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There is little research on high frequency emergency department users (HEDU) in Sweden. We aim to determine the prevalence and costs of HEDU compared to non-HEDU at Örebro University Hospital (ÖUH). Additionally, we will determine the factors and outcomes associated with being a HEDU. This was a retrospective, observational cohort study of ED patients presenting to ÖUH, Sweden between 2018-19. Analyses used electronic registry, ambulance, and cost data. The definition for HEDU was [greater than or equal to]4 visits/year. HEDUs were categorized further into Repeat, High and Super HEDU with 4-7, 8-18 and [greater than or equal to]19 visits/year, respectively. We used multivariable logistic regression to determine the adjusted odds ratios for factors and outcomes between HEDU and non-HEDU. Of all ÖUH ED patients, 6.1% were HEDU and accounted for 22.4% of ED visits and associated costs. Compared to the mean cost of non-HEDU, the Repeat, High and Super HEDU were more costly by factors of 4, 8 and 27, respectively. The HEDUs were more likely to be male, self-referred, present with abdominal pain, arrive by ambulance, at night and from the Örebro municipal region. Super HEDU were more likely to be of adult age and assigned lower acuity scores. HEDU were more likely to be directed to the surgical zone, less likely to receive radiologic imaging or achieve a 4-hr time target. In contrast to the Repeat and High HEDU, Super HEDU were less likely to be admitted, but more likely to leave without being seen. ÖUH has a HEDU population with associated factors and outcomes. They account for a substantial proportion of ED costs compared to non-HEDU.

Background There is little research on high frequency emergency department users (HEDU) in Sweden. We aim to determine the prevalence and costs of HEDU compared to non-HEDU at Örebro University Hospital (ÖUH). Additionally, we will determine the factors and outcomes associated with being a HEDU. Methods This was a retrospective, observational cohort study of ED patients presenting to ÖUH, Sweden between 2018–19. Analyses used electronic registry, ambulance, and cost data. The definition for HEDU was ≥4 visits/year. HEDUs were categorized further into Repeat, High and Super HEDU with 4–7, 8–18 and ≥19 visits/year, respectively. We used multivariable logistic regression to determine the adjusted odds ratios for factors and outcomes between HEDU and non-HEDU. Findings Of all ÖUH ED patients, 6.1% were HEDU and accounted for 22.4% of ED visits and associated costs. Compared to the mean cost of non-HEDU, the Repeat, High and Super HEDU were more costly by factors of 4, 8 and 27, respectively. The HEDUs were more likely to be male, self-referred, present with abdominal pain, arrive by ambulance, at night and from the Örebro municipal region. Super HEDU were more likely to be of adult age and assigned lower acuity scores. HEDU were more likely to be directed to the surgical zone, less likely to receive radiologic imaging or achieve a 4-hr time target. In contrast to the Repeat and High HEDU, Super HEDU were less likely to be admitted, but more likely to leave without being seen. Conclusion ÖUH has a HEDU population with associated factors and outcomes. They account for a substantial proportion of ED costs compared to non-HEDU.

Background There is no universal agreement on what competence in disaster medicine is, nor what competences and personal attributes add value for disaster responders. Some studies suggest that disaster responders need not only technical skills but also non-technical skills. Consensus of which non-technical skills are needed and how training for these can be provided is lacking, and little is known about how to apply knowledge of non-technical skills in the recruitment of disaster responders. Therefore, this scoping review aimed to identify the non-technical skills required for the disaster medicine response. Method A scooping review using the Arksey & O´Malley framework was performed. Structured searches in the databases PuBMed, CINAHL Full Plus, Web of Science, PsycInfo and Scopus was conducted. Thereafter, data were structured and analyzed. Results From an initial search result of 6447 articles, 34 articles were included in the study. These covered both quantitative and qualitative studies and different contexts, including real events and training. The most often studied real event were responses following earthquakes. Four non-technical skills stood out as most frequently mentioned: communication skills; situational awareness; knowledge of human resources and organization and coordination skills; decision-making, critical-thinking and problem-solving skills. The review also showed a significant lack of uniform use of terms like skills or competence in the reviewed articles. Conclusion Non-technical skills are skills that disaster responders need. Which non-technical skills are most needed, how to train and measure non-technical skills, and how to implement non-technical skills in disaster medicine need further studies.

