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Reduced transport time of patients from the scene of an accident to definitive surgical treatment is one important reason to employ ambulance helicopters on trauma missions. However, if the helicopter is unable to land close to the scene, the transport time may be increased compared to transport with ground ambulance, due to time-consuming transfer of the patient between vehicles.The objective of this study was to evaluate how the landing site, as determined by distance from the scene, and rapid sequence intubation (RSI) affected on-scene time (OST).This was a prospective observational study performed during a 12-month period in a mixed urban and rural anesthesiologist-staffed Helicopter Emergency Medical Service in Norway. Data regarding the landing sites, the accident, and patient treatment were recorded.A total of 252 primary trauma missions were included in the study. In 75% of the missions, the aircraft landed50 meters from the scene, and in 7% the distance exceeded 200 meters. Mean OST when the patient was not intubated was 14.5 min (median 14 min). When an RSI was performed, the mean OST was significantly higher (22.7 min, median 20 min; p0.001).Usually, a helicopter can land close to the accident scene and the location of the landing site does not contribute to a delay in arrival of the patient at the hospital. The OST is significantly higher, however, in those patients who receive endotracheal intubation before take-off. This reflects the time needed for intubation, as well as the increased complexity and workload when the patient is severely injured.

The influence of meteorological parameters on soil radon concentrations in a permeable ice-marginal deposit in Kinsarvik, Norway, was investigated based on continuous measurements of soil radon concentrations, temperature, precipitation, wind speed, wind direction, air pressure and soil moisture content over a period of 10 months. The results show that the soil radon concentrations exhibit distinct seasonal and diurnal variations that predominantly are caused by changes in air temperature. Air flows between areas of different elevation occur in the ice-marginal deposit due to temperature differences between soil air and atmospheric air, and instantaneous changes in air flow direction were recorded when the atmospheric air temperature reached the average annual air temperature. Air pressure was found to be the second most important parameter influencing soil radon concentrations, while no apparent effect of precipitation, wind speed, wind direction or soil moisture was observed. Seasonal variations in indoor and soil radon levels were also investigated in a glaciofluvial deposit located 40 km southwest of Kinsarvik, and the close correlation between the seasonal variation patterns observed in the two areas suggests that the results of the Kinsarvik study also might be applicable to other areas of highly permeable building grounds where differences in terrain elevation exist.

Indoor radon concentrations were measured in different seasons in 104 dwellings located on a highly permeable ice-marginal moraine in Kinsarvik, Western Norway. The measurements revealed the highest indoor radon levels ever detected in Norway and extreme variations in seasonal and short-term indoor radon levels. Annual average indoor radon concentrations up to 56 000 Bq m(-3) and a mean value of 4340 Bq m(-3) for the whole residential area are reported. By using the ICRP conversion factors to effective dose, these indoor radon values correspond to a total annual effective dose of 930 mSv and 72 mSv, respectively. By using the conversion as recommended by UNSCEAR, the effective doses would be about 50% higher. The indoor radon concentrations are found to be strongly influenced by thermally induced flows of radon-bearing soil air directed towards the upper part of the ice-marginal deposit in winter and towards the area of lowest elevation in summer. The pattern of seasonal variations observed suggests that in areas where thermal convection may occur, annual average indoor radon levels should be derived from measurements performed both in summer and in winter.

A quality-controlled hydrogeochemical dataset of 1604 groundwater samples from Norwegian crystalline bedrock aquifers has been obtained and subject to analyses of radon (scintillation counting), major and minor elements (ion chromatography and ICP-AES), pH and alkalinity. Cumulative probability curves may be constructed to assess the risk of given parameters violating drinking water norms. Parameters such as radon and fluoride show clear lithological correlation, occurring at high concentrations in granites and low concentrations in anorthosites. Other parameters exhibit a lower degree of correlation with aquifer geochemistry (e.g. pH, major ions) and are likely to be governed by more universal thermodynamic equilibria (the calcium carbonate system) and kinetic factors. On a national basis 13.9% of the bedrock groundwaters exceed the recommended action level for radon, while 16.1% exceed the drinking water norm for fluoride. Considering pH, sodium, radon and fluoride together, 29.9% of all wells violate drinking water maximum concentrations for one or more of these parameters.

