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Introduction: Preoperative templating in hip arthroplasty surgery is crucial for accurate implant selection and reducing postoperative complications. This study examines whether there is a correlation between femoral head size and shoe size, with the aim of simplifying the preoperative planning process., Methods: A total of 14 patients had their shoe size and femoral head size measured. Data were analyzed using linear regression and Pearson's correlation analysis to quantify the relationship between the two variables., Results: The Pearson correlation coefficient revealed a value of 0.80 (p = 0.0007), and the linear regression model showed that 63% of the variation in shoe size was based on femoral head size., Conclusion: The study demonstrates a strong and significant correlation between shoe size and femoral head size. This correlation could potentially be used to develop a simple calculation method, where femoral head size = (shoe size - 23.9) / 0.36, which may streamline preoperative planning in orthopedic surgery and reduce workload., Funding: None., Trial Registration: None., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Introduction: Christmas parties, a longstanding Danish tradition, became festive occasions in the 1960s. This study examines if healthcare professionals, especially doctors and nurses, have larger bladder capacities than the general population, as they often delay restroom breaks., Methods: At the North Zealand University Hospital Department of Anesthesiology's 2023 Christmas party, participants delayed urination until a strong urge occurred. Bladder volumes were measured using a Biocon-700 ultrasound bladder scanner. The primary endpoint was maximum bladder capacity, which was analysed as a continuous variable and compared with population data from the literature. Data included gender, profession, and scanning time. Statistical analyses were done using t-tests and multiple linear regression analysis., Results: Of the 60 bladder scans, the average bladder capacity was 644 ml (SD: ± 248 ml). No significant difference was found between healthcare professionals and the general population (p = 0.55). However, excluding measurements within functional capacity (less-than 400 ml), healthcare professionals showed significantly larger maximal bladder capacities. Men and doctors had larger capacities than women and nurses., Conclusion: Although the primary analysis showed no significant difference, the secondary analysis suggests that healthcare professionals may have larger bladder capacities. Potential limitations include measurement uncertainties and a lack of data on comorbidities. Further research is needed to confirm these findings., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Patients with ST-elevation myocardial infarction (STEMI) are treated with primary percutaneous coronary intervention (pPCI) or fibrinolysis. pPCI is superior to fibrinolysis when initiated timely. However, geography and weather sometimes become obstacles for transporting the patient to a PCI centre. In this case story teamwork between hospital instances and the military enabled transport to a PCI centre for a PCI intervention even though the weather conditions were unfavourable.

Introduction: The World Health Organization defines violence as a public health problem, affecting mainly boys and young men. Interpersonal violence with sharp objects and arms is rare in Denmark, but has been the focus of attention from the media and general population. This study describes the incidence and characteristics of penetrating trauma treated by the Medical Emergency Care Unit in Copenhagen (MECU) from 2000 to 2007., Material and Methods: The study is a historical cohort study with 30-day follow-up. Patients treated by the MECU for penetrating trauma were included. The physician manning the MECU prospectively registered clinical data and pre-hospital treatment for later analyses. Mortality after 30 days was assessed via the Danish Civil Registry System., Results: A total of 764 patients were eligible for inclusion. We were unable to identify three patients due to missing civil registration numbers. Among the remaining 761 patients, 86% were male with a median age of 32 years. A total of 12 foreigners could only be followed to hospital discharge. The annual incidence of penetrating trauma remained unchanged around 93 cases throughout the study period (p = 0.39). The percentages of trauma caused by violence, as well as 30-day mortality, were constant., Conclusion: The incidence of and mortality from penetrating trauma has not been rising in Copenhagen during the last eight years.

Introduction: Prompt and correct triage to a facility capable of providing optimal care is important for survival and functional outcome after major trauma. This study compared the influence of on-scene deployment of physicians with medical telephone counselling of paramedics on the triage of trauma patients., Material and Methods: A retrospective study of trauma patients triaged to tertiary treatment outside Frederiksborg County from March 2006 to February 2007. Patients were either triaged directly from the scene of the accident or secondarily transferred from a local hospital. The study period was divided into two intervals. Triage in the first interval was based on telephone counselling of paramedics by consultant anaesthesiologists. Triage in the second interval was performed by the same anaesthesiologists deployed in the field. Triage decisions, Injury Severity Score (ISS) and 30-day mortality were registered., Results: Among 607 patients, 82 were triaged to tertiary treatment. The proportion of patients triaged directly from the scene of the accident increased from 27.8% to 69.6% after prehospital deployment of physicians, whereas secondary transfers decreased from 72.2% to 30.4% (p = 0.0002). Patients triaged directly from the scene had a significantly lower ISS than secondarily transferred patients (5 (1-17) versus 17 (14-26), p < 0.0001)., Conclusion: Prehospital, physician-based triage of trauma significantly reduced the need for secondary transfers to tertiary facilities.

