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Search Results: 1 - 10 of 407913 matches for " Hans M Lossius "
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The Scandinavian journal of trauma, resuscitation and emergency medicine – grown up at last
Hans Lossius
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2008, DOI: 10.1186/1757-7241-16-1
Abstract: Over the years, SJTREM has gained valuable experience through both funding several international conferences (i.e. TraumaCare 2002, HLR 2003, The Scandinavian Update on Trauma, Resuscitation, and Emergency Medicine 2005 and 2007 – to mention but a few), and publishing widely on topics in subspecialties covered by its scope [1].Today, SJTREM is the official journal of The Scandinavian Networking Group on Trauma and Emergency Management (SCANTEM) [2], and 9 more societies involved in trauma, resuscitation, and emergency medicine in Scandinavia. Although primarily directed at the Scandinavian audience, the articles published reflect the journal's considerable international orientation. Our large and distinguished Editorial Board represents several different countries, including UK, Germany, Australia, and the US.When you read this, a new and significant step in the history of SJTREM is achieved. The journal is now published as an open access online journal in cooperation with BioMed Central. This means that articles will be published online immediately upon acceptance (after peer-review) and soon after listed in PubMed Central, the US National Library of Medicine's full-text repository of life science literature, and hence indexed in PubMed.SJTREM has chosen open access publishing for several reasons. Articles are freely and universally accessible online, thus articles are highly visible and read by a wide audience. The authors hold copyright for their work and grant anyone the right to reproduce and disseminate the article provided that it is correctly cited, in accordance with BioMed Central's open access license agreement [3]. Besides PubMed Central, the journal's articles are archived in repositories at the University of Potsdam in Germany, at INIST in France and in e-Depot, the National Library of the Netherlands' digital archive of all electronic publications.Thanks to substantial funding from The Norwegian Air Ambulance Foundation and The Laerdal Foundation for
A concept for major incident triage: full-scaled simulation feasibility study
Marius Rehn, Jan E Andersen, Trond Vigerust, Andreas J Krüger, Hans M Lossius
BMC Emergency Medicine , 2010, DOI: 10.1186/1471-227x-10-17
Abstract: The learners participated in two standardised bus crash simulations: without and with competence of TAS-triage and access to TAS-triage equipment. The instructors calculated triage accuracy and measured time consumption while the learners participated in a self-reported before-after study. Each question was scored on a 7-point Likert scale with points labelled "Did not work" (1) through "Worked excellent" (7).Among the 93 (85%) participating emergency service professionals, 48% confirmed the existence of a major incident triage system in their service, whereas 27% had access to triage tags. The simulations without TAS-triage resulted in a mean over- and undertriage of 12%. When TAS-Triage was used, no mistriage was found. The average time from "scene secured to all patients triaged" was 22 minutes (range 15-32) without TAS-triage vs. 10 minutes (range 5-21) with TAS-triage. The participants replied to "How did interdisciplinary cooperation of triage work?" with mean 4,9 (95% CI 4,7-5,2) before the course vs. mean 5,8 (95% CI 5,6-6,0) after the course, p < 0,001.Our modified triage Sieve tool is feasible, time-efficient and accurate in allocating priority during simulated bus accidents and may serve as a candidate for a future national standard for major incident triage.A major incident has occurred when incident location, severity, type or number of victims require extraordinary resources. Major incidents are heterogeneous by nature and their unexpectedness favours an "all-hazards" approach. Since rescue capacity varies within systems, a major incident for a rural emergency service may not apply to a larger urban emergency service [1]. Rapid access to advanced major incident management have proven to optimize resource use and improve patient outcome [2].Major incident management involves responders from multiple rescue services and it traverses geographical and jurisdictional lines. Further, it involves multiple tasks such as leadership, preparation, risk-evaluation
Patients Referred to a Norwegian Trauma Centre: effect of transfer distance on injury patterns, use of resources and outcomes
Thomas Kristiansen, Hans M Lossius, Kjetil S?reide, Petter A Steen, Christine Gaarder, P?l A N?ss
Journal of Trauma Management & Outcomes , 2011, DOI: 10.1186/1752-2897-5-9
