Danish Emergency Research Articles

VISZAPP - a tool for rapid patient urgency assessment, admission, and care monitoring and evaluation in emergency departments

Background In 2010 the Danish emergency departments will be fewer, but larger which leads to an increase of patients within the units. This induces logistic challenges and demands considerable resources. For instance the phenomenon of “over-crowding” in the emergency room may occur, where a large number of patients blur the clinician’s overview and increases the risk of overlooking patients requiring immediate attention. In cooperation with the regional hospitals in Viborg, Silkeborg and Skive Logica has developed and implemented VISZAPP(Visitation Zap Application). VISZAPP is a tool for assessing the need for care and prioritizing patients even before actually arriving to the emergency departments.

Optimizing treatment of acute patients in a Danish Emergency Department

The aim of this study was to observe and characterize the organization and quality of the treatment from a patient's point of view in a Danish Emergency Department.

Demographic and socioeconomic risk factors of adult violent victimization from an accident and emergency department and forensic medicine perspective: A register-based case-control study

Objectives To describe demographic and socioeconomic risk factors of adult violent victimization leading to contact with an emergency department and/or an institute of forensic medicine based on a case-control study design. Design A register-based case-control study comparing demographic and socioeconomic characteristics of 10,799 adult victims of violence (cases) and 53,986 randomly selected population-based controls matched for age, gender, and date. Data sources Cases were included from a Danish emergency department and a Danish institute of forensic medicine. Demographic and socioeconomic data for cases and controls were extracted from two national longitudinal registers. Statistics Data were analysed using logistic regression in a semi-adjusted model adjusting for age, gender, and year, and a fully adjusted model including several variables. Results Factors positively associated with adult violent victimization were “being a pensioner” (OR: 4.71; 95% CI: 4.18–5.30), “being unemployed” (OR: 3.15; 95% CI: 2.85–3.48), and “not living with a partner” (OR: 2.93; 95% CI: 2.74–3.14), whereas the factors strongly negatively associated with adult violent victimization was “being a student” (OR: 0.72; 95% CI: 0.63–0.83). In the semi-adjusted analysis a foreign citizenship of a country outside Europe was significantly associated with adult violent victimization (OR: 1.79; 95% CI: 1.60–2.00), whereas in the fully adjusted analyses the association decreased to an insignificant level. Conclusions Our findings emphasize the multifaceted nature of injuries from violence. The findings from this study indicated potential risk factors, which should be specifically addressed when planning preventive strategies.

Methodology for Probabilistic Atmospheric Studies using Long-Term Dispersion Modelling

The main focus of this paper is the description of a methodology for probabilistic or long-term evaluation of the atmospheric transport and deposition of harmful (for example radioactive) releases from risk sites based on a dispersion modelling approach. This work was realised as a part of the multidisciplinary 'Arctic Risk' study; the purpose of which was the development ofa methodology for environmental risk and vulnerability assessments and the testing of this methodology through estimation of the nuclear risk to the population in the Northern European countries in case of a severe accident at a nuclear risk site. The following research tools were applied for probabilistic atmospheric studies: (1) dispersion modelling - Danish Emergency Response ModeloftheAtmosphereandDanishMeteorological Institute HIgh Resolution Limited Area Model - for long-term simulation and case studies of radionuclide transport for hypothetical accidental releases at sites; (2) probability fields analysis - to construct annual, monthly and seasonal indicators based on dispersion modelling results to identify the most impacted geographical regions.

The Danish emergency response model of the atmosphere (DERMA)

The three-dimensional atmospheric dispersion model DERMA is of Lagrangian type making use of a hybrid stochastic particle-puff diffusion description. It is currently capable of describing plumes at downwind distances greater than about 20 km and up to the global scale. The model employs aerosol-size dependent dry and wet deposition parameterisations. DERMA is developed and used mainly for nuclear emergency preparedness purposes, and it has recently become integrated with the ARGOS nuclear decision-support system.

