Objective Breathing difficulties and respiratory diseases have been under-reported in Emergency Medical Services research, despite these conditions being prevalent with substantial mortality. Our aim was two-fold; 1) to investigate the diagnostic pattern and mortality among EMS patients to whom an ambulance was dispatched due to difficulty breathing, and 2) to investigate the initial symptoms and mortality for EMS patients diagnosed with respiratory diseases in hospital. Methods Population-based historic cohort study in the North Denmark Region 2012–2015. We included two patient groups; 1) patients calling the emergency number with breathing difficulty as main symptom, and 2) patients diagnosed with respiratory diseases in hospital following an emergency call. Main outcome was estimated 1- and 30-day mortality rates. Results There were 3803 patients with the symptom breathing difficulty , nearly half were diagnosed with respiratory diseases 47.3%, followed by circulatory diseases 13.4%, and symptoms and signs 12.0%. The 1-day mortality rate was highest for circulatory diseases , then respiratory diseases and o ther factors . Over-all 30-day mortality was 13.2%, and the highest rate was for circulatory diseases (17.7%) then respiratory diseases and other factors . A total of 4014 patients were diagnosed with respiratory diseases , 44.8% had the symptom breathing difficulty , 13.4% unclear problems and 11.3%. chest pain/heart disease . 1-day mortality rates were highest for decreased consciousness , then breathing difficulties and unclear problem . Over-all 30-day mortality rates were 12.5%, the highest with symptoms of decreased consciousness (19.1%), then unclear problem and breathing difficulty . There was an overlap of 1797 patients between the two groups. Conclusions The over-all mortality rates alongside the distribution of symptoms and diagnoses, suggest the breathing difficulty patient group is complex and has severe health problems. These findings may be able to raise awareness towards the patient group, and thereby increase focus on diagnostics and treatment to improve the patient outcome.

Background Emergency medical service patients are a vulnerable population and the risk of mortality is considerable. In Denmark, healthcare professionals receive 112-emergency calls and assess the main reason for calling. The main aim was to investigate which of these reasons, i.e. which symptoms or mechanism of injury, contributed to short-term risk of death. Secondary aim was to study 1–30 day-mortality for each symptom/ injury. Methods Historic population-based cohort study of emergency medical service patients calling 112 in the North Denmark Region between 01.01.2016–31.12.2018. We defined 1-day mortality as death on the same or the following day. The frequency of each symptom and cumulative number of deaths on day 1 and 30 together with 1- and 30-day mortality for each symptom/mechanism of injury is presented in proportions. Poisson regression with robust variance estimation was used to estimate incident rates (IR) of mortality with 95% confidence intervals (CI), crude and age and sex adjusted, mortality rates on day 1 per 100,000 person-year in the population. Results The five most frequent reasons for calling 112 were “chest pain” (15.9%), “unclear problem” (11.9%), “accidents” (11.2%), “possible stroke” (10.9%), and “breathing difficulties” (8.3%). Four of these contributed to the highest numbers of deaths: “breathing difficulties” (17.2%), “unclear problem” (13.2%), “possible stroke” (8.7%), and “chest pain” (4.7%), all exceeded by “unconscious adult – possible cardiac arrest” (25.3%). Age and sex adjusted IR of mortality per 100,000 person-year was 3.65 (CI 3.01–4.44) for “unconscious adult – possible cardiac arrest” followed by “breathing difficulties” (0.45, CI 0.37–0.54), “unclear problem”(0.30, CI 0.11–0.17), “possible stroke”(0.13, CI 0.11–0.17) and “chest pain”(0.07, CI 0.05–0.09). Conclusion In terms of risk of death on the same day and the day after the 112-call, “unconscious adult/possible cardiac arrest” was the most deadly symptom, about eight times more deadly than “breathing difficulties”, 12 times more deadly than “unclear problem”, 28 times more deadly than “possible stroke”, and 52 times more deadly than “chest pain”. “Breathing difficulties” and “unclear problem” as presented when calling 112 are among the top three contributing to short term deaths when calling 112, exceeding both stroke symptoms and chest pain.

ObjectivesTo examine the severity and progression of acute illness or injury in children using vital signs obtained during ambulance transport and categorised according to a paediatric triage model.DesignA population-based historical cohort study using data from prehospital patient medical records linked to a national civil registration database.SettingEmergency medical services providing ground-level transport in a mixed urban–rural region with three hospitals in Denmark.Participants25 039 events with patients aged <18 years attended by emergency medical services dispatched after a 1-1-2 emergency call during the years 2006–2018.Primary and secondary outcome measuresDistribution of the first observed vital signs according to a paediatric triage model: heart rate, Glasgow Coma Score, respiratory rate, oxygen saturation and oxygen treatment, and proportion of patients progressing to a triage score with a lower level of urgency during ambulance transport.ResultsThe proportion of patients with the first observed vital signs outside the normal age-specific range was as follows: 33.6% for heart rate, 15.3% for Glasgow Coma Score, 17.4% for respiratory rate and 37.4% for oxygen saturation regardless of oxygen treatment. The proportion of patients progressing to a triage score with a lower level of urgency during transport varied with age: 146/354 (41.2%) for age 0–2 months, 440/986 (44.6%) for age 3–11 months, 1278/3212 (39.8%) for age 1–2 years, 967/2814 (34.4%) for age 3–7 years and 4029/13 864 (29.1%) for age 8–17 years (p<0.001). One-day mortality was 3.05 deaths per 1000 patient-days (95% CI 2.43 to 3.83).ConclusionsOne third of the patients’ condition progressed to a triage score with a lower level of urgency during ambulance transport. Vital sign documentation in paediatric patients was incomplete, and educational initiatives should be taken to increase documentation of vital signs, especially in patients aged ≤2 years.

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Background: Prehospital dyspnoea patients are a frequent group with a high mortality. However, there is limited knowledge about their characteristics. We aimed to investigate causes for dispatched ambulances to patients diagnosed with dyspnoea, and diagnoses given to patients to whom an ambulance was dispatched due to dyspnoea. Method: Retrospective cohort study in the North Denmark region in the period 2012-2015. We included all emergency ambulance patients where the main cause for a dispatched ambulance was “Breathing difficulty”, and all emergency ambulance patients who were diagnosed within the ICD-10 chapter “Diseases of the respiratory system” at hospital.  Results: 4933 patients had an ambulance dispatched due to “Breathing difficulty”. Their most frequent diagnoses at hospital were ICD-10 chapter “Diseases of the respiratory system” (49.45%), “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified” (18.56%), “Diseases of the circulatory system” (9.20%), and “Factors influencing health status and contact with health services” (5.71%). Contrariwise, 5163 emergency ambulance patients received a diagnosis within ICD-10 chapter “Diseases of the respiratory system” at hospital. The most frequent causes for dispatched ambulances to these patients were “Breathing difficulty” (49.45%), “Unclarified problem” (11.16%), and “Chest pain - heart disease” (9.55%). 16.00% of dispatches were without cause. Conclusion: Only half of the patients had both ambulance dispatch and hospital diagnose related to breathing difficulties. The variation and distribution of causes for ambulance dispatch and diagnoses given at hospital, suggests that dyspnoea is a symptom present in many conditions and the patient group is complex.