Abstract: Patients included in the OUH trauma registry from 2001 to 2008 were included in the study. Demographic, injury, management and outcome data were abstracted. Patients were grouped according to transfer distance: ≤20 km, 21-100 km and > 100 km.Of the 7.353 included patients, 5.803 were admitted directly, and 1.550 were transferred. The number of transfers per year increased, and there was no reduction in injury severity during the study period. Seventy-six per cent of the transferred patients were severely injured. With greater transfer distances, injury severity increased, and there were larger proportions of traffic injuries, polytrauma and hypotensive patients. With shorter distances, patients were older, and head injuries and injuries after falls were more common. The shorter transfers less often activated the trauma team: ≤20 km -34%; 21-100 km -51%; > 100 km -61%, compared to 92% of all directly admitted patients. The mortality for all transferred patients was 11%, but was unequally distributed according to transfer distance.This study shows heterogeneous characteristics and high injury severity among interhospital transfers. The rate of trauma team assessment was low and should be further examined. The mortality differences should be interpreted with caution as patients were in different phases of management. The descriptive characteristics outlined may be employed in the development of triage protocols and transfer guidelines.The formalisation of trauma management has been associated with increased survival for injured patients, and trauma systems implementation is gaining momentum [1-5]. An important concept of trauma systems is to triage the most severely injured patients to a regional trauma centre, while patients not requiring this level of resources are managed at the nearest acute care hospital [6]. This necessitates effective prehospital triage and interhospital transfer; thus, these processes are key quality indicators of the trauma system [7,8].Few Eu
Implementation of recommended trauma system criteria in south-eastern Norway: a cross-sectional hospital survey
Thomas Kristiansen, Kjetil G Ringdal, Tarjei Skotheimsvik, Halvor K Salthammer, Christine Gaarder, P?l A N?ss, Hans M Lossius
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2012, DOI: 10.1186/1757-7241-20-5
Abstract: Recommendations for a national trauma system in Norway were published in 2007. We wanted to assess the level of implementation of these recommendations.A survey of all acute care hospitals that receive severely injured patients in the south-eastern health region of Norway was conducted. A structured questionnaire based on the 2007 national recommendations was used in a telephone interview of hospital trauma personnel between January 17 and 21, 2011. Seventeen trauma system criteria were identified from the recommendations.Nineteen hospitals were included in the study and these received more than 2000 trauma patients annually via their trauma teams. Out of the 17 criteria that had been identified, the hospitals fulfilled a median of 12 criteria. Neither the size of the hospitals nor the distance between the hospitals and the regional trauma centre affected the level of trauma resources available. The hospitals scored lowest on the criteria for transfer of patients to higher level of care and on the training requirements for members of the trauma teams.Our study identifies a major shortcoming in the efforts of regionalizing trauma in our region. The findings indicate that training of personnel and protocols for inter-hospital transfer are the major deficiencies from the national trauma system recommendations. Resources for training of personnel partaking in trauma teams and development of inter-hospital transfer agreements should receive immediate attention.Formalized trauma systems were described more than three decades ago [1]. Supported by an increasing amount of empirical evidence, the benefit of trauma systems have been widely accepted among trauma care providers [2-5]. In spite of this, relatively few regions internationally have fully implemented the trauma system concepts. Factors that make trauma system implementation challenging, like financial costs, lack of political will, and resistance against centralizing health care services, have been identified [6-9]
Open access publishing: a girder in the success of the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Hans Lossius, Kjetil S?reide
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2011, DOI: 10.1186/1757-7241-19-7
Abstract: SJTREM converted into open access (OA) online publishing in July 2008 [2]. The decision was based on the importance of making research accessible for all, regardless of financial status or capabilities. This conversion resulted in a substantial rise in submissions, and not least citations. In line with the visions of saving more lives, the Norwegian Air Ambulance Foundation and the Laerdal Foundation for Acute Medicine have supported SJTREM by covering the article processing charges for the first and critical 2 years of establishing an independent scientific, open access journal of trauma, resuscitation and emergency medicine [3-5].The OA conversion was timely. Scandinavian research founders have for the last two years been steadily moving from a supportive attitude for the OA principles, to making policy decisions that have a direct guidance to authors to publish OA. The Norwegian Research Council declared in 2009 that all public founded research should be published OA [6], and in Denmark the Open Access Committee has, on behalf of the Ministry of Science, Technology and Innovation, made clear recommendations for OA publishing [7]. But the most significant step till now was the decision of the Swedish Research Council and other major Swedish research founders to include an OA mandate for all its research grants from 2010 [8-10]. In line with this, universities in Scandinavia are moving towards OA publishing, and national libraries are following closely. Chalmers University of Technology was in 2010 the first Swedish university to take a strong Open Access mandate [11], and there is probably just a question of time before this is the common policy within most Scandinavian Universities.The Scandinavian move is part of the wider global picture where mandates and funding mechanisms, constituting the equivalent of library budgets at many universities, are springing into life. With the support of European Commission, OA are evolving all over Europe http://www.openaire.eu
