To determine proper priorities for the provision of health care in large stadiums, we studied the medical incident patterns occurring in a major college facility and combined this with previously reported information from four other large stadiums. Medical incidents were an uncommon occurrence (1.20 to 5.23 per 10,000 people) with true medical emergencies being even more unusual (0.09 to 0.31 per 10,000 people). Cardiac arrest was rare (0.01 to 0.04 events per 10,000 people). However, the rates of successful resuscitation in three studies were 85% or higher. The previous studies were descriptive in nature and failed to provide specific recommendations for medical aid system configuration or response times. A model is proposed to provide rapid response of advanced life support care to victims of cardiac arrest. We believe that the use of this model in large stadiums throughout the United States could save as many as 100 lives during each football season.

Bakgrund: Den svenska definitionen på prehospital akutsjukvård är omedelbara medicinska åtgärder som vidtas utanför vårdenhet och vidare benämns prehospital ambulanssjukvård som hälso- och sjukvård som utförs i eller i anslutning till ambulans. Sedan 1980-talet har den prehospitala akutsjukvården i Sverige utvecklats inom forskning, kompetens och utrustning. Utvecklingen inom prehospitala akutsjukvården har medfört att det ställs högre krav på personalen som är verksam inom ambulanssjukvård, kraven föreligger för att upprätthålla god och säker vård av patienten. Sveriges ambulanser bemannas idag med minst en legitimerad sjuksköterska. Litteratur och omvårdnadsteoretiker har tidigare belyst att vårdmötet bör präglas av ett personcentrerat förhållningssätt, där patienten betraktas som en unik individ med mångfacetterade behov att tillgodose, oavsett om dessa behov är medicinska eller omvårdnadsmässiga. Sjuksköterskor verksamma inom prehospital akutsjukvård har arbetat utifrån ett medicinskt fokus som resulterat i att patienternas behov inte alltid tillgodoses. När patientens känslomässiga och existentiella behov inte anses vara lika viktig som det medicinska utesluts det holistiska perspektivet och patientens mångfacetterade behov tillgodoses inte. Forskning tyder även på att det råder brist på forskning utifrån patientperspektivet. Patienternas perspektiv är inte välbeskrivet och behöver således belysas. Syfte: Att belysa patientens upplevelse av vårdmötet vid prehospital akutsjukvård. Metod: Studien är en litteraturöversikt med systematisk metod och integrerad dataanalys där totalt 19 artiklar inkluderades. Arton artiklar var av kvalitativ design och en artikel var mixad metod. Resultat: Patienternas positiva och negativa upplevelser presenterades under två huvudkategorier som arbetades fram: Att vara patient i den prehospitala akutsjukvården, Patientens upplevelse av ambulanspersonalens förhållningssätt. Patientens upplevelse av vårdmötet vid prehospital akutsjukvård baseras till stor del på personalens förhållningssätt. Kommunikation, delaktighet, bekräftelse, kompetens och attityd är hörnstenar som presenterades i resultatet och som svarade till tidigare litteratur som belyser fördelar som personcentrerad vård leder till.  Slutsats: Internationell forskning har påvisat att det råder brist på forskning utifrån patientperspektiv och att sjuksköterskan verksam inom ambulans efterfrågar återkoppling. Majoriteten av artiklarna i litteraturöversikten hade ursprung från Sverige, därmed drogs slutsatsen att Sverige är på framkant inom forskning av prehospital akutsjukvård utifrån ett patientperspektiv. Vikten av att belysa patientens perspektiv av vårdmötet är att öka förståelsen hos personalen och således höja kvalitén på vården av patienten som bör präglas utifrån personcentrerat perspektiv. Sjuksköterskan kan se denna litteraturöversikt som en generell återkoppling och bör i sin vård av patienten sträva efter ett samspel med patienten. Att vårda varje enskild patient utifrån ett holistiskt perspektiv där så många behov som möjligt tillgodoses, oavsett om behoven avser medicinsk vård eller omvårdnadshandling. / Background: The Swedish definition of pre-hospital acute care is immediate medical measures that are taken outside the hospital and is further referred to as prehospital ambulance care as care and care that is carried out in or in connection with an ambulance. Since the 1980s, pre-hospital acute care in Sweden has developed in terms of research, competence, and equipment. Developments in pre-hospital emergency