Camilla Hardeland

• Andersen, Fredrik; Løkkeberg, Stine Eileen Torp; Hardeland, Camilla & Leonardsen, Ann-Chatrin Linqvist (2026). Emergency Primary Care Personnel’s Perspectives Toward AI-Based Decision Support Tools: A Qualitative Study in Norway. Journal of Primary Care & Community Health. ISSN 2150-1319. 17. doi: https:/journals.sagepub.com/doi/10.1177/21501319251408672. Full text in Research Archive Show summary

  Background: Artificial intelligence-based decision support systems have been suggested as possible aids for decision makers in emergency care. To balance patient safety, cost, efficiency, and professional integrity, we need to understand the views and arguments health professionals have for and against the implementation of such systems. The current study aimed to explore emergency primary care personnel’s perspectives on artificial intelligence-based decision support systems in emergencies in the municipality. Method: This study used a qualitative design with online, semistructured interviews with 12 primary emergency health care personnel. A purposive sampling strategy was used, and participants were recruited either from EPC center or municipal healthcare institutions receiving services from the EPCRU. The data were analyzed following thematic analysis. Results: Four main themes were identified, namely, “Human need, clinical evaluations,” “Balancing skepticism and confidence,” “Digital sparring partner and alternative hypotheses,” and “Health personnel’s role in procurement and development.” The participants emphasized a need for human and clinical assessments to detect illness and initiate appropriate actions. Aspects of skepticism and confidence were also discussed. However, they perceived that AI-based decision support systems could be ideal digital sparring partners. Moreover, all the participants underlined the importance of involving intended users when developing and implementing decision support systems. Conclusions: This study emphasizes the essential role of health personnel in decision-making processes in emergency primary care, as well as in the implementation processes of AI in these services. AI is suggested as a supportive tool that provides safe and trustworthy solutions. These aspects are useful for managers and other decision makers in the transformation of health services for the future.

• Leonardsen, Ann-Chatrin Linqvist; Hardeland, Camilla; Dehre, Andreas & Larsson, Glenn (2025). Emergency medical services providers’ perspectives on the use of artificial intelligence in prehospital identification of stroke- a qualitative study in Norway and Sweden. BMC Emergency Medicine. 25(1). doi: 10.1186/s12873-025-01300-1. Full text in Research Archive
• Halstensen, Thor-David; Hardeland, Camilla; Ghanima, Waleed; Grøndahl, Vigdis Abrahamsen; Hubin, Aliaksandr & Jørgensen, Camilla Tøvik [Show all 8 contributors for this article] (2025). External validation of the DAYS score for suspected deep vein thrombosis. Research and Practice in Thrombosis and Haemostasis (RPTH). 9(4). doi: 10.1016/j.rpth.2025.102885. Full text in Research Archive
• Guterud, Mona; Hardeland, Camilla; Bugge, Helge Fagerheim; Sandset, Else Charlotte; Svendsen, Edel Jannecke & Hov, Maren Ranhoff (2024). Experiences from a cluster-randomized trial (ParaNASPP) exploring triage and diagnostic accuracy in paramedic-suspected stroke: a qualitative interview study. European Journal of Neurology. ISSN 1351-5101. 31(5). doi: 10.1111/ene.16252. Full text in Research Archive Show summary

  Background and purpose: Timely prehospital stroke recognition was explored in the Paramedic Norwegian Acute Stroke Prehospital Project (ParaNASPP) by implementation of stroke education for paramedics and use of the National Institutes of Health Stroke Scale (NIHSS) through a mobile application. The study tested triage and facilitated ommunication between paramedics and stroke physicians. To complement the quantitative results of the clinical trial, a qualitative approach was used to identify factors that influence triage decisions and diagnostic accuracy in prehospital stroke recognition experienced by paramedics and stroke physicians. Method: Semi-­structured qualitative individual interviews were performed following an interview guide. Informants were recruited from the enrolled paramedics and stroke physicians who participated in the ParaNASPP trial from Oslo University Hospital. Interviews were audio recorded, transcribed verbatim and approached inductively using the principles of thematic analysis. Results: Fourteen interviews were conducted, with seven paramedics and seven stroke physicians. Across both groups two overarching themes were identified related to triage decisions and diagnostic accuracy in prehospital stroke recognition: prehospital NIHSS reliably improves clinical assessment and communication quality; overtriage is widely accepted whilst undertriage is not. Conclusion: Paramedics and stroke physicians described how prehospital NIHSS improved communication quality and reliably improved prehospital clinical assessment. The qualitative results support a rationale of an application algorithm to decide which NIHSS items should prompt immediate prenotification rather than a complete NIHSS as default.

