Introduction: Suicide is a leading cause of death globally and represents a common, resource-intensive duty for police patrol officers (PPOs). Responding to suicidal crises is often traumatic, and PPOs rarely receive comprehensive training, leaving them inadequately prepared. Police authorities frequently assume operational responsibility in such situations, encompassing emotional, legal, tactical and safety considerations.

Aim: This study aimed to explore and describe the competencies required of PPOs when encountering individuals in suicidal crisis.

Method: An exploratory, descriptive design was employed using a modified Delphi technique. Descriptions provided by PPOs of encounters with individuals in suicidal crisis were used to inform the development of items for a two-round questionnaire distributed to an expert panel. Experts were defined as individuals employed by the Swedish Police Authority or a university college, with additional training and/or teaching experience related to managing suicidal crises.

Results: Of the 50 experts invited, 43 completed both rounds, yielding a response rate of 86%. Consensus was achieved on 50 items, categorised into knowledge (n = 14), skills (n = 22) and attitudes (n = 14).

Conclusion: The findings highlight the wide-ranging competencies required of PPOs, including policing-specific skills related to safety, interpersonal communication and psychiatric knowledge such as understanding mental disorders. Attitudinal competencies, such as demonstrating compassion and adopting a problem-solving approach, were also emphasised.

Background: Ambulance clinicians regularly encounter medical, caring, existential and ethical challenges. Meeting patients with complex medical presentations underscore the need for holistic decision-making and actions as ambulance clinicians struggle to strike a balance between addressing medical and caring needs.

Aim: This study aimed to explore action alternatives considered and discussed during ethics case reflections in response to care-related challenges in ambulance services.

Research design: A qualitative descriptive study design was applied. Data were analyzed using conventional and summative content analysis.

Participants and research context: Ethics case reflections were performed with 14 groups comprising a total of 78 ambulance clinicians. Prior to the reflections, a video depicting the encounter between two ambulance clinicians and an older patient and his spouse was viewed.

Ethical considerations: The principles of the Declaration of Helsinki were applied throughout the research process, and an advisory statement was obtained from the Swedish Ethical Review Authority (No. 2019-02127 and 2021-03490).

Findings: The ethics case reflections generated a variety and breadth of action alternatives to manage challenges in caring, suggesting that this format is suitable for discussing ethical issues in clinical cases that depart from standard medical emergencies. Furthermore, the breadth of the results reveals the wide professional discretion afforded to ambulance clinicians and suggest the presence of tacit competences embedded in professional practice.

Conclusions: Ethics case reflection has a potential to enhance ambulance clinicians’ ethical decision-making by deepening reflections about patient autonomy as well as highlighting the potential for a caring approach and promoting holistic care. By generating a breadth of specific action alternatives, many possible ways forward even in situations with complex care-related challenges are illustrated. Further investigation regarding the role of ethics case reflections to articulate implicit attitudes and tacit competencies is warranted.

The purpose of both precision medicine and precision nursing is to improve patient outcomes. This theoretical article is designed as a conceptual and position paper situated within caring science, with a specific focus on understanding precision nursing across diverse clinical contexts. Rather than presenting empirical findings, the paper synthesizes theoretical perspectives, caring science foundations, and selected scholarly literature. In this position paper, we seek to expand the concept of precision nursing from a caring science perspective with clinical examples, vignettes, from an emergency care context. Precision medicine can be viewed as an effort to truly individualize a treatment and make it as accurate and effective as possible. While the focus on measurable outcomes saves lives, it also carries the risk of narrowing attention to what can be observed and quantified. These visible clinical markers represent only part of what matters in care. To get the full picture of a patient and their treatment, caring must serve as the foundation for precision nursing, as it is caring that ensures that technological advancements remain aligned with individual patient needs. Precision medicine and precision nursing may offer direction, but to provide meaning to the concepts, a grounding in caring science is provided in this study.

Background: Persons living with dementia (PLWD) are at an increased risk of going missing, with an elevated risk of harm. In Sweden, thousands of PLWD go missing annually, and the police are responsible for locating them. However, there is limited knowledge about the key factors that contribute to effective search efforts. Therefore, this study aimed to identify these key factors as expressed by police experts.

Method: Using the Delphi technique, this exploratory study sought consensus among 43 Swedish police search experts over three rounds. The consensus was set at ≥70%.

Results: Of the initial 73 items described by individual police experts, 53 reached consensus among the expert group. Five categories were identified: Information, Search Management, Search Tactics, Knowledge, and Collaboration.

Discussion/conclusion: Limited situational awareness and lack of structure can hamper police search efforts when PLWD go missing. Knowing the person, critical partners, and the terrain all enhance search effectiveness.

Background: Ambulance clinicians increasingly refer patients to self-care, positioning ambulance service within a wider gatekeeping role and necessitating the assessment of whether self-care is a safe option or if further support is needed. Contrary to primary healthcare centre (PHC) referrals, self-care referrals often lack structured follow-ups, with the decision consequences remaining underexplored. This study investigates the outcomes and predictors of subsequent healthcare contact (SHC) and mortality among patients referred to self-care by ambulance services in three Swedish regions.

Methods: This retrospective cohort study included 6,452 (954 children and 5,498 adults) ambulance assignments between 1 January 2023 and 31 December 31 2023 that resulted in self-care referrals. The primary outcome was SHC (PHC visits, ambulance service recontact, emergency department visits, and hospitalisations) and all-cause mortality within 72 h and 30 days. Bayesian multilevel logistic regression models were used to estimate the probability of recontact and mortality.

