{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T01:08:23Z","timestamp":1790816903051,"version":"4.1.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"vor","delay-in-days":2233,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,11,8]],"date-time":"2019-11-08T00:00:00Z","timestamp":1573171200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008376","name":"Helsingin ja Uudenmaan Sairaanhoitopiiri","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008376","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Department of Emergency Medicine, Helsinki University Hospital, University of Helsinki"},{"DOI":"10.13039\/100008376","name":"Helsingin ja Uudenmaan Sairaanhoitopiiri","doi-asserted-by":"publisher","award":["http:\/\/dx.doi.org\/10.13039\/100008376"],"award-info":[{"award-number":["http:\/\/dx.doi.org\/10.13039\/100008376"]}],"id":[{"id":"10.13039\/100008376","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To illustrate the pre-hospital management arsenals and protocols in different EMS units, and to estimate the perceived difficulty of diagnosing suspected acute heart failure (AHF) compared with other common pre-hospital conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>A multinational survey included 104 emergency medical service (EMS) regions from 18 countries. Diagnostic and therapeutic arsenals related to AHF management were reported for each type of EMS unit. The prevalence and contents of management protocols for common medical conditions treated pre-hospitally was collected. The perceived difficulty of diagnosing AHF and other medical conditions by emergency medical dispatchers and EMS personnel was interrogated.<\/jats:p>\n                    <jats:p>Ultrasound devices and point-of-care testing were available in advanced life support and helicopter EMS units in fewer than 25% of EMS regions. AHF protocols were present in 80.8% of regions. Protocols for ST-elevation myocardial infarction, chest pain, and dyspnoea were present in 95.2, 80.8, and 76.0% of EMS regions, respectively. Protocolized diagnostic actions for AHF management included 12-lead electrocardiogram (92.1% of regions), ultrasound examination (16.0%), and point-of-care testings for troponin and BNP (6.0 and 3.5%). Therapeutic actions included supplementary oxygen (93.2%), non-invasive ventilation (80.7%), intravenous furosemide, opiates, nitroglycerine (69.0, 68.6, and 57.0%), and intubation 71.5%. Diagnosing suspected AHF was considered easy to moderate by EMS personnel and moderate to difficult by emergency medical dispatchers (without significant differences between de novo and decompensated heart failure). In both settings, diagnosis of suspected AHF was considered easier than pulmonary embolism and more difficult than ST-elevation myocardial infarction, asthma, and stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The prevalence of AHF protocols is rather high but the contents seem to vary. Difficulty of diagnosing suspected AHF seems to be moderate compared with other pre-hospital conditions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.12524","type":"journal-article","created":{"date-parts":[[2019,11,8]],"date-time":"2019-11-08T04:42:50Z","timestamp":1573188170000},"page":"290-297","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Pre-Hospital Management Protocols and Perceived Difficulty in Diagnosing Acute Heart Failure"],"prefix":"10.1093","volume":"7","author":[{"given":"Pia","family":"Harjola","sequence":"first","affiliation":[{"name":"Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital , Helsinki ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d2scar","family":"Mir\u00f3","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Cl\u00ednic, University of Barcelona , Villarroel 170, Barcelona, 08036 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco J.","family":"Mart\u00edn-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Cl\u00ednico San Carlos, Instituto de Investigaci\u00f3n Sanitaria Hospital Cl\u00ednico San Carlos (IdISSC), Facultad de Medicina de Universidad Complutense de Madrid , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Escalada","sequence":"additional","affiliation":[{"name":"Sistema d'Emerg\u00e8ncies M\u00e8diques , Tarragona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0262-3848","authenticated-orcid":false,"given":"Yonathan","family":"Freund","sequence":"additional","affiliation":[{"name":"Emergency Department, H\u00f4pital Pitie-Salp\u00eatri\u00e8re, Assistance Publique-H\u00f4pitaux de Paris, INSERM 1166, Sorbonne University , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Penaloza","sequence":"additional","affiliation":[{"name":"Emergency Department, Cliniques Universitaires St-Luc, Universit\u00e9 Catholique de Louvain , Brussels ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Christ","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Luzerner Kantonsspital , Lucerne ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David C.","family":"Cone","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Yale University School of Medicine , New Haven, CT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Said","family":"Laribi","sequence":"additional","affiliation":[{"name":"D\u00e9partement de M\u00e9decine d'Urgence, CHRU de Tours, Facult\u00e9 de M\u00e9decine, Universit\u00e9 de Tours Centre d'\u00c9tude des Pathologies Respiratoires - Inserm U1100 , Tours ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markku","family":"Kuisma","sequence":"additional","affiliation":[{"name":"Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital , Helsinki ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuukka","family":"Tarvasm\u00e4ki","sequence":"additional","affiliation":[{"name":"Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital , Helsinki ,","place":["Finland"]},{"name":"Cardiology, University of Helsinki, Heart and Lung Center, Helsinki University Hospital , Helsinki ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veli-Pekka","family":"Harjola","sequence":"additional","affiliation":[{"name":"Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital , Helsinki ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,11,8]]},"reference":[{"key":"2026012115055799000_ehf212524-bib-0001","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1080\/10903120390937049","article-title":"Prehospital therapy for acute congestive heart failure: state of the art","volume":"7","author":"Mosesso","year":"2003","journal-title":"Prehosp Emerg Care"},{"key":"2026012115055799000_ehf212524-bib-0002","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1080\/10903120600884848","article-title":"Effectiveness of prehospital continuous positive airway pressure in the management of acute pulmonary edema","volume":"10","author":"Hubble","year":"2006","journal-title":"Prehosp Emerg Care"},{"key":"2026012115055799000_ehf212524-bib-0003","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.ijcard.2017.01.017","article-title":"The impact of emergency medical services in acute heart failure","volume":"232","author":"Harjola","year":"2017","journal-title":"Int J Cardiol"},{"key":"2026012115055799000_ehf212524-bib-0004","first-page":"223","article-title":"Prehospital emergency care of patients with acute heart failure in Spain: the SEMICA study (Emergency Medical Response Systems for Patients with Acute Heart Failure)","volume":"29","author":"Miro","year":"2017","journal-title":"Emergencias"},{"key":"2026012115055799000_ehf212524-bib-0005","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-010201","article-title":"Arrival by ambulance in acute heart failure: insights into the mode of presentation from Acute Studies of Nesiritide in Decompensated Heart Failure (ASCEND-HF)","volume":"6","author":"Ezekowitz","year":"2016","journal-title":"BMJ Open"},{"key":"2026012115055799000_ehf212524-bib-0006","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1161\/CIRCHEARTFAILURE.112.000161","article-title":"IN-HF (Italian Network on Heart Failure) outcome investigators. 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