• Jamtli, Bjørn; Svendsen, Edel Jannecke; Jørgensen, Trine Møgster; Kramer-Johansen, Jo; Hov, Maren Ranhoff & Hardeland, Camilla (2024). Factors affecting emergency medical dispatchers decision making in stroke calls – a qualitative study. BMC Emergency Medicine. 24(1), p. 214–214. doi: 10.1186/s12873-024-01129-0. Full text in Research Archive Show summary

  Objectives Emergency Medical Communication Centers (EMCC) have a key role in the prehospital chain-of-stroke-survival by recognizing stroke patients and reducing prehospital delay. However, studies on EMCC stroke recognition report both substantial undertriage and overtriage. Since mis-triage at the EMCC challenges the whole chain-of-stroke-survival, by occupying limited resources for non-stroke patients or failing to recognize the true stroke patients, there is a need to achieve a more comprehensive understanding of the dispatchers’ routines and experiences. The aim of this study was to explore factors affecting EMCC dispatcher’s decision-making in stroke calls. Materials and methods A qualitative exploratory study, based on individual semi-structured interviews of 15 medical dispatchers from EMCC Oslo, Norway. Interviews were conducted during August and October 2022 and analyzed using the principles of thematic analysis. Results We identified four themes: [1] Pronounced stroke symptoms are easy to identify [2]. Non-specific neurological symptoms raise suspicion of acute stroke but are difficult to differentiate from other medical conditions [3]. Consistent use of the Criteria Based Dispatch (CBD) protocol may increase EMCC overtriage [4]. Contextual conditions at EMCC can affect dispatchers’ decision-making process and the ability for experiential learning. Conclusions Medical dispatchers at the EMCC perceive vague and non-specific stroke symptoms, such as dizziness, confusion or altered behaviour, challenging to differentiate from symptoms of other less time-critical medical conditions. They also perceive the current CBD protocol in use as less supportive in assessing such symptoms. High workload and strict EMCC response time interval requirements hinder the gathering of essential patient information and the ability to seek guidance in cases of doubt, potentially exacerbating both EMCC undertriage and overtriage. The absence of feedback loops and other strategies for experiential learning in the EMCC hampers the medical dispatcher’s ability to evaluate their own assessments and improve dispatch accuracy.

• Halstensen, Thor-David; Hardeland, Camilla; Ghanima, Waleed; Grøndahl, Vigdis Abrahamsen; Hubin, Aliaksandr & Tavoly, Mazdak (2024). Development and internal validation of a simple clinical score for the estimation of the probability of deep vein thrombosis in outpatient emergency department patients. Research and Practice in Thrombosis and Haemostasis (RPTH). 8(8). doi: 10.1016/j.rpth.2024.102608. Full text in Research Archive Show summary

  Background: Wells score comprises subjective elements, making physicians reluctant to use Wells score or cause them to use it incorrectly. Objectives: To develop and internally validate a prediction score that is objective and simple for evaluating suspected deep vein thrombosis (DVT), with a safety comparable with that of Wells score. Methods: We performed a post hoc analysis using data from the Ri-Schedule study (NCT02486445) involving suspected DVT patients at Østfold Hospital’s Emergency Department, Norway (2015-2018). Candidate variables were identified through bootstrapping technique, with a confirmed DVT diagnosis as the outcome variable. Sensitivity, specificity, negative predictive value (NPV), and positive predictive values (PPV) were estimated and compared with the 2-tier Wells score. Results: Among 1312 patients (median age, 64 years [IQR, 52-73]; 55% women), 19.9% were diagnosed with DVT. Exploration of 30 variables identified tenderness along deep veins and previous venous thromboembolism as significant predictors (selection frequency >60% in 1000 bootstrapping samples). The derived score categorized 450 patients with 0 items as unlikely to have DVT, of whom 8.0% were diagnosed with DVT, compared with 8.2% in DVT unlikely category according to Wells score. Compared with Wells score, the derived score demonstrated sensitivity of 86.2 (95% CI, 81.4-90.2) vs 80.1 (95% CI, 74.7-84.8), specificity of 39.4 (95% CI, 36.4-42.4) vs 55.3 (95% CI, 52.2-58.3), NPV of 92.0 (95% CI, 89.4-94.0) vs 91.8 (95% CI, 89.7-93.5), and PPV of 26.1 (95% CI, 24.8-27.5) vs 30.8 (95% CI, 28.9-32.8). When incorporating D-dimer cutoff of <0.5 mg/mL, the derived score had sensitivity of 99.6 (95% CI, 97.9-99.9), specificity of 16.1 (95% CI, 13.1-18.4), NPV of 99.4 (95% CI, 96.0-99.9), and PPV of 22.8 (95% CI, 22.3-23.3). Conclusion: The derived DVT score, with 2 objective variables, had a comparable safety with that of the Wells score. However, an external validation is mandated prior to clinical use.

• Jamtli, Bjørn; Hov, Maren Ranhoff; Jørgensen, Trine Møgster; Kramer-Johansen, Jo; Ihle-Hansen, Hege Beate & Sandset, Else Charlotte [Show all 8 contributors for this article] (2024). Telephone triage and dispatch of ambulances to patients with suspected and verified acute stroke - a descriptive study. BMC Emergency Medicine. 24(1). doi: 10.1186/s12873-024-00962-7. Full text in Research Archive Show summary

