Stiftelsen Norsk Luftambulanse

ABSTRACTIntroductionThis study investigates the impact of active external warming on afterdrop in simulated accidental hypothermia, compared to the effect of passive warming measures.MethodsThis study used data from a randomized crossover field study of experimental hypothermia. Hypothermia was induced in 11 healthy volunteers by pharmacological inhibition of endogenous thermoregulation and exposure to −2°C ambient air in a glacial ice tunnel, wearing wet clothes for a maximum of 2 h, or until their esophageal temperature reached 35°C. Esophageal temperature was measured using a transnasal probe. After cooling, wet clothing was removed and the participants were placed in a hypothermia wrap system for 1 h, with three different sources of active warming applied to the participants in the intervention scenario. After 1 h, the participants were walked with minimal support for balance out of the ice tunnel to a warm tent to recover. The 10 min after the end of the rewarming phase was defined as the afterdrop phase.ResultsMost participants experienced a small drop in temperature during the wrapping phase between the cooling and rewarming phases, followed by a second larger afterdrop while walking out of the ice tunnel. The afterdrop was smaller in the actively rewarmed group, with a mean drop of 0.3°C (min 0.0°C, max 1.2°C) compared to 0.7°C (min 0.0°C, max 1.6°C) in the passively rewarmed group.ConclusionsAdding active external warming reduces afterdrop compared with using only passive external warming measures in non‐shivering individuals. These results may increase understanding of both the afterdrop phenomenon and heat distribution in the body during rewarming.Editorial CommentThis study assessed temperature afterdrop in controlled hypothermia in healthy volunteers who were treated with active external rewarming or passive rewarming. These findings provide detailed insight into how temperature redistribution can occur during rewarming, at least in healthy cases.

• Helicopter crews solved rescue missions with rope and hoist, in randomized sequence. • NASA Task Load Index workload, heart rate, and heart rate variability were analyzed. • Workload was lower in hoist operations for all crewmembers, most markedly for pilots. • Findings were consistent across mission terrain types and operational flight phases. • Physiological measures aligned with workload among pilots and rescuers, but not among physicians. High workloads can deplete cognitive capacity, impairing individuals’ ability to meet task demands and increasing the likelihood of human error. Helicopter rescue operations are inherently complex and require effective multitasking by all crewmembers. This study aimed to quantify subjective workload and physiological activation associated with two different rescue methods, hoist operations and rope operations, in a three-crew Helicopter Emergency Medical Service. The National Aeronautics and Space Administration (NASA) Task Load Index was used to assess workload. Heart rate and heart rate variability were used as markers for physiological activation. Crews performed fifty-five standardized rescue missions covering four distinct terrain categories: alpine, gorge, forest, and vertical environments. Each mission was solved with both rope and hoist rescue methods, in randomized sequence. Linear mixed-model regression analyses were used to account for repeated measures within individuals. Across all mission phases, pilots (n = 4), physicians (n = 3), and rescuers (n = 4) reported lower workloads during hoist operations than during rope operations. For pilots and rescuers, hoist operations were also associated with lower physiological activation. The opposite was found in physicians, who acted as hoist operators. Rescue method affected pilots most markedly, their mean workload scores during active mission being 35 [19,52] for hoisting versus 53 [37,70] for rope operations (R 2 = 0.76, p <0.0001). Analogously, pilot mean heart rate was 80 [57,103] during hoisting compared to 88 [65,111] during rope operations (R 2 = 0.91, p <0.0001). A reduction in workload could contribute to improved flight safety, favouring hoist as rescue method.

The working environment for ambulance professionals in prehospital services is complex, dynamic, and associated with a high degree of unpredictability. It is therefore essential that ambulance professionals adapt to provide high-quality and safe care, yet the research literature on how they successfully adapt in their everyday work remains sparse. The aim of this study is to address this knowledge gap by exploring adaptations in the context of prehospital services, through ambulance professionals' descriptions of successful missions. A qualitative descriptive study was conducted using the Critical Incident Technique methodology for data collection and analysis, the latter through the processes of re-storying and cross-incident analysis. Twenty semi-structured individual interviews were conducted between October 2023 and May 2024 with ambulance professionals, including licensed ambulance medical technicians and paramedics with dual licensing or other additional medical licenses across four ambulance stations in Norway with contrasting geographical locations. A wide range of successful adaptations were described by the ambulance professionals and grouped into seven core themes: (1) Adaptations in mission planning; (2) Practical adaptations; (3) Time-critical adaptations; (4) Personal adaptations; (5) Task-focused adaptations; (6) Adaptations in stakeholder coordination; (7) Adapting to patients and informal caregivers. This study provides insight and new knowledge about successful adaptations in prehospital services and illuminates the variety of adaptations ambulance professionals make in different contexts. Trust is an underlying feature for successful adaptations, while communication is the overall predominant feature, especially vital in stakeholder coordination and decision-making processes impacting team efforts and mission efficiency. Further research should provide insight into cross-occupational and cross-stakeholder collaborative processes.

