Background. Certain aspects (frequency and management) of medical emergencies in Norwegian municipalities have not been adequately documented. Previous studies indicate an annual incidence rate of about 10 emergency contacts per 1 000 inhabitants. This article presents results from recording of medical emergencies during two years in the Norwegian municipality Austevoll; an island community (without a mainland connection) south of Bergen, with 4 400 citizens.

S. aureus resistance to fusidic acid in relation to impetigo is now less frequent in this population than at the start of the century. At present, most S. aureus bacteria resistant to fusidic acid in impetigo belong to the EEFIC.

BackgroundPriority grade assessment according to urgency level of the patients (triage) is considered vital in emergency medicine casualties. Little is known of the experiences of pre-hospital emergency medicine triage performed by General Practitioners (GPs) in the community. In this study we bring such experiences from a Norwegian island community, with special emphasis on over- and undertriage.MethodsIn the island municipality of Austevoll, Western Norway, where the GPs and the ambulance services both take part in all medical emergency cases, all these cases were recorded during a 2-year period (2005–2007). We compared the triage of the patients at the stage of the telephone reception of the incident, and the subsequent revision of the triage at the first personal examination of the patient.Results236 emergency medical events were recorded, comprising 240 patients. Of these, 42% were downgraded between the stages (i.e. initially overtriaged), 11% were upgraded (i.e. initially undertriaged) and 47% remained in unchanged priority group. Of the diagnostic groups, acute abdominal cases had the highest probability of being upgraded between stages, while the aggregated diagnostic group of syncopes, seizures, intoxications and traumas had the highest probability of being downgraded. The principal reason for upgrading was lack of necessary information at the stage of call. In a minority of cases the upgrading was due to real patient deterioration between stages.ConclusionsIn pre-hospital triage of emergency patients, downgrading happens between notification of events and actual patient examination in a substantial proportion. Upgradings of cases are considerably fewer, but the potential serious implications of upgrading warrants individual scrutiny of such cases.

Discrimination between influenza and other viral upper respiratory tract infections is difficult in daily clinical practice, even during an influenza pandemic. A gender difference was found in reported precautions to prevent influenza.

Distinctive epidemic outbreaks occurred during the summer of three of the five follow-up years. In outbreaks, S. aureus was more frequently the causal agent and the sensitivity to fusidic acid decreased significantly.

For emergency medicine work general practitioners should focus on training fundamental practical skills. The doctors and the ambulance personnel have complementary roles in handling of medical emergency events. Ability of obtaining an adequate overall view of the patient's condition is an important aspect of the doctor's role.

BackgroundTraining of lay first responder personnel situated closer to the potential victims than medical professionals is a strategy potentially capable of shortening the interval between collapse and start of cardiopulmonary resuscitation (CPR) in cases of out-of-hospital cardiac arrest. In this study we trained lay first responders personnel in basic life support (BLS) and defibrillation for cases of cardiac arrest and suspected acute myocardial infarction (AMI).MethodsForty-two lay first responders living in remote areas or working in industries in the island community of Austevoll, Western Norway, were trained in CPR and defibrillation. We placed particular emphasis on the first responders being able to defibrillate a primary ventricular fibrillation (PVF) in patients with AMI. The trainees were organised in four teams to attend victims of AMI and cardiac arrest while awaiting the arrival of the community emergency medical services. The purpose of the study was to find out whether the teams were able to function during the five-year study project, and to examine whether lives could be saved. The first responders completed questionnaires each year on their experiences of participation. Data on the medical actions of the teams were also collected.ResultsBy the end of the project all groups were functioning. The questionnaires evidenced a reasonable degree of motivation and self-evaluated competence in both types of group organisation, but in spite of this attrition effects in the first responders were considerable. The first responders were called out on 24 occasions, for a total of 17 patients. During the study period no case of PVF occurred after the arrival of the first responders, and the number of AMIs was very low, strongly deviating from what was anticipated. No lives were saved by the project.ConclusionsThe teams were sustained for almost five years without any significant deterioration of self-reported stress or mastering, but still showed attrition effects. Evaluated as a medical project the intervention was not successful, but the small scale prevents us from drawing firm conclusions on this aspect.

BackgroundFrom around the year 2000, Northern Europe experienced a rise in impetigo caused by Staphylococcus aureus resistant to fusidic acid. A single clone of S. aureus was found to be the bacterial pathogen involved in the impetigo outbreak in Norway, Sweden, the UK and Ireland, termed ‘the epidemic European fusidic acid-resistant impetigo clone’ (EEFIC). We have followed the incidence of impetigo during the years 2001–2012 based on all patients in general practice in the island community of Austevoll, Western Norway. We previously reported a marked decline of impetigo incidence in Austevoll, from 0.0260 cases per person-year in 2002 to 0.0038 in 2009. This article explores indications of an end to the impetigo epidemic caused by the EEFIC clone. Methods: All four general practitioners (GPs) in the community (mean population = 4400) were asked to diagnose impetigo in a uniform way and to take bacterial specimens from all impetigo cases. Phenotypic characteristics of specimen bacteria were determined for the whole period and molecular analyses were performed on isolates in the period 2008–2012. Results: We observed a further decline in incidence of impetigo in Austevoll in the study period. The proportion of fusidic acid-resistant S. aureus isolates decreased during the period 2002–2012, with a mean of 80% in the epidemic years of 2002–2004, 55% in 2005–2009, and 6% in 2010–2012. In total, 44 S. aureus isolates from impetigo were subject to molecular analyses in the period 2008–2012, and 11 were found to be related to the EEFIC. All EEFIC isolates were found in 2008–2009, with no new isolates in 2010–2012. Conclusion: There is an apparent end to the impetigo epidemic related to the EEFIC in this population in Western Norway.