Urban meteorological modelling for nuclear emergency preparedness

The main objectives of the current EU project “Integrated Systems for Forecasting Urban Meteorology, Air Pollution and Population Exposure” (FUMAPEX) are the improvement of meteorological forecasts for urban areas, the connection of numerical weather prediction (NWP) models to urban air pollution and population dose models, the building of improved urban air quality information and forecasting systems, and their application in cities in various European climates. In addition to the forecast of the worst air-pollution episodes in large cities, the potential use of improved weather forecasts for nuclear emergency management in urban areas, in case of hazardous releases from nuclear accidents or terror acts, is considered. Such use of NWP data is tested for the Copenhagen metropolitan area and the Øresund region. The Danish Meteorological Institute (DMI) is running an experimental version of the HIRLAM NWP model over Zealand including the Copenhagen metropolitan area with a horizontal resolution of 1.4 km, thus approaching the city-scale. This involves 1-km resolution physiographic data with implications for the urban surface parameters, e.g. surface fluxes, roughness length and albedo. For the city of Copenhagen, the enhanced high-resolution NWP forecasting will be provided to demonstrate the improved dispersion forecasting capabilities of the Danish nuclear emergency preparedness decision–support system, the Accident Reporting and Guidance Operational System (ARGOS), used by the Danish Emergency Management Agency (DEMA). Recently, ARGOS has been extended with a capability of real-time calculation of regional-scale atmospheric dispersion of radioactive material from accidental releases. This is effectuated through on-line interfacing with the Danish Emergency Response Model of the Atmosphere (DERMA), which is run at DMI. For local-scale modelling of atmospheric dispersion, ARGOS utilises the Local-Scale Model Chain (LSMC), which makes use of high-resolution DMI-HIRLAM NWP model data provided to DEMA by DMI four times a day under operational surveillance and covering Denmark and surroundings. The integration of DERMA in ARGOS is effectuated through automated on-line digital communication and exchange of data. The calculations are carried out in parallel for each NWP model to which DMI has access, thereby providing a mini-ensemble of dispersion forecasts for the emergency management.

Does a Distal Forearm Fracture Lead to Evaluation for Osteoporosis?

In postmenopausal women, a low-trauma distal forearm fracture is a risk factor for osteoporosis and future fracture, which indicates osteoporosis follow-up according to prevailing guidelines. We decided to determine how often women over 45 yr presenting with a low-trauma distal forearm fracture to a Danish emergency department during a 1-yr period were followed up for osteoporosis. We performed a retrospective review of hospital records and we sent the women and their general practitioners (GPs) questionnaires regarding the follow-up undertaken in primary care. Finally, we invited the women for a densitometry to estimate the prevalence of osteoporosis. From May 1, 2001 to April 30, 2002, 147 women presented with a low-trauma distal forearm fractures. According to the review of hospital records, none of the women was referred for bone densitometry or spine X-rays. One woman had calcium and vitamin D supplementation (CVDS) prescribed and two were recommended to consult their GPs for osteoporosis follow-up. In primary care, 12 women were referred for densitometry or spine X-rays, and 11 women started CVDS after the fracture. Women with risk factors for osteoporosis in addition to the forearm fracture were not more likely to be referred for densitometry or spine X-rays (p = 0.10). The prevalence of osteoporosis was 24% among the 79 women who underwent densitometry. Our study demonstrates a low use of available measures to reduce the risk of future fracture in women with a low-trauma distal forearm fracture, and it emphasizes the need to decide on a local level how to provide osteoporosis follow-up for women with fragility fractures.

Acute Stress Disorder in physical assault victims visiting a Danish emergency ward.

