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Hasebrook JP, Michalak L, Kohnen D, Metelmann B, Metelmann C, Brinkrolf P, Flessa S, Hahnenkamp K. Digital transition in rural emergency medicine: Impact of job satisfaction and workload on communication and technology acceptance. PLoS One 2023; 18:e0280956. [PMID: 36693080 PMCID: PMC9873191 DOI: 10.1371/journal.pone.0280956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 01/11/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Tele-emergency physicians (TEPs) take an increasingly important role in the need-oriented provision of emergency patient care. To improve emergency medicine in rural areas, we set up the project 'Rural|Rescue', which uses TEPs to restructure professional rescue services using information and communication technologies (ICTs) in order to reduce the therapy-free interval. Successful implementation of ICTs relies on user acceptance and knowledge sharing behavior. METHOD We conducted a factorial design with active knowledge transfer and technology acceptance as a function of work satisfaction (high vs. low), workload (high vs. low) and point in time (prior to vs. after digitalization). Data were collected via machine readable questionnaires issued to 755 persons (411 pre, 344 post), of which 304 or 40.3% of these persons responded (194 pre, 115 post). RESULTS Technology acceptance was higher after the implementation of TEP for nurses but not for other professions, and it was higher when the workload was high. Regarding active communication and knowledge sharing, employees with low work satisfaction are more likely to share their digital knowledge as compared to employees with high work satisfaction. This is an effect of previous knowledge concerning digitalization: After implementing the new technology, work satisfaction increased for the more experienced employees, but not for the less experienced ones. CONCLUSION Our research illustrates that employees' workload has an impact on the intention of using digital applications. The higher the workload, the more people are willing to use TEPs. Regarding active knowledge sharing, we see that employees with low work satisfaction are more likely to share their digital knowledge compared to employees with high work satisfaction. This might be attributed to the Dunning-Kruger effect. Highly knowledgeable employees initially feel uncertain about the change, which translates into temporarily lower work satisfaction. They feel the urge to fill even small knowledge gaps, which in return leads to higher work satisfaction. Those responsible need to acknowledge that digital change affects their employees' workflow and work satisfaction. During such times, employees need time and support to gather information and knowledge in order to cope with digitally changed tasks.
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Zwischen Notfall und Fehleinsatz – eine retrospektive Analyse der Einsätze eines Notarzteinsatzfahrzeugs in Frankfurt am Main von 2014 bis 2019. Notf Rett Med 2022. [DOI: 10.1007/s10049-022-01097-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Zusammenfassung
Hintergrund
Ein steigendes Einsatzaufkommen lässt sich sowohl im Rettungsdienst als auch im notärztlichen System in Deutschland verzeichnen. Oft werden dabei Fehleinsätze durch leicht erkrankte/verletzte Patienten als wachsende Problematik vermutet. Die vorliegende Untersuchung überprüft die Hypothese von steigenden Einsatzzahlen mit gleichzeitiger Zunahme von gegebenenfalls nichtindizierten Einsätzen.
Material und Methoden
Es erfolgte eine retrospektive Analyse der notärztlichen Einsätze des an der Universitätsklinik Frankfurt am Main stationierten Notarzteinsatzfahrzeugs von 2014 bis 2019. Die Analyse berücksichtigt zudem Faktoren wie die notärztliche Tätigkeit, Behandlungspriorität, Alarmierungsart und das Patientenalter.
Ergebnisse
Im beobachteten Zeitraum lässt sich ein Anstieg der notärztlichen Einsatzzahlen um mehr als 20 % erkennen. Der größte Anstieg zeigt sich bei Einsätzen, bei denen keine notärztliche Tätigkeit (+80 %) notwendig war. Einsätze der niedrigsten Behandlungspriorität (+61 %) sowie der höchsten Behandlungspriorität (+61 %) nahmen ebenfalls signifikant zu.
Diskussion
Die vorliegenden Zahlen stützen die Hypothese, dass bei signifikant gesteigertem Einsatzaufkommen mehr Einsätze durch den Notarzt bewältigt werden müssen, bei denen er rückblickend nicht notwendig gewesen wäre. Trotzdem gibt es auch mehr Patienten, die einen sofortigen Arztkontakt benötigen. Die hieraus resultierende erhöhte Einsatzfrequenz kann zu einer erhöhten Belastung sowie erschwerten zeitgerechten Disposition der notärztlichen Ressource führen.
Graphic abstract
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Piedmont S, Reinhold AK, Bock JO, Rothhardt J, Swart E, Robra BP. Apart from the Medical Complaints, Why do Patients Use Emergency Medical Services? Results of a Patient Survey. DAS GESUNDHEITSWESEN 2022; 84:638-646. [PMID: 34847591 PMCID: PMC11248664 DOI: 10.1055/a-1657-9676] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Many countries face an increased use of emergency medical services (EMS) with a decreasing percentage of life-threatening complaints. Though there is a broad discussion among experts about the cause, patients' self-perceived, non-medical reasons for using EMS remain largely unknown. METHODS The written survey included EMS patients who had≥1 case of prehospital emergency care in 2016. Four German health insurance companies sent out postal questionnaires to 1312 insured patients. The response rate was 20%; 254 questionnaires were eligible for descriptive and interferential analyses (t-tests, chi2-tests, logistic models). RESULTS The majority of respondents indicated that their EMS use was due to an emergency or someone else's decision (≥84%; multiple checks allowed); 56% gave need for a quick transport as a reason. Other frequently stated reasons addressed the health care system (e. g., complaints outside of physicians' opening hours) and insecurity/anxiety about one's state of health (>45% of the respondents). "Social factors" were similarly important (e. g., 42% affirming, "No one could give me a ride to the emergency department or doctor's office."). Every fifth person had contact with other emergency care providers prior to EMS use. Respondents negating an emergency as a reason were less likely to confirm wanting immediate medical care on site or quick transports compared to those affirming an emergency. Patients using EMS at night more often denied having an emergency compared to patients with access to care during the day. CONCLUSION The study identified a bundle of reasons leading to EMS use apart from medical complaints. Attempts for needs-oriented EMS use should essentially include optimization of the health care and social support system and measures to reduce patients' insecurity.