Background This study aimed to describe the characteristics of frequent users of ambulance services and their corresponding ambulance missions. Methods A retrospective cohort study using register data from a Swedish region (approximately 308,000 inhabitants) was conducted. The dataset covered ambulance missions dispatched between 2019 and 2023; data from 2020–2022 were analyzed, with the extended timeframe (2019–2023) used to identify frequent users. Frequent users were defined as patients with four or more ambulance missions within a 365-day period, divided into moderate (patients with 4–11 missions within 365 days) and high-frequency users (≥ 12 missions within 365 days). Missions associated with these users were referred to as frequent, moderate-frequent, high-frequency, or non-frequent ambulance missions. Results Between 2020 and 2022, 73,461 ambulance missions were utilized by 41,407 unique patients. Of these 41,407 patients, 8.4% were frequent users (7.9% moderate and 0.5% high-frequency users), but accounted for 29.0% of all ambulance missions. The remaining 91.6% were non-frequent users, accounting for 71.0% of the ambulance missions. Frequent users were older than non-frequent users (median age 75 vs 62, p  < .001). Frequent ambulance missions were more often dispatched for dyspnoea (17.8% vs 11.6%, p  < .001), convulsions (4.2% vs 2.1%, p  < .001), and abdominal pain (10.5% vs 8.7%, p  < .001) compared with non-frequent ambulance missions. Frequent ambulance missions were also more likely to be assigned to a higher triage level, and 77.7% resulted in transport to the emergency department. Compare to moderate-frequent ambulance missions, high-frequency missions were more often dispatched for psychiatric emergencies (6.2% vs 2.1%, p  < .001) and intoxications (5.3% vs 2.0%, p  < .001), and more frequently resulted in transport to psychiatric emergency care (3.6% vs 1.4%, p  < .001), or not being conveyed (24.0% vs 16.1%, p  < .001). Conclusions Frequent ambulance users account for a large proportion of all ambulance missions. The results indicate that frequent users are often in need of emergency care, and understanding this population’s needs is essential to ensure appropriate care. However, the group is heterogeneous and can be divided into frequent and high-frequency users, which have different characteristics. We suggest that future research investigates system-level approaches to identify frequent ambulance users and implement care plans to address patients’ needs and reduce ambulance utilisation.

ObjectiveTo measure the 1 year cumulative incidence of and analyse the risk factors associated with workplace violence directed towards the ambulance service in a Swedish region.DesignProspective cohort study.SettingThe ambulance services in Örebro County Council (Sweden) contain approximately 300 000 inhabitants.ParticipantsAll ambulance missions during the period of 12 months (n=28 640) were assessed.Primary and secondary outcome measuresThe primary outcome measure was workplace violence together with the associated risk factors.ResultsThe 1 year cumulative incidence of workplace violence within the ambulance service was 0.7%. Non-physical violence was most common. There was an increased odds for violence when the patient was under the influence of alcohol or drugs or suffering from mental illness. There was an association between the dispatch categories intoxication, unconsciousness or mental health problems and workplace violence against ambulance personnel. The offenders were mostly men aged 18–29 and workplace violence was more likely to occur in public places.ConclusionsThe 1 year cumulative incidence of workplace violence within the regional ambulance service was low in comparison to that of previous research. The overall regression model had low explanatory power, indicating that the phenomenon is complex and that additional variables need to be taken into account when trying to predict when workplace violence will occur. Additional research is needed to fully understand why workplace violence within the ambulance service occurs and how to mitigate such situations.