  Objectives In this study we aimed to explore EMCC triage of suspected and confirmed stroke patients to gain more knowledge about the initial phase of the acute stroke response chain. Accurate dispatch at the Emergency Medical Communication Center (EMCC) is crucial for optimal resource utilization in the prehospital service, and early identification of acute stroke is known to improve patient outcome. Materials and methods We conducted a descriptive retrospective study based on data from the Emergency Department and EMCC records at a comprehensive stroke center in Oslo, Norway, during a six-month period (2019–2020). Patients dispatched with EMCC stroke criteria and/or discharged with a stroke diagnosis were included. We identified EMCC true positive, false positive and false negative stroke patients and estimated EMCC stroke sensitivity and positive predictive value (PPV). Furthermore, we analyzed prehospital time intervals and identified patient destinations to gain knowledge on ambulance services assessments. Results We included 1298 patients. EMCC stroke sensitivity was 77% (95% CI: 72 − 82%), and PPV was 16% (95% CI: 14 − 18%). EMCC false negative stroke patients experienced an increased median prehospital delay of 11 min (p < 0.001). Upon arrival at the scene, 68% of the EMCC false negative patients were identified as suspected stroke cases by the ambulance services. Similarly, 68% of the false positive stroke patients were either referred to a GP, out-of-hours GP acute clinic, local hospitals or left at the scene by the ambulance services, indicating that no obvious stroke symptoms were identified by ambulance personnel upon arrival at the scene. Conclusions This study reveals a high EMCC stroke sensitivity and an extensive number of false positive stroke dispatches. By comparing the assessments made by both the EMCC and the ambulance service, we have identified specific patient groups that should be the focus for future research efforts aimed at improving the sensitivity and specificity of stroke recognition in the EMCC.

• Leonardsen, Ann-Chatrin Linqvist; Hardeland, Camilla; Hallgren, Jenny; Femdal, Ingrid; Thapa, Dip Raj & Helgesen, Ann Karin [Show all 10 contributors for this article] (2023). Nursing students’ attitudes towards the use of digital technology in the healthcare of older people- a cross-sectional study in Norway and Sweden. BMC Nursing. 22(1). doi: 10.1186/s12912-023-01600-6. Full text in Research Archive
• Leonardsen, Ann-Chatrin Linqvist; Bååth, Carina Barbro; Helgesen, Ann Karin; Grøndahl, Vigdis Abrahamsen & Hardeland, Camilla (2023). Person-Centeredness in Digital Primary Healthcare Services—A Scoping Review. Healthcare. 11(9). doi: 10.3390/healthcare11091296. Full text in Research Archive
• Leonardsen, Ann-Chatrin Linqvist; Hardeland, Camilla; Helgesen, Ann Karin; Bååth, Carina Barbro; Busso, Lilliana Andrea Del & Grøndahl, Vigdis Abrahamsen (2023). The Use of Robotic Technology in the Healthcare of People above the Age of 65—A Systematic Review. Healthcare. 11(6). doi: 10.3390/healthcare11060904. Full text in Research Archive
• Hardeland, Camilla; Svendsen, Edel Jannecke; Heitmann, Grethe Berger & Leonardsen, Ann-Chatrin Linqvist (2023). Healthcare personnel self-assessed competence and knowledge following implementation of a new guideline on maternal resuscitation in Norway. A repeated measures study. Health Science Reports. 6(1), p. 1–10. doi: 10.1002/hsr2.1035. Full text in Research Archive
• Svendsen, Edel Jannecke; Opheim, Randi; Hermansen, Bjørg Elisabeth & Hardeland, Camilla (2023). Ad hoc digital communication and assessment during clinical placements in nursing education; a qualitative research study of students', clinical instructors', and teachers' experiences. PLOS ONE. 18(7), p. 1–14. doi: 10.1371/journal.pone.0287438. Full text in Research Archive
• Fremstad, Kjell Otto; Lindenskov, Paal Helge H.; Ihle-Hansen, Hege; Jamtli, Bjørn; Kramer-Johansen, Jo & Hardeland, Camilla [Show all 8 contributors for this article] (2022). Veien inn til sykehus for pasienter innlagt ved mistanke om akutt hjerneslag. Sykepleien Forskning. ISSN 1890-2936. 17(17). doi: 10.4220/Sykepleienf.2022.89354. Full text in Research Archive Show summary

  Bakgrunn: Hjerneslag er en tidskritisk tilstand, men fremdeles ankommer under halvparten av pasientene sykehus innen fire timer fra symptomdebut. En mulig forklaring på forsinkelsen kan være at første kontakt med helsevesenet er hos legevakten eller fastlegen. Hensikt: Hensikten med denne studien var å kartlegge innleggende instans for pasienter ved mistanke om akutt hjerneslag før de kom til akuttmottaket ved Oslo universitetssykehus (OUS) på Ullevål. Vi ville også kartlegge hvorvidt innleggelsesinstans kunne korreleres til slagdiagnose ved utskrivelse. Metode: En retrospektiv observasjonsstudie identifiserte alle pasienter der mistanke om hjerneslag var innleggelsesårsaken på akuttmottaket ved Ullevål i 2018. Vi grupperte pasientene etter innleggende instans: ambulanse, legevakt, fastlege eller direkte kontakt. Vi sammenliknet utskrivelsesdiagnoser «hjerneslag» eller «ikke hjerneslag» etter innleggende instans og fordelte på alder ved å bruke kjikvadrattest. Resultat: Totalt 1399 pasienter med mistanke om hjerneslag ble innlagt, hvorav 594 (42 prosent) fikk en hjerneslagdiagnose. Medianalderen var 72 år, og 52 prosent var kvinner. Halvparten ble innlagt direkte med ambulanse, en tredel via legevakten og 12 prosent fra fastlegen. Signifikant flere pasienter av de som ble innlagt med ambulanse (51 prosent), fikk hjerneslag som utskrivelsesdiagnose sammenliknet med pasienter som kom via henholdsvis legevakt (29 prosent) eller fastlege (40 prosent) (kjikvadrat p < 0,001). Pasientene som ble innlagt med ambulanse, var signifikant eldre enn pasientene som kom via legevakten (72 år versus 65 år, p < 0,001). Konklusjon: Kun halvparten av pasientene med symptomer på mistenkt hjerneslag ble innlagt med ambulanse. Pasientene som ble innlagt direkte med ambulanse, ble oftere utskrevet med en hjerneslagdiagnose. Vi trenger mer kunnskap om årsakene til at de resterende pasientene kom via fastlegen eller legevakten.