Introduction: There are substantial differences in long-term survival of patients resuscitated from out-of-hospital cardiac arrest, and the level of care during hospitalization may be a contributing factor. The purpose of this study was to determine if a difference in long-term prognosis between hospitals could be detected in patients surviving cardiac arrest in Copenhagen., Material and Methods: The mobile emergency care unit attempted resuscitation in 1,098 patients with out-of-hospital cardiac arrest in the period 2002 to 2006, among whom return of spontaneous circulation occurred in 336 (30%) of the patients admitted to hospital. Survival was determined using the Central Population Registry through Statistics Denmark., Results: Patients admitted to a tertiary facility were younger, more frequently male, they had more commonly ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) as their initial rhythm, and they had more frequently received bystander cardiopulmonary resuscitation. Survival at 4.6 years was 41% in patients admitted to the tertiary hospital and 10% in patients admitted to other hospitals, p < 0.0001. After adjustment for other known risk factors, patients admitted to other hospitals had a hazard ratio of 1.8 for death (95% confidence interval: 1,4-2,5) compared with patients admitted to a tertiary facility., Conclusion: The survival rate after out-of-hospital cardiac arrest was significantly higher in patients admitted to a tertiary facility than among patients admitted to less specialized hospitals. Further studies are needed to identify causal factors.

Introduction: The Mobile Emergency Care Unit (MECU) in Copenhagen provides prehospital healthcare for the citizens in the Capital Region in case of acute illness or accidents. The aim of this study was to describe the patients whose treatment was categorized by the MECU as lifesaving and to compare these with all other patients., Material and Methods: We analysed the MECU database contents and ambulance records from 2005 with emphasis on treatment and diagnosis. Data related to admission to hospital and 30-day survival were retrieved via the Central Population Registry., Results: A total of 296 treatments were classified as lifesaving in 2005, corresponding to 4.3% of all patient contacts in 2005. The most frequent diagnoses were "opioid-poisoning" and cardiac arrest. The treatment given in those cases was lifesaving in 34% and 16%, respectively. This is significantly higher than in the cases of convulsions/unconsciousness and trauma where only 0.6% and 6% of the treatments were lifesaving, respectively. After 30 days, 60.4% of the patients who received lifesaving treatment were alive. We found considerable differences among the individual diagnoses regarding both the 30-day survival and the hospitalization frequency., Conclusion: Approximately 4% of patient contacts in 2005 were classified as lifesaving, they were most frequently related to opioid-poisoning and cardiac arrest. A total of 60% of the patients were alive 30 days after the intervention.

Thoracic aortic dissection is a life-threatening emergency that must be met and surmounted immediately to increase survival. In this case, telemedicine involving ECG and GSM-based communication between the patient in the ambulance and the centre doctor was used to obtain remote pre-hospital suspicion of aorta dissection. Thus, the ambulance was re-routed directly to a specialized unit where the diagnosis was confirmed and immediate and successful surgical treatment was performed. Telemedicine allowing direct communication between the patient and the doctor is recommended.

Mortality in untreated pulmonary embolism is high and short-term outcome depends on a timely diagnosis. In this case telemedicine involving 12-lead ECG and GSM-based communication between the patient in the ambulance and the telemedical staff resulted in remote pre-hospital suspicion of acute pulmonary embolism. The ambulance was referred directly to the nearest department of cardiology where acute CT and echocardiography confirmed the diagnosis. Acute trombolysis was successful. Telemedicine may be beneficial in other medical emergencies than acute myocardial infarction.