Introduction Disaster responders are an important part of disaster response. However, despite large efforts to train disaster responders, there is a limited scientific knowledge regarding which competences and skills such responders value and lack during a real mission. The aim of this study was to investigate used and needed skills among disaster responders responding to the earthquake in Türkiye and Syria 2023 Methods A cross-sectional study using a non-randomized sample was conducted, collected between March and July, 2023. The participants were recruited through invitations distributed to international organizations, and the data were gathered through a web-based survey. The data were analyzed using descriptive and comparative statistics. Results A total of 525 participants involved in the disaster response in Türkiye or Syria in February 2023 were included. The most common valued skills were teamwork skills ( n  = 252, 59%), technical knowledge ( n  = 204, 48%), leadership skills ( n  = 105, 24%) and communication skills ( n  = 114, 17%). Women valued stress management ( n  = 33, 26%) more than leadership ( n  = 24, 19%) Technical knowledges were more valued among first-time responders ( n  = 168, 82%) compared to experienced responders ( n  = 108, 54%, p-value < 0.001). The most reported lacked skills were mental preparedness ( n  = 237, 53%), knowledge of the management system of international response ( n  = 132, 30%), stress management ( n  = 105, 24%) and leadership ( n  = 102, 23%). Conclusion The results showed slightly different needs in the various phases of a response, as well as some differences between men and women. Improving mental preparedness was not one of the most highly valued skills, but it was one of the skills that was most lacking; this discrepancy is an interesting finding. More in-depth analysis and additional studies are needed to further understand how best to prepare disaster responders and how their training can include the desirable skills. Further studies should be focused on the experience and knowledge of qualified disaster responders. This knowledge could also be of use when recruiting since several of the non-technical skills are not only gained solely through specific training.

ObjectivesDynamic ambulance relocation means that the operators at a dispatch centre place an ambulance in a temporary location, with the goal of optimising coverage and response times in future medical emergencies. This study aimed to scope the current research on dynamic ambulance relocation.DesignA scoping review was conducted using a structured search in PubMed, Scopus and Web of Science. In total, 21 papers were included.ResultsMost papers described research with experimental designs involving the use of mathematical models to calculate the optimal use and temporary relocations of ambulances. The models relied on several variables, including distances, locations of hospitals, demographic-geological data, estimation of new emergencies, emergency medical services (EMSs) working hours and other data. Some studies used historic ambulance dispatching data to develop models. Only one study reported a prospective, real-time evaluation of the models and the development of technical systems. No study reported on either positive or negative patient outcomes or real-life chain effects from the dynamic relocation of ambulances.ConclusionsCurrent knowledge on dynamic relocation of ambulances is dominated by mathematical and technical support data that have calculated optimal locations of ambulance services based on response times and not patient outcomes. Conversely, knowledge of how patient outcomes and the working environment are affected by dynamic ambulance dispatching is lacking. This review has highlighted several gaps in the scientific coverage of the topic. The primary concern is the lack of studies reporting on patient outcomes, and the limited knowledge regarding several key factors, including the optimal use of ambulances in rural areas, turnaround times, domino effects and aspects of working environment for EMS personnel. Therefore, addressing these knowledge gaps is important in future studies.

Background Workplace violence is a widely recognised problem within the ambulance service context. The causes of workplace violence have often been attributed to patient- or situation-related risk factors. However, there is a lack of research on workplace violence from the offender’s perspective. Aim To explore workplace violence directed toward ambulance services from the offender’s perspective. Methods An explorative qualitative study was conducted using inductive thematic analysis of trial transcripts from cases tried in court between 2013 and 2023. Plaintiffs in these cases were ambulance personnel or the ambulance service itself. Offenders were those convicted of committing or attempting any of the following acts: threats, theft, assault, molestation or murder. Results Twenty-three trial transcripts were analysed, and four themes were found: (I) the offender was misunderstood , which included communication problems and other misunderstandings; (II) the offender was disrespected , which described perceived unprofessional behaviour and unpleasant or painful treatment by ambulance personnel; (III) the offender was vulnerable , which described the state of the offender (i.e., being under the influence of alcohol or drugs); and (IV) the offender had unmet expectations , which included perceived unreasonable waiting time and conflicting expectations of ambulance care. Conclusion The analysis of trial transcripts revealed four themes from the offender perspective: feelings of being misunderstood, disrespected, vulnerable, and having unmet expectations. It is important to view these results critically, as they are based on trial transcripts in which the offender was found guilty of a crime and may have been attempting to defend his or her actions during the trial. Despite this caveat, healthcare professionals need also to recognise that their behaviour may influence the risk of workplace violence. This knowledge can be harnessed to develop training programs for ambulance personnel.

