| 1. |
- Berglund, Ellinor, et al.
(författare)
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A smartphone application for dispatch of lay responders to out-of-hospital cardiac arrests.
- 2018
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Ingår i: Resuscitation. - : Elsevier BV. - 1873-1570 .- 0300-9572. ; 126, s. 160-165
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Tidskriftsartikel (refereegranskat)abstract
- Dispatch of lay volunteers trained in cardiopulmonary resuscitation (CPR) and equipped with automated external defibrillators (AEDs) may improve survival in cases of out-of-hospital cardiac arrest (OHCA). The aim of this study was to investigate the functionality and performance of a smartphone application for locating and alerting nearby trained laymen/women in cases of OHCA.A system using a smartphone application activated by Emergency Dispatch Centres was used to locate and alert laymen/women to nearby suspected OHCAs. Lay responders were instructed either to perform CPR or collect a nearby AED. An online survey was carried out among the responders.From February to August 2016, the system was activated in 685 cases of suspected OHCA. Among these, 224 cases were Emergency Medical Services (EMSs)-treated OHCAs (33%). EMS-witnessed cases (n=11) and cases with missing survey data (n=15) were excluded. In the remaining 198 OHCAs, lay responders arrived at the scene in 116 cases (58%), and prior to EMSs in 51 cases (26%). An AED was attached in 17 cases (9%) and 4 (2%) were defibrillated. Lay responders performed CPR in 54 cases (27%). Median distance to the OHCA was 560m (IQR 332-860m), and 1280m (IQR 748-1776m) via AED pick-up. The survey-answering rate was 82%.A smartphone application can be used to alert CPR-trained lay volunteers to OHCAs for CPR. Further improvements are needed to shorten the time to defibrillation before EMS arrival.
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| 2. |
- Berglund, Ellinor
(författare)
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Dispatch of lay responders to out-of-hospital cardiac arrests
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and aim: Out-of-hospital cardiac arrest (OHCA) remains a major public-health problem affecting around 300 000 Europeans each year. If treatment is not started within a couple of minutes the chances of survival are slim. One important predictor of survival is the time from call to start of treatment. To reduce this time frame, different strategies, in addition to emergency medical services (EMS), such as widespread deployment of automated external defibrillators (AEDs) and dispatch of fire fighters and police officers have been implemented. The aim of this thesis is to study the implementation and effects of a third additional resource, lay responders dispatched by the emergency dispatch center. The aim of study 1 was to evaluate the technical function and performance of a lay responder system during a run-in phase. The aim of study 2 was to measure the travelling speed and response time of the dispatched lay responders. In study 3 the aim was to investigate the emotional response, both positive and negative, wellbeing and post-traumatic stress disorder, among dispatched lay responders. In study 4 the aim was to investigate if lay responders instructed to fetch a public AED by using a smartphone application could increase the bystander use of AEDs before arrival of EMS, fire fighters and police officers. Methods and results: In study 1 data from the smartphone application were collected and linked to cardiac arrest data from the Swedish Register for Cardiopulmonary Resuscitation (SRCR). During six months in 2016 the system was activated 685 times. 224 of these cases were EMS treated OHCAs. After exclusion of EMS-witnessed cases (n=11) and cases with missing survey data (n=15), 198 cases remained in the analytical sample. The results showed that dispatched lay responders reached the scene in 116 cases (58%), in 51 (26%) cases before the EMS. An AED was attached 17 times (9%) and defibrillated 4 times (2%). The median Euclidian distance to travel to perform CPR was 560 meters (IQR=332-860) compared with 1280 (IQR=748-1776) among for those who were directed to fetch an AED. In study 2, data on lay responder movement were collected from the smartphone application. During the 7-month study period 1406 suspected OHCAs were included. In these calls, 9058 lay responders accepted the mission and 2176 reached the scene of the suspected cardiac arrest (the study population). Among all cases the median travelling speed was 2.3 meters/sec (IQR=1.4–4.0) while the response time was 6.2 minutes, and the travelling distance was 956 meters (IQR=480–1661). In the most densely populated areas the median travelling speed was 1.8 meters/sec compared with 3.1 in the least densely populated areas. In study 3 we included 886 unexposed and 1389 exposed lay-responders. The lay responders were divided into 3 groups; unexposed, exposed-1 (who tried, but failed to reach the scene before EMS) and exposed-2 (who either reached the scene before EMS or performed CPR). Using the two dimensions of the Swedish Core Affect Scales (SCAS), valence and activation the results suggested that exposed lay responders showed higher activation (Exp-1=7.5, Exp-2=7.6) than unexposed lay responders (7.0) (p<0.001). Exposed lay responders had lower valence (Exp-1=6.3, Exp-2=6.3) compared with unexposed lay responders (6.8) (p<0.001). PCL-6 mean scores were highest in the unexposed group (10.4) compared with the exposed group (Exp-1=8.8, Exp-2=9.2) (p=0.007). There were no differences in the