Introduction: Time to reperfusion is critical to the outcome of patients with ST-elevation myocardial infarction (MI). Other studies have indicated that wireless transmission of prehospital ECGs can reduce the time to reperfusion. This study evaluated the effect on time to treatment using prehospitalisation ECG transmission to a cardiologist's handheld device in patients with acute chest pain, as well as the potential effect of direct transfer of patients to the closest appropriate cardiological facility., Materials and Methods: During a one-year study period, prehospitalisation ECGs were transmitted for all patients with symptoms indicative of acute coronary syndrome. The ECGs were received on a handheld device by an attending cardiologist, and the patient was referred to PCI treatment if ST-elevation was found., Results: 152 transmissions were registered; 27 of these patients underwent primary PCI treatment. 135 (89%) of the attempted transmissions were successful. Compared to historic controls, there was an increased on-scene time usage of 7 minutes, including transfer. The median time spent from arrival at the hospital to the start of invasive treatment was low, 22 minutes. Compared to historic controls, we found a total reduction in time spent of 72 minutes (p< 0.01)., Discussion: The results indicate that it is possible to minimize the time delay to primary PCI treatment by direct transfer through consultation and use of wireless transmission of prehospitalisation-acquired ECGs to a handheld device carried by an attending cardiologist.

Introduction: Early admission after stroke and TIA is important in modern stroke treatment. We studied the time delay to admission and explored predictive factors of early/late admission., Material and Methods: The study was prospective and community-based comprising all patients with stroke or TIA admitted to a Copenhagen hospital from 1 September 1999 to 30 April 2000. The catchment area is well defined with 283,000 inhabitants. All had a neurological examination and a structured interview within three days with registration of age, gender, premorbid Rankin, Scandinavian stroke scale score, time of onset, knowledge of the cause of symptoms, cohabitation, alone at onset, whether admitted by a general practitioner (GP) or by ambulance after calling emergency, and relevant stroke risk factors. Univariate and multivariate statistics were used., Results: Altogether 494 patients with stroke and 63 with TIA were entered; 49% were admitted by a GP, 38% by ambulance after calling emergency, 13% via other routes. Time from onset to hospital admission could be assessed reliably in 374 patients (67%) and was a median of 2.6 hours; 37% arrived within 0-3 hours, 55% within 0-6 hours. Patients calling an ambulance over emergency arrived at a median of 1.0 hour after the stroke; those calling the GP a median of 6.0 hours after the stroke. In a multivariate analysis only admission by ambulance after calling emergency (OR 5.7), TIA (OR 5.6), or the patient's knowledge of the cause of the symptoms (OR 2.2) were predictors of early admission., Discussion: Patients with stroke or TIA in a Danish metropolitan area arrive at hospital a median of 2.6 hours after the stroke. Admission by ambulance after calling emergency was associated with the shortest onset to admission time.

Introduction: Neonatal transport is difficult and often associated with problems. In 1998, the Neonatal Intensive Care Unit, University Hospital of Copenhagen, H:S Rigshospitalet, set up a neonatal transport team. The aim of this study was to assess whether a better quality of high risk transport could justify the increased consumption of time., Method: The schedules for observation and assessment filled in by the transport team were collected and compared with records of the transport of high-risk neonates by local transport. The comparison consisted in the number of infants, severity of the problems, interventions carried out either locally or after arrival at the Neonatal Intensive Care Unit, and the condition of the infants judged on the pH, blood sugar level, blood pressure, and body temperature., Results: The neonatal transport team fetched 68 high-risk infants, whereas 140 high-risk infants were brought by local transport. Infants fetched by the transport team were more sick, both before and during transport, than those brought to us. On arrival at the Neonatal Intensive Care Unit, more infants brought by local transport had problems (31% vs 16%): 12 (9%) transports had more than one critical problem, in contrast to none of the infants fetched by the transport team. The transport team carried out 71 interventions on 44 of the 68 infants (65%). These interventions explain the better condition of the infants on arrival. Acute interventions soon after arrival at the Neonatal Intensive Care Unit were carried out on 91 of the 140 infants brought by local transport (65%)., Discussion: Neonatal transport of extremely ill infants is difficult. A specialised (transport) team with local stabilisation and transport reduces the frequency of complications. The number of high-risk neonates transported is so small that it is improbable that adequate expertise can be built up and maintained locally.