• Hardeland, Camilla; Leonardsen, Ann-Chatrin Linqvist; Isern, Cecilie Benedicte & Berge, Hilde Moseby (2022). Experiences of cardiac arrest survivors among young exercisers in Norway: A qualitative study. Resuscitation Plus. 11. doi: 10.1016/j.resplu.2022.100293. Full text in Research Archive Show summary

  Aim: To explore how young exercisers experience surviving sudden cardiac arrest (SCA), focusing on interpretation of warning signs and experi-ences with the healthcare system. Methods: The study had a qualitative design, and data was collected using individual, semi-structured interviews. Inclusion criteria were SCA sur-vivors aged 18–50 years old who reported at least five hours of exercise/week prior to SCA, or who suffered SCA during or 60 min after exercise. Results: 18 interviews were performed (4 females), age range 19–49 years old. Analysis identified the themes [1] neglected warning signs, [2] fluc-tuating between gratitude and criticism and [3] one size does not fit all. When young exercisers experienced symptoms such as fainting, chest pain, arrythmia, shortness of breath and fatigue, these were often ignored by either the participants, healthcare personnel or both. SCA survivors were grateful to the healthcare system and for the efforts made by healthcare personnel, but experienced a mismatch between what patients needed and could utilize, and what they actually received regarding both information and individualised services. Being young exercisers, the participants reported to have individual needs, but treatment and rehabilitation were not adapted and were mainly targeted to rehabilitation of older patients. Conclusion: Patients and healthcare personnel should be aware of cardiac related symptoms and warning signs for SCA, and these should be properly assessed in the population of young exercisers. SCA survivors need useful and repeated information. The needs of SCA survivors among young exercisers require individualisation of services

• Hardeland, Camilla; Leonardsen, Ann-Chatrin Linqvist; Isern, Cecilie Benedicte & Berge, Hilde Moseby (2022). The aftermath of surviving a sudden cardiac arrest for young exercisers- a qualitative study in Norway. BMC Health Services Research. 22(1), p. 1–9. doi: 10.1186/s12913-022-08674-z. Full text in Research Archive Show summary

  Background: When surviving a sudden cardiac arrest (SCA), physical, cognitive, and emotional efects of surviving may be present for months or years. The survivors’ family and colleagues are also highly afected by the incident. There is little knowledge about experiences of surviving SCA in individuals who prior to the incident were young and reported to exercise regularly. Consequently, the aim of this study was to explore the aftermath of surviving a SCA in young, regular exercisers. Methods: The study had a qualitative design, conducting in-depth individual interviews with SCA survivors<50 years of age reporting to exercise≥5 h/week and/or who sufered SCA during or less than 60 min after exercise. The data were analysed using systematic text condensation in-line with recommendations from Malterud. Results: 18 of 31 eligible participants were included in the study. Through analysis we identifed ‘Establishing a new everyday life’ as superordinate category, with subordinate categories a) being part of my surroundings, b) expecting normality but facing a new reality and c) lucky to be alive! Conclusion: This study adds knowledge about young and regular exercisers’ experiences after surviving a SCA. The obligations of everyday life in young survivors of SCA often imply a high work load and complex tasks, e.g. due to being in the beginning of their career or even still studying. Healthcare personnel, as well as the society, need to acknowledge that although lucky to be alive and apparently well-functioning, young survivors of SCA may have per‑sistent challenges that cause frustration and reduced quality of life.

• Hardeland, Camilla; Claesson, Andreas; Blom, Marieke T; Blomberg, Stig Nikolaj Fasmer; Folke, Fredrik & Hollenberg, Jacob [Show all 14 contributors for this article] (2021). Description of call handling in emergency medical dispatch centres in Scandinavia: recognition of out-of-hospital cardiac arrests and dispatcher-assisted CPR. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. doi: 10.1186/s13049-021-00903-4. Full text in Research Archive Show summary

  Background The European resuscitation council have highlighted emergency medical dispatch centres as an important key player for early recognition of Out-of-Hospital Cardiac Arrest (OHCA) and in providing dispatcher assisted cardiopulmonary resuscitation (CPR) before arrival of emergency medical services. Early recognition is associated with increased bystander CPR and improved survival rates. The aim of this study is to describe OHCA call handling in emergency medical dispatch centres in Copenhagen (Denmark), Stockholm (Sweden) and Oslo (Norway) with focus on sensitivity of recognition of OHCA, provision of dispatcher-assisted CPR and time intervals when CPR is initiated during the emergency call (NO-CPRprior), and to describe OHCA call handling when CPR is initiated prior to the emergency call (CPRprior). Methods Baseline data of consecutive OHCA eligible for inclusion starting January 1st 2016 were collected from respective cardiac arrest registries. A template based on the Cardiac Arrest Registry to Enhance Survival definition catalogue was used to extract data from respective cardiac arrest registries and from corresponding audio files from emergency medical dispatch centres. Cases were divided in two groups: NO-CPRprior and CPRprior and data collection continued until 200 cases were collected in the NO-CPRprior-group. Results NO-CPRprior OHCA was recognised in 71% of the calls in Copenhagen, 83% in Stockholm, and 96% in Oslo. Abnormal breathing was addressed in 34, 7 and 98% of cases and CPR instructions were started in 50, 60, and 80%, respectively. Median time (mm:ss) to first chest compression was 02:35 (Copenhagen), 03:50 (Stockholm) and 02:58 (Oslo). Assessment of CPR quality was performed in 80, 74, and 74% of the cases. CPRprior comprised 71 cases in Copenhagen, 9 in Stockholm, and 38 in Oslo. Dispatchers still started CPR instructions in 41, 22, and 40% of the calls, respectively and provided quality assessment in 71, 100, and 80% in these respective instances. Conclusions We observed variations in OHCA recognition in 71–96% and dispatcher assisted-CPR were provided in 50–80% in NO-CPRprior calls. In cases where CPR was initiated prior to emergency calls, dispatchers were less likely to start CPR instructions but provided quality assessments during instructions.