Sepsis is a time dependent condition. Screening tools based on clinical parameters have been shown to increase the identification of sepsis. The aim of current study was to evaluate the additional predictive value of immunological molecular markers to our previously developed prehospital screening tools. This is a prospective cohort study of 551 adult patients with suspected infection in the ambulance setting of Stockholm, Sweden between 2017 and 2018. Initially, 74 molecules and 15 genes related to inflammation were evaluated in a screening cohort of 46 patients with outcome sepsis and 50 patients with outcome infection no sepsis. Next, 12 selected molecules, as potentially synergistic predictors, were evaluated in combination with our previously developed screening tools based on clinical parameters in a prediction cohort (n = 455). Seven different algorithms with nested cross-validation were used in the machine learning of the prediction models. Model performances were compared using posterior distributions of average area under the receiver operating characteristic (ROC) curve (AUC) and difference in AUCs. Model variable importance was assessed by permutation of variable values, scoring loss of classification as metric and with model-specific weights when applicable. When comparing the screening tools with and without added molecular variables, and their interactions, the molecules per se did not increase the predictive values. Prediction models based on the molecular variables alone showed a performance in terms of AUCs between 0.65 and 0.70. Among the molecular variables, IL-1Ra, IL-17A, CCL19, CX3CL1 and TNF were significantly higher in septic patients compared to the infection non-sepsis group. Combing immunological molecular markers with clinical parameters did not increase the predictive values of the screening tools, most likely due to the high multicollinearity of temperature and some of the markers. A group of sepsis patients was consistently miss-classified in our prediction models, due to milder symptoms as well as lower expression levels of the investigated immune mediators. This indicates a need of stratifying septic patients with a priori knowledge of certain clinical and molecular parameters in order to improve prediction for early sepsis diagnosis. Trial registration : NCT03249597. Registered 15 August 2017.

Introduction The aging population is a challenge for the healthcare system that must identify strategies that meet their needs. Practicing patient-centered care has been shown beneficial for this patient-group. The effect of patient-centered care is called patient-centered outcomes and can be appraised using outcomes measurements. Objectives The main aim was to review and map existing knowledge related to patient-centered outcomes and patient-centered outcomes measurements for older people, as well as identify key-concepts and knowledge-gaps. The research questions were: How can patient-centered outcomes for older people be measured, and which patient-centered outcomes matters the most for the older people? Study design Scoping review. Methods Search for relevant publications in electronical databases, grey literature databases and websites from year 2000 to 2021. Two reviewers independently screened titles and abstracts, followed by full text review and extraction of data using a data extraction framework. Results Eighteen studies were included, of which six with involvement of patients and/or experts in the process on determine the outcomes. Outcomes that matter the most to older people was interpreted as: access to- and experience of care, autonomy and control, cognition, daily living, emotional health, falls, general health, medications, overall survival, pain, participation in decision making, physical function, physical health, place of death, social role function, symptom burden, and time spent in hospital. The most frequently mentioned/used outcomes measurements tools were the Adult Social Care Outcomes Toolkit (ASCOT), EQ-5D, Gait Speed, Katz- ADL index, Patient Health Questionnaire (PHQ9), SF/RAND-36 and 4-Item Screening Zarit Burden Interview. Conclusions Few studies have investigated the older people’s opinion of what matters the most to them, which forms a knowledge-gap in the field. Future research should focus on providing older people a stronger voice in what they think matters the most to them.