The 2024 revision of the Norwegian standard for the safe practice of anaesthesia.

The Norwegian standard for the safe practice of anaesthesia was first published in 1991, and revised in 1994, 1998, 2005, 2010 and 2016 respectively. The 1998 version was published in English for the first time in Acta Anaesthesiologica Scandinavica in 2002. It must be noted that this is a national standard, reflecting the specific opportunities and challenges in a Norwegian setting, which may be different from other countries in some respects. A feature of the Norwegian healthcare system is the availability, on a national basis, of specifically highly trained and qualified nurse anaesthetists. Another feature is the geography, with parts of the population living in remote areas. These may be served by small, local emergency hospitals. Emergency transport of patients to larger hospitals is not always achievable when weather conditions are rough. These features and challenges were considered important when designing a balanced and consensus-based national standard for the safe practice of anaesthesia, across Norwegian clinical settings. In this article, we present the 2024 revision of the document. This article presents a direct translation of the complete document from the Norwegian original.

Evaluation of a trauma team activation protocol revision: a prospective cohort study.

BACKGROUND: Correct triage based on prehospital information contributes to a better outcome for potentially seriously injured patients. In 2011 we changed the trauma team activation (TTA) criteria in our center in order to improve the high over- and undertriage properties of the protocol. Five criteria that were unable to predict severe injury were removed. In the present study, we evaluated the protocol revision by comparing over- and undertriage in the former and present set of criteria. METHODS: All severely injured patients (Injury Severity Score (ISS) > 15) and all patients admitted with TTA in the period of 01.01.2013 - 31.12.2014 were included in the study. We defined overtriage as the fraction of patients with TTA when ISS ≤15 and undertriage as the fraction of patients without TTA when ISS > 15. We also evaluated triage with the occurrence of emergency procedures immediately after admission. RESULTS: 324 patients were included, 164 patients had ISS>15, 287 were admitted with TTA. Over- and undertriage were 74 % and 28 % respectively. When we used emergency procedure as reference, the figures were 83 % and 15 % respectively. Undertriaged patients had significantly more neurosurgical injuries and were significantly more often transferred from an acute care hospital. DISCUSSION: Over- and undertriage are almost the same as before the criteria were revised, and higher thanrecommended levels. CONCLUSIONS: Revision of the TTA criteria has not improved triage, and further measures are necessary to achieveacceptable levels.

The treatment of spleen injuries: a retrospective study.

BACKGROUND: Hemorrhage after blunt trauma is a major contributor to death after trauma. In the abdomen, an injured spleen is the most frequent cause of major bleeding. Splenectomy is historically the treatment of choice. In 2007, non-operative management (NOM) with splenic artery embolization (SAE) was introduced in our institution. The indication for SAE is hemodynamically stable patients with extravasation of contrast, or grade 3-5 spleen injury according to the Abbreviated Organ Injury Scale 2005, Update 2008. We wanted to examine if the introduction of SAE increased the rate of salvaged spleens in our trauma center. METHOD: All patients discharged with the diagnosis of splenic injury in the period 01.01.2000 - 31.12.2013 from the University Hospital of North Norway Tromsø were included in the study. Patients admitted for rehabilitation purposes or with an iatrogenic injury were excluded. RESULTS: A total of 109 patients were included in the study. In the period 2000-7, 20 of 52 patients were splenectomized. During 2007-13, there were 6 splenectomies and 24 SAE among 57 patients. The reduction in splenectomies is significant (p < 0.001). There is an increase in the rate of treated patients (splenectomy and SAE) from 38 to 53 % in the two time periods, but not significantly (p = 0.65). CONCLUSION: The rate of salvaged spleens has increased after the introduction of SAE in our center. TRIAL REGISTRATION: The study is registered at www.clinicaltrials.gov with the identification number NCT01965548.

[Reliability of air ambulances--a survey in three municipalities in Helgeland?]. / Luftambulansens pålitelighet - en undersøkelse i tre kommuner på Helgeland.

BACKGROUND: The Norwegian health authorities have promised the population equal health service, also in the most remote areas; the air ambulance system is important in reaching this goal. It is likely that changes in hospitals' systems for emergency preparedness will increasingly require air ambulance transport. We wanted to find out how reliable the air ambulance is in a remote area with difficult accessibility. MATERIAL AND METHODS: Data have been retrieved from the air ambulance's database and quality-assured against the database for the acute medical services in a three-month period (1 November 2006 - to 31 October 2007). RESULTS: 105 calls were recorded from the area assessed. Reliability of the services was best in June and July, when all requests were served. The helicopter was only available for 7 of 24 requests from November to February. During the entire year, 79 requests were considered medically necessary and of these the helicopter was only available for 42. INTERPRETATION: Our survey indicates that a considerable part of the population has poor air ambulance regularity during the winter. This must be taken into consideration when planning emergency health service.