• Leonardsen, Ann-Chatrin Linqvist; Svendsen, Edel Jannecke; Heitmann, Grethe Berger; Dhayyat, Adam; Morris, Ann & Sjøborg, Katrine Dønvold [Show all 8 contributors for this article] (2020). Development and validation of a questionnaire to assess Healthcare personnel competence in cardiac arrest and resuscitation in pregnancy. PLOS ONE. 15(5). doi: 10.1371/journal.pone.0232984. Full text in Research Archive Show summary

  Background Cardiac arrest is rare in pregnancy, and up-to date competence can be difficult to assess and maintain. The objective of this study was to develop and validate a questionnaire to assess healthcare personnel experiences, self-assessed competence and perception of role and resposibility related to cardiac arrest and cardio-pulmonary resuscitation (CPR) in pregnancy Methods The study had a cross-sectional design, developing and validating a questionnaire: the Competence in cardiac arrest and CPR in pregnancy (ComCA-P). Development and validation of the ComCA-P was conducted in three stages: 1) Literature review and expert group panel inputs, 2) a pilot study and 3) a cross-sectional questionnaire study. In stage one, the ComCA-P was developed over several iterations between the researchers, including inputs from an expert group panel consisting of highly competent professionals (n = 11). In stage two, the questionnaire was piloted in a group of healthcare personnel with relevant competence (n = 16). The ComCA-P was then used in a baseline study including healthcare personnel potentially involved in CPR in pregnancy (n = 527) in six hospital wards. Based on these data, internal consistency, intra-class correlations, and confirmatory factor analysis were utilized to validate the questionnaire. Results The expert group and pilot study participants evaluated the appropriateness, relevance and accuracy to be high. Formulation of the items was considered appropriate, with no difficulties identified related to content- or face validity. Cronbach’s alpha was 0.8 on the thematic area self-assessment, and 0.73 on the theoretical knowledge area of the ComCA-P. On both the self-assessed competence items and the teoretical knowledge items, Kaiser-Meyer-Olkin was 0.8. Moreover, the Bertletts’ test of sphericity was greater than the critical value for chi-square, and significant (p < .0001). Conclusions Findings indicate that the ComCA-P is a valid questionnaire that can be used to assess healthcare personnel competence in cardiac arrest and resuscitation in pregnancy.

• Leonardsen, Ann-Chatrin Linqvist; Hardeland, Camilla; Helgesen, Ann Karin & Grøndahl, Vigdis Abrahamsen (2020). Patient experiences with technology enabled care across healthcare settings- a systematic review. BMC Health Services Research. 20. doi: 10.1186/s12913-020-05633-4. Full text in Research Archive Show summary

  Background - Healthcare services are facing extensive challenges due to the increased proportion of elderly persons and persons with chronic disease. Technology enabled care (TEC) is a collective term for telecare, telehealth, telemedicine, mobile (m)-, digital- and electronic (e) health services. TEC is increasingly seen as a solution to many of the challenges facing the health sector. Patient perspectives may provide a useful evaluation tool for new healthcare technologies that have limited clinical data to support their effectiveness. More studies need to be done to better understand the acceptance of technology in healthcare. This review aim to summarize empirical studies exploring patient experiences with TEC. Findings in this study can be used to better understand what is needed to develop, implement and improve such services. Methods - Systematic searches were conducted in the Pubmed, Psycinfo, Cinahl, Embase, Cochrane systematic reviews and Cochrane clinical trials databases. These studies were systematically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, subjected to quality appraisals using the Critical Appraisal Skills Program (CASP), and synthesized via integrative analysis. Results - After removal of duplicates, languages other than English, and non-scientific records, 4087 titles and abstracts were screened. After assessment against inclusion and exclusion criteria, 69 records were screened in full-text, and underwent quality appraisal. 21 records were included in the integrative analysis. Patients’ experiences with TEC related to 1) technological features, namely functionality and appearance, and 2) evolving independence, namely empowerment, autonomy and security. Technological challenges lead to frustrations and negative experiences, while a stigmatizing appearance lead to patients not using the solution. Through the use of TECs, patients felt more empowered, learning about their condition, increasing awareness to their symptoms and treatment, and feeling more safe and self-efficient. Patient participation was seen as a central aspect of the development of the TECT, as well as when using it. Conclusion - This review deepens the understanding of patients’ experiences with technology enabled care solutions. Patients’ experiences not only relate to the practical/technical element of the device or solution, but to how this impact on their everyday life. Patient participation in development and planned use of such solutions should be considered an integral part in healthcare quality initiatives.