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Affiliation(s)
- Silke Piedmont
- Institut für Sozialmedizin und Gesundheitssystemforschung, Otto von Guericke Universitat Magdeburg, Magdeburg, Deutschland
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - Anna Katharina Reinhold
- Universitätsklinik für Unfallchirurgie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
- Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | | | - Janett Rothhardt
- Institut für Sozialmedizin und Gesundheitssystemforschung, Otto von Guericke Universitat Magdeburg, Magdeburg, Deutschland
| | - Enno Swart
- Institut für Sozialmedizin und Gesundheitssystemforschung, Otto von Guericke Universitat Magdeburg, Magdeburg, Deutschland
| | - Bernt-Peter Robra
- Institut für Sozialmedizin und Gesundheitssystemforschung, Otto von Guericke Universitat Magdeburg, Magdeburg, Deutschland
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Which health-related reasons lead to prehospital emergency care and how does subjective emergency status connect to subsequent care? Notf Rett Med 2021. [DOI: 10.1007/s10049-020-00832-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
Objectives/Background
In many countries, the use of emergency medical services (EMS) increases steadily each year. At the same time, the percentage of life-threatening complaints decreases. To redesign the system, an assessment and consideration of the patients’ perspectives is helpful.
Methods
We conducted a paper-based survey of German EMS patients who had at least one case of prehospital emergency care in 2016. Four health insurance companies sent out the questionnaire to 1312 insured persons. We linked the self-reported data of 254 respondents to corresponding claims data provided by their health insurance companies. The analysis focuses a.) how strongly patients tend to call EMS for themselves and others given different health-related scenarios, b.) self-perceived health complaints in their own index case of prehospital emergency care and c.) subjective emergency status in combination with so-called “objective” characteristics of subsequent EMS and inpatient care. We report principal diagnoses of (1) respondents, (2) 57,240 EMS users who are not part of the survey and (3) all 20,063,689 inpatients in German hospitals. Diagnoses for group 1 and 2 only cover the inpatient stay that started on the day of the last EMS use in 2016.
Results
According to the survey, the threshold to call an ambulance is lower for someone else than for oneself. In 89% of all cases during their own EMS use, a third party called the ambulance. The most common, self-reported complaints were pain (38%), problems with heart and circulation (32%), and loss of consciousness (17%). The majority of respondents indicated that their EMS use was due to an emergency (89%). We could detect no or only weak associations between patients’ subjective urgency and different items for objective care.
Conclusion
Dispatchers can possibly optimize or reduce the disposition of EMS staff and vehicles if they spoke directly to the patients more often. Nonetheless, there is need for further research on how strongly the patients’ perceived urgency may affect the disposition, rapidness of the service and transport targets.
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Michael M, Al Agha S, Böhm L, Bosse HM, Pohle AN, Schürmann J, Hannappel O, Tengg E, Weiß C, Bernhard M. Alters- und geschlechtsbezogene Verteilung von Zuführung, Ersteinschätzung, Entlassart und Verweildauer in der zentralen Notaufnahme. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00895-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Zusammenfassung
Einleitung
Jährlich stellen sich bundesweit zahlreiche Patienten in zentralen Notaufnahmen vor. Ziel der vorliegenden Untersuchung war es, alters- und geschlechtsabhängig Zuführung, Ersteinschätzung, Entlassart und Verweildauer an einem universitären Standort zu analysieren.
Material und Methodik
In dieser retrospektiven Studie wurden alle Patientenkontakte der zentralen Notaufnahme des Universitätsklinikums Düsseldorf des Jahres 2019 erfasst und anhand der Prozesskriterien Zuführung, Ersteinschätzung, Entlassart und Verweildauer kategorisiert und deren Verteilung untersucht.
Ergebnisse
Vom 01.01. bis 31.12.2019 wurden insgesamt 43.821 Patientenkontakte erfasst. Das durchschnittliche Alter der Patienten betrug 47 ± 24 Jahre (Median: 47, Min.–Max.: 0–106). Der Anteil weiblicher Patienten betrug 48 %. Ein Alter ≤ 17 Jahren wiesen 10 % der Patienten (♀ vs. ♂: 4 vs. 6 %, p < 0,0001) und ein Alter ≥ 70 Jahre 24 % auf (♀ vs. ♂: 13 vs. 11 %, p < 0,0001). Für beide Geschlechter nahm der Anteil der Triagekategorien „blau“ und „grün“ über die aufsteigenden Altersgruppen stetig ab. Ab der Altersgruppe der 50- bis 59-Jährigen lag für beide Geschlechter führend eine höhere Dringlichkeit („gelb“ bis „rot“) vor. Während im Alter ≤ 17 Jahren mit 84–90 % vorwiegend eine ambulante Behandlung erfolgte, reduzierte sich dieser Anteil über die weiteren Altersgruppen bis auf 22 % bei Männern und 28 % bei Frauen in der Altersgruppe der ≥ 90-Jährigen. Für die drei Entlassarten „ambulant“, „prästationär“ und „stationär“ stieg die Verweildauer bei beiden Geschlechtern mit dem Alter kontinuierlich an.
Schlussfolgerung
Es finden sich deutliche und vor allem altersabhängige Unterschiede in den Prozesskriterien Zuführung, Ersteinschätzung, Entlassart und Verweildauer. Rund 15 % der Patienten sind kritisch krank oder verletzt („orange“ und „rot“). Mit steigendem Alter nimmt der Anteil dieser Triagekategorien zu. Bei rund 30 % der Patienten besteht eine stationäre Aufnahmeindikation, entsprechende Bettenkapazitäten müssen täglich eingeplant werden.
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Abstract
Zusammenfassung
Hintergrund
Die Berichterstattung aus einzelnen Bundesländern zeigt über viele Jahre kontinuierlich steigende Einsatzzahlen im bodengebundenen Rettungsdienst.
Fragestellung
Ziel der Arbeit ist es aufzuzeigen, wie stark sich die Einsatzzahlen und das Einsatzspektrum im Rettungsdienst in den letzten Jahren entwickelt haben.
Material und Methode
Die Arbeit führt nach Literaturrecherche geeignete Publikationen synoptisch zusammen, um einen umfassenden Überblick der aktuellen Erkenntnisse zu geben.