The purpose of this article is to assess the prevalence of Acute Stress Disorder (ASD) following violent assault in victims who come to the emergency ward, and compare the effects with degrees of injury. Two hundred and fourteen victims of violence completed a questionnaire 1 to 2 weeks after the assault. Measures included the Harvard Trauma Questionnaire, the Trauma Symptom Checklist and the Crisis Support Scale. Twenty-four percent met the full ASD diagnosis and 21% a subclinical ASD diagnosis. Childhood sexual and physical abuse and shock due to a traumatic event that happened to someone close increased the likelihood of ASD four to ten times. Feeling of security and ability to express feelings reduced the likelihood of ASD by one-quarter, while feeling let down by others and hopelessness increased the likelihood of ASD respectively 1.4 and 2.6 times.

Sensitivity of the DERMA long-range Gaussian dispersion model to meteorological input and diffusion parameters

The Danish Emergency Response Model of the Atmosphere (DERMA) is described and applied to the first ETEX experiment. By using analysed low-resolution numerical weather-prediction data from the global model of the European Centre for Medium-range Weather Forecast (ECMWF) as well as higher-resolution data from two versions of the High Resolution Limited Area Model (HIRLAM), which are operational at the Danish Meteorological Institute (DMI), the sensitivity of DERMA to the resolution of meteorological data is analysed by comparing DERMA results with concentration measurements. Furthermore, the sensitivity to boundary-layer height and diffusion parameters is studied. These parameters include the critical bulk Richardson number, which is used to estimate the atmospheric boundary-layer height, the horizontal eddy diffusivity and the Lagrangian turbulence time scale. The parameters, which provide the best performance of DERMA, are 0.25 for the critical bulk Richardson number, 6×10 3 m 2 s -1 for the horizontal eddy diffusivity, and 3 h for the Lagrangian time scale. DERMA is much more sensitive to boundary-layer parameters when using high-resolution DMI-HIRLAM data than when using data of lower resolution from the ECMWF. Finally, the bulk Richardson number method of boundary-layer height calculation applied to DMI-HIRLAM data is verified directly against routine radiosondes released under the tracer gas plume. The boundary-layer height estimates based on analysed NWP model data agree well with observations, and the agreement deteriorates as a function of forecast length.

Mesoscale influence on long-range transport — evidence from ETEX modelling and observations

During the first European Tracer Experiment (ETEX) tracer gas was released from a site in Brittany, France, and subsequently observed over a range of 2000 km. Hourly measurements were taken at the National Environmental Research Institute (NERI) located at Risø, Denmark, using two measurement techniques. At this location, the observed concentration time series shows a double-peak structure occurring between two and three days after the release. By using the Danish Emergency Response Model of the Atmosphere (DERMA), which is developed at the Danish Meteorological Institute (DMI), simulations of the dispersion of the tracer gas have been performed. Using numerical weather-prediction data from the European Centre for Medium-Range Weather Forecast (ECMWF) by DERMA, the arrival time of the tracer is quite well predicted, so also is the duration of the passage of the plume, but the double-peak structure is not reproduced. However, using higher-resolution data from the DMI version of the HIgh Resolution Limited Area Model (DMI-HIRLAM), DERMA reproduces the observed structure very well. The double-peak structure is caused by the influence of a mesoscale anti-cyclonic eddy on the tracer gas plume about one day earlier.

20. Danish prehospital emergency medicine

20. Danish prehospital emergency medicine

20. Danish prehospital emergency medicine

20. Danish prehospital emergency medicine

The treatment of acute soft tissue trauma in Danish emergency rooms.

Rest, ice, compression, elevation (RICE) is the most recommended treatment for acute traumatic soft tissue injuries. A questionnaire was given to all Danish emergency rooms (n = 5) regarding their routines for acute treatment of ankle sprains and muscle contusions. Complete answers were received from 37 emergency rooms (73%), covering the treatment of 111 ankle sprains and 101 muscle contusions. Treatment with RICE was given in a minority of injuries, ice (21%), compression (32%) and elevation (58%) similarly between injury types. A complete RICE treatment was rarely applied (3%). Verbal information on RICE and rehabilitation was given in less than half of the cases. We conclude that the acute treatment of ankle sprains and muscle contusions in the Danish emergency rooms is not applied in accordance with consensus from international literature, and that the instruction in rehabilitation should be improved.