• Leonardsen, Ann-Chatrin Linqvist; Ramsdal, Helge Normann; Olasveengen, Theresa M.; Steen-Hansen, Jon Erik; Westmark, Fredrik & Hansen, Andreas [Show all 7 contributors for this article] (2019). Exploring individual and work organizational peculiarities of working in emergency medical communication centers in Norway- a qualitative study. BMC Health Services Research. 19(1). doi: 10.1186/s12913-019-4370-0. Full text in Research Archive Show summary

  Emergency Medical call-takers working in Emergency Medical Communication Centers (EMCCs) are addressing complex and potentially life threatening problems. The call-takers have to make fast decisions, responding to problems described in phone calls. Recent studies focus mainly on individual aspects of call-takers’ work. The objectives of this study were to explore 1) What characterizes individual work performance of call takers in EMCCs? and 2) What characterizes work organizational factors call takers see as most relevant to the performance of their work? The research is based upon in-depth interviews with call takers at three EMCCs in Norway (n = 19). Interviews were performed during the period May 2013 to September 2014. Data was analyzed using thematic analysis. Two main themes that related to individual work performance and to work organizational factors in EMCCs were identified, namely: 1) “Core technologies” and 2) “Environmental issues” . The theme “Core technologies” included the subthemes a) multiple tasks, b) critical incidents, and c) unpredictability. The theme “Environmental issues” included the subthemes a) lack of support, b) lack of resources, c) exposure to complaints, and d) an invisible service. At the individual level, multiple tasks, how to cope with critical incidents, and the unpredictability of daily work when calls are received, make the work of call takers both stressful and challenging. The individual call taker’s ability to interprete the situation by intuition and experience when calls are received, is the main factor behind the peculiarities working in the centers at the individual level. At the organizational level, the lack of resources and managerial support seems to provoke concerns about the quality of services rendered by the centers. These aspects should be taken into account in the managing of these services, making them a more integrated part of the health service system.

• Hardeland, Camilla; Skaare, Christiane; Kramer-Johansen, Jo; Birkenes, Tonje Søraas; Myklebust, Helge & Hansen, Andreas [Show all 8 contributors for this article] (2017). Targeted simulation and education to improve cardiac arrest recognition and telephone assisted CPR in an emergency medical communication centre. Resuscitation. ISSN 0300-9572. 114, p. 21–26. doi: 10.1016/j.resuscitation.2017.02.013. Full text in Research Archive
• Hardeland, Camilla; Sunde, Kjetil; Ramsdal, Helge Normann; Hebbert, Susan R.; Soilammi, Linda Christina & Westmark, Fredrik [Show all 10 contributors for this article] (2016). Factors impacting upon timely and adequate allocation of prehospital medical assistance and resources to cardiac arrest patients. Resuscitation. ISSN 0300-9572. 109, p. 56–63. doi: 10.1016/j.resuscitation.2016.09.027. Full text in Research Archive Show summary

  Aim Explore, understand and address issues that impact upon timely and adequate allocation of prehospital medical assistance and resources to out-of-hospital cardiac arrest (OHCA) patients. Methods Mixed-methods design obtaining data for one year in three emergency medical communication centres (EMCC); Oslo-Akershus (OA), Vestfold-Telemark (VT) and Østfold (Ø). Data collection included quantitative data from analysis of dispatch logs, ambulance records and audio files. Qualitative data were collected through in-depth interviews and non-participant observations. Results OA-, VT- and Ø-EMCC responded to 1095 OHCAs and 579 of these calls were included for further analysis (333, 143 and 103, respectively). There were significant site differences in their recognition of OHCA (89, 94 and 78%, respectively, p < 0.001), provision of CPR instructions (83, 83 and 61%, respectively, p < 0.001), time from call answered to initial CPR instructions (1.4 min (1.2, 1.6), 1.1 min (0,9, 1.2) and 1.3 (1.2, 1.7) respectively, p = 0.002). The most frequent reason for delayed or failed recognition of OHCA was misinterpretation of agonal breathing. Interviews and observations revealed individual differences in protocol use, interrogation strategy and assessment of breathing. Use of protocol was only part of decision making, dispatchers trusted their own clinical experience and intuition, and used assumptions about the patient and the situation as part of decision making. Conclusion Agonal breathing continues to be the main barrier to recognition of cardiac arrest. Individual differences among dispatchers’ strategies can directly impact on performance, mainly due to the wide definition of cardiac arrest and lack of uniform tools for assessment of breathing.

• Birkenes, Tonje Søraas; Myklebust, Helge; Hardeland, Camilla; Kramer-Johansen, Jo; Ong, Marcus Eng Hock & Shin, Sang Do [Show all 8 contributors for this article] (2015). HOW to train for telephone-CPR. Trends in Anaesthesia and Critical Care. ISSN 2210-8440. 5(5), p. 124–129. doi: 10.1016/j.tacc.2015.07.003. Full text in Research Archive
• Hardeland, Camilla; Olasveengen, Theresa M.; Lawrence, Rob; Garrison, Danny; Lorem, Tonje & Farstad, Gunnar [Show all 7 contributors for this article] (2014). Comparison of Medical Priority Dispatch (MPD) and Criteria Based Dispatch (CBD) relating to cardiac arrest calls. Resuscitation. ISSN 0300-9572. 85(5), p. 612–616. doi: 10.1016/j.resuscitation.2014.01.029. Full text in Research Archive Show summary

