Background: Out-of-hospital cardiac arrest (OHCA) studies from the Middle East and Asian region are limited. This study describes the epidemiology, emergency health services, and outcomes of OHCA in Qatar. Methods: This was a prospective nationwide population-based observational study on OHCA patients in Qatar according to Utstein style guidelines, from June 2012 to May 2013. Data was collected from various sources; the national emergency medical service, 4 emergency departments, and 8 public hospitals. Results: The annual crude incidence of presumed cardiac OHCA attended by EMS was 23.5 per 100,000. The age sex standardized incidence was 87.8 per 100,000 population. Of the 447 OHCA patients included in the final analysis, most were male (n = 360, 80.5%) with median age of 51 years (IQR = 39-66). Frequently observed nationalities were Qatari (n = 89, 19.9%), Indian (n = 74, 16.6%) and Nepalese (n = 52, 11.6%). Bystander cardiopulmonary resuscitation (CPR) was carried out in 92 (20.6%) OHCA patients. Survival rate was 8.1% (n = 36) and multivariable logistic regression indicated that initial shockable rhythm (OR 13.4, 95% CI 5.4-33.3, p = 0.001) was associated with higher odds of survival while male gender (OR 0.27, 95% CI 0.1-0.8, p = 0.01) and advanced cardiac life support (ACLS) (OR 0.15, 95% CI 0.04-0.5, p = 0.02) were associated with lower odds of survival. Conclusions: Standardized incidence and survival rates were comparable to Western countries. Although expatriates comprise more than 80% of the population, Qataris contributed 20% of the total cardiac arrests observed. There are significant opportunities to improve outcomes, including community-based CPR and defibrillation training. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Hoivapalvelujen laadun vaihtelu ja henkilöstön puutteellinen sairaanhoidollinen osaaminen on lisännyt ensihoito- ja päivystys¬palvelujen kysyntää merkittävästi. Riittävien konsultaatiopalvelujen kautta moni asia olisi ennakoitavissa hoivakodissa

Introduction: Out-of-hospital cardiac arrest (OHCA) survival varies greatly between communities. The Utstein template was developed and promulgated to improve the comparability of OHCA outcome reports, but it has undergone limited empiric validation. We sought to assess how much of the variation in OHCA survival between emergency medical services (EMS) across the globe is explained by differences in the Utstein factors. We also assessed how accurately the Utstein factors predict OHCA survival. Methods: We performed a retrospective analysis of patient-level prospectively collected data from 12 OHCA registries from 12 countries for the period 1 Jan 2006 through 31 Dec 2011. We used generalized linear mixed models to examine the variation in survival between EMS agencies (n = 232). Results: Twelve registries contributed 86,759 cases. Patient arrest characteristics, EMS treatment and patient outcomes varied across registries. Overall survival to hospital discharge was 10% (range, 6% to 22%). Overall survival with Cerebral Performance Category of 1 or 2 (available for 8/12 registries) was 8%(range, 2% to 20%). The area-under-the-curve for the Utstein model was 0.85 (Wald CI: 0.85-0.85). The Utstein factors explained 51% of the EMS agency variation in OHCA survival. Conclusions: The Utstein factors explained 51%. of the variation in survival to hospital discharge among multiple large geographically separate EMS agencies. This suggests that quality improvement and public health efforts should continue to target modifiable Utstein factors to improve OHCA survival. Further study is required to identify the reasons for the variation that is incompletely understood.

• Terrorististen iskujen ja muiden joukkosurmien määrä on lisääntynyt Euroopassa ja Suomessa 2000-luvulla. • Poliisi ja muut turvallisuusviranomaiset ovat panostaneet merkittävästi ratkaisumallien kehittämiseen näitä tilanteita varten. • Terveydenhuollon pitää osallistua joukkosurmatilanteiden moniammatillisen vasteen kehittämiseen ja parantaa lääketieteellistä valmiutta. • Toimintavalmiutta parantavat esimerkiksi potilasluokittelujärjestelmät ja taktisen lääketieteen toimintamallit ensihoidossa ja päivystyksessä.

Massatapahtumat voivat kuormittaa tapahtumapaikkakunnan terveyspalveluja, erityisesti ¬ensihoitoa ja päivystystä. Kuormitusta voidaan vähentää hyvin järjestetyllä ja oikein varustetulla tapahtumaensiavulla.

The Emergency Medical Services (EMS) are emergency services generally been designed to provide urgent treatment of patients with life-threatening conditions outside medical facilities. Even though the EMS belongs to the category of socio-economic rights, it nevertheless has great significance in safeguarding one of the most fundamental human rights, the right to life. In fact, international humanitarian law has recognised this important connection by establishing explicit legal rules that oblige states to ensure urgent medical care for the wounded and sick. International human rights law, on the other hand, has no such expressed provisions. However, the problem is not the lack of legal rules applicable to the EMS as such but rather the challenges in human rights perception, which hinder the EMS being perceived as a valuable human right. Therefore, this article essentially argues that international human rights law does not recognise the EMS as a human right sufficiently and that more thorough actions are required from the UN Committee of Economic, Social and Cultural Rights (CESCR) in this regard.

Akut hjärtstopp är den vanligaste dödsorsaken i västländerna. Av prehospitala patienter med hjärtstopp överlever endast 7-8%. Speciellt initialrytmen pulslös elektsik aktivitet (PEA) har en väldigt dålig prognos. På senare tid har man märkt att incidensen av PEA ökat samtidigt som prognosen blivit något bättre. Trots det är överlevnaden fortfarande låg. Avsikten med denna studie är att kartlägga hurdana patienter som återfår spontan cirkulation (ROSC) efter prehospitalt PEA inom Nyland samt att beskriva faktorer som påverkar överlevnaden. Detta är en retrospektiv observationsstudie där data samlades för hand från läkarhelikoptern Medi-Helis (nuförtiden FinnHEMS 10) Vanda basens pappersjournaler mellan åren 2010 - 2013. Ur journalerna identifierades alla över 18 år gamla patienter som prehospitalt fått hjärtstopp med initialrytmen PEA, uppnått spontan cirkulation och överlevt till sjukhuset. Sammanlagt inkluderades 90 patienter i studien, var av 64 var män och 26 kvinnor. Patienterna hade en medelålder på 67,5 år och ROSC uppnåddes i medeltal på 19 minuter. Etiologin bakom initialrytmen PEA är bred och patienterna i regel mångsjuka. En 90 dygns överlevnad tyder på en god fortsatt prognos. Varken kön eller ålder påverkade signifikant överlevnaden i denna studie. Självständiga patienter med god cerebral prestationsförmåga vid tidpunkten för hjärtstoppet har en större sannolikhet att överleva. Även en kort ROSC tid korrelerar positivt med prognosen. (208 ord)