Ergebnisse
Vollerhebungen der Einsatzzahlen einzelner Bundesländer sowie Hochrechnungen der Rettungsdiensteinsätze auf Bundesebene zeigen jährliche Zuwachsraten von etwa 5 %. Zudem belegen einzelne Untersuchungen vor allem einen Anstieg nichttraumatologischer Einsatzgründe. Sowohl die Einsatzzunahme als auch die Änderung im Einsatzspektrum können, neben weiteren Einflussfaktoren, u. a. auf den demografischen Wandel zurückgeführt werden.
Schlussfolgerungen
Um dem Anstieg und der Änderung der Inanspruchnahme zu begegnen, erscheint neben der Ausweitung bestehender Angebote der Notfallversorgung die Etablierung alternativer Ansätze (z. B. Telenotarzt) zielführend. Begleitend sollte eine umfassende Datenerfassung und -auswertung erfolgen, um im Rahmen des Qualitätsmanagements ein kontinuierliches Nachsteuern des Systems zu erlauben.
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Metelmann C, Metelmann B, Kohnen D, Prasser C, Süss R, Kuntosch J, Scheer D, Laslo T, Fischer L, Hasebrook J, Flessa S, Hahnenkamp K, Brinkrolf P. Evaluation of a Rural Emergency Medical Service Project in Germany: Protocol for a Multimethod and Multiperspective Longitudinal Analysis. JMIR Res Protoc 2020; 9:e14358. [PMID: 32130193 PMCID: PMC7055856 DOI: 10.2196/14358] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/10/2019] [Accepted: 09/24/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND German emergency medical services are a 2-tiered system with paramedic-staffed ambulances as the primary response, supported by prehospital emergency doctors for life-threatening conditions. As in all European health care systems, German medical practitioners are in short supply, whereas the demand for timely emergency medical care is constantly growing. In rural areas, this has led to critical delays in the provision of emergency medical care. In particular, in cases of cardiac arrest, time is of the essence because, with each passing minute, the chance of survival with good neurological outcome decreases. OBJECTIVE The project has 4 main objectives: (1) reduce the therapy-free interval through widespread reinforcement of resuscitation skills and motivating the public to provide help (ie, bystander cardiopulmonary resuscitation), (2) provide faster professional first aid in addition to rescue services through alerting trained first aiders by mobile phone, (3) make more emergency physicians available more quickly through introducing the tele-emergency physician system, and (4) enhance emergency care through improving the cooperation between statutory health insurance on-call medical services (German: Kassenärztlicher Bereitschaftsdienst) and emergency medical services. METHODS We will evaluate project implementation in a tripartite prospective and intervention study. First, in medical evaluation, we will assess the influences of various project measures on quality of care using multiple methods. Second, the economic evaluation will mainly focus on the valuation of inputs and outcomes of the different measures while considering various relevant indicators. Third, as part of the work and organizational analysis, we will assess important work- and occupational-related parameters, as well as network and regional indexes. RESULTS We started the project in 2017 and will complete enrollment in 2020. We finished the preanalysis phase in September 2018. CONCLUSIONS Overall, implementation of the project will entail realigning emergency medicine in rural areas and enhancing the quality of medical emergency care in the long term. We expect the project to lead to a measurable increase in medical laypersons' individual motivation to provide resuscitation, to strengthen resuscitation skills, and to result in medical laypersons providing first aid much more frequently. Furthermore, we intend the project to decrease the therapy-free interval in cases of cardiac arrest by dispatching first aiders via mobile phones. Previous projects in urban regions have shown that the tele-emergency physician system can provide a higher availability and quality of emergency call-outs in regular health care. We expect a closer interrelation of emergency practices of statutory health insurance physicians with the rescue service to lead to better coordination of rescue and on-call services. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/14358.
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Affiliation(s)
- Camilla Metelmann
- Clinic for Anaesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Bibiana Metelmann
- Clinic for Anaesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Dorothea Kohnen
- zeb.business school, Steinbeis University Berlin, Münster, Germany
| | - Clara Prasser
- Chair of General Business Administration and Health Management, University of Greifswald, Greifswald, Germany
| | - Rebekka Süss
- Chair of General Business Administration and Health Management, University of Greifswald, Greifswald, Germany
| | - Julia Kuntosch
- Chair of General Business Administration and Health Management, University of Greifswald, Greifswald, Germany
| | - Dirk Scheer
- District of Vorpommern-Greifswald, Greifswald, Germany
| | - Timm Laslo
- Communal Rescue Services, District of Vorpommern-Greifswald, Greifswald, Germany
| | - Lutz Fischer
- Communal Rescue Services, District of Vorpommern-Greifswald, Greifswald, Germany
| | | | - Steffen Flessa
- Chair of General Business Administration and Health Management, University of Greifswald, Greifswald, Germany
| | - Klaus Hahnenkamp
- Clinic for Anaesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Peter Brinkrolf
- Clinic for Anaesthesiology, University Medicine Greifswald, Greifswald, Germany
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Kreutziger J, Hornung S, Harrer C, Urschl W, Doppler R, Voelckel WG, Trimmel H. Comparing the McGrath Mac Video Laryngoscope and Direct Laryngoscopy for Prehospital Emergency Intubation in Air Rescue Patients: A Multicenter, Randomized, Controlled Trial. Crit Care Med 2019; 47:1362-1370. [PMID: 31389835 PMCID: PMC6791500 DOI: 10.1097/ccm.0000000000003918] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Tracheal intubation in prehospital emergency care is challenging. The McGrath Mac Video Laryngoscope (Medtronic, Minneapolis, MN) has been proven to be a reliable alternative for in-hospital airway management. This trial compared the McGrath Mac Video Laryngoscope and direct laryngoscopy for the prehospital setting. DESIGN Multicenter, prospective, randomized, controlled equivalence trial. SETTING Oesterreichischer Automobil- und Touring Club (OEAMTC) Helicopter Emergency Medical Service in Austria, 18-month study period. PATIENTS Five-hundred fourteen adult emergency patients (≥ 18 yr old). INTERVENTIONS Helicopter Emergency Medical Service physicians followed the institutional algorithm, comprising a maximum of two tracheal intubation attempts with each device, followed by supraglottic, then surgical airway access in case of tracheal intubation failure. No restrictions were given for tracheal intubation indication. MEASUREMENTS MAIN RESULTS The Primary outcome was the rate of successful tracheal intubation; equivalence range was ± 6.5% of success rates. Secondary outcomes were the number of attempts to successful tracheal intubation, time to glottis passage and first end-tidal CO2 measurement, degree of glottis visualization, and number of problems. The success rate for the two devices was equivalent: direct laryngoscopy 98.5% (254/258), McGrath Mac Video Laryngoscope 98.1% (251/256) (difference, 0.4%; 99% CI, -2.58 to 3.39). There was no statistically significant difference with regard to tracheal intubation times, number of attempts or difficulty. The view to the glottis was significantly better, but the number of technical problems was increased with the McGrath Mac Video Laryngoscope. After a failed first tracheal intubation attempt, immediate switching of the device was significantly more successful than after the second attempt (90.5% vs 57.1%; p = 0.0003), regardless of the method. CONCLUSIONS Both devices are equivalently well suited for use in prehospital emergency tracheal intubation of adult patients. Switching the device following a failed first tracheal intubation attempt was more successful than a second attempt with the same device.