healthcare have meant that higher demands are placed on the staff who work in ambulance healthcare, the requirement is to maintain good and safe care for the patient. Ambulances in Sweden are currently staffed with at least one registered nurse. Literature and care theorists have previously highlighted that the caring encounter should be characterized by a person-centred approach, where the patient is regarded as a unique individual with multifaceted needs to be met, regardless of whether these needs are medical or care-related. Nurses who work in pre-hospital acute care have worked based on a medical focus, which has resulted in patients' needs not always being met. When the patient's emotional and existential needs are not considered as important as the medical ones, the overall perspective is excluded, and the patient's multifaceted needs are not met. Research also indicates that there is a lack of research from the patient perspective. The patients' perspective is not well described and therefore needs to be elucidated. Purpose: To explore the patient's experiences of the caring encounter in the prehospital emergency care. Method: The study is a literature review with a systematic method and integrated data analysis in which a total of 19 articles were included. Eighteen articles were of qualitative design and one article was mixed method. Results: The patients' positive and negative experiences were presented under two main categories that were developed: Being a patient in pre-hospital emergency care, The patient's experience of the treatment of the ambulance staff. The patient's experience of the caring encounter in pre-hospital acute care is largely based on the staff's approach. Communication, participation, confirmation, competence, and attitude are cornerstones that were presented in the results and that corresponded to previous literature that highlights the benefits that person-centered care leads to. Conclusion: International research has shown that there is a lack of research from the patient's perspective and that nurses working in ambulances require feedback. Most of the articles in the literature review originate in Sweden, therefore it was concluded that Sweden is at the forefront of prehospital acute care research from a patient perspective. The importance of highlighting the patient's perspective at the care meeting is to increase the understanding of the staff and thereby raise the quality of the patient's care, which should be based on a person-centred perspective. The nurse can see this literature review as general feedback and should strive for an interaction with the patient in their care of the patient. To care for each individual patient from a holistic perspective whereas many needs as possible are met, regardless of whether the needs relate to healthcare or nursing.

<p><strong>Introduktion: </strong>Akut hjärtinfarkt är en vanlig dödsorsak. Viktigaste behandlingsinsatsen vid hjärtinfarkt är att snabbt öppna det ockluderade kranskärlet genom primär Perkutan Coronar Intervention (PCI). Viktigt är även att behandlingen förhindrar att kärlet åter ockluderar. Detta görs genom att behandla med det blodproppshämmande och kärlpåverkande läkemedlet Clopidogrel. Enligt en ny behandlingsrutin ges Clopidogrel redan i ambulansen vid konstaterande av hjärtinfarkt för att uppnå effekt så fort som möjligt. <strong>Syfte:</strong><em> </em>Syftet var att undersöka om prehospital behandling med Clopidogrel leder till god vård i form av snabbare PCI-behandling, kortare vårdtid, färre medicinska komplikationer, färre komplikationer relaterade till omvårdnad för patienter med ST-höjningsinfarkt samt undersöka vilka omvårdnadsåtgärder som dokumenterats vid förekomst av komplikationer. <strong>Metod: </strong>En retrospektiv fall/kontroll studie utfördes där patientjournaler och databasutskrifter från angiolaboratoriets interna register undersöktes. Studien inkluderade patienter som fått PCI-behandling mellan 1 juni 2006 och 1 februari 2008 och som inkommit med ambulans direkt till angiolaboratoriet.<strong> </strong>I fallgruppen (n = 37) ingick de som fått Clopidogrel i ambulans och i kontrollgruppen (n = 83) de som fått Clopidogrel i direkt anslutning till PCI-behandlingen.  <strong>Resultat: </strong>En skillnad uppmättes mellan grupperna för tiden mellan ankomst till angiolaboratoriet och påbörjad PCI-behandling.