  Background: Prompt emergency medical service (EMS) system activation with rapid delivery of prehospital treatment is essential for patients suffering out-of-hospital cardiac arrest (OHCA). The two most commonly used dispatch tools are Medical Priority Dispatch (MPD) and Criteria Based Dispatch (CBD). We compared cardiac arrest call processing using these two dispatch tools in two different dispatch centres. Methods: Observational study of adult EMS confirmed (non-EMS witnessed) OHCA calls during one year in Richmond, USA (MPD) and Oslo, Norway (CBD). Patients receiving CPR prior to call, interrupted calls or calls where the caller did not have access to the patients were excluded from analysis. Dispatch logs, ambulance records and digitalized dispatcher and caller voice recordings were compared. Results: The MPDS-site processed 182 cardiac arrest calls and the CBD-site 232, of which 100 and 140 calls met the inclusion criteria, respectively. The recognition of cardiac arrest was not different in the MPD and CBD systems; 82% vs. 77% (p = 0.42), and pre-EMS arrival CPR instructions were offered to 81% vs. 74% (p = 0.22) of callers, respectively. Time to ambulance dispatch was median (95% confidence interval) 15 (13, 17) vs. 33 (29, 36) seconds (p < 0.001) and time to chest compression delivery; 4.3 (3.7, 4.9) vs. 3.7 (3.0, 4.1) min for the MPD and CBD systems, respectively (p = 0.05). Conclusion: Pre-arrival CPR instructions were offered faster and more frequently in the CBD system, but in both systems chest compressions were delayed 3–4 min. Earlier recognition of cardiac arrest and improved CPR instructions may facilitate earlier lay rescuer CPR.