WHO wellbeing index, (Un-Exp: 77.7; Exp-1: 77.8; Exp-2: 78.2) (p=0.963). In Study 4, cases of suspected OHCA were randomly assigned to either an intervention group, where the majority of lay responders (4/5) were guided to the nearest AED, or to a control group, where all lay responders were directed to perform CPR. Data from the smartphone application system were linked to data from the SRCR. During the 13-month study period 2553 suspected OHCAs were randomized. Among these, 815 (32%) were EMS-treated. The AED attachment rate was 13.2% in the intervention group compared with 9.4 in the control group (p=0.087). In both groups combined, 29.3% of all bystanders attached AEDs, and 35.3% of all cases of bystander CPR were performed by a dispatched lay responder. Conclusions: The conclusion from the first run-in study (study 1) was that it is feasible to dispatch lay responders to suspected OHCAs but that further system improvements are needed to reduce the time to defibrillation. The results from study 2 suggested that lay responders travel faster than previously estimated and that the travelling speed is dependent on population density, information that may be used for simulation studies as well as in configurations in app-based systems. Study 3 showed that lay responders rated the experience as high-energy and mostly positive. No indication of harm was seen, as the lay responders had low post-traumatic stress scores and high levels of general wellbeing at follow-up. Study 4 revealed that smartphone dispatch of lay responders to public AEDs did not increase the AED attachment rate before arrival of the EMS or first responders, versus smartphone dispatch to perform CPR. If dispatched lay responders arrived prior to the EMS, the likelihood of bystander AED use and CPR was increased.
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| 3. |
- Berglund, Ellinor, et al.
(författare)
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Effect of Smartphone Dispatch of Volunteer Responders on Automated External Defibrillators and Out-of-Hospital Cardiac Arrests : The SAMBA Randomized Clinical Trial
- 2023
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Ingår i: JAMA cardiology. - : American Medical Association (AMA). - 2380-6583 .- 2380-6591. ; 8:1, s. 81-88
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Tidskriftsartikel (refereegranskat)abstract
- Importance Smartphone dispatch of volunteer responders to nearby out-of-hospital cardiac arrests (OHCAs) has emerged in several emergency medical services, but no randomized clinical trials have evaluated the effect on bystander use of automated external defibrillators (AEDs).Objective To evaluate if bystander AED use could be increased by smartphone-aided dispatch of lay volunteer responders with instructions to collect nearby AEDs compared with instructions to go directly to patients with OHCAs to start cardiopulmonary resuscitation (CPR).Design, Setting, and Participants This randomized clinical trial assessed a system for smartphone dispatch of volunteer responders to individuals experiencing OHCAs that was triggered at emergency dispatch centers in response to suspected OHCAs and randomized 1:1. The study was conducted in 2 main Swedish regions: Stockholm and Västra Götaland between December 2018 and January 2020. At study start, there were 3123 AEDs in Stockholm and 3195 in Västra Götaland and 24 493 volunteer responders in Stockholm and 19 117 in Västra Götaland. All OHCAs in which the volunteer responder system was activated by dispatchers were included. Excluded were patients with no OHCAs, those with OHCAs not treated by the emergency medical services, and those with OHCAs witnessed by the emergency medical services.Interventions Volunteer responders were alerted through the volunteer responder system smartphone application and received map-aided instructions to retrieve nearest available public AEDs on their way to the OHCAs. The control arm included volunteer responders who were instructed to go directly to the OHCAs to perform CPR.Main Outcomes and Measures Overall bystander AED attachment, including those attached by volunteer responders and lay volunteers who did not use the smartphone application.Results Volunteer responders were activated for 947 patients with OHCAs. Of those, 461 were randomized to the intervention group (median [IQR] age of patients, 73 [61-81] years; 295 male patients [65.3%]) and 486 were randomized to the control group (median [IQR] age of patients, 73 [63-82] years; 312 male patients [65.3%]). Primary outcome of AED attachment occurred in 61 patients (13.2%) in the intervention arm vs 46 patients (9.5%) in the control arm (difference, 3.8% [95% CI, −0.3% to 7.9%]; P = .08). The majority of AEDs were attached by lay volunteers who were not using the smartphone application (37 in intervention arm, 28 in control). There were no significant differences in secondary outcomes. Among the volunteer responders using the application, crossover was 11% and compliance to instructions was 31%. Volunteer responders attached 38% (41 of 107) of all AEDs and provided 45% (16 of 36) of all defibrillations and 43% (293 of 666) of all CPR.Conclusions and Relevance In this study, smartphone dispatch of volunteer responders to OHCAs to retrieve nearby AEDs vs instructions to directly perform CPR did not significantly increase volunteer AED use. High baseline AED attachement rate and crossover may explain why the difference was not significant.Trial Registration ClinicalTrials.gov Identifier: NCT02992873
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| 4. |
- Berglund, Ellinor, et al.