Introduction: Moderate blood pressure (BP) reduction reduces hematoma growth, but this has not been shown to translate into improved functional recovery after intracerebral hemorrhage (ICH). This study aimed to define patient profiles according to hematoma growth and functional recovery patterns, and explore the prognostic factors of the patterns. Methods: Analysis of the Blood Pressure in Acute Stroke Collaboration (BASC) dataset involved randomized controlled trials of early BP lowering in acute ICH. Latent class analysis was used to identify patient profiles by hematoma volume change from baseline to 24 h on outcome trajectories. Clinical outcomes include functional outcomes measured according to modified Rankin Scale (mRS) and serious adverse events at follow-up (usually 90 days). Generalized linear mixed models were used with adjustment of source trial as a random effect for clustering to identify the prognostic factors. Results: Among 6,221 participants from BASC, 2,450 patients (mean age 64.1 + 13.1 years, female 36.7%) were included. Baseline hematoma volumes (mL) were 6.8, 13.2, 27.1, and 59.2, respectively, for each class identified by patient profiles: no growth with favorable outcome (52.1%, median growth 0.2 [IQR −0.4 to 1.1] mL, median mRS 2 [IQR 1 to 2]), mild growth with disability (32.6%, 0.8 [−0.8 to 4.6] mL, mRS 4 [4 to 5]), moderate growth with death or disability (13.2%, 11.2 [4.9 to 27.0] mL, mRS 4 [3 to 6]), and large growth with death (2.1%, 35.2 [12.8 to 81.2] mL, mRS 6 [6 to 6]). Patients with moderate growth were younger and more likely to undergo neurosurgery than those in the mild or large growth groups. Baseline hematoma volume was the only significant factor associated with all the hematoma pattern groups. Conclusions: Patients with moderate growth were younger and more likely to receive neurosurgery than those in the mild or large growth groups. Baseline hematoma volume is the most important factor for hematoma growth and clinical outcome.

Neonatal transport is an essential component of modern neonatal intensive care globally, providing access to advanced treatment while exposing vulnerable neonates to environmental conditions that may increase the risk of physiological instability. To systematically review studies measuring environmental exposures, specifically vibration, sound and temperature fluctuations during neonatal transport and to evaluate their impact on clinical parameters in neonates. A systematic literature review identified studies reporting environmental factors or clinical data during transport via ground, rotor or fixed-wing air ambulances. The medical databases searched included MEDLINE/PubMed, Embase, the Cochrane database of systematic reviews, Nursing Reference Center Plus, UpToDate and SveMed covering the period from November 2020 to January 2025. 15 observational studies, 13 prospective and 2 retrospective covering publications from 1992 to 2025 were included. The studies included data on vibration, sound, ambient temperature and a wide range of clinical parameters such as heart rate and heart rate variability, change in clinical behaviour scales and cortisol in saliva reflecting the neonatal condition. Only four articles reported the effect of environmental factors on neonatal physiology. This review highlights the presence of environmental factors, particularly noise and vibration, during transport and raises concerns about their impact on neonates. Although diverse clinical parameters were documented, the small sample sizes and variability in measurement methods across studies limit the ability to draw definitive conclusions. These observations emphasise the need for standardised monitoring protocols and further research to optimise neonatal transport practices.

Delirium is commonly observed in older patients who are admitted to the emergency department (ED). Previous systematic reviews have identified poor outcomes associated with delirium in surgical, intensive care and other hospital settings, yet none have specifically considered the ED. This systematic review aims to examine associations between older patients who present or develop delirium in the ED and adverse outcomes within the hospital and after discharge. Searches will be conducted in MEDLINE, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library. There will be no date or language restrictions. Key terms will include concepts related to delirium, the ED and older adults. Observational studies or non-intervention clinical studies will be included that compare outcomes in older patients (ie, ≥65 years) with and without delirium. Outcomes of interest will include length of hospital stay, non-home discharge (eg, nursing home/residential aged care facility), cognitive impairment, decreased physical function, mortality, readmission to hospital and quality of life measures. Two reviewers will independently screen the studies. Data extraction and quality assessment will be extracted by one reviewer and checked by a second reviewer, with any disagreements resolved by discussion or by a third reviewer. Where appropriate, data will be combined in a meta-analysis and a GRADE assessment will be made for each outcome. All methods will be guided by the Cochrane Handbook and the Centre for Reviews and Dissemination and reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis statement as well as the recommendations set out by the Meta-analysis Of Observational Studies in Epidemiology group. As this systematic review will use published data, ethical approval is not required. The results will be disseminated through a peer-reviewed publication and conference presentations. CRD42024594975.

BackgroundTraumatic brain injury (TBI) is a significant public health concern. Advancing age and comorbidities are associated with a reduced probability of being transferred to neurotrauma centres (NTCs) from non-neurosurgical acute care trauma hospitals (ACTHs). However, the extent to which these decisions reflect well-considered treatment-limiting decisions and which influence other factors have on the decision-making process remains unclear.ObjectiveTo increase the understanding of adults’ access to NTC care by exploring the decision-making process for interhospital transfer of patients with isolated TBI, elucidating factors influencing these decisions.MethodsFifteen surgeons and neurosurgeons from four hospitals in Norway were recruited through purposive sampling to four semi-structured focus group interviews. Surgeons represented ACTHs and neurosurgeons NTCs, and all participants were responsible for TBI patients' initial care and transfer decisions. Interviews were thematically analysed.ResultsWe identified several factors influencing transfer decisions, captured in six main themes under one overarching theme; ‘The chance of a favourable outcome’. The six main themes reflect surgeons’ and neurosurgeons’ decision-making process, which included clinical and system-level factors: (A) ‘Establish TBI severity: Glasgow Coma Scale score and head CT’, (B) ‘Preinjury health status: comorbidity, functioning, and age’, (C) ‘Distance from ACTH to NTC: distance is time and time is brain’, (D) ‘Uncertainty and insecurity’, (E) ‘Capacity at NTC’, and (F) ‘Next of kin involvement’.ConclusionOn-call surgeons and neurosurgeons responsible for making transfer decisions for TBI patients emphasise the importance of patient-centred decisions, including individual patients’ risk factors and overall health status.

The error has no consequence on the results or interpretations. The Original Article has been corrected.