Seventy-two samples of groundwater derived from Norwegian Quaternary (largely glaciofluvial or glacial) aquifers were analysed for a wide range of major and minor hydrochemical parameters. The waters exhibit a relatively uncomplex evolution from Na-Cl dominated, immature waters (which reflect marine salts in precipitation) to Ca-HCO3 dominated waters via calcite dissolution. The median pH of these waters is 7.37, in contrast to similar waters from crystalline bedrock aquifers with a median pH of 8.07. The water samples provide little evidence of significant acidification or sulphatisation of groundwaters by 'acid rain'. In fact, a positive correlation emerges between non-marine sulphate and alkalinity/pH, suggesting dominantly lithological sources for non-marine sulphate. No groundwaters from Quaternary deposits exceed maximum recommended concentrations for Rn, F- and Na, while 10% fall outside the required pH range. This again contrasts with bedrock aquifers where 30% of waters are non-compliant with respect to one or more of these parameters.

In 1992 Anthony Hopwood introduced a hypothesis that electric and magnetic fields close to high voltage power lines might focus electrically charged particles in cosmic radiation so that people living close by would be exposed to higher doses of ionising radiation than if the power line was not present. This hypothesis has been tested using thermoluminescent dosemeters as detectors, which are free from electric noise artifacts that might influence Geiger - M?ller detectors. Detectors were placed on snow covered cultivated land at low altitudes as well as on an ice covered lake in a mountain area to reduce background radiation from the ground. In neither case could a focusing effect be demonstrated.

The study is based on a collaboration between the Cancer Registry of Norway, the Norwegian Radiation Protection Authority, and National Radiological Protection Board (NRPB, UK). The association between indoor radon exposure and lung cancer was studied in 427 municipalities. NRPB detectors were sent to 10,000 householders, and 7,500 of the detectors were returned. Data from a nation-wide survey of smoking habits in 1964-1965 were available. Data on asbestos exposure were also used in a regression analysis. The reporting to the Cancer Registry of all new cases of cancer is fairly complete, as hospital departments and institutes of pathology are obliged to report all cancer cases. The histologically confirmed lung cancer cases were grouped into squamous-cell carcinoma, small-cell carcinoma, adenocarcinoma and other or non-specified histological types. The age-adjusted rate of lung cancer by histological type was the dependent variable in the regression analysis. A consistent increase in incidence of lung cancer was seen with increasing tobacco consumption, but no positive trend could be shown with increasing radon exposure in the descriptive presentation of the data. In the regression analysis, however, the incidence of small-cell anaplastic lung tumors in females increased significantly with increasing radon exposure. When based on the regression coefficients, the fraction of lung cancers attributable to radon is about 2-4%. However, systematic errors cannot be excluded in an ecological study such as presented here. © 1994 Wiley-Liss, Inc.

Background Key words : Radon exposure, lung cancer, cost-effect analysis, attributable risk, models-mathematical: Radon is a radioactive gas that may leak into buildings from the ground. Radon exposure is a risk factor for lung cancer. An intervention against radon exposure in homes may consist of locating homes with high radon exposure (above 200 Bq m-3) and improving these, and of protecting future houses. The purpose of this paper is to calculate the costs and the effects of this intervention. Methods: We performed a cost-effect analysis from the perspective of the society, followed by an uncertainty and sensitivity analysis. The distribution of radon levels in Norwegian homes is lognormal with mean=74.5 Bq/m3, and 7.6% above 200 Bq/m3. Results: The preventable attributable fraction of radon on lung cancer was 3.8% (95% uncertainty interval: 0.6%, 8.3%). In cumulative present values the intervention would cost $238 (145, 310) million and save 892 (133, 1981) lives, each life saved costs $0.27 (0.09, 0.9) million. The cost-effect ratio was sensitive to the radon risk, the radon exposure distribution, and the latency period of lung cancer. Together these three parameters explained 90% of the variation in the cost-effect ratio. Conclusions: Reducing the radon concentration in present and future homes to below 200 Bq/m3 will cost $0.27 (0.09, 0.9) million per life saved. The uncertainty in the estimated cost per life is large, mainly due to uncertainty in the risk of lung cancer from radon. Based on estimates from road construction, the Norwegian society has been willing to pay $1 million to save a life. We therefore conclude that the intervention against radon in homes is justifiable. The willingness to pay is also larger that the upper uncertainty limit of the cost per life. Our conclusion is therefore robust against the uncertainties in the parameters.

