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BackgroundIn situ simulation (ISS) is a form of simulation-based training conducted in participants’ working environments to improve clinical performance and system readiness. This study aimed to estimate the incidence of non-satisfactory ISS assessments in the Danish nationwide lifeguard service and to identify associated factors.MethodsThis retrospective study analysed ISS assessment reports completed by lifeguard instructors from 2018 to 2023. Unadjusted logistic regression was used to identify factors associated with non-satisfactory assessments, reported as ORs with 95% CIs using the Wald method.ResultsOf 768 ISS assessments, 151 (20%) were non-satisfactory. Baseline characteristics, including wave height, showed no significant differences between satisfactory and non-satisfactory groups. The most frequent scenario was an adult, unconscious drowning patient. Discovery time was significantly longer in the non-satisfactory group (median 26 s (IQR: 3–99) vs 1 s (IQR: 0–11), p<0.01). Distractions were associated with a non-satisfactory ISS assessment (OR 2.58 (95% CI: 1.55 to 4.30), p<0.001). Other significant associations included corrective feedback on beach setup (OR 1.69 (95% CI: 1.13 to 2.52), p=0.01), response time (OR 3.54 (95% CI: 1.66 to 7.53), p=0.001), board rescue (OR 1.83 (95% CI: 1.23 to 2.74), p=0.003), boat rescue (OR 2.98 (95% CI: 1.51 to 5.90), p=0.002), alarm call (OR 1.60 (95% CI: 1.02 to 2.50), p=0.04), defibrillation (OR 3.68 (95% CI: 2.23 to 6.07), p<0.001) and non-technical skills (OR 1.71 (95% CI: 1.19 to 2.46), p=0.004).Discussion and conclusionsNon-satisfactory ISS assessments occurred in 20%. Several modifiable factors were associated with a non-satisfactory assessment, indicating areas for improvement within the organisation and the educational programme.

Many junior doctors must prepare to manage acutely ill patients in the emergency department. The setting is often stressful, and urgent treatment decisions are needed. Overlooking symptoms and making wrong choices may lead to substantial patient morbidity or death, and it is essential to ensure that junior doctors are competent. Virtual reality (VR) software can provide standardized and unbiased assessment, but solid validity evidence is necessary before implementation. This study aimed to gather validity evidence for using 360-degree VR videos with integrated multiple-choice questions (MCQs) to assess emergency medicine skills. Five full-scale emergency medicine scenarios were recorded with a 360-degree video camera, and MCQs were integrated into the scenarios to be played in a head-mounted display. We invited 3 groups of medical students with different experience levels to participate: first- to third-year medical students (novice group), last-year medical students without emergency medicine training (intermediate group), and last-year medical students with completed emergency medicine training (experienced group). Each participant's total test score was calculated based on the number of correct MCQ answers (maximum score of 28), and the groups' mean scores were compared. The participants rated their experienced presence in emergency scenarios using the Igroup Presence Questionnaire (IPQ) and their cognitive workload with the National Aeronautics and Space Administration Task Load Index (NASA-TLX). We included 61 medical students from December 2020 to December 2021. The experienced group had significantly higher mean scores than the intermediate group (23 vs 20; P=.04), and the intermediate group had significantly higher scores than the novice group (20 vs 14; P<.001). The contrasting groups' standard-setting method established a pass-or-fail score of 19 points (68% of the maximum possible score of 28). Interscenario reliability was high, with a Cronbach α of 0.82. The participants experienced the VR scenarios with a high degree of presence with an IPQ score of 5.83 (on a scale from 1-7), and the task was shown to be mentally demanding with a NASA-TLX score of 13.30 (on a scale from 1-21). This study provides validity evidence to support using 360-degree VR scenarios to assess emergency medicine skills. The students evaluated the VR experience as mentally demanding with a high degree of presence, suggesting that VR is a promising new technology for emergency medicine skills assessment.