A local rendez-vous arrangement is described retrospectively in which the medical officer on duty at the infirmary, Oksbøl military camp participated in the ambulance service and the prehospital treatment of acutely ill patients. The military ambulance supports the civilian ambulance service in the municipality of Blåvandshuk, Western Jutland. This arrangement was carried out in 430 cases and 399 patients were brought to hospital. More than 14% of the services did not result in transportation. Forty-seven percent of the services were due to accidents and 30% to illness. In 16% of all cases the response-time was less than five minutes. All the patients were classified according to the Oksbøl-score. Injuries were diagnosed in 48% and cardiovascular disease in 19%. Sixty-seven percent were treated immediately by the military ambulance. This arrangement has improved the prehospital treatment of acutely ill patients by using pre-existing resources from a military camp. We propose further cooperation between civilian health authorities and the Danish Armed Forces' Health Services when planning the prehospital services.

As part of the community planning of prehospital treatment in Northern Jutland, a mixed rural and urban region with a population of 500,000 people, we estimated the prehospital treatment in connection with 1617 emergency ambulance services. The investigation included data collected by the ambulance staff, the hospital doctors and review of medical records. The frequency of use of the emergency ambulance per 1000 population was 41 annually, and rapid emergency transport using signals constitutes 65% of call-outs. In the rural region the time from ambulance call until the ambulance reached the patients was longer than in the urban region. The ambulance staff as well as the doctor at the hospital considered a minor number of the patients as seriously ill. In 60% of the emergency ambulance transports the ambulance staff performed therapeutic efforts, frequently oxygen treatment (34%). In 305 transports the staff would have liked to carry out other forms of prehospital service, most often electrocardiographic-monitoring and treatment of pain. Only a few patients had need of advanced prehospital services but political consideration should be given to the possibility of advanced prehospital service in both rural and urban regions.

It is a common view, shared by Emergency Department staff and ambulance crews, that a large number of patients unnecessarily use Emergency Service ambulances instead of transporting themselves to the hospital by other, more appropriate means. In this retrospective study, 528 consecutive Emergency Service calls to the Herlev Hospital Casualty/Emergency Department during a six week period were reviewed for relevance. Attention was solely aimed at the relevance of the use of Emergency Service ambulances in each case, but not on patient or health care providers' perception of urgency. All calls resulting in admission to hospital were pre-defined as being relevant. Seventeen point six percent of all calls were deemed irrelevant. Thirty-three percent of all calls not resulting in admission were deemed irrelevant. The results confirm Emergency Department health care providers' and ambulance crews' view that Emergency Service ambulances are used inappropriately by the public.

As an attempt to assess the value of a medically-staffed mobile emergency care unit in Aarhus City, we carried out a seven-day experiment (17 hours per day) with an anaesthesiologist and a nurse on duty in a fully equipped vehicle. Aarhus City is an area of approximately 300 km2, with a population of 330,000. The unit responded to emergency calls in 106 patients (38% of all emergency calls during this week). In 31% of all cases the response-time was less than five minutes. Medical disease was diagnosed in 73 patients. Twenty-three patients were suffering from trauma and in three cases the reason for the emergency call was attempted suicide. Fifty-seven percent were treated immediately by the emergency unit, and in 4% of these the treatment was lifesaving. Twenty percent of the patients had their treatment completed outside the hospital. Eighty percent were brought to hospital, 47% with medical assistance. We conclude that there seems to be a basis for a medically-staffed mobile emergency care unit in Aarhus City.

A prospective registration was carried out of all injuries or near-injuries to hospital staff that took place while the staff were engaged in transporting patients between hospitals. A total of 480 transports were registered over one year. Of these, 146 took place as emergencies, 60 with police escort. Four accidents to staff were registered (0.86% of all transports), where the staff in two cases suffered light bruising. Equipment that is brought along in order to treat and monitor patients should be able to be securely fastened during transport with a view to optimizing safety during transportation for patients and staff.

Many patients suffering from trauma or acute illness are in need of pain treatment in the prehospital phase, a treatment they seldom receive. In Denmark, it has been considered whether ambulance personnel should be allowed to administer pain treatment. Inhalation of 50% nitrous oxide and 50% oxygen has been administered for many years by non-physicians around the world. Therefore considerations concerning implementation of this treatment in Denmark are relevant. The aim of this paper was to evaluate the available knowledge about and experiences in using nitrous oxide outside the hospital for patients suffering from acute pain. The papers so far published are positive, but give no definite background for uncritical recommendation of prehospital pain treatment with nitrous oxide. There are no controlled studies concerning the effect of pain treatment in the prehospital phase. The few available controlled studies conducted inside the hospital have not shown significant pain-relieving effects of nitrous oxide for patients suffering from pain of acute medical of surgical origin when compared to other methods of pain treatment. Controlled studies of the effects of prehospital treatment with nitrous oxide need to be done. Technical problems and problems concerning indications, side effects, complications, pollution and possible addiction remain to be fully elucidated before prehospital treatment with nitrous oxide can be recommended for routine use in the Danish ambulances.