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Affiliation(s)
- Janett Kreutziger
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Sonja Hornung
- Department of Anesthesiology, Emergency and Critical Care Medicine, Wiener Neustadt General Hospital, Wiener Neustadt, Austria
- Karl Landsteiner Institute of Emergency Medicine, Wiener Neustadt General Hospital, Wiener Neustadt, Austria
- OEAMTC Air Rescue, Vienna, Austria
| | | | | | | | - Wolfgang G Voelckel
- OEAMTC Air Rescue, Vienna, Austria
- Department of Anesthesiology and Critical Care Medicine, AUVA Trauma Center, Dr.-Franz-Rehrl-Platz 5, Salzburg, Austria
- Paracelsus Medical University Salzburg, Salzburg, Austria
- Network for Medical Science, University of Stavanger, Stavanger, Norway
| | - Helmut Trimmel
- Department of Anesthesiology, Emergency and Critical Care Medicine, Wiener Neustadt General Hospital, Wiener Neustadt, Austria
- Karl Landsteiner Institute of Emergency Medicine, Wiener Neustadt General Hospital, Wiener Neustadt, Austria
- OEAMTC Air Rescue, Vienna, Austria
- Medical University of Vienna, Vienna, Austria
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Hanefeld C, Haschemi A, Lampert T, Trampisch HJ, Mügge A, Miebach J, Kloppe C, Klaaßen-Mielke R. Social Gradients in Myocardial Infarction and Stroke Diagnoses in Emergency Medicine. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:41-48. [PMID: 29467072 DOI: 10.3238/arztebl.2018.0041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 07/31/2017] [Accepted: 10/23/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Persons of lower socio-economic status are at higher risk of disease, especially with respect to severe and chronic illnesses. To date, there have not been any studies with large case numbers regarding acute medical emergencies in this population. METHODS In a retrospective study, data were obtained on all cases treated by emergency physicians in Bochum, Germany, in 2014/2015, including the diagnoses that were made by the emergency physicians. There were a total of 16 767 cases. The local unemployment rate was taken as an indicator of the socioeconomic situation of a neighborhood; it was defined as the percentage of registered unemployed persons among persons aged 15 to 64 with their domicile in the neighborhood. 12 168 cases were grouped by emergency medical diagnosis and analyzed with respect to the three most heavily represented diagnostic categories (cardiovascular, neurological, and pulmonary emergencies), which accounted for nearly two-thirds of all diagnoses. RESULTS The overall rates of deployment involving emergency physicians were found to be positively correlated with the unemployment rate. After adjustment for age, sex, and possible confounders, this correlation was statistically significant (p<0.01). The indirectly standardized rate ratio (IRR) for the overall case-activity rate ranged from 0.841 (95% confidence interval: [0.808; 0.875]) with less than 5% unemployment to 1.212 [1.168; 1.256] with 9.5% unemployment or higher. The same finding was obtained with respect to diagnosis-specific case activity in each of the three main diagnostic categories (cardiovascular, neurological, and pulmonary emergencies), as well as for the respective commonest individual diagnoses (acute coronary syndrome/circulatory arrest [1498 cases], transient ischemic attack/ischemic stroke/intracerebral hemorrhage [1274 cases], and asthma/chronic obstructive pulmonary disease [663 cases]). CONCLUSION This study shows that the case-activity rate of the emergency medical services is significantly higher in socially disadvantaged neighborhoods, both with respect to total numbers and with respect to individual diseases. It demonstrates a problem affecting society as a whole, which should be taken into account in the organization of medical rescue services.
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Affiliation(s)
- Christoph Hanefeld
- Department of Medicine III, St. Josef and St. Elisabeth Hospital, Bochum; Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin; Department of Medical Informatics, Biometrics and Epidemiology, University of Bochum; Department of Medicine II - Cardiology, St. Josef Hospital, Bochum University Hospitals
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Warnecke T, Dobbermann M, Becker T, Bernhard M, Hinkelbein J. [Performance of prehospital emergency anesthesia and airway management : An online survey]. Anaesthesist 2018; 67:654-663. [PMID: 29959500 DOI: 10.1007/s00101-018-0466-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/11/2018] [Accepted: 06/13/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND The goal of rapid sequence induction (RSI) in cases of emergency situations is to secure the airway as quickly as possible to prevent pulmonary aspiration of gastric contents; however, the technique itself is not standardized. For example, the choice of drugs, application of cricoid pressure and the patient position remain controversial. A survey of emergency medical services (EMS) physicians throughout Germany was carried out to assess the different RSI techniques used and with respect to complying with the national guidelines for emergency airway management anesthesia and local standard operating procedures (SOP). MATERIAL AND METHODS Between 1 April 2017 and 31 May 2017, EMS medical directors in Germany were contacted and asked to distribute a 28-question online questionnaire to local EMS physicians. Of the questions 26 were multiple choice and 2 with plain text. After 6 weeks an e‑mail reminder was sent. In addition, the survey was distributed via social media to EMS physicians. RESULTS In total the survey was opened 2314 times and 1074 completed responses were received (completion rate 46%). Most of the participants were male (78%) and anesthesiologists (70%) and only one quarter had a local SOP for RSI. The most frequently used muscle relaxant was succinylcholine (62%) and over half of the participants reported using cricoid pressure (57%). There was a distinction between the specialist disciplines in the selection of drugs. Propofol was used most by anesthesiologists, while the others still used etomidate on a larger scale. Nearly 100% could fall back on supraglottic devices (one third laryngeal mask, two thirds laryngeal tube) but only 32.8% with the recommended esophageal drainage. A video laryngoscope was available to 51% of all EMS physicians surveyed. CONCLUSION The results of the survey demonstrate heterogeneity in RSI techniques used by EMS physicians in Germany. Medical equipment and safe care practices, such as labeling of syringes varied considerably between different service areas. The recommendations of the S1 national guidelines on emergency airway management and anesthesia should be adhered to together with the implementation of local SOPs.