Background Pediatric out-of-hospital cardiac arrest (POHCA) has received limited attention. All causes of POHCA and outcomes were examined during a 4-year period in a Danish nationwide register and prehospital medical records. The aim was to describe the incidence, reversible causes, and survival rates for POHCA in Denmark. Methods This is a registry-based follow-up cohort study. All POHCA for a 4-year period (2016–2019) in Denmark were included. All prehospital medical records for the included subjects were reviewed manually by five independent raters establishing whether a presumed reversible cause could be assigned. Results We identified 173 cases within the study period. The median incidence of POHCA in the population below 17 years of age was 4.2 per 100,000 persons at risk. We found a presumed reversible cause in 48.6% of cases, with hypoxia being the predominant cause of POHCA (42.2%). The thirty-day survival was 40%. Variations were seen across age groups, with the lowest survival rate in cases below 1 year of age. Defibrillators were used more frequently among survivors, with 16% of survivors defibrillated bystanders as opposed to 1.9% in non-survivors and 24% by EMS personnel as opposed to 7.8% in non-survivors. The differences in initial rhythm being shockable was 34% for survivors and 16% for non-survivors. Conclusion We found pediatric out-of-hospital cardiac arrests was a rare event, with higher incidence and mortality in infants compared to other age groups of children. Use of defibrillators was disproportionally higher among survivors. Hypoxia was the most common presumed cause among all age groups.

Background Effective interventions to reduce drowning incidents require accurate and reliable data for scientific analysis. However, the lack of high-quality evidence and the variability in drowning terminology, definitions, and outcomes present significant challenges in assessing studies to inform drowning guidelines. Many drowning reports use inappropriate classifications for drowning incidents, which significantly contributes to the underreporting of drowning. In particular, non-fatal drowning incidents are underreported because many countries do not routinely collect this data. The Danish Drowning Cohort The Danish Drowning Cohort was established in 2016 to facilitate research to improve preventative, rescue, and treatment interventions to reduce the incidence, mortality, and morbidity of drowning. The Danish Drowning Cohort contains nationwide data on all fatal and non-fatal drowning incidents treated by the Danish Emergency Medical Services. Data are extracted from the Danish prehospital electronic medical record using a text-search algorithm (Danish Drowning Formula) and a manual validation process. The WHO definition of drowning, supported by the clarification statement for non-fatal drowning, is used as the case definition to identify drowning. All drowning patients are included, including unwitnessed incidents, non-conveyed patients, patients declared dead prehospital, or patients with obvious clinical signs of irreversible death. This method allows syndromic surveillance and monitors a nationwide cohort of fatal and non-fatal drowning incidents in near-real time to inform future prevention strategies. The Danish Drowning Cohort complies with the Utstein style for drowning reporting guidelines. The 30-day mortality is obtained through the Civil Personal Register to differentiate between fatal and non-fatal drowning incidents. In addition to prehospital data, new data linkages with other Danish registries via the patient’s civil registration number will enable the examination of various additional factors associated with drowning risk. Conclusion The Danish Drowning Cohort contains nationwide prehospital data on all fatal and non-fatal drowning incidents treated by the Danish Emergency Medical Service. It is a basis for all research on drowning in Denmark and may improve preventative, rescue, and treatment interventions to reduce the incidence, mortality, and morbidity of drowning. Graphical Abstract Plain Language Summary The Danish Drowning Cohort includes data on fatal and non-fatal drowning incidents treated by the Emergency Medical Services from 2016 and onwards and serves as the foundation for drowning research in Denmark. Data are extracted from the Danish Prehospital Electronic Medical Record using the Danish Drowning Formula and manual validation. The research data can advance prevention, rescue, and treatment interventions, aiming to decrease drowning incidence, mortality, and morbidity. The research data follows the Utstein style for drowning reporting guidelines linked with 30-day survival.