In a Danish suburban community the following attempts were made aimed at increasing survival of out-of-hospital cardiac arrest (CA): the citizens were offered training in diagnosis and treatment of CA and the ambulances serving the community were provided with a semiautomatic defibrillator. The results of these effects were evaluated over a two-year period. One hundred and seventy persons out of a population of 85,824 received training in CPR. The study included 113 cases of CA due to ischaemic heart disease. CA was witnessed in 84 cases (74%). Bystander CPR was attempted in 21 cases out of whom three survived (14%), compared to seven survivors among the remaining 92 patients (8%). If CPR was initiated within five minutes of CA, eight of 57 patients survived (15%), compared to one in 31 cases if resuscitation was attempted later. If ventricular fibrillation was present seven of 51 patients survived (14%); none of the 24 patients who initially had asystole, survived. In 336 situations tape recordings of the ECG at CA were available for analysis. Ventricular fibrillation was present in all of the 129 cases where DC-conversion was advised by the apparatus. There were two additional cases, one of ventricular fibrillation of low frequency and one of ventricular tachycardia where DC-conversion was not advised, but might have been beneficial.

In 1990, The Danish Ministry of Health and the County Council Association undertook a spot test investigation of the activities in connection with 3,182 emergency ambulance services (AU) in the Municipality of Copenhagen (a city), the Odense district (a large provincial town) and the County of Ringkøbing (a mixed rural and urban region). The investigation included data collected by the ambulance staff before hospitalization and the diagnoses on discharge from casualty and hospital departments. The frequency of AU per 1,000 population was found to be 101 annually in Copenhagen, 44 in Odense and 19 in the County of Ringkøbing. More than 10% of the services in all three regions did not result in transport of the patient to hospital treatment. The average age of the patients was 52 years in Copenhagen compared with 44 years in the other two regions. The age-specific frequency of AU for patients aged 0-4 year-old was nine times as great in Copenhagen than in Odense and the County of Ringkøbing and, where patients aged more than 80 years were concerned, the frequency was 4-10 times as great. In all three regions, the activities of ambulance services were most numerous between 6-16 hours and lowest during the period 0-6 hours. Services to patients' homes constituted 44-46% and to traffic regions 32-40%. Services on account of illness constituted 41-45% and, on account of accidents, 27-35%. In cases of rapid emergency transport (using signals), 78% of the ambulances had reached the patient within five minutes in Copenhagen as compared with 44% in Odense and the County of Ringkøbing.(ABSTRACT TRUNCATED AT 250 WORDS)

In this investigation, the results from a spot test investigation comprising 3182 emergency ambulance services (AU) from three geographical regions with different degrees of urbanization are presented: The Danish capital (Municipality of Copenhagen), a large provincial town (Odense) and a rural district with smaller towns (the County of Ringkøbing). The conditions of the patients were assessed by the ambulance staff: 7-12% of the patients transported had visible haemorrhage, 5-8% were unconscious, 4-7% were cyanotic, 2-3% had seizures and 1-2% had pareses. The serious cases tended to be most frequent in the least urbanized regions. Registration of the therapeutic efforts by the ambulance staff prior to and during transport revealed that 15-33% of the patients did not receive any treatment. The commonest forms of treatment consisted of oxygen treatment (13-18%), treatment for shock (8-12%), Nato position (4-16%) and stopping of haemorrhage (7-12%). No differences were observed between the three geographic regions except that fewer patients in the capital received treatment. In cases of emergency ambulance services employing signals, medical support was available in 22% of the cases in Copenhagen, mainly by means of medically staffed ambulances. In the County of Ringkøbing, doctors, usually the doctor-on-call, participated in 27% of these services while medical support was only available in 2% of the cases in Odense. Registration of the diagnoses by the hospitals which received the patients revealed that the commonest group of diagnoses were injuries (36-44%) and cardiovascular disease (14-21%).(ABSTRACT TRUNCATED AT 250 WORDS)