in 74 of the EMS cases, which lead to exclusion of these records in regard to the EMS personnel’s ability to identify sepsis. The personnel documented suspicion of severe sepsis in eight (n=8) of the remaining 111 records (7.2%). The proportion of patients ˃65 years of age was 73% (n=135) of which 37% (n=50) were over 80 years old. Thirty-nine percent (39%, n=72) were females. The personnel documented blood pressure in 91% (n=168), respiratory rate in 76% (n=140), saturation in 100% (n=185), temperature in 76% (n=141), and heart rate in 94% (n=174) of the records. Systolic blood pressure <90 mmHg was documented in 14,2% (n=24), respiratory rate ˃30 in 36% (n=50), saturation <90 in 49% (n=91), temperature >38°C in 37.6% (n=53), and heart rate ˃90 in 70% (n=121) of the records. Documented medical procedures and treatments were intravenous lines (70%, n=130), intravenous fluids (10%, n=19) and administration of oxygen (72%, n=133).Conclusion: The EMS personnel identified only a few septic patients with the help of the BAS 90-30-90 model when all three criteria would be met for severe sepsis. Either advanced age (>65 years), fever (>38°C) or tachypnea (˃20 breaths/min) appeared to increase the personnel’s suspicion of sepsis. Oxygen, but not intravenous fluids, was given in an adequate way.
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- Backlund, Per, et al.
(författare)
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Pre-hospital training and simulation initiative
- 2014
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Konferensbidrag (refereegranskat)abstract
- Background The pre-hospital process is a complex one involving aspects such as medical skills as well as care taking, team performance, inter-organizational cooperation and communication. This calls for novel training methods and technology support. Our review of literature (covering the areas of pre-hospital care, training simulator technologies and methods and process modelling) indicates that the different aspects are typically trained in isolation, e.g. medical skills using patient simulators.Objective The pre-hospital training center project addresses the overall complexity of the pre-hospital process by taking all of the aspects into account when designing scenarios and technology support for training the complete prehospital process (covering alarm, on-scene activities, transportation and hand-over). This is indeed a challenging task as we need to develop both training methods and technology support for a very complex training situation.Methods The project will develop a prototype scenario along with technology support to enact it. The training scenario will involve many of the aspects listed above and will be tested in a field experiment with ambulance personnel. Results The expected outcome of the project is a platform for establishing a pre-hospital simulation and training center. The initial technologies, research results and experiences will be used to form a consortium for further work and development. Conclusions We have identified a need for a pre-hospital training center with the unique and ambitious idea of covering the entire pre-hospital process as well as its many interacting aspects. To the best of our knowledge this approach is not at all common and we expect the complexity to be so high that it is a challenging enough research area that can only be addressed if we have a well-designed simulation and training center in place with all the different areas of knowledge represented, i.e. pre-hospital medicine as well as simulation and visualization technology.
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- Lundberg, Lars, et al.
(författare)
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Applying military medical training models on the training of civilian ambulance nurses
- 2012
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Konferensbidrag (refereegranskat)abstract
- Background: The pre-mission training of military medical personnel is based on simulation, using either moulage patients or full-scale simulation manikins. Furthermore, the training is preferably conducted in a realistic environment, including the logistic procedures required. Summary of work: The military approach to medical training has been considered interesting to apply on the postgraduate and continuing education for civilian ambulance nurses. One MD (professor) and one RN (associate professor) are now working part-time for the Armed Forces Centre for Defence Medicine and part-time for the University of Borås. A general aim is to improve the trauma education for civilian ambulance nurses, including prehospital procedures for command & control, and by introducing selected military techniques such as tourniquets and haemostatic agents to stop life-threatening bleedings also in civilian practice. Conclusions: We have a reason to believe that this recently initiated collaboration between military medicine and civilian prehospital medicine is mutually beneficial. The civilian Emergency Medical Services will become better trained and prepared, while the Armed Forces are likely to get a larger recruitment base of skilled medical personnel for future service in international missions. Take-home messages: Collaboration between organisations with similar interests, in this case the prehospital management of trauma victims, is likely to be mutually beneficial.
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| 9. |
- Lundberg, Lars, et al.
(författare)
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The development of a military hybrid simulation model for the training of haemorrhage control in proximal extremity bleedings
- 2014
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background Exsanguination from extremity wounds is a major cause of potentially preventable deaths in the military environment. With the widespread use of different techniques to control this type of bleeding, such as tourniquets and haemostatic agents, it has now become possible to dramatically improve the survival rate for these casualties. Objective Varying techniques for pre-deployment training of haemorrhage control have been tested and used by the Swedish Armed Forces, for example different types of patient simulators. The recently developed military trauma patient simulators have for example become a major improvement for the training of standard tourniquet application. However, very proximal ‘junctional’ bleedings located in for example axillae and groins still represent a special training problem, since tourniquets cannot be used on these locations. Methods Based upon an idea presented by Moorhouse et al.*, we have developed a hybrid training model, consisting of a modified Laerdal® SimMan® 2G manikin, with a slab of meat with artificial ‘vessels’ running through the base of a series of wounds. Artificial blood under pressure is used to produce a bleeding effect. Results This hybrid model has been used for two years in the training of medics and combat life savers. It represents a realistic bleeding model, which can be used over and over again. Also, the cost for training is low compared to other alternatives. Conclusions Existing patient simulators are not suitable for training of haemorrhage control on proximal extremity locations. Live tissue training on anaesthetized animals is not a first alternative for this kind of training. We consider the proposed hybrid simulation model as the best training method so far.
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