Background Trauma guidelines on spinal motion restriction (SMR) have changed drastically in recent years. An international group of experts explored whether consensus could be reached and if guidelines on SMR performed by trained lifeguards and prehospital EMS following in-water traumatic spinal cord injury (TSCI) should also be changed. Methods An international three-round Delphi process was conducted from October 2022 to November 2023. In Delphi round one, brainstorming resulted in an exhaustive list of recommendations for handling patients with suspected in-water TSCI. The list was also used to construct a preliminary flowchart for in-water SMR. In Delphi round two, three levels of agreement for each recommendation and the flowchart were established. Recommendations with strong consensus (≥ 85% agreement) underwent minor revisions and entered round three; recommendations with moderate consensus (75–85% agreement) underwent major revisions in two consecutive phases; and recommendations with weak consensus (< 75% agreement) were excluded. In Delphi round 3, the level of consensus for each of the final recommendations and each of the routes in the flowchart was tested using the same procedure as in Delphi round 2. Results Twenty-four experts participated in Delphi round one. The response rates for Delphi rounds two and three were 92% and 88%, respectively. The study resulted in 25 recommendations and one flowchart with four flowchart paths; 24 recommendations received strong consensus (≥ 85%), and one recommendation received moderate consensus (81%). Each of the four paths in the flowchart received strong consensus (90–95%). The integral flowchart received strong consensus (93%). Conclusions This study produced expert consensus on 25 recommendations and a flowchart on handling patients with suspected in-water TSCI by trained lifeguards and prehospital EMS. These results provide clear and simple guidelines on SMR, which can standardise training and guidelines on SMR performed by trained lifeguards or prehospital EMS.

Accurate, reliable, and sufficient data is required to reduce the burden of drowning by targeting preventive measures and improving treatment. Today's drowning statistics are informed by various methods sometimes based on data sources with questionable reliability. These methods are likely responsible for a systematic and significant underreporting of drowning. This study's aim was to assess the 30-day survival of patients with out-of-hospital cardiac arrest (OHCA) identified in the Danish Cardiac Arrest Registry (DCAR) after applying the Danish Drowning Formula. This nationwide, cohort, registry-based study with 30-day follow-up used the Danish Drowning Formula to identify drowning-related OHCA with a resuscitation attempt from the DCAR from January 1st, 2016, through December 31st, 2021. The Danish Drowning Formula is a text-search algorithm constructed for this study based on trigger-words identified from the prehospital medical records of validated drowning cases. The primary outcome was 30-day survival from OHCA. Data were analyzed using multiple logistic regression. Drowning-related OHCA occurred in 374 (1%) patients registered in the DCAR compared to 29,882 patients with OHCA from other causes. Drowning-related OHCA more frequently occurred at a public location (87% vs 25%, p < 0.001) and were more frequently witnessed by bystanders (80% vs 55%, p < 0.001). Both 30-day and 1-year survival for patients with drowning-related OHCA were significantly higher compared to OHCA from other causes (33% vs 14% and 32% vs 13%, respectively, p < 0.001). The adjusted odds ratio for 30-day survival for drowning-related OHCA and other causes of OHCA was 2.3 [1.7–3.2], p < 0.001. Increased 30-day survival was observed for drowning-related OHCA occurring at swimming pools compared to public location OHCA from other causes with an OR of 11.6 [6.0–22.6], p < 0.001. This study found higher 30-day survival among drowning-related OHCA compared to OHCA from other causes. This study proposed that a text-search algorithm (Danish Drowning Formula) could explore unstructured text fields to identify drowning persons. This method may present a low-resource solution to inform the drowning statistics in the future. Registration: This study was registered at ClinicalTrials.gov before analyses (NCT05323097).

Background The primary objective of this study was to estimate the incidence and describe the characteristics of non-fatal and fatal drowning incidents treated by the Royal Danish Air Force’s Search And Rescue (SAR) helicopters from 2014 to 2023. Methods This nationwide registry-based cohort study identified drowning patients treated by the SAR helicopters from January 1, 2014, through December 31, 2023. The medical records within the SAR database were used for patient identification and data extraction. We reported the annual number of fatal and non-fatal drowning incidents stratified for prehospital survival and assessed prognostic factors associated with fatal drowning using Fisher’s Exact Test. Results During the 10-year study period from 2014 to 2023, 247 drowning incidents treated by SAR helicopters were recorded, corresponding to an incidence rate of 0.43 cases per 100,000 person-years [95% CI: 0.38–0.49]. After exclusion of patients with irreversible signs of death, 229 patients were analysed. Males accounted for 89%, and most patients were treated from June to August (42%). The prehospital survival rate was 55%. Significantly higher fatal drowning rates were observed for male vs. female patients (39% vs. 5%), patients aged 50–70 years vs. <20 years (approx. 50% vs. 8%), submersion vs. immersion (86% vs. 1%) and low GCS score < 14 vs. 14–15 at SAR arrival 85% vs. 0%). The fatal group received prehospital critical care interventions more frequently, as part of advanced life support. Conclusions The SAR helicopters rescue and treat a significant number of drowning patients every year. The overall prehospital survival rate was 55%, and significant prognostic factors associated with fatal drowning included male sex, increasing age, submersion injury, and a GCS score < 14 at SAR arrival. Highlights The SAR helicopters treated 247 drowning incidents in Denmark from 2014 to 2023, corresponding to a median of 22 (IQR: 19–28) drowning patients per year. Prehospital mortality was 45%, associated with male sex, high age, submersion injury, and a GCS score < 14 at SAR arrival. Data from the SAR helicopters remain important in the nationwide drowning cohort.

