Pain in prehospital paediatric patients is often poorly managed. Prehospital opioid doses generally stay below the upper limits recommended by guidelines. Concerns about the risk of overdosing may affect analgesic administration in children. This study investigated whether prehospital administration of opioids in children resulted in clinical signs of adverse effects at hospital admission. This retrospective, register-based study included children aged 0–14 years who received prehospital opioids in the Region of Southern Denmark between 2017 and 2022. Medical records were reviewed for clinical signs of opioid-related adverse effects. The effects were categorised as nonspecific signs, including nausea/vomiting, drowsiness and sedation and more serious clinical signs, comprising bradycardia and respiratory depression. We assessed diagnoses, antidote use, and vasopressor administration. In-hospital analgesia was recorded. 1,531 children were included. Fentanyl was administered alone or in combination with other analgesics to 99.7
Access to adequate pain treatment is considered a fundamental human right, yet around 60
Abstract Background Helicopter-based Emergency Medical Services (EMS) are a costly and finite resource and should only be deployed when they provide substantial benefits to patients. One such benefit is a more rapid response to incidents and transport to hospital compared to Ground-based EMS. This study evaluates methods for estimating travel times for the purpose of optimizing the selection of helicopter vs. ground EMS. Methods Ground EMS travel times were estimated using an open-source routing tool, the estimates of which were adjusted using linear regression and gradient boosting models based on historical travel times. Helicopter travel times were similarly estimated based on great circle distances adjusted by historical data. Models were evaluated using several measures of predictive accuracy to enable comparison with other studies. Results In validation data collected after finalization of the methods, the best performing prediction models for Ground EMS travel times explained a substantial portion of variation in drive times to location and to hospital (R2 0.79 and 0.70 respectively), and less for helicopter flight times (R2 0.46 and 0.38 respectively). Mean average percentage error was 18-20% for all investigated estimation techniques and time intervals. Conclusion Integrating tools based on the open-source code provided with this study has the potential to improve the ability of dispatchers to estimate relative travel times and assess the potential time benefit of directing the most appropriate resources to a given patient.
Abstract Background High-quality clinical practice guidelines are essential for safe and consistent prehospital bleeding control, particularly in settings with variable geography and transport times. This study appraised the methodological quality of Swedish regional prehospital guidelines for traumatic external haemorrhage using the AGREE II instrument. Methods This cross-sectional study included clinical practice guidelines requested from all 21 Swedish healthcare regions. Guideline quality was assessed independently by two appraisers using AGREE II, which evaluates 23 items across six domains. Domain scores were calculated as percentages of the maximum possible score. Results Complete responses were obtained from 15 of 21 regions. Overall methodological quality was low across the included guidelines. The highest median domain score was observed for clarity of presentation, whereas rigour of development, stakeholder involvement, applicability, and editorial independence scored poorly. Most guidelines lacked explicit descriptions of evidence search strategies, criteria for selecting evidence, links between recommendations and supporting evidence, update procedures, and declarations of editorial independence. Conclusions Swedish regional prehospital guidelines for traumatic external bleeding control showed limited methodological quality when assessed using AGREE II. Future guideline development should prioritise transparent evidence linkage, multidisciplinary stakeholder involvement, clear implementation considerations, scheduled updating, and adaptation to regional differences in transport and evacuation times. Trial registration Not applicable.
High-altitude rescue operations expose Emergency Medical Services (EMS) teams to hypobaric hypoxia, which may impair cognition and team performance. However, its effect on the overall quality of prehospital emergency care remains unclear. We aimed to assess whether acute exposure to high altitude (3,450 m) is associated with reduced quality of simulated prehospital emergency medical care delivered by non-acclimatized EMS physicians. We conducted an assessor-blinded, randomised crossover simulation study in Switzerland between September 2024 and January 2025, in which 20 non-acclimatised EMS physicians managed simulated emergency scenarios under four conditions: baseline at low altitude (540 m), acute exposure to high altitude (3,450 m), acute exposure to 3,450 m with supplemental oxygen at 4 L/min, and after 20 hours at 3,450 m. Video-recorded performances were independently assessed by three blinded experts using validated instruments for medical and non-technical performance. The primary outcome was a prespecified composite score comprising 50