A year of contemplation: looking back and moving forward
Kjetil S?reide, Hans Lossius
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2009, DOI: 10.1186/1757-7241-17-31
Abstract: The Journal has over the past year received and published original and review papers from several Scandinavian research groups [3-11]. Also, contributions from several international researchers including the USA [12-15], several European countries (e.g. UK, Germany, Switzerland, Italy and Greece) [16-22], and even Asia [23] are influencing the Journal content. Currently, we have submissions in-house from virtually all corners of the world, with several contributors outside Scandinavia and Europe. We believe this demonstrates the increasing global impact of the Journal and hope to establish a truly international profile and outreach while not loosing the vision of being a forum for scientific exchange and improvements for Scandinavian countries in particular. Also, the Journal has supported and published abstracts from international congresses, with the supplements from the London Trauma Conference available on the website[24], and the abstracts for the 3rd Scandinavian Update on Trauma, Resuscitation and Emergency Medicine and the Research Symposium 2009 for the Danish Society of Emergency Medicine will follow soon.The success of the Journal is measured also by the number of accessed papers – currently, more than 10 of the published papers have been accessed over 1000 times, even though many of them have been available for only a few months on the Web, and 3 papers have been accessed more than 2000 times each[13,25,26]. The international consensus paper by Ringdal et al[26] has even been included in the "Faculty of 1000 medicine" with almost 5000 hits in less than one year.We strive to ensure high visibility of the Journal, and have for 2008 published a yearbook, which has been distributed to several hundred participants at the Scandinavian Update conference as well as to a wide number of libraries and research institutions. The success of this publication will be repeated for 2009, thus ensuring high visibility both electronically as well as on paper.Several of the
Collecting core data in severely injured patients using a consensus trauma template: an international multicentre study
Kjetil Ringdal, Hans Lossius, J Mary Jones, Jens M Lauritsen, Timothy J Coats, Cameron S Palmer, Rolf Lefering, Stefano Di Bartolomeo, David J Dries, Kjetil S?reide, The Utstein Trauma Data Collaborators
Critical Care , 2011, DOI: 10.1186/cc10485
Abstract: Trauma centres from three different continents were invited to submit Utstein Trauma Template core data during a defined period, for up to 50 consecutive trauma patients. Directly admitted patients with a New Injury Severity Score (NISS) equal to or above 16 were included. Main outcome variables were data completeness, data differences and data collection difficulty.Centres from Europe (n = 20), North America (n = 3) and Australia (n = 1) submitted data on 965 patients, of whom 783 were included. Median age was 41 years (interquartile range (IQR) 24 to 60), and 73.1% were male. Median NISS was 27 (IQR 20 to 38), and blunt trauma predominated (91.1%). Of the 36 Utstein variables, 13 (36%) were collected by all participating centres. Eleven (46%) centres applied definitions of the survival outcome variable that were different from those of the template. Seventeen (71%) centres used the recommended version of the Abbreviated Injury Scale (AIS). Three variables (age, gender and AIS) were documented in all patients. Completeness > 80% was achieved for 28 variables, and 20 variables were > 90% complete.The Utstein Template was feasible across international trauma centres for the majority of its data variables, with the exception of certain physiological and time variables. Major differences were found in the definition of survival and in AIS coding. The current results give a clear indication of the attainability of information and may serve as a stepping-stone towards creation of a European trauma registry.Major trauma is a leading cause of death and disability around the world [1], and it accounts for approximately 10% of the world's deaths. Globally, unintentional injuries are ranked as the sixth leading cause of death and the fifth leading cause of moderate and severe disability [2]. The introduction of regionalised trauma systems has the potential to reduce preventable deaths [3], but an improved understanding of the benefits and limitations of different trauma care
Patient safety in pre-hospital emergency tracheal intubation: a comprehensive meta-analysis of the intubation success rates of EMS providers
Hans Lossius, Jo R?islien, David J Lockey
Critical Care , 2012, DOI: 10.1186/cc11189
Abstract: We conducted a systematic search of Medline and EMBASE to identify all of the published original English-language articles reporting pre-hospital ETI in adult patients. We selected all of the studies that reported ETI success rates and extracted information on the number of attempted and successful ETIs, type of provider, level of ETI training and the availability of drugs on scene. We calculated the overall success rate using meta-analysis and assessed the relationships between the ETI success rate and type of provider and between the ETI success rate and the types of drugs available on the scene.From 1,070 studies initially retrieved, we identified 58 original studies meeting the selection criteria. Sixty-four per cent of the non-physician-manned services and 54% of the physician-manned services reported ETI success rates but the success rate