Forecast of atmospheric boundary-layer height utilised for ETEX real-time dispersion modelling

A robust method for determining the ABL height is studied and verified against radiosonde observations. The method which is based on a bulk Richardson number approach, is suited for use in dispersion models based on output from numerical weather prediction (NWP) models with limited vertical resolution in the boundary layer. Based on NWP data from the DMI-HIRLAM model, the method was utilised for real-time dispersion modelling during the European Tracer Experiment (ETEX) by the Danish Emergency Response Model of the Atmosphere (DERMA). In a preliminary model evaluation, DERMA performed very well.

Injuries due to deliberate violence in Chile

An analysis was made over a period of 6 months of the incidents involving deliberate violence as registered in ‘Vicaria’, the clinic for out-patients within the Cathedral of Santiago de Chile. A total of 236 victims of deliberate violence were observed. Men aged 15–24 years were found to be victims of deliberate violence most frequently. ‘Under education’ was the most frequently registered occupation for both sexes, and a large group of male victims were ‘Unemployed’. 82% of the victims were men and 14% women, 1.5% were boys and 1.5% girls ⩽ 14 years of age. None of the victims were alcohol intoxicated when arriving in the clinic. The incidents took place in streets for 81% of the male victims and 79% of the female victims, and in the majority of the cases the aggressor(s) was one (or several) police officer(s). Six percent of the male victims had been injured in a police station/quarter or military lorry. Only 8% of the female victims had been injured at home. There was no reporting of the aggressor being a relative or acquaintance. The most frequent type of violence was blunt violence from baton(s) (44%), while blunt violence without the use of instruments was reported less frequently (33%). The use of firearms was registered in 18% of the cases, and of sharp instruments, combustion, electro-shock and chain in 1.4%, 1.4%, 1.1% and 0.4% of the cases, respectively. A total of 517 primary and secondary diagnoses were applied to the patients. Most of the victims (99%) had moderate or less serious lesions according to the Abbreviated Injury Scale (AIS) (score ⩽ 2). Twenty-four percent of the victims had more than 4 lesions, and 7% more than 10 lesions. The head/neck region and the trunk were affected with equal frequency, the frequency of injuries of the head/neck region being comparable with that observed among torture victims and in contrast to the pronounced predominance of injuries of the head/neck region observed in a Danish emergency ward study of deliberate violence.

Injuries due to deliberate violence in areas of Denmark. V. Violence against women and children

As part of an European-South American study of deliberate violence cases of violence against women ⩾15 years of age and violence against and among children under the age of 15 years were registered at 3 Danish emergency wards and at the Institute of Forensic Medicine in Copenhagen. 352 cases of violence against women and 46 cases of violence against children were registered in the three emergency wards corresponding to rates of about 1.6 1000 per year for women, 0.6 1000 per year for boys and 0.7 1000 per year for girls in a provincial/rural district, the catchment region of Holbaek County Hospital, 3.4 1000 per year for women, 2.8 1000 per year for boys and 0.6 1000 per year for girls in a mainly middle income area of the metropolis Copenhagen, the catchment region of Frederiksberg Hospital, and 0.4 1000 per year for women, 4.0 1000 per year for boys and 0.9 1000 per year for girls in a mainly low income area of Copenhagen, the catchment region of the Rigshospital. Nineteen live adult female victims and 17 dead adult female victims of violence were registered in the Institute of Forensic Medicine in Copenhagen, where also one was registered as a victim of homicide. Nearly half of the adult live female victims of violence had been injured at home while this was the case for approximately three fourth of the dead victims. In 35% of the live cases the husband was the aggressor and in 12% a former cohabitant. In 71% of the homicide cases the husband was the aggressor. The live women appeared to have fewer but more serious lesions than men. The pattern of deliberate violence against women appears to be associated with socio-economic and cultural factors. In cases with a preceding quarrel there is statistically a link to alcohol intoxication. In half of the cases of violence against children the aggressor was known to the victim, in 15% the aggressor was one of the parents, while 42% of the cases were violence among children. The pattern of violence according to sex, and the distribution and severity of lesions for 10–14 years old children showed resemblance to the situation for adults. The lesions were more serious in young infant victims, especially boys, than in adult victims.