<strong> </strong>En förlängning av tiden uppmättes i fallgruppen (p = 0,05). Det är oklart i vilken mån prehospital behandling med Clopidogrel förbättrar utfallet vad gäller vårdtid, medicinska komplikationer samt komplikationer relaterade till omvårdnad för patienter med ST-höjningsinfarkt. Omvårdnadsåtgärder var bristfälligt dokumenterade. Studiens omfattning är begränsad vilket gör att resultaten bör beaktas med försiktighet. <strong>Konklusion:</strong> Fler studier behövs för att undersöka värdet av prehospital behandling med Clopidogrel.</p> / <p><strong>Introduction:</strong> Acute myocardial infarction is a very common cause of death. The most important treatment for myocardial infarction is to rapidly open the occluded coronary artery by Perkutan Coronar Intervention (PCI). It is also important that treatment prevents re-occlusion of the coronary artery. This is done by treatment with Clopidogrel which is a blood thrombosis inhibiting and vessel affective medicine. According to a new guideline Clopidogrel should be given already in the ambulance when myocardial infarction is established in order to achieve effect as quickly as possible.<strong>Purpose:</strong><em> </em>The purpose of the study was to examine if pre-hospital treatment with Clopidogrel leads to good care in the form of quicker PCI-treatment, reduced length of stay, fewer medical complications, fewer complications related to nursing for patients with STEMI and to examine what kind of nursing care was documented when complications occurred. <strong>Method: </strong>A retrospective case/control study was carried out where patient journals and database prints from the angiolaboratory internal registry were examined. The study included patients who received PCI-treatment between 1 June 2006 and 1 February 2008 and who arrived with ambulance directly to the angiolaboratory. The case group (n = 37) included patients that received Clopidogrel during ambulance transport and the control group (n = 83) included patients who received Clopidogrel in direct proximity to the PCI-treatment.<strong>Results: </strong>A difference was found between the groups for the time between arrival at the angio-laboratory and the start of PCI-treatment. The time was extended in the case group (p = 0,05). It is uncertain if pre-hospital treatment with Clopidogrel improves the length of hospital stay, numbers of medical complications and complications related to nursing for STEMI-patients. Nursing treatment was poorly documented. The range of the study is limited, therefore the results should be considered carefully. </p><p><strong>Conclusion:</strong> Further studies needs to be carried out to examine the value of pre-hospital treatment with Clopidogrel.</p>

<p> The aim of this study was to explore Swedish ambulance nurses experiences in caring for sick or wounded children.</p><p><p>Method: A qualitative interview study with a descriptive/ explorative design. The sample consists of 10 ambulance nurses, both men and women, with varying years within ambulance service. Trough unstructured questions the data was collected. The data was analyzed with qualitative content analysis.</p><p>Results: Compared to previous published studies the results of this study shows a broader perspective on ambulance nurses experiences in caring for sick or wounded children. The experiences were focused on following five categories:</p><p>o <em>The character of the alarm </em></p><p><p>o <em>The organization of the work </em></p><p><p>o <em>The specific in the meeting and treating of a child in an ambulance </em></p><p><p>o <em>Children who dies or suffer from a trauma </em></p><p><p>o <em>To work in an ambulance and at the same time being a parent </em></p><p><p>Conclusion: It is always special to take care of a sick or wounded child. All the informer’s expressed that it is very special to take care of children because there are many aspects to take into consideration. The care of a child is special in both positive and negative senses.</p></p></p></p></p></p></p> / <p>Syftet med studien var att undersöka ambulanssjuksköterskors upplevelser och erfarenheter av att vårda sjuka och skadade barn.</p><p>Metod: En kvalitativ intervjustudie med en beskrivande och utforskande design. Urvalet bestod av 10 sjuksköterskor, både män och kvinnor, med varierande antal tjänsteår inom ambulanssjukvården. Genom en ostrukturerad intervjumetod insamlades data som analyserats med hjälp av kvalitativ innehållsanalys.</p><p>Resultat: Jämfört med tidigare publicerad forskning visar resultatet i denna studie ett bredare perspektiv kring ambulanssjuksköterskors upplevelser vid vården av sjuka och skadade barn. Ambulanssjuksköterskornas upplevelser fokuserades kring följande fem kategorier:</p><p>o <em>Larmets karaktär </em><p>o <em>Att organisera arbetet </em><p>o <em>Det speciella med att bemöta och vårda barn i ambulans </em><p>o <em>Barn som dör eller drabbas av trauma </em><p>o <em>Att arbeta i ambulans och samtidigt vara förälder </em><p>Slutsats: Att som ambulanspersonal åka på larm till ett sjukt eller skadat barn upplevs alltid vara speciellt, i både positiv och negativ bemärkelse. Det är många aspekter att ta hänsyn i vården och bemötandet av barn.</p></p></p></p></p></p>