reporting was incomplete in three studies from non-physician-manned services. Median success rate was 0.905 (0.491, 1.000). In a weighted linear regression analysis, physicians as providers were significantly associated with increased success rates, 0.092 (P = 0.0345). In the non-physician group, the use of drug-assisted intubation significantly increased the success rates. All physicians had access to traditional rapid sequence induction (RSI) and, comparing these to non-physicians using muscle paralytics or a traditional RSI, there still was a significant difference in success rate in favour of physicians, 0.991 and 0.955, respectively (P = 0.047).This comprehensive meta-analysis suggests that physicians have significantly fewer pre-hospital ETI failures overall than non-physicians. This finding, which remains true when the non-physicians administer muscle paralytics or RSI, raises significant patient safety issues. In the absence of pre-hospital physicians, conducting basic or advanced airway techniques other than ETI should be strongly considered.Airway compromise has been identified as a preventable cause of poor outcome
Revisiting the value of pre-hospital tracheal intubation: an all time systematic literature review extracting the Utstein airway core variables
Hans Lossius, Stephen JM Sollid, Marius Rehn, David J Lockey
Critical Care , 2011, DOI: 10.1186/cc9973
Abstract: We performed an all time systematic search according to the PRISMA guidelines of Medline and EMBASE to identify original research pertaining to pre-hospital TI in adult patients.From 1,076 identified records, 73 original papers were selected. Information was extracted according to an Utstein template for data reporting from in-the-field advanced airway management. Fifty-nine studies were from North American EMS systems. Of these, 46 (78%) described services in which non-physicians conducted TI. In 12 of the 13 non-North American EMS systems, physicians performed the pre-hospital TI. Overall, two were randomised controlled trials (RCTs), and 65 were observational studies. None of the studies presented the complete set of recommended Utstein airway variables. The median number of core variables reported was 10 (max 21, min 2, IQR 8-12), and the median number of fixed system variables was 5 (max 11, min 0, IQR 4-8). Among the most frequently reported variables were "patient category" and "service mission type", reported in 86% and 71% of the studies, respectively. Among the least-reported variables were "co-morbidity" and "type of available ventilator", both reported in 2% and 1% of the studies, respectively.Core data required for proper interpretation of results were frequently not recorded and reported in studies investigating TI in adults. This makes it difficult to compare scientific reports, assess their validity, and extrapolate to other EMS systems. Pre-hospital TI is a complex intervention, and terminology and study design must be improved to substantiate future evidence based clinical practice.Tracheal intubation (TI) to secure the airway of severely ill or injured patients is a critical intervention regularly conducted by emergency medical service (EMS) providers throughout the world. This activity is based on the assumption that, in keeping with in-hospital practice, a compromised airway should be secured as early as possible to ensure adequate ventilation a
Pre-hospital advanced airway management by anaesthesiologists: Is there still room for improvement?
Stephen JM Sollid, Jon Heltne, Eldar S?reide, Hans Lossius
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2008, DOI: 10.1186/1757-7241-16-2
Abstract: Using a semi-structured questionnaire, we interviewed anaesthesiologists working in the three HEMS programs covering Western Norway. We compared answers from specialists and non-specialists as well as full- and part-time HEMS physicians.Of the 17 available respondents, most (88%) felt that their continuous exposure to intubations was not sufficient. Additional training was mainly acquired through other clinical practice and mannequin- or cadaver-based skills training. Of the respondents, 77% and 35% reported having experienced difficult and failed intubations, respectively. Further, 59% reported knowledge of airway management-related deaths in their HEMS program. Significantly more full- than part-time HEMS physicians had experienced these problems. All respondents had airway back-up equipment in their service, but 29% were not familiar with all the equipment.The majority of anaesthesiologists working as HEMS physicians view pre-hospital advanced airway management as a high-risk procedure. Relevant airway management competencies for HEMS physicians in Norway seem to be insufficiently trained and maintained. A better-defined level of competence with better training methods and systems seems warranted.Endotracheal intubation (ETI) plays an important role in pre-hospital advanced life support (ALS) [1-3]. Despite this fact, there is an increased concern that both quality of care and patient safety suffer from intubation attempts by pre-hospital clinicians with limited training and experience [4,5]. The notion that advanced airway management in the pre-hospital setting should only be handled by specially trained personnel has led to the recently developed guidelines for pre-hospital airway management by the Scandinavian Society for Anaesthesiology and Intensive care medicine (SSAI)[6]. These guidelines stress the importance of extensive airway management experience and the ability to use anaesthetic drugs to facilitate ETI, thus suggesting that the skill should be restr
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