We test whether airborne gamma ray spectrometer measurements can be used to estimate levels of radon hazard in the Oslofjord region of Norway. We compile 43,000 line kilometres of gamma ray spectrometer data from 8 airborne surveys covering 10,000 km2 and compare them with 6326 indoor radon measurements. We find a clear spatial correlation between areas with elevated concentrations of uranium daughters in the near surface of the ground and regions with high incidence of elevated radon concentrations in dwellings. This correlation permits cautious use of the airborne data in radon hazard evaluation where direct measurements of indoor radon concentrations are few or absent. In radon hazard evaluation there is a natural synergy between the mapping of radon in indoor air, bedrock and drift geology mapping and airborne gamma ray surveying. We produce radon hazard forecast maps for the Oslofjord region based on a spatial union of hazard indicators from all four of these data sources. Indication of elevated radon hazard in any one of the data sets leads to the classification of a region as having an elevated radon hazard potential. This approach is inclusive in nature and we find that the majority of actual radon hazards lie in the assumed elevated risk regions.

The frequent use of mechanical circulatory assistive devices in the treatment of patients in cardiogenic shock increases the need for advanced air and ground transport services. In this article we describe a critically ill patient with acute myocardial infarction. He was treated with intraaortic balloon pump at the local hospital before transfer to a university hospital by air. Close cooperation between the university hospital, the Norwegian Air Ambulance and the Norwegian aviation authorities has facilitated this service.

Indoor radon levels in 1618 Norwegian dwellings located in different geological settings are compared with geological information. The results show a significant correlation between indoor radon levels and geological factors. Radium content and permeability of the building ground have been found to be useful indicators of indoor radon concentrations. Based on easily accessible geological data, an assessment of the radon potential of an area can be given. Areas of high radon risk in Norway include: (a) exposed bedrock with elevated levels of radium; and (b) highly permeable unconsolidated sediments derived from all rock types and moderately permeable sediments derived from rock types rich in radium. A comparison of indoor radon with house construction characteristics and ventilation habits suggests that radon concentrations in Norwegian dwellings are also influenced by ventilation system, aeration habits and floor level of the room where the measurements were carried out. The significant correlation between indoor radon levels and geological factors observed in the present investigation indicates that it is possible to outline areas of high radon risk in Norway based on geological information.

Radon is a radioactive gas that may leak into buildings from the ground. Radon exposure is a risk factor for lung cancer. An intervention against radon exposure in homes may consist of locating homes with high radon exposure (above 200 Bq m(-3)) and improving these, and protecting future houses. The purpose of this paper is to calculate the costs and the effects of this intervention.We performed a cost-effect analysis from the perspective of the society, followed by an uncertainty and sensitivity analysis. The distribution of radon levels in Norwegian homes is lognormal with mean = 74.5 Bq m(-3), and 7.6% above 200 Bq m(-3).The preventable attributable fraction of radon on lung cancer was 3.8% (95% uncertainty interval: 0.6%, 8.3%). In cumulative present values the intervention would cost $238 (145, 310) million and save 892 (133, 1981) lives; each life saved costs $0.27 (0.09, 0.9) million. The cost-effect ratio was sensitive to the radon risk, the radon exposure distribution, and the latency period of lung cancer. Together these three parameters explained 90% of the variation in the cost-effect ratio.The uncertainty in the estimated cost per life is large, mainly due to uncertainty in the risk of lung cancer from radon. Based on estimates from road construction, the Norwegian society has been willing to pay $1 million to save a life. This is above the upper uncertainty limit of the cost per life. The intervention against radon in homes, therefore, seems justifiable.