Injuries due to deliberate violence in areas of Denmark. III. Lesions

As part of a transcultural investigation of violent behaviour in Denmark and South America, the lesions from accidents involving deliberate violence registered in three Danish emergency wards during a 1-year period were studied. A quantity of 2211 lesions were diagnosed in 1316 patients (953 male and 363 female patients). Sixty-five percent of the lesions were in the head/neck region, 13% in truncus, 18% in the upper extremities and 5% in the lower extremities. The most frequent diagnosis was an open wound in the head/neck region. Adding contusions and fractures in the same region this amounted to more than half of the total number of lesions. In the upper extremities 62% of the lesions were contusions or open wounds. Serious lesions of internal arteries were few, however always caused by sharp instruments (knives). Serious lesions due to firearms were not recorded/reported. Strangulation had been used against 1.1% of the victims, the male/female ratio being 1:6. The main part of the lesions were of minor severity when assessed on the basis of the scores in the Abbreviated Injury Scale (AIS). The lesions were, however, more serious compared to other recent studies, and it appeared that the female victims had fewer but more serious lesions than the male victims. The need for treatment and hospitalization was in the range of other recent studies.

Injuries due to deliberate violence in areas of Denmark. IV. Alcohol intoxication in victims of violence

A material of 1316 victims of deliberate violence was collected prospectively during a one year period in three Danish emergency wards covering a provincial/rural area and two metropolitan areas. The frequency of alcohol intoxication was determined. Forty-one percent of the patients were intoxicated. The highest frequency was found in male victims, in the provincial/rural area, in restaurants or their vicinity, in the age group 35–49, during evenings and nights and in May. It is difficult to indicate specific preventive measures. However, a more restrictive attitude is suggested with regard to serving alcohol to intoxicated persons in restaurants.

Injuries due to deliberate violence in areas of Denmark. I. The extent of violence

As part of a transeultural investigation of violent behavior in Denmark and South America an analysis was made during a one year period of the incidents involving deliberate violence as registered at 3 Danish emergency wards, and at the Institute of Forensic Medicine in Copenhagen. In the three emergency wards a total of 1316 victims of deliberate violence were observed corresponding to a rate of about 3.3 1000 per year in a provincial/rural district, the catchment region of Holbaek County Hospital, 5.5 1000 per year in a mainly middle income area of the metropolis Copenhagen, the catchment region of Frederiksberg Hospital, and 7.6 1000 per year in a mainly low income area of Copenhagen, the catchment region of the Rigshospital. The highest risk, 28 1000 per year, was found for young men between 15 and 19 years of age living in the low income area of Copenhagen. The risk was low for people ⩾60 years of age in all three areas investigated, ranging from 0 (men) to 1.3 1000 per year (women). Skilled and unskilled workers were greatly over represented as victims of violence, considering their share of the background population. Seventy percent of the victims were men. At least 44% of the men and 32% of the women were alcohol intoxicated when arriving in the emergency ward. The incidents took place in restaurants or in the vicinity of restaurants for 30% of the male and 11% of female victims respectively, while 45% of the women had been subject to deliberate violence at home. The rate of fatal cases of deliberate violence in the Eastern part of Denmark, the catchment area for the Institute of Forensic Medicine in Copenhagen, was found to be 0.02 1000 per year. The risk of becoming a victim of deliberate violence has not increased during the last 4 years comparing with similar investigations from other parts of Denmark. However, the rate of homicide seems to have increased, and so has the severity of the injuries caused by deliberate violence. The pattern of deliberate violence appears to be associated with socio-economic and cultural factors, and to be closely linked with alcohol intoxication.