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Affiliation(s)
- T Warnecke
- Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, Evangelisches Klinikum Niederrhein, Fahrner Straße 133, 47169, Duisburg, Deutschland.
| | - M Dobbermann
- Klinik für Anästhesie, Operative Intensiv- und Palliativmedizin, Städtisches Klinikum Solingen gGmbH, Akademisches Lehrkrankenhaus der Universität zu Köln, Solingen, Deutschland
| | - T Becker
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
| | - M Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland.,Arbeitsgruppe "Trauma- und Schockraummanagement" des Arbeitskreises Notfallmedizin der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin, Nürnberg, Deutschland
| | - J Hinkelbein
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln (AöR), Köln, Deutschland
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Gries A, Bernhard M, Helm M, Brokmann J, Gräsner JT. [Future of emergency medicine in Germany 2.0]. Anaesthesist 2018; 66:307-317. [PMID: 28424835 DOI: 10.1007/s00101-017-0308-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In 2003 an article on the future of prehospital emergency medicine in Germany was published in the journal Der Anaesthesist. Emergency medicine in Germany, which at that time was almost exclusively defined as prehospital emergency rescue, has evolved and now in-hospital domains have increasingly moved into the focus. At that time, the primary goal was to connect prehospital management with a smooth transition to hospital admission and further care in the hospital and to further optimize the rescue chain from the actual emergency through to causative treatment. Now after 15 years, the authors have critically assessed the development postulated in 2003 and reevaluated it. Which aspects could be developed further and become firmly established, what is still open and which questions in preclinical and clinical emergency treatment of the population will occupy us in the coming 15 years? With a critical eye to the past, the present contribution aims to capture the essential and new topics and open questions and provide a fresh perspective for the future of emergency medicine. Regulation at the state level or even lower levels of government often stand in contrast to more sweeping and economically effective approaches at the federal level. Prehospital emergency medicine in Germany is on the whole well-positioned with respect to facilities and personnel; however, as far as the economic situation and the utilization of available systems are concerned, there is still substantial room for improvement.
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Affiliation(s)
- A Gries
- Zentrale Notaufnahme, Universitätsklinikum Leipzig, Leipzig, Deutschland.
| | - M Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - M Helm
- Abt X, Anästhesie und Intensivmedizin, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - J Brokmann
- Zentrale Notaufnahme, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - J-T Gräsner
- Institut für Rettungs- und Notfallmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
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[Development of ground-based physician-staffed emergency missions in the city of Leipzig from 2003 to 2013]. Anaesthesist 2017; 67:177-187. [PMID: 29230501 DOI: 10.1007/s00101-017-0393-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 10/10/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The annual number of physician-based emergency missions reported is continuously increasing. Data from large cities concerning this development over long periods is sparse. MATERIAL AND METHODS In this retrospective study the charts of all ground-based physician-staffed emergency missions in the city of Leipzig for the first quarters of 2003 and 2013 were analyzed. Patient characteristics, injury and illness severities, mission location, hospital admission rate, as well as emergency interventions were collated. The emergency mission rate was calculated as rescue missions per 1000 inhabitants per year. RESULTS The number of physician-staffed emergency missions increased by approximately 24% between 2003 and 2013 (6030 vs. 7470, respectively). The emergency mission rate was 48 vs. 58 in the 2 study periods. The median patient age increased from 66 to 70 years. The number of geriatric patients (age ≥ 85 years: n = 650 (11%) vs. n = 1161 (16%), p < 0.01) also increased. The corresponding number of emergency missions in nursing homes showed a fourfold (n = 175, 3% vs. n = 750, 10%, p < 0.01). The percentage of hospital admissions also increased (n = 3049, 51% vs. n = 4738, 66%, p < 0.01). A change in patient distribution to level I hospitals was noticed (n = 1742, 29% vs. n = 3436, 46%, p < 0.01). CONCLUSION The findings suggest that the necessity for the high number of physician-staffed emergency missions should be verified, especially in the context of strained emergency healthcare resources. The basis of an optimized use of resources could be a better inclusion of alternative, especially ambulant, healthcare structures and the implementation of a structured emergency call questionnaire accompanied by a more efficient disposition of the operating resources, not least in view of the economic aspects. Taking the concentrated patient allocation to level 1 hospitals into consideration, there is a need for optimized patient distribution strategies to minimize the overload of individual institutions and thereby improve the general quality of care at the interface between preclinical and clinical emergency medicine.