(författare)
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Wellbeing, emotional response and stress among lay responders dispatched to suspected out-of-hospital cardiac arrests
- 2022
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Ingår i: Resuscitation. - : Elsevier Ireland Ltd. - 0300-9572 .- 1873-1570. ; 170, s. 352-360
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Tidskriftsartikel (refereegranskat)abstract
- Background: Systems for smartphone dispatch of lay responders to perform cardio-pulmonary resuscitation (CPR) and bring automated external defibrillators to out-of-hospital cardiac arrests (OHCAs) are advocated by recent international guidelines and emerging worldwide. Objectives: This study aimed to investigate the emotional responses, posttraumatic stress reactions and levels of wellbeing among smartphone-alerted lay responders dispatched to suspected OHCAs. Methods: Lay responders were stratified by level of exposure: unexposed (Exp-0), tried to reach (Exp-1), and reached the suspected OHCA (Exp-2). Participants rated their emotional responses online, at 90 minutes and at 4–6 weeks after an incident. Level of emotional response was measured in two dimensions of core affect: “alertness” – from deactivation to activation, and “pleasantness” – from unpleasant to pleasant. At 4–6 weeks, WHO wellbeing index and level of posttraumatic stress (PTSD) were also rated. Results: Altogether, 915 (28%) unexposed and 1471 (64%) exposed responders completed the survey. Alertness was elevated in the exposed groups: Exp-0: 6.7 vs. Exp-1: 7.3 and Exp-2: 7.5, (p < 0.001) and pleasantness was highest in the unexposed group: 6.5, vs. Exp-1: 6.3, and Exp-2: 6.1, (p < 0.001). Mean scores for PTSD at follow-up was below clinical cut-off, Exp-0: 9.9, Exp-1: 8.9 and Exp-2: 8.8 (p = 0.065). Wellbeing index showed no differences, Exp-0: 78.0, Exp-1: 78.5 and Exp-2: 79.9 (p = 0.596). Conclusion: Smartphone dispatched lay responders rated the experience as high-energy and mainly positive. No harm to the lay responders was seen. The exposed groups had low posttraumatic stress scores and high-level general wellbeing at follow-up. © 2021
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| 5. |
- Böttcher, Johanna, et al.
(författare)
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Adding a smartphone app to internet-based self-help for social anxiety : A randomized controlled trial
- 2018
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Ingår i: Computers in human behavior. - : Elsevier BV. - 0747-5632 .- 1873-7692. ; 87, s. 98-108
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Tidskriftsartikel (refereegranskat)abstract
- Background: Increasing access to treatment via smartphone apps is an important topic in Social Anxiety Disorder (SAD). ‘Challenger’ is an app promoting exposure exercises in daily life. The present study evaluated the additional benefit of using the app as adjunct to Internet-based unguided self-help for SAD. In a second step, we also tested how the app and the self-help programme (SH) should best be combined.Method: 209 patients diagnosed with SAD were randomly allocated to three groups. Group 1 received the app and the self-help programme for six weeks (parallel treatment), group 2 first received SH for six weeks and then the app for six weeks (sequential treatment). Group 3 was a wait-list group. Comparisons were made at week 7 evaluating the potential add-on effect of the app (SH plus app versus SH only) and at week 14 comparing the parallel to the sequential treatment. Participants filled in questionnaires prior, during, and post treatment, and at 4- and 12- months follow-up.Results: Intention-to-treat analyses showed no significant effect of adding the app to Internet-based self-help. However, among participants actively using the app, adding Challenger to self-help resulted in significantly less social anxiety (d = 0.30). At week 14, decreases in social anxiety were large for both the parallel and the sequential group with no differences between the active groups (dwithin = 1.12–1.19). Changes were maintained throughout the follow-up period.Conclusion: Results of the current study cautiously support the notion of adding a smartphone app to unguided self-help for SAD. Future studies should investigate how patients can be motivated to use the app more frequently.
