| 1. |
- 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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| 2. |
- 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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| 3. |
- Axelsson, Christer, et al.
(författare)
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How the context of ambulance care influences learning to become a specialist ambulance nurse a Swedish perspective.
- 2015
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Ingår i: Nurse Education Today. - : Elsevier BV. - 0260-6917 .- 1532-2793.
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Ambulance emergency care is multifaceted with extraordinary challenges to implement accurate assessment and care. A clinical learning environment providing opportunities for mastering these essential skills is a key component in ensuring that prehospital emergency nurse (PEN) students acquire the necessary clinical competence.AIM: The aim is to understand how PEN students experience their clinically based training, focusing on their learning process.METHOD: We applied content analysis with its qualitative method to our material that consisted of three reflections each by 28 PEN students over their learning process during their 8weeks of clinical ambulance practice. The research was carried out at the Center for Prehospital Care, University of Borås, Sweden.RESULTS: The broad spectrum of ambulance assignments seems to awaken great uncertainty and excessive respect in the students. Student vulnerability appears to decrease when the clinical supervisor behaves calmly, knowledgeably, confidently and reflectively. Early traumatic incidents on the other hand may increase the students' anxiety. Each student is offered a unique opportunity to learn how to approach patients and relatives in their own environments, and likewise an opportunity to gather information for assessment. Infrequency of missions seems to make PEN students less active in their student role, thereby preventing them from availing themselves of potential learning situations. Fatigue and hunger due to lack of breaks or long periods of transportation also inhibit learning mode.CONCLUSION: Our findings suggest the need for appraisal of the significance of the clinical supervisor, the ambulance environment, and student vulnerability. The broad spectrum of conditions in combination with infrequent assignments make simulation necessary. However, the unique possibilities provided for meeting patients and relatives in their own environments offer the PEN student excellent opportunities for learning how to make assessments.
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| 4. |
- 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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| 5. |
- 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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| 6. |
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| 7. |
- Bremer, Anders, et al.
(författare)
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Vårdvetenskaplig analys
- 2016. - 2
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Ingår i: Prehospital akutsjukvård. - Stockholm : Liber. - 9789147114740 ; , s. 318-321
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 8. |
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| 9. |
- Bång, Angela, et al.
(författare)
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Dispatcher-assisted telephone CPR : A qualitative study exploring how dispatchers perceive their experiences
- 2000
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Ingår i: Resuscitation. - : Elsevier Ireland Ltd. - 0300-9572 .- 1873-1570. ; 53:1, s. 135-151
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Tidskriftsartikel (refereegranskat)abstract
- Objectives:To investigate how emergency medical dispatchers (EMDs) perceive their experience of identifying suspected cardiac arrests (CA), and offer and provide instructions in cardiopulmonary resuscitation via telephone (t-CPR). Design: A qualitative method using the phenomenographic design where 10 EMDs were approached for semi-structured interviews. Main outcome measures: Perception in identifying CA, perception in offering t-CPR and perception in providing t-CPR. Results: In this analysis, 12 categories and 31 subcategories emerged. The categories for perception in identifying CA were; to trust the witness's account, to be open-minded and to be organised. The categories for perception in offering t-CPR were: to feel prepared to connect with the witness on a mental level by being organised, flexible and supportive, to obtain a basis for assessments and to be observant for diverse obstacles in a situation. Finally, the categories for perception in providing t-CPR were: to feel engaged, to be supportive of the witness, to feel secure by recognising response-feedback from the witness, to observe external conditions with regard to the locality and technical complications, to be composed and adjust to the needs of the situation, to feel competent or to feel despair. Conclusions: By listening in an open-minded way, a vast amount of information can be collected. Using criteria-based dispatch (CBD) and their own resources, the possibilities and difficulties of the situation are analysed. The EMDs believe that they are being an empathic support, relieving the witness of the burden of responsibility, and connecting with them mentally to enable them to act at the scene. There are EMDs who feel competent and experienced in managing these cases, and other EMDs who feel insecure and despair. The choice between providing t-CPR and answering incoming calls is prioritised differently among EMDs. There is also a broad subjective assessment among EMDs of offering t-CPR, especially to persons over 70 years old whom they consider incapable of performing CPR. The competence of the EMDs in t-CPR is dependent on re-training and a feedback on patient outcome. Witnesses who are negative towards acting constitute a common problem. There are witnesses with physical impediments or psychologically not susceptible to suggestions. The EMD is also dependent on the knowledge and trustworthiness of the witness. Convincing answers from witnesses prompt a more secure feeling in the EMDs, just as lack of knowledge in the witness has a negative effect on the efforts.