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Häske D, Beckers SK, Hofmann M, Lefering R, Gliwitzky B, Wölfl CC, Grützner P, Stöckle U, Dieroff M, Münzberg M. Quality of Documentation as a Surrogate Marker for Awareness and Training Effectiveness of PHTLS-Courses. Part of the Prospective Longitudinal Mixed-Methods EPPTC-Trial. PLoS One 2017; 12:e0170004. [PMID: 28107394 PMCID: PMC5249224 DOI: 10.1371/journal.pone.0170004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 12/25/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Care for severely injured patients requires multidisciplinary teamwork. A decrease in the number of accident victims ultimately affects the routine and skills. PHTLS ("Pre-Hospital Trauma Life Support") courses are established two-day courses for medical and non-medical rescue service personnel, aimed at improving the pre-hospital care of trauma patients worldwide. The study aims the examination of the quality of documentation before and after PHTLS courses as a surrogate endpoint of training effectiveness and awareness. METHODS This was a prospective pre-post intervention trial and was part of the mixed-method longitudinal EPPTC (Effect of Paramedic Training on Pre-Hospital Trauma Care) study, evaluating subjective and objective changes among participants and real patient care, as a result of PHTLS courses. The courses provide an overview of the SAMPLE approach for interrogation of anamnestic information, which is believed to be responsible for patient safety as relevant, among others, "Allergies," "Medication," and "Patient History" (AMP). The focus of the course is not the documentation. RESULTS In total, 320 protocols were analyzed before and after the training. The PHTLS course led to a significant increase (p < 0.001) in the "AMP" information in the documentation. The subgroups analysis of "allergies" (+47.2%), "drugs" (+38.1%), and "medical history" (+27.8%) before and after the PHTLS course showed a significant increase in the information content. CONCLUSION In summary, we showed that PHTLS training improves documentation quality, which we used as a surrogate endpoint for learning effectiveness and awareness. In this regard, we demonstrated that participants use certain parts of training in real life, thereby suggesting that the learning methods of PHTLS training are effective. These results, however, do not indicate whether patient care has changed.
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Affiliation(s)
- David Häske
- Faculty of Medicine, Eberhard Karls University Tübingen, Tuebingen, Germany
| | - Stefan K. Beckers
- Department of Anesthesiology, University Hospital RWTH, Aachen, Aachen, Germany
- Emergency Medical Service, Fire Department, City of Aachen, Aachen, Germany
| | | | - Rolf Lefering
- Institute for Research in Operative Medicine, University of Witten/Herdecke, Cologne, Germany
| | | | - Christoph C. Wölfl
- Department of Orthopedics, Trauma Surgery and Sports Traumatology, Hospital Hetzelstift, Neustadt, Germany
| | - Paul Grützner
- Department of Trauma and Orthopedic Surgery, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany
| | - Ulrich Stöckle
- Department of Traumatology and Reconstructive Surgery, BG Hospital Tuebingen, Tuebingen, Germany
| | - Marc Dieroff
- Fire Service, Emergency Preparedness and Crisis Management, City of Wiesbaden, Wiesbaden, Germany
| | - Matthias Münzberg
- Department of Trauma and Orthopedic Surgery, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany
- * E-mail:
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Marung H, Höhn M, Gräsner JT, Adler J, Schlechtriemen T. NASIM 25 – eine Option zur Verbesserung der Ausbildung von Notärzten. Notf Rett Med 2016. [DOI: 10.1007/s10049-016-0204-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Taubenböck S, Lederer W, Kaufmann M, Kroesen G. HEMS in Alpine Rescue for Pediatric Emergencies. Wilderness Environ Med 2016; 27:409-14. [PMID: 27377920 DOI: 10.1016/j.wem.2016.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 03/11/2016] [Accepted: 03/12/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objective of this study was to describe the pediatric emergencies encountered by the Christophorus-1 helicopter emergency medical service (HEMS) during a period of 2 years. METHODS Emergency treatment of pediatric casualties by HEMS was evaluated at a helicopter base. Children up to 14 years who were treated by HEMS emergency physicians from Christophorus-1 during primary missions in the alpine region were retrospectively enrolled. RESULTS Of the 1314 HEMS operations conducted during a 2-year investigation period, pediatric emergencies accounted for 114 (8.7%). Trauma was the most common emergency indication (91.3%) in alpine areas, and 77.5% of the indications were related to skiing and snowboarding; 11.3% of the prehospital pediatric emergencies were classified as life-threatening. Interventions on site were rendered in 46.3% of cases. Mean and SD intervals for approach were 11.0 ± 3.0 minutes; for treatment, 14.0 ± 6.0 minutes; and for transport, 8.0 ± 4.0 minutes. Intervals on site were significantly longer whenever it was necessary to search for an interim landing place (P < .001) or perform rope extrication (P < .001). Aggravating environmental conditions such as low temperature (78.8%), rocky terrain (18.8%), or precipitation (12.5%) were common. CONCLUSIONS Rapid procedures are preferred to sustained on-scene treatment, particularly when surrounding conditions are hostile. HEMS emergency physicians attempt to keep on-site intervals short and treatment and monitoring to the essential to minimize delay in rescue.
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Affiliation(s)
- Stefan Taubenböck
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Wolfgang Lederer
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria.
| | - Marc Kaufmann
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Gunnar Kroesen
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
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Armbruster W, Kubulus D, Schlechtriemen T, Adler J, Höhn M, Schmidt D, Duchêne S, Steiner P, Volk T, Wrobel M. [Improvement of emergency physician education through simulator training. Consideration on the basis of the model project "NASimSaar25"]. Anaesthesist 2015; 63:691-6. [PMID: 25056410 DOI: 10.1007/s00101-014-2353-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prehospital emergency medicine is a challenge for trainee emergency physicians. Rare injuries and diseases as well as patients in extreme age groups can unexpectedly face emergency physicians. In the regulations on medical education the German Medical Association requires participation in 50 emergency missions under the supervision of an experienced emergency physician. This needs to be improved because on-the-job training does not generally represent the whole spectrum of emergency medicine and a good and structured training under on call conditions is nearly impossible. AIM The subject of the model project described was whether practical training for emergency physicians can be achieved by participation in simulation training instead of real emergency situations. MATERIAL AND METHODS After modification of the Saarland regulations on medical education it was possible to replace up to 25 participations in emergency missions by simulation training. The concept of the course NASimSaar25 requires participants to complete 25 simulator cases in 3 days in small training groups. Emergency situations from all medical disciplines need to be treated. A special focus is on the treatment of life-threatening and rare diseases and injuries. Modern simulators and actors are used. The debriefings are conducted by experienced tutors based on approved principles. Medical contents, learning targets from the field of crew resource management (CRM) and soft skills are discussed in these debriefings. RESULTS Education in the field of emergency medicine can be improved by simulator-based learning and training. However, practical work under a tutor in real and clinical experience cannot be completely replaced by simulation. Simulator training can only be successful if theoretical knowledge has already been acquired. CONCLUSION A simulator-based course concept can result in an improvement of emergency medical education. The model project NASimSaar25 was well received by the target audience and mostly very well evaluated in terms of learning and reality. If this project becomes established the demand on simulation-based training will increase. The training should achieve a consistent standard of quality.