<p>The purpose of this study was to explore nurses' experiences of obstructed airways in the prehospital work.</p><p>A qualitative interview study with a descriptive and explorative design was used. The sample consisted of nine registered nurses whereof three were women and six were men, with or without further education and varying length of experience in the ambulance service.</p><p>Prehospital personnel builds up a vast plan of action based on the emergency information provided by SOS. Simple methods for managing obstructed airways were stated often enough. Problems with obstructed airways are considered so unusual that it never becomes a routine. Several factors affect the identification and managing of obstructed airways, both external factors and the different patient categories are considered important. The study found that the bystanders rarely perceived to be performing actions for the creation of a free airway. While obstructed airways perceived to be stressful for ambulance nurses, however, they are not worried to face such a situation. For the coping of what has happened during an emergency, ambulance crew talk through the whole situation of what could have been done better or if something could be done differently. Many factors affect the identification and managing of obstructed airways in prehospital nurses' work. While obstructed airways perceived to be stressful for ambulance nurses they are not concerned to face such a situation. The tools and techniques available for managing airways are usually considered to be adequate and well-functioning</p>

<p>The aim of thie literature review was to study the advantages and disadventages of the intranasal medication, treating children with acute pain in  prehsopital settings and in emergency care. Searches were performed in databases PubMed and Cinahl. The intranasal method of administrating drugs could be a acceptable compliment to todays's traditional metods. Unnecessary pain is avoided as there is no need for skin penetration. Further studies are necessary in order to integrate this metod both in prehospital settings and in emeregncy care.</p>

Introduktion: Akut hjärtinfarkt är en vanlig dödsorsak. Viktigaste behandlingsinsatsen vid hjärtinfarkt är att snabbt öppna det ockluderade kranskärlet genom primär Perkutan Coronar Intervention (PCI). Viktigt är även att behandlingen förhindrar att kärlet åter ockluderar. Detta görs genom att behandla med det blodproppshämmande och kärlpåverkande läkemedlet Clopidogrel. Enligt en ny behandlingsrutin ges Clopidogrel redan i ambulansen vid konstaterande av hjärtinfarkt för att uppnå effekt så fort som möjligt. Syfte: Syftet var att undersöka om prehospital behandling med Clopidogrel leder till god vård i form av snabbare PCI-behandling, kortare vårdtid, färre medicinska komplikationer, färre komplikationer relaterade till omvårdnad för patienter med ST-höjningsinfarkt samt undersöka vilka omvårdnadsåtgärder som dokumenterats vid förekomst av komplikationer. Metod: En retrospektiv fall/kontroll studie utfördes där patientjournaler och databasutskrifter från angiolaboratoriets interna register undersöktes. Studien inkluderade patienter som fått PCI-behandling mellan 1 juni 2006 och 1 februari 2008 och som inkommit med ambulans direkt till angiolaboratoriet. I fallgruppen (n = 37) ingick de som fått Clopidogrel i ambulans och i kontrollgruppen (n = 83) de som fått Clopidogrel i direkt anslutning till PCI-behandlingen.  