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| 10. |
- Bång, Angela
(författare)
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Emergency medical dispatch. The first medical response for life-threatening conditions. Assessment and invention of patients with chest pain and/or suspected cardiac arrest
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: To describe the Emergency Medical Dispatcher's (EMDs) possibility of assessment and intervention of patients reported having chest pain and/or cardiac arrest, with regard to identification of the problem, priority-decision, provision of instructions in dispatcher-assisted bystander cardiopulmonary resuscitation (CPR), and the subsequent outcome in terms of final diagnosis and survival. Methods: Prospective and retrospective observational studies based on registrations made by EMDs in case record forms (during two months, 1993), and in the dispatch protocol (27 months, 1994-1996) and subsequent follow-up in ambulance and hospital files. Evaluations of tape recordings of emergency calls to the EMS dispatch centre, concerning patients treated for out-of-hospital cardiac arrest (99 calls/1986, 100 calls/2000-2001). A qualitative study was used to describe the EMDs perceptions of identifying cardiac arrest, offer and provide instructions in CPR to callers. Ten EMDs were approached for face-to-face interviews in 1997. Results: Among 503 patients reporting chest pain, 68% were judged as having severe chest pain, of which 26% developed acute myocardial infarction (AMI) as compared with 13% among patients judged as having only vague chest pain (p = 0.0004). The EMDs had a strong suspicion of AMI in 36%, a moderate suspicion of AMI in 34%, and a vague or no suspicion in 30%. Among patients with a strong suspicion of AMI, 29% subsequently developed AMI compared with 18% among patients with a moderate suspicion, and 15% among patients with only a vague or no suspicion of AMI (p< 0.001). The study sample size was too small to evaluate the predictive value of various associated symptoms accompanying chest pain. The priority level was similar in patients with and without a life-threatening condition (81% vs. 73% receiving the highest priority). In patients with cardiac arrest outside hospital, more attention should be paid to the detection of these patients by the EMDs, however, when the EMDs had a suspicion, their accuracy was high. Half of witnesses accepted an offer of instructions in CPR, and one-third completed dispatcher-assisted bystander CPR. The comparison between no performance and performance of dispatcher-assisted bystander CPR, suggests an increase in survival from 6% to 9%. Among suspected cardiac arrest cases, EMDs offer CPR instruction to only a small fraction of callers, with an accomplishment in all, of ~8%. However, 30-50% of suspected cardiac arrest cases seemed eligible to be approached with such an offer. A major obstacle was the presentation of suspected agonal breathing, which was estimated to occur in about 30%, and was described as: difficulties breathing, poorly, gasping, wheezing, impaired and occasional breathing. The EMDs have a belief that they are being an empathic authority that relieves the caller of the burden of responsibility, and by meeting the witness mentally, this may enable the caller to act at the scene. The EMDs are dependent on the callers knowledge and trustworthiness, and convincing answers from the caller prompt a more secure feeling in the EMDs, just as caller's lack of knowledge having a negative effect on the EMDs efforts. Conclusion: There was a strong relationship between the EMDs suspicion of AMI and subsequent development of AMI. One-third, however, developed AMI among those where the EMD had had a moderate, vague or no suspicion of AMI. Patients judged to have severe chest pain, developed AMI twice as often as patients judged to have vague pain. Caller's reporting patients with a combination of unconsciousness and agonal breathing or respiratory arrest should be offered dispatcher-assisted CPR instruction. This may improve survival in out-of hospital cardiac arrest.
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