title: Pre-hospital critical care by anaesthesiologist-staffed pre-hospital services in Scandinavia: a prospective population-based study.
abstract: BACKGROUND
  All Scandinavian countries provide anaesthesiologist-staffed pre-hospital services. Little is known of the incidence of critical illness or injury attended by these services. We aimed to investigate anaesthesiologist-staffed pre-hospital services in Scandinavia with special emphasis on incidence and severity.
  
  
  METHODS
  This population-based, prospective study recorded activity in 16 anaesthesiologist-staffed pre-hospital services in Denmark, Finland, Norway and Sweden serving half of the Scandinavian population. We calculated population incidence of medical conditions, and the proportion of patients with severely deranged vital signs and/or receiving advanced therapy.
  
  
  RESULTS
  Four thousand two hundred thirty-six alarm calls were recorded during 4 weeks. Two thousand two hundred fity-six alarms resulted in a patient encounter. The population incidence varied from 74.9 missions per 10,000 person-years (Denmark), followed by Finland with 14.6, Norway with 11, and Sweden with 5. Medical aetiology was most frequent (14.9 missions per 10,000 person-years, 95% CI: 14.2-15.8). Trauma was second (5.6 missions per 10,000 person-years, 95%CI: 5.12-6.09). Twenty-three per cent of patients had severely deranged vital functions, and advanced emergency medical procedures were performed in every four to twelve encounters (Denmark 8%, Sweden 15%, Norway 23%, and Finland 25%). The probability that the patient was physiologically deranged, received advanced medication, or procedure was 35%. Critical illness or injury occured at a rate of 25-30 per 10,000 person-years.
  
  
  CONCLUSIONS
  The incidence of pre-hospital anaesthesiologist patient encounters in Scandinavia varies. Medical aetiology is most frequent. Almost one-quarter of patients presents with deranged vital functions requiring emergency measures. The Scandinavian pre-hospital population incidence of critical illness and injury is 25-30 per 10,000 person-years.
authors.affiliation: Department for Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Anaesthesia and Emergency Medicine, St. Olav University Hospital, Trondheim, Norway.
authors.forename: A J
authors.initials: AJ
authors.lastname: Krüger
authors.forename: H M
authors.initials: HM
authors.lastname: Lossius
authors.forename: S
authors.initials: S
authors.lastname: Mikkelsen
authors.forename: J
authors.initials: J
authors.lastname: Kurola
authors.forename: M
authors.initials: M
authors.lastname: Castrén
authors.forename: E
authors.initials: E
authors.lastname: Skogvoll
mesh_terms: D000776:Anesthesiology; D016638:Critical Illness / Q000453:epidemiology / Q000628:therapy; D003627:Data Interpretation, Statistical; D003718:Denmark / Q000453:epidemiology; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005387:Finland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D009664:Norway / Q000453:epidemiology; D010101:Oxygen Consumption; D010820:Physicians; D011153:Population; D011446:Prospective Studies; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D055986:Vital Signs; D000078329:Workforce; D014947:Wounds and Injuries / Q000628:therapy