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Affiliation(s)
- W Armbruster
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikums des Saarlandes, Gebäude 57, Kirrberger Str., 66421, Homburg/Saar, Deutschland,
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Einsatzspektrum eines Rettungshubschraubers. Anaesthesist 2014; 63:932-41. [DOI: 10.1007/s00101-014-2380-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/19/2014] [Accepted: 08/19/2014] [Indexed: 10/24/2022]
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Gries A, Lenz W, Stahl P, Spiess R, Luiz T. [On-scene times for helicopter services. Influence of central dispatch center strategy]. Anaesthesist 2014; 63:555-62. [PMID: 24962365 DOI: 10.1007/s00101-014-2340-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 04/17/2014] [Accepted: 04/27/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Previous studies have suggested that when using several emergency systems and air rescue prehospital and on-scene times are extended, depending on the dispatch strategy. Emergency medical services (EMS) in Germany are delivered by ambulances (AMB) staffed by paramedics alone or with physicians (EMD) and by helicopter emergency medical services (HEMS) always staffed by both. The advantages of HEMS in countries with short transport distances and high hospital density are controversial. The best dispatching strategy for HEMS has not been determined OBJECTIVE The BoLuS study in the German state of Hessen was designed to evaluate the influence of dispatch strategy on prehospital times for responses involving both HEMS and EMS. METHODS Rescue responses involving HEMS were prospectively evaluated in 12 regions of Hessen from July 2010 to September 2011. Although all regions had access to HEMS, only one had its own service. Data from both central dispatch centers and helicopter services were collected and combined to calculate the on-scene time (OST) and correlate it with dispatch strategy. RESULTS A total of 2111 emergency interventions were evaluated. Internal medicine emergencies accounted for 42.9 % of cases and trauma for 36.7 %. Just one patient was involved in 87.9 % of rescues. Two services were involved in 65.3 % of rescues and three or more in 31.5 %. The most common dispatch categories were initial dispatch of EMS and HEMS (50.6 %), initial dispatch of EMS with later request for HEMS (19.7 %) and initial dispatch of both EMS and EMD with later request for HEMS (17.4 %). The OST for these categories were 31.0 ± 13.7 min, 43.7 ± 16.2 min and 54.6 ± 21.3 min (p < 0.01), respectively. CONCLUSION OST varies significantly depending on the number of EMS involved and the dispatch strategy. Sequential dispatching of ground and later HEMS wastes time. Getting an emergency physician to the scene as quickly as possible, reducing transport time to an appropriate hospital and caring for more complex emergencies are the main indications for HEMS. If HEMS appears likely to be needed, it should be dispatched immediately.
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Affiliation(s)
- A Gries
- Zentrale Notaufnahme/Notaufnahmestation, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland,
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[Intraosseous infusion in the German Air Rescue Service : Guideline recommendations versus mission reality]. Anaesthesist 2013; 62:981-7. [PMID: 24201560 DOI: 10.1007/s00101-013-2262-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 10/15/2013] [Accepted: 10/16/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND In emergency medicine intraosseous access (IOA) has been established as an alternative to conventional intravenous access. Originally the use of IOA was strictly limited to children up to 6 years of age and to adults for cardiopulmonary resuscitation. These limitations have been relaxed and the indications for IOA have been expanded. MATERIAL AND METHODS A retrospective nationwide analysis of rescue missions by all helicopter emergency medical services of the German Automobile Club (ADAC) Air Rescue Service as well as the German Air Rescue (DRF) over a 7-year period was carried out. RESULTS A total of 466,813 patients were treated during the study period and an IOA was established in 1,498 (0.32 %) patients. There was a significant increase in using an IOA from 0.1-0.5 % (p < 0.05) from 2005 to 2011. Furthermore, there was an increase in using an IOA in elderly patients and in patients with lower degrees of severity according to the National Advisory Committee for Aeronautics (NACA) scales (2005-2011): decreased use of IOA in patients up to 6 years of age from 92.4 % to 19.7 % (p < 0.05) and in patients with NACA grades VII/VI from 74.4 % to 46.6 % (p < 0.05) and temporarily limited increase of non-indicated IOA use in patients with NACA grade III between 2008 and 2010. Furthermore, there was an increase in the number of the different drug groups used for intraosseous infusion over the study period. CONCLUSION The current guidelines and recommendations for the use of IOA in the prehospital setting are reflected more and more in mission reality for helicopter emergency medical services.
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[Use of intraosseus infusion in the German air rescue service : nationwide analysis in the time period 2005 to 2009]. Anaesthesist 2011; 60:1119-25. [PMID: 21881928 DOI: 10.1007/s00101-011-1937-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 08/03/2011] [Accepted: 08/10/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Intraosseous infusion has become established as a fast and safe alternative to conventional vascular access in emergency situations. Originally the use of intraosseous access was limited to children up to 6 years of age and to adults for cardiopulmonary resuscitation but this limitation has now been removed. The aim of this study was to obtain data on mission reality regarding the use of intraosseous access in the prehospital setting against the background of the expanded recommendations on the use of the intraosseous infusion. METHODS An analysis of rescue missions by all rescue helicopters of the ADAC (German Automobile Club) Air Rescue as well as the German Air Rescue Service (58 helicopter emergency medical service bases) over a 4 year period from January 2005 to December 2008 was carried out. RESULTS A total of 247,454 rescue missions were carried out during the study period and in 525 patients (0.2% of the total study collective) an intraosseous access was established. There was a significant increase in the intraosseous infusion rate from 0.1% to 0.4% (p<0.05). Furthermore, there was a significant increase in its use in elderly patients and in patients with lower National Advisory Committee for Aeronautics (NACA) scores (2005 vs. 2008): 92.4% vs. 42.9% of all intraosseous infusions in patients ≤ 6 years of age (p<0.05) and 74.4% vs. 42.9% of all intraosseous infusions in patients with NACA score VI/VII (p<0.05). The proportion of trauma patients in the total study collective was 33% and there was no significant change in the frequency of trauma cases over the study period but there was a remarkable increase of intraosseous infusions in trauma patients in the last year of the study period compared to the previous years (38% in 2008 vs. 27-30% in 2005-2007). Furthermore, there was an increase in the number of different drug groups used for intraosseous infusion over the study period. CONCLUSIONS The expanded indication recommendations for the use of intraosseous infusion in the prehospital setting enter more and more mission reality in air rescue services in Germany.