Resultat: En skillnad uppmättes mellan grupperna för tiden mellan ankomst till angiolaboratoriet och påbörjad PCI-behandling. En förlängning av tiden uppmättes i fallgruppen (p = 0,05). Det är oklart i vilken mån prehospital behandling med Clopidogrel förbättrar utfallet vad gäller vårdtid, medicinska komplikationer samt komplikationer relaterade till omvårdnad för patienter med ST-höjningsinfarkt. Omvårdnadsåtgärder var bristfälligt dokumenterade. Studiens omfattning är begränsad vilket gör att resultaten bör beaktas med försiktighet. Konklusion: Fler studier behövs för att undersöka värdet av prehospital behandling med Clopidogrel. / Introduction: Acute myocardial infarction is a very common cause of death. The most important treatment for myocardial infarction is to rapidly open the occluded coronary artery by Perkutan Coronar Intervention (PCI). It is also important that treatment prevents re-occlusion of the coronary artery. This is done by treatment with Clopidogrel which is a blood thrombosis inhibiting and vessel affective medicine. According to a new guideline Clopidogrel should be given already in the ambulance when myocardial infarction is established in order to achieve effect as quickly as possible.Purpose: The purpose of the study was to examine if pre-hospital treatment with Clopidogrel leads to good care in the form of quicker PCI-treatment, reduced length of stay, fewer medical complications, fewer complications related to nursing for patients with STEMI and to examine what kind of nursing care was documented when complications occurred. Method: A retrospective case/control study was carried out where patient journals and database prints from the angiolaboratory internal registry were examined. The study included patients who received PCI-treatment between 1 June 2006 and 1 February 2008 and who arrived with ambulance directly to the angiolaboratory. The case group (n = 37) included patients that received Clopidogrel during ambulance transport and the control group (n = 83) included patients who received Clopidogrel in direct proximity to the PCI-treatment.Results: A difference was found between the groups for the time between arrival at the angio-laboratory and the start of PCI-treatment. The time was extended in the case group (p = 0,05). It is uncertain if pre-hospital treatment with Clopidogrel improves the length of hospital stay, numbers of medical complications and complications related to nursing for STEMI-patients. Nursing treatment was poorly documented. The range of the study is limited, therefore the results should be considered carefully.  Conclusion: Further studies needs to be carried out to examine the value of pre-hospital treatment with Clopidogrel.

The aim of this study was to explore Swedish ambulance nurses experiences in caring for sick or wounded children. Method: A qualitative interview study with a descriptive/ explorative design. The sample consists of 10 ambulance nurses, both men and women, with varying years within ambulance service. Trough unstructured questions the data was collected. The data was analyzed with qualitative content analysis. Results: Compared to previous published studies the results of this study shows a broader perspective on ambulance nurses experiences in caring for sick or wounded children. The experiences were focused on following five categories: o The character of the alarm o The organization of the work o The specific in the meeting and treating of a child in an ambulance o Children who dies or suffer from a trauma o To work in an ambulance and at the same time being a parent Conclusion: It is always special to take care of a sick or wounded child. All the informer’s expressed that it is very special to take care of children because there are many aspects to take into consideration. The care of a child is special in both positive and negative senses. / Syftet med studien var att undersöka ambulanssjuksköterskors upplevelser och erfarenheter av att vårda sjuka och skadade barn. Metod: En kvalitativ intervjustudie med en beskrivande och utforskande design. Urvalet bestod av 10 sjuksköterskor, både män och kvinnor, med varierande antal tjänsteår inom ambulanssjukvården. Genom en ostrukturerad intervjumetod insamlades data som analyserats med hjälp av kvalitativ innehållsanalys. Resultat: Jämfört med tidigare publicerad forskning visar resultatet i denna studie ett bredare perspektiv kring ambulanssjuksköterskors upplevelser vid vården av sjuka och skadade barn. Ambulanssjuksköterskornas upplevelser fokuserades kring följande fem kategorier: o Larmets karaktär o Att organisera arbetet o Det speciella med att bemöta och vårda barn i ambulans o Barn som dör eller drabbas av trauma o Att arbeta i ambulans och samtidigt vara förälder Slutsats: Att som ambulanspersonal åka på larm till ett sjukt eller skadat barn upplevs alltid vara speciellt, i både positiv och negativ bemärkelse. Det är många aspekter att ta hänsyn i vården och bemötandet av barn.