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| 6. |
- Jernberg, Tomas, et al.
(författare)
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Long-Term Effects of Oxygen Therapy on Death or Hospitalization for Heart Failure in Patients With Suspected Acute Myocardial Infarction
- 2018
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Ingår i: Circulation. - : LIPPINCOTT WILLIAMS & WILKINS. - 0009-7322 .- 1524-4539. ; 138:24, s. 2754-2762
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Tidskriftsartikel (refereegranskat)abstract
- Background: In the DETO2X-AMI trial (Determination of the Role of Oxygen in Suspected Acute Myocardial Infarction), we compared supplemental oxygen with ambient air in normoxemic patients presenting with suspected myocardial infarction and found no significant survival benefit at 1 year. However, important secondary end points were not yet available. We now report the prespecified secondary end points cardiovascular death and the composite of all-cause death and hospitalization for heart failure.Methods: In this pragmatic, registry-based randomized clinical trial, we used a nationwide quality registry for coronary care for trial procedures and evaluated end points through the Swedish population registry (mortality), the Swedish inpatient registry (heart failure), and cause of death registry (cardiovascular death). Patients with suspected acute myocardial infarction and oxygen saturation of ≥90% were randomly assigned to receive either supplemental oxygen at 6 L/min for 6 to 12 hours delivered by open face mask or ambient air.Results: A total of 6629 patients were enrolled. Acute heart failure treatment, left ventricular systolic function assessed by echocardiography, and infarct size measured by high-sensitive cardiac troponin T were similar in the 2 groups during the hospitalization period. All-cause death or hospitalization for heart failure within 1 year after randomization occurred in 8.0% of patients assigned to oxygen and in 7.9% of patients assigned to ambient air (hazard ratio, 0.99; 95% CI, 0.84–1.18; P=0.92). During long-term follow-up (median [range], 2.1 [1.0–3.7] years), the composite end point occurred in 11.2% of patients assigned to oxygen and in 10.8% of patients assigned to ambient air (hazard ratio, 1.02; 95% CI, 0.88–1.17; P=0.84), and cardiovascular death occurred in 5.2% of patients assigned to oxygen and in 4.8% assigned to ambient air (hazard ratio, 1.07; 95% CI, 0.87–1.33; P=0.52). The results were consistent across all predefined subgroups.Conclusions: Routine use of supplemental oxygen in normoxemic patients with suspected myocardial infarction was not found to reduce the composite of all-cause mortality and hospitalization for heart failure, or cardiovascular death within 1 year or during long-term follow-up.Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01787110.
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| 7. |
- Ramberg, Ellinor, et al.
(författare)
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Prescribed fire is an effective restoration measure for increasing boreal fungal diversity
- 2023
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Ingår i: Ecological Applications. - 1051-0761 .- 1939-5582. ; 33
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Tidskriftsartikel (refereegranskat)abstract
- Intensive forestry practices have had a negative impact on boreal forest biodiversity; as a consequence, the need for restoration is pressing. Polypores (wood-inhabiting fungi) are key decomposers of dead wood, but, due to a lack of coarse woody debris (CWD) in forest ecosystems, many species are under threat. Here, we study the long-term effects on polypore diversity of two restoration treatments: creating CWD by felling whole trees and prescribed burning. This large-scale experiment is located in spruce-dominated boreal forests in southern Finland. The experiment has a factorial design (n = 3) including three levels of created CWD (5, 30, and 60 m(3) ha(-1)) crossed with burning or no burning. In 2018, 16 years after launching the experiment, we inventoried polypores on 10 experimentally cut logs and 10 naturally fallen logs per stand. We found that overall polypore community composition differed between burned and unburned stands. However, only red-listed species abundances and richness were positively affected by prescribed burning. We found no effects of CWD levels created mechanically by felling of trees. We show, for the first time, that prescribed burning is an effective measure for restoring polypore diversity in a late-successional Norway spruce forest. Burning creates CWD with certain characteristics that differ from what is created by CWD restoration by felling trees. Prescribed burning promotes primarily red-listed species, demonstrating its effectiveness as a restoration measure to promote diversity of threatened polypore species in boreal forests. However, because the CWD that the burning creates will decrease over time, to be functional, prescribed burns need to be applied regularly on the landscape scale. Large-scale and long-term experimental studies, such as this one, are invaluable for establishing evidence-based restoration strategies.
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