Are severely injured trauma victims in Norway offered advanced pre‐hospital care? National, retrospective, observational cohort

Wisborg, Torben; Ellensen, Eirin Nybø; Svege, Ida; Dehli, Trond

doi:10.1111/aas.12931

Cited by 14 publications

(13 citation statements)

References 24 publications

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“…However, while population data are fairly stable, the same does not hold for incident data. The yearly reports on HEMS missions indicate that overall very few missions are not completed, be it due to concurrent events or other, but studies have shown that for certain patient groups a large proportion of eligible patients do not receive a physician team response [ 27 ]. Also, ground ambulance HEMS missions are not included, which might affect in particular areas in and around the larger cities.…”

Section: Discussionmentioning

confidence: 99%

Comparing population and incident data for optimal air ambulance base locations in Norway

Røislien

Berg

Lindner

et al. 2018

Scand J Trauma Resusc Emerg Med

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BackgroundHelicopter emergency medical services are important in many health care systems. Norway has a nationwide physician manned air ambulance service servicing a country with large geographical variations in population density and incident frequencies. The aim of the study was to compare optimal air ambulance base locations using both population and incident data.MethodsWe used municipality population and incident data for Norway from 2015. The 428 municipalities had a median (5–95 percentile) of 4675 (940–36,264) inhabitants and 10 (2–38) incidents. Optimal helicopter base locations were estimated using the Maximal Covering Location Problem (MCLP) optimization model, exploring the number and location of bases needed to cover various fractions of the population for time thresholds 30 and 45 min, in green field scenarios and conditioned on the existing base structure.ResultsThe existing bases covered 96.90% of the population and 91.86% of the incidents for time threshold 45 min. Correlation between municipality population and incident frequencies was −0.0027, and optimal base locations varied markedly between the two data types, particularly when lowering the target time. The optimal solution using population density data put focus on the greater Oslo area, where one third of Norwegians live, while using incident data put focus on low population high incident areas, such as northern Norway and winter sport resorts.ConclusionUsing population density data as a proxy for incident frequency is not recommended, as the two data types lead to different optimal base locations. Lowering the target time increases the sensitivity to choice of data.

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Section: Discussionmentioning

confidence: 99%

Comparing population and incident data for optimal air ambulance base locations in Norway

Røislien

Berg

Lindner

et al. 2018

Scand J Trauma Resusc Emerg Med

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“…[15] The challenge of the EMCC picking out the right resource for the right patient was recently discussed in a paper on the use of HEMS in Norway. [2] A study from 2013 showed that the EMCC assessment was downgraded in 42% of cases and upgraded in 11% of cases when the patient was seen by a GP. [9] The problem of under triage was also shown in a systematic review of telephone triage in out-of-hours care.…”

Section: Discussionmentioning

confidence: 99%

“…However, the capacity of the HEMS ambulance is limited, and most patients are handled by the casualty clinic GPs and EMTs alone. [1,2]…”

Section: Introductionmentioning

confidence: 99%

Rural GPs’ attitudes toward participating in emergency medicine: a qualitative study

Hjortdahl

Halvorsen

Risør

2016

Scandinavian Journal of Primary Health Care

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ObjectiveHealth authorities want to increase general practitioner (GP) participation in emergency medicine, but the role of the GP in this context controversial. We explored GPs’ attitudes toward emergency medicine and call outs.DesignThematic analysis of focus group interviews.SettingFour rural casualty clinics in Norway.ParticipantsGPs with experience ranging from one to 32 years.ResultsThe GPs felt that their role had changed from being the only provider of emergency care to being one of many. In particular, the emergency medical technician teams (EMT) have evolved and often manage well without a physician. Consequently, the GPs get less experience and feel more uncertain when encountering emergencies. Nevertheless, the GPs want to participate in call outs. They believed that their presence contributes to better patient care, and the community appreciates it. Taking part in call outs is seen as being vital to maintaining skills. The GPs had difficulties explaining how to decide whether to participate in call outs. Decisions were perceived as difficult due to insufficient information. The GPs assessed factors, such as distance from the patient and crowding at the casualty clinic, differently when discussing participation in call outs.ConclusionAlthough their role may have changed, GPs argue that they still play a part in emergency medicine. The GPs claim that by participating in call outs, they maintain their skills and improve patient care, but further research is needed to help policy makers and clinicians decide when the presence of a GP really counts.Norwegian health authorities want to increase participation by general practitioners (GPs) in emergency medicine, but the role of the GP in this context is controversial. KEY POINTSThe role of the GP has changed, but GPs argue that they still play an important role in emergency medicine.GPs believe that their presence on call outs improve patient care, but they find it defensible that patients are tended to by emergency medical technicians (EMTs) only.GPs offered different assessments regarding whether to participate in call outs in seemingly similar cases.

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“…In Norway, four independent regions, each with one major trauma center, and an additional thirty-three acute care hospitals, form a national trauma system (29). In the South-Eastern Health Region, which is Norway's largest health region, the Oslo University Hospital (OUH) is the major trauma center.…”

Section: Contextmentioning

confidence: 99%

Discharge From the Trauma Hospital as A Transition Into Insecurity, - Experiences Among Physical Trauma Survivors

Finstad¹,

Røise²,

Rosseland³

et al. 2020

Preprint

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Background: Physical trauma is associated with mortality, long-term pain and morbidity. Effective pain management is fundamental in trauma care and opioids are indispensable for treating acute pain; however, the use and misuse of prescribed opioids is an escalating problem. Despite this, few studies have been directed towards trauma patients in an early phase of rehabilitation with focusing on experiences and perspectives of health and recovery including pain and persistent use of prescribed opioids with abuse potential. To explore pre- and post-discharge trauma care experiences, including exposure to opioids, physical trauma survivors were recruited from a major trauma center in Norway that provides the highest level of surgical trauma care. Method: Qualitative exploratory study. Individual semi-structured interviews were conducted among 13 trauma patients with orthopedic injuries, known to be associated with severe pain, six weeks post-discharge. The interviews were recorded, transcribed verbatim, and thematically analyzed with an interdisciplinary approach. Results: The overarching theme was that discharge from the trauma hospital and the period that immediately followed were associated with feelings of insecurity. The three main themes that were identified as contributing to this was a) unmet information needs about the injury, b) exposure to opioids, and c) lack of follow-up after discharge from the hospital. Participants experienced to be discharged with prescribed opioids, but without information about their addictive properties or tapering plans. This, and lack of attention to mental health and psychological impact of trauma, gave rise to unmet treatment needs of pain management and mental health problems during hospitalization and following discharge. Conclusion: The findings from this study suggest that in addition to delivery of high-quality biomedical trauma care, health professionals should direct more attention to psychosocial health and safe pain management, including post-discharge opioid tapering and individually tailored follow-up plans for physical trauma survivors.

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Are severely injured trauma victims in Norway offered advanced pre‐hospital care? National, retrospective, observational cohort

Cited by 14 publications

References 24 publications

Comparing population and incident data for optimal air ambulance base locations in Norway

Comparing population and incident data for optimal air ambulance base locations in Norway

Rural GPs’ attitudes toward participating in emergency medicine: a qualitative study

Discharge From the Trauma Hospital as A Transition Into Insecurity, - Experiences Among Physical Trauma Survivors

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