title: Cardiac arrest teams and medical emergency teams in Finland: a nationwide cross-sectional postal survey.
abstract: BACKGROUND
  The implementation, characteristics and utilisation of cardiac arrest teams (CATs) and medical emergency teams (METs) in Finland are unknown. We aimed to evaluate how guidelines on advanced in-hospital resuscitation have been translated to practice.
  
  
  METHODS
  A cross-sectional postal survey including all public hospitals providing anaesthetic services.
  
  
  RESULTS
  Of the 55 hospitals, 51 (93%) participated in the study. All hospitals with intensive care units (university and central hospitals, n = 24) took part. In total, 88% of these hospitals (21/24) and 30% (8/27) of the small hospitals had CATs. Most hospitals with CATs (24/29) recorded team activations. A structured debriefing after a resuscitation attempt was organised in only one hospital. The median incidence of in-hospital cardiac arrest in Finland was 1.48 (Q1 = 0.93, Q3 = 1.93) per 1000 hospital admissions. METs had been implemented in 31% (16/51) of the hospitals. A physician participated in MET activation automatically in half (8/16) of the teams. Operating theatres (13/16), emergency departments (10/16) and paediatric wards (7/16) were the most common sites excluded from the METs' operational areas. The activation thresholds for vital signs varied between hospitals. The lower upper activation threshold for respiratory rate was associated with a higher MET activation rate. The national median MET activation rate was 2.3 (1.5, 4.8) per 1000 hospital admissions and 1.5 (0.96, 4.0) per every cardiac arrest.
  
  
  CONCLUSIONS
  Current guidelines emphasise the preventative actions on in-hospital cardiac arrest. Practices are changing accordingly but are still suboptimal especially in central and district hospitals. Unified guidelines on rapid response systems are required.
authors.affiliation: Department of Intensive Care Medicine and Critical Care Medicine Research Group, Tampere University Hospital, Tampere, Finland; Medical School, University of Tampere, Tampere, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Tirkkonen
authors.forename: J
authors.initials: J
authors.lastname: Nurmi
authors.forename: K T
authors.initials: KT
authors.lastname: Olkkola
authors.forename: J
authors.initials: J
authors.lastname: Tenhunen
authors.forename: S
authors.initials: S
authors.lastname: Hoppu
mesh_terms: D016887:Cardiopulmonary Resuscitation; D003419:Crisis Intervention; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005387:Finland / Q000453:epidemiology; D019983:Guideline Adherence; D017408:Guidelines as Topic; D019538:Health Care Surveys; D006323:Heart Arrest / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D015278:Intensive Care Units, Pediatric; D009873:Operating Rooms; D010348:Patient Care Team; D011795:Surveys and Questionnaires; D055986:Vital Signs; D000078329:Workforce