SAMMANFATTNING Buksmärtor är en av de vanligaste orsakerna till att människor söker sjukvård. Historiskt sett har smärtlindring till patienter med buksmärta varit restriktiv. Otillräcklig smärtlindring kan bero på rädsla för att smärtlindrande läkemedel ska dölja viktiga kliniska tecken som kan leda till diagnostiska svårigheter. Syfte: Att undersöka i vilken omfattning ambulanssjuksköterskan smärtlindrar patienter med buksmärta, i vilken utsträckning patienter smärtskattas samt om det föreligger någon skillnad mellan män och kvinnor när det gäller administrering av smärtlindrande läkemedel och omfattning av smärtskattning prehospitalt. Metod: En retrospektiv jämförande deskriptiv journalgranskning med kvantitativ ansats. Ett konsekutivt urval gjordes och sammanlagt granskades 200 journaler, varav 100 omfattade kvinnor och 100 omfattade män. Resultat: 21 % (n=42) av patienterna smärtlindrades. Det fanns ingen statistisk signifikans som visade att kvinnor och män smärtlindrades i olika omfattning. Det var 34,5 % (n=69) av patienterna som smärtskattades, och ingen skillnad mellan könen påvisades. Denna studie är av betydelse för specialistsjuksköterskor och andra personalkategorier som omhändertar patienter med buksmärta. Studien bidrar med kunskap som kan leda till att det prehospitala omhändertagandet av patienter med buksmärta utvecklas och förbättras. / ABSTRACT Abdominal pain is one of the most common reasons for seeking medical care. Historically, pain relief in patients with abdominal pain has been restrictive. Causes of inadequate pain relief could be fear that analgesics will mask important clinical signs that can lead to diagnostic difficulties. Aim: To investigate to what extent patients with abdominal pain receive analgesics, the extent to which patients’ pain is rated and if there is any difference between men and women in the administration of analgesics and the extent of prehospital pain measurement. Method: A retrospective comparative descriptive medical record review with quantitative data. A consecutive selection was made and a total of 200 medical records were reviewed, 100 involved women and 100 involved men. Result: 21 % (n=42) of the patients were given analgesics. Men and women were treated equally in terms of pain relief. There were 34,5 % (n=69) of the patients who were asked to estimate their pain, and no difference between sexes was detected. This study is relevant to healthcare professionals who treat patients with abdominal pain. The result of this study can be used in the development and the improvement of the prehospital care of patients with abdominal pain.

The purpose of this study was to explore nurses' experiences of obstructed airways in the prehospital work. A qualitative interview study with a descriptive and explorative design was used. The sample consisted of nine registered nurses whereof three were women and six were men, with or without further education and varying length of experience in the ambulance service. Prehospital personnel builds up a vast plan of action based on the emergency information provided by SOS. Simple methods for managing obstructed airways were stated often enough. Problems with obstructed airways are considered so unusual that it never becomes a routine. Several factors affect the identification and managing of obstructed airways, both external factors and the different patient categories are considered important. The study found that the bystanders rarely perceived to be performing actions for the creation of a free airway. While obstructed airways perceived to be stressful for ambulance nurses, however, they are not worried to face such a situation. For the coping of what has happened during an emergency, ambulance crew talk through the whole situation of what could have been done better or if something could be done differently. Many factors affect the identification and managing of obstructed airways in prehospital nurses' work. While obstructed airways perceived to be stressful for ambulance nurses they are not concerned to face such a situation. The tools and techniques available for managing airways are usually considered to be adequate and well-functioning