Results: Approximately 30% and 25% of the adults and children sought SHC, respectively, with the majority being PHC visits. Mortality was < 2% within 30 days, and no deaths were observed among the children. Respiratory, infectious, and medical symptoms predominated among the children, compared with medical, surgical, and neurological symptoms among adults. Predictors of SHC included increased age, longer on-scene time, advisory decision support system (ADSS) use, and distance to hospital.

Conclusion: Approximately one-third (30%) of patients sought SHC within 72 h of a self-care referral decision. Whilst this does not necessarily indicate adverse events, the lack follow-up and patient-reported data limits interpretation. Although the ADSS have the potential to reduce ED conveyance, they cannot replace nuanced clinical judgment, risking inequitable care for patients in rural areas, those with low health literacy, and frail older adults. Non‑conveyance decisions for patients aged 80 years or older should therefore be approached with heightened caution. Future research should explore patient perspectives to better understand re-engagement and improve the safety of self-care referrals.

Introduction Making decisions about the appropriate level of care is a significant challenge for healthcare professionals, especially when older patients present with diffuse symptoms. Collaboration between ambulance services and primary care may promote a comprehensive understanding of patient needs. However, such collaboration remains limited, potentially leading to lower care quality and higher costs. There is a need to understand how collaboration can be effectively implemented. This scoping review aims to explore existing models of collaboration between ambulance services and primary care, identifying their characteristics, outcomes and current research gaps.

Methods and analysis This scoping review will follow the methodological framework proposed by Arksey and O’Malley, supplemented with recommendations from the Joanna Briggs Institute Handbook for Scoping Reviews. A comprehensive literature search will be conducted in PubMed, CINAHL, Web of Science and Scopus. In addition, Google Scholar, Overton, SwePub and the Swedish national library database Libris will be searched for relevant grey literature. The review will include studies published from January 2014 to the present. Data will be analysed descriptively, with findings categorised by collaboration models and patterns identified through inductive analysis to address the research questions. The review will apply the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews to present the results.

Ethics and dissemination This review is the first stage of an overarching research study to develop a model for extended collaboration between ambulance services and primary care (the ECAP project). Results will be disseminated through peer-reviewed publications, conference presentations and sharing with ambulance services and primary care stakeholders to inform practice and policy. This scoping review protocol has been registered on the Open Science Framework (https://osf.io/nrkm5/). No participants will be involved at this stage, and the selected literature is publicly available, so no ethical approval will be required for this scoping review.

Background: Shared decision-­ making aims to ensure that healthcare professionals and patients jointly make decisions regarding the patient's care. However, professionals often find it challenging to implement shared decision-­ making with older patients who have cognitive impairments or diminished decision-­making capacity. Research indicates a significant gap in the understanding of how decision-­ making processes unfold in prehospital settings.

Aim: The objective of this scoping review was to explore how decision-­making involving older patients in acute prehospital situations is characterized.

Design and Method: This scoping review is based on the Joanna Briggs Institute's guidelines for scoping reviews and is reportedusing the Preferred Reporting Items for Systematic Reviews and Meta-­Analyses extension for Scoping Review (PRISMA-­ScR).

Data Sources: CINAHL, PubMed, Scopus, PsychINFO and Web of Science were searched to identify relevant studies published between the years 2000 and 2024.

Results: The results are based on 26 studies and indicate that decision-­making among older patients is a conditional process,characterised by collaborative support involving the patient, significant others and healthcare professionals. Barriers to this process include hierarchical dynamics, fear of reprisals and uncertainty regarding the risk–benefit ratio. Factors that support decision-­making include situationally relevant competence, organisational resources and the presence of specific symptoms and signs.

Conclusion: Shared decision-­making with older patients in acute prehospital settings is conditional, often resulting in decisions being made primarily by healthcare professionals. There is considerable room for improvement in how this process is systematically approached. A structured approach is needed—one that assesses the older patient's decision-­ making capacity, considers the perspectives of family members, and incorporates input from individuals who know the patient well, all while minimizing hierarchical barriers.

Background The number of persons living with dementia is increasing globally, including in Sweden, and these persons are at heightened risk of going missing and coming to harm. When they do go missing, the police get involved. There is a dearth of knowledge surrounding the prevalence and outcomes of harm in these instances in many countries, including Sweden, which affects our understanding of the associated risks and necessary interventions. Therefore, the aim of this study was to describe incidents of missing people and explore factors associated with harm in persons living with dementia as reported to the Swedish Police.

Methods Data on background characteristics, the missing incidents, and police response was collected from a nationwide police registry. The missing incidents were analysed using descriptive statistics and logistic regression was used to explore factors associated with harm.

Results A total of 1,041 missing person case reports concerning persons living with dementia were identified. In 61 (6%) of these reports, the missing person was harmed. The level of harm varied from lacerations to death. Male sex, no prior missing incidents, cold season, time since last contact, delayed reporting, and prolonged duration of police search effort were significantly associated with an increased probability of harm.

Conclusions Persons living with dementia constituted a substantial proportion of all missing persons case reports submitted to the Swedish Police during the study period. Persons living with dementia were also at considerable risk of harm when missing, as even minor injuries can lead to substantial consequences. Furthermore, time was a critical factor, emerging as the strongest predictor of harm in the study. This calls for the development of collaborative routines between the police and professional caregivers caring for persons living with dementia.