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• Hardeland, Camilla (2025). Gjenkjenning av hjertestans på 113 i Norge. doi: https:/www.helse-stavanger.no/fag-og-forskning/kompetansetjenester/rakos/rakos-pa-resuscitation-academy-i-danmark/. Full text in Research Archive
• Leonardsen, Ann-Chatrin Linqvist; Hogstedt, Åsa; Lundgren, Peter & Hardeland, Camilla (2025). Norge og Sverige bruker ulike beslutningsstøtteverktøy i kommunehelsetjenesten. Sykepleien.no. doi: 10.4220/Sykepleiens.2025.98564. Full text in Research Archive
• Leonardsen, Ann-Chatrin Linqvist; Hardeland, Camilla & Magnusson, Lars Vidar (2024). Kunstig intelligens og beslutningsstøtte i helsetjenesten. dagensmedisin.no. Full text in Research Archive
• Jamtli, Bjørn; Hardeland, Camilla; Kramer-Johansen, Jo & Hov, Maren Ranhoff (2024). Hjerneslag - en utfordring for AMK. Full text in Research Archive
• Guterud, Mona; Bugge, Helge Fagerheim; Sandset, Else Charlotte; Hardeland, Camilla; Svendsen, Edel Jannecke & Hov, Maren Ranhoff (2023). BRIDGING THE GAP BETWEEN PRE-AND IN-HOSPITAL SERVICES IN THE STROKE CARE PATHWAY DURING A CLUSTER RANDOMISED TRIAL: A QUALITATVE THEMATIC ANALYSIS. European Stroke Journal. ISSN 2396-9873. 8(2), p. 424–425. doi: 10.1177/2396987323116966. Full text in Research Archive
• Jamtli, Bjørn; Hov, Maren Ranhoff; Jørgensen, Trine Møgster; Kramer-Johansen, Jo; Ihle-Hansen, Hege & Sandset, Else Charlotte [Show all 7 contributors for this article] (2023). Emergency medical communication center assessment of suspected and verified stroke patients. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 31(1). doi: 10.1186/s13049-023-01100-1. Full text in Research Archive
• Kristiansen, Nina & Hardeland, Camilla (2022). Hvor nyttig er egentlig helseforskning? [Internet]. Forskning.no. Full text in Research Archive
• Grøndahl, Vigdis Abrahamsen; Busso, Lilliana Andrea Del; Hardeland, Camilla; Løkkeberg, Stine Eileen Torp; Bååth, Carina Barbro & Femdal, Ingrid [Show all 7 contributors for this article] (2022). MoU og samarbeid mellom Høgskolen i Østfold og Högskolan i Skövde. [Internet]. Högskolan i Skövdes nettside. Full text in Research Archive
• Halstensen, Thor-David; Ghanima, Waleed; Tavoly, Mazdak; Hardeland, Camilla & Grøndahl, Vigdis Abrahamsen (2022). Forbedre beslutningsstøtteverktøy. Dyp venetrombose. Full text in Research Archive
• Leonardsen, Ann-Chatrin Linqvist; Hardeland, Camilla; Helgesen, Ann Karin & Grøndahl, Vigdis Abrahamsen (2021). Hva synes pasientene om helseteknologien? Sykepleien. ISSN 0039-7628. doi: 10.4220/Sykepleiens.2021.83172. Full text in Research Archive
• Svendsen, Edel Jannecke; Leonardsen, Ann-Chatrin Linqvist; Heitmann, Grethe; Dhayyat, Adam; Morris, Ann & Sjøborg, Kathrine [Show all 8 contributors for this article] (2019). Health care providers self-assessed competence about cardiac arrest in pregnancy. Resuscitation. ISSN 0300-9572. doi: 10.1016/j.resuscitation.2019.06.163. Full text in Research Archive
• Olasveengen, Theresa M. & Hardeland, Camilla (2019). Man vs. machine? The future of emergency medical dispatching. Resuscitation. ISSN 0300-9572. 138, p. 304–305. doi: 10.1016/j.resuscitation.2019.03.005. Full text in Research Archive
• Hardeland, Camilla (2019). Telefon-HLR. AMK’s håndtering av hjertestans utenfor sykehus. Full text in Research Archive
• Ekman, Stina; Fladeby, Nina; Johansen, Ingunn; Hardeland, Camilla & Leonardsen, Ann-Chatrin Linqvist (2019). Hvordan kan sykepleierstudenter få det bedre i praksis? Tidsskriftet sykepleien. ISSN 0806-7511. doi: 10.4220/Sykepleiens.2019.74902. Full text in Research Archive
• Hardeland, Camilla (2019). Dead patients breathing? Presence of agonal breathing in cardiac arrest. Full text in Research Archive
• Hardeland, Camilla; Claesson, Andreas; Blomberg, Stig Nikolaj Fasmer; Folke, Fredrik; Hollenberg, Jacob & Kramer-Johansen, Jo [Show all 13 contributors for this article] (2019). Differences in out-of-hospital cardiac arrest emergency dispatch recognition and dispatcher assisted cpr instructions – a Scandinavian multicentre study. Resuscitation. ISSN 0300-9572. Full text in Research Archive
• Hardeland, Camilla (2018). Forskning på AMK - en oppsummering. Full text in Research Archive
• Hardeland, Camilla (2018). Hjertestansbehandling i AMK. Full text in Research Archive
• Hardeland, Camilla (2018). Hjertestans: Selv om pasienten puster, kan du starte hjerte-lungeredning! Full text in Research Archive
• Hardeland, Camilla (2018). When time counts - Emergency Medical Dispatch. Full text in Research Archive
• Tjelmeland, Ingvild; Hardeland, Camilla; Mydske-Earl, Kristine; Bakkelund, Karin Elvenes; Johnsen, Knut Roar & Skogvoll, Eirik [Show all 7 contributors for this article] (2018). How to find all out-of-hospital cardiac arrests (OHCA) that fill the inclusion criteria in the Norwegian cardiac arrest registry. Resuscitation. ISSN 0300-9572. 130, p. e17–e17. doi: 10.1016/j.resuscitation.2018.07.340. Full text in Research Archive
• Hardeland, Camilla; Soilammi, Linda Christina; Skaare, Christiane; Kramer-Johansen, Jo; Birkenes, Tonje & Myklebust, Helge [Show all 8 contributors for this article] (2015). Targeted Simulation and Education to Improve Cardiac Arrest Recognition and Telephone Cpr in an Emergency Medical Dispatch Centre. Circulation. ISSN 0009-7322. 132. Full text in Research Archive
• Hardeland, Camilla; Soilammi, Linda Christina; Hansen, Andreas Ernst & Olasveengen, Theresa Mariero (2014). Delayed Recognition of Cardiac Arrest in Emergency Medical Dispatch - Best Source of Key Information for System Improvement? Circulation. ISSN 0009-7322. 130. Full text in Research Archive
• Hardeland, Camilla; Olasveengen, Theresa Mariero; Lawrence, Rob; Garrison, Danny; Lorem, Tonje & Farstad, Gunnar [Show all 7 contributors for this article] (2013). Comparison of Medical Priority Dispatch (MPD) and Criteria Based Dispatch (CBD) when Processing Cardiac Arrest Calls. Circulation. ISSN 0009-7322. 128. Full text in Research Archive
• Hardeland, Camilla (2018). When time counts: Emergency medical dispatch. Exploring, understanding and addressing issues that impact upon timely and adequate allocation of prehospital medical assistance and resources to cardiac arrest patients. Universitetet i Oslo. Full text in Research Archive Show summary

  When an out-of-hospital cardiac arrest (OHCA) occurs, patient outcome can be influenced by bystanders ability to start cardiopulmonary resuscitation (CPR) before ambulance arrival. Recognition of cardiac arrest and provision of telephone-assisted CPR (T-CPR) by emergency medical dispatchers (EMDs) are key process measures that have been associated with improved survival after OHCA. The aims of this thesis were to provide a comprehensive description and analysis of factors impacting on EMDs when handling cardiac arrest calls. Voice logs of actual cardiac arrest calls in four different emergency medical communication centres (EMCC) were analysed and compared and EMDs were interviewed and observed. A bundle of targeted interventions were performed and evaluated in one EMCC. All included EMCCs faced similar challenges with agonal breathing as the main barrier to recognition of cardiac arrest. Few differences were observed when comparing two commonly used dispatch tools in use in Norway (Criteria Based Dispatch -CBD) and USA (Medical Priority Dispatch-MPD), but T-CPR were offered faster and more frequently in the CBD system. Some variations in performance standards were seen when comparing three different EMCCs in Norway, despite similar organisation, professional backgrounds and dispatch tool/protocols. A mixed-methods approach is effective to explore the challenges regarding OHCA calls in an EMCC, and revealed both use and non-use of protocols, inaccuracy of definition of cardiac arrest and differences in interrogation strategies, in particular concerning assessment of breathing. Monitoring key quality indicators helped identify the challenges to the system, and enabled development of effective strategies to improve quality of care. Targeted simulation, education and feedback significantly increased recognition of OHCA, delivery of T-CPR and reduced time to first chest compression.

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