Background Cardiac arrest following trauma is a leading cause of death, mandating urgent treatment. This study aimed to investigate and compare the incidence, prognostic factors, and survival between patients suffering from traumatic cardiac arrest (TCA) and non-traumatic cardiac arrest (non-TCA). Methods This cohort study included all patients suffering from out-of-hospital cardiac arrest in Denmark between 2016 and 2021. TCAs were identified in the prehospital medical record and linked to the out-of-hospital cardiac arrest registry. Descriptive and multivariable analyses were performed with 30-day survival as the primary outcome. Results A total of 30,215 patients with out-of-hospital cardiac arrests were included. Among those, 984 (3.3%) were TCA. TCA patients were younger and predominantly male (77.5% vs 63.6%, p  =  < 0.01) compared to non-TCA patients. Return of spontaneous circulation occurred in 27.3% of cases vs 32.3% in non-TCA patients, p  < 0.01, and 30-day survival was 7.3% vs 14.2%, p  < 0.01. An initial shockable rhythm was associated with increased survival (aOR = 11.45, 95% CI [6.24 – 21.24] in TCA patients. When comparing TCA with non-TCA other trauma and penetrating trauma were associated with lower survival (aOR: 0.2, 95% CI [0.02–0.54] and aOR: 0.1, 95% CI [0.03 – 0.31], respectively. Non-TCA was associated with an aOR: 3.47, 95% CI [2.53 – 4,91]. Conclusion Survival from TCA is lower than in non-TCA. TCA has different predictors of outcome compared to non-TCA, illustrating the differences regarding the aetiologies of cardiac arrest. Presenting with an initial shockable cardiac rhythm might be associated with a favourable outcome in TCA.

ObjectivesThis study aimed to compare hospital admission and 30-day mortality between patients assessed by the prehospital assessment unit (PAU) and patients not assessed by the PAU.DesignThis was a matched cohort study.SettingThis study was conducted between November 2021 and October 2022 in Region Zealand, Denmark.Participants989 patients aged >18, assessed by the PAU, were identified, and 9860 patients not assessed by the PAU were selected from the emergency calls using exposure density sampling.ExposurePatients assessed by the PAU. The PAU is operated by paramedics with access to point-of-care test facilities. The PAU is an alternative response vehicle without the capability of transporting patients.Primary and secondary outcome measuresThe primary outcome was hospital admission within 48 hours after the initial call. The key secondary outcomes were admission within 7 days, 30-day mortality and admission within 6 hours. Descriptive statistical analyses were conducted, and logistic regression models were used to estimate adjusted OR (aOR) and 95% CI.ResultsAmong the PAU assessed, 44.1% were admitted within 48 hours, compared with 72.9% of the non-PAU assessed, p<0.001. The multivariable analysis showed a lower risk of admission within 48 hours and 7 days among the PAU patients, aOR 0.31 (95% CI 0.26 to 0.38) and aOR 0.50 (95% CI 0.38 to 0.64), respectively. The 30-day mortality rate was 3.8% in the PAU-assessed patients vs 5.5% in the non-PAU-assessed patients, p=0.03. In the multivariable analysis, no significant difference was found in mortality aOR 0.99 (95% CI 0.71 to 1.42). No deaths were observed in PAU-assessed patients without subsequent follow-up.ConclusionThe recently introduced PAU aims for patient-centred emergency care. The PAU-assessed patients had reduced admissions within 48 hours and 7 days after the initial call. Study findings indicate that the PAU is safe since we identified no significant differences in 30-day mortality.Trial registration numberNCT05654909.