The effects of infusing a buffer solution on resuscitability and outcome was tested in patients during out-of-hospital cardiac arrest. A number (502) of adults with asystole or ventricular fibrillation with failure of first defibrillation attempt were entered into a prospective, randomized, double-blind, controlled trial. Of these, 245 patients received 250 ml of sodium bicarbonate-trometamol- phosphate mixture with buffering capacity 500 mmol/l and 257 patients received 250 ml 0.9% saline. Except for the investigational infusion, all patients were resuscitated according to international guidelines. Eighty-seven patients (36%) receiving buffer were admitted to hospital ICU and 24 (10%) were discharged from hospital alive, vs. 92 (36%) and 35 (14%) receiving saline (95% confidence interval (CI) for difference between groups: -6%-6% for rate of admission and -1%-9% for rate of discharge). Using a logistic regression analysis, ventricular fibrillation as initial rhythm (odds ratio 8.06, CI 3.70-17.56) improved the outcome, whereas buffer therapy had no effect (odds ratio 0.77, CI 0.43-1.41). Mean base excess at hospital admission was -9 after Tribonat vs. -11 after saline (P = 0.04, CI for difference 0.2-3.8). Only 16 of the 502 patients had arterial alkalosis on arrival in the hospital and no patient had a positive base excess. Patients resuscitated after out-of-hospital cardiac arrest had metabolic acidosis, but buffer therapy did not improve the outcome.

The Fen Central Complex in southern Norway, a geologically well investigated area of magmatic carbonatite rocks, is assumed to be among the world largest natural reservoirs of thorium ((232)Th). These rocks, also rich in iron (Fe), niobium (Nb), uranium ((238)U) and rare earth elements (REE), were mined in several past centuries. Waste locations, giving rise to enhanced levels of both radionuclides and metals, are now situated in the area. Estimation of radionuclide and metal contamination of the environment and radiological risk assessment were done in this study. The average outdoor gamma dose rate measured in Fen, 2.71 μGy h(-1), was significantly higher than the world average dose rate of 0.059 μGy h(-1). The annual exposure dose from terrestrial gamma radiation, related to outdoor occupancy, was in the range 0.18-9.82 mSv. The total activity concentrations of (232)Th and (238)U in soil ranged from 69 to 6581 and from 49 to 130 Bq kg(-1), respectively. Enhanced concentrations were also identified for metals, arsenic (As), lead (Pb), chromium (Cr) and zinc (Zn), in the vicinity of former mining sites. Both radionuclide and heavy metal concentrations suggested leaching, mobilization and distribution from rocks into the soil. Correlation analysis indicated different origins for (232)Th and (238)U, but same or similar for (232)Th and metals As, Cr, Zn, nickel (Ni) and cadmium (Cd). The results from in situ size fractionation of water demonstrated radionuclides predominately present as colloids and low molecular mass (LMM) species, being potentially mobile and available for uptake in aquatic organisms of Norsjø Lake. Transfer factors, calculated for different plant species, showed the highest radionuclide accumulation in mosses and lichens. Uptake in trees was, as expected, lower. Relationship analysis of (232)Th and (238)U concentrations in moss and soil samples showed a significant positive linear correlation.

In Norway, external doses of radiation resulting from fallout from the Chernobyl nuclear accident were estimated from detailed measurements, including soil deposition patterns. Internal doses were estimated from measurements of radioactive cesium in meat and milk supplies. The doses were calculated as average monthly doses for each of 454 municipalities during 36 consecutive months after the accident in spring 1986. Prospectively collected data on all newborns listed in the Medical Birth Registry of Norway who were conceived in the period May 1983-April 1989 were used to assess possible dose-response relations between estimated external and food-based exposures and congenital malformations and some other conditions. A positive association was observed between total radiation dose (external plus food-based) and hydrocephaly, while a negative association was observed for Down's syndrome. However, an important conclusion of the study was that no associations were found for conditions previously reported to be associated with radiation, i.e., small head circumference, congenital cataracts, anencephaly, spina bifida, and low birth weight. Potential sources of bias, including exposure misclassification and incomplete ascertainment of cases, are discussed.

Background On July 22, 2011, a single perpetrator killed 77 people in a car bomb attack and a shooting spree incident in Norway. This article describes the emergency medical service (EMS) response elicited by the two incidents. Methods A retrospective and observational study was conducted based on data from the EMS systems involved and the public domain. The study was approved by the Data Protection Official and was defined as a quality improvement project. Results We describe the timeline and logistics of the EMS response, focusing on alarm, dispatch, initial response, triage and evacuation. The scenes in the Oslo government district and at Utøya island are described separately. Conclusions Many EMS units were activated and effectively used despite the occurrence of two geographically separate incidents within a short time frame. Important lessons were learned regarding triage and evacuation, patient flow and communication, the use of and need for emergency equipment and the coordination of helicopter EMS.