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Bernhard M, Helm M, Luiz T, Biehn G, Kumpch M, Hainer C, Meyburg J, Gries A. Pädiatrische Notfälle in der prähospitalen Notfallmedizin. Notf Rett Med 2010. [DOI: 10.1007/s10049-010-1402-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Messelken M, Kehrberger E, Dirks B, Fischer M. The quality of emergency medical care in baden-württemberg (Germany): four years in focus. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:523-30. [PMID: 20737058 DOI: 10.3238/arztebl.2010.0523] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 12/28/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND In 2004, the German federal state of Baden-Württemberg implemented a quality management system for pre-hospital emergency care. Since then, there has been a semi-annual assessment of the frequency of different types of emergency medical interventions and the quality of care. METHODS The frequencies of different types of intervention were determined and reported both in absolute numbers and as incidence figures, i.e., interventions per 1000 inhabitants per year. The quality of care was rated with the Mainz Emergency Evaluation Score (MEES), and analyses of resuscitation outcomes and guideline implementation were performed. RESULTS From 2004 to 2008, there were a total of 524,833 pre-hospital emergency medical interventions in Baden-Württemberg. The annual incidence of emergency interventions rose by 22% over this period (from 16.2 to 19.9 interventions per 1000 inhabitants per year), and the percentage of patients who were severely ill or severely injured rose as well, from 47.3% to 51.1%. The percentage of patients over age 75 rose from 29.1% to 31.3%. 11,858 patients with myocardial infarction (MI) were treated in 2008; the incidence of treatment for MI rose by 60% from 2004 to 2008, from 0.907 to 1.448 interventions per 1000 inhabitants per year. A major improvement in the diagnostic evaluation of MI came about through the purchase of more 12-channel ECG machines. In 2008, the emergency medical teams succeeded in improving the patient's condition in 69.07% of all cases (77.9% for MI, 63.2% for stroke, 74.4% for multiple trauma). 21 patients per 100,000 inhabitants per year arrived in the hospital alive after out-of-hospital cardiac arrest and pre-hospital resuscitation. CONCLUSIONS Even in the face of increasing utilization, the quality of emergency medical care in Baden-Württemberg has remained high. Since a quality management system was introduced in 2004, the physicians in charge of emergency medical teams have had access to the data that they need in order to evaluate and further develop the services that they provide.
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Affiliation(s)
- Martin Messelken
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Kliniken des Landkreis Göppingen gGmbH - Klinik am Eichert, 73035 Göppingen, Germany.
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Helm M, Biehn G, Lampl L, Bernhard M. Pädiatrischer Notfallpatient im Luftrettungsdienst. Anaesthesist 2010; 59:896-903. [DOI: 10.1007/s00101-010-1759-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 05/31/2010] [Accepted: 06/01/2010] [Indexed: 11/24/2022]
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[Emergency medical treatment of palliative care patients at the end of life: regulatory emergency medical care framework--a case control investigation of medical intervention and advance directives]. Anaesthesist 2010; 58:1097-106. [PMID: 19890614 DOI: 10.1007/s00101-009-1627-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The treatment of out-of-hospital palliative emergency care situations during cardiac arrest is a special situation. The prehospital emergency physician (EP) and the paramedic must be informed about the medical, legal, and ethical specifics of these situations, but this knowledge is not integrated within emergency medical curricula at all. We present a case study to discuss such legal and ethical specifics. METHODS We retrospectively analysed six emergency cases with palliative care patients in the final stages of their illnesses. On the basis of these case studies, we present six different emergency cases with different regulatory frameworks for each EP and paramedic. In accordance with the Declaration of Helsinki, data were collected pseudonymously. RESULTS The six case studies show therapeutic concepts concerning the emergency medical care of palliative care patients during cardiac arrest. The differences are apparent in the treatment given by EPs and by paramedics (such as whether to start or stop resuscitation). EPs and paramedics differ in their therapeutic approach to these specific situations (e.g. paramedics more often start resuscitation during cardiac arrest even though patients would refuse this according to their advance directives). These differences may be important for the patient and his or her caregivers. CONCLUSIONS Every EP and paramedic may be involved in the care of palliative care patients who are at the end of their lives. EPs and paramedics do not always adapt their treatment to the will or supposed will of the patient (especially in accordance with the new German law concerning advance directives). The reasons for this usually concern legal uncertainties. Therefore, EPs and paramedics should know that different legal meanings could be important in emergency medical care therapy of palliative care patients. A written "do not resuscitate" order as an advance directive must be evaluated as a desired therapeutic limitation.
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Meyburg J, Bernhard M, Hoffmann GF, Motsch J. Principles of pediatric emergency care. DEUTSCHES ARZTEBLATT INTERNATIONAL 2009; 106:739-47; quiz 748. [PMID: 19997587 PMCID: PMC2788902 DOI: 10.3238/arztebl.2009.0739] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 09/17/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Children account for only a small percentage of pre-hospital emergency patients but are a special challenge for the treating physician. METHODS The Medline database was selectively searched for articles appearing up to June 2009. The authors added other important literature of which they were aware. RESULTS The broad spectrum of diseases, the wide age range with the physiological and anatomical changes that occur in it, and the special psychological, emotional, and communicative features of children make pediatric emergencies a special challenge for emergency physicians. CONCLUSIONS A mastery of basic emergency techniques including clinical evaluation of the child, establishment of venous access, airway management, resuscitation, and drug dosing is essential for the successful emergency treatment of children. We recommend classifying the common non-traumatic pediatric emergencies by four cardinal manifestations: respiratory distress, altered consciousness, seizure, and shock. Classifying these rare emergency situations in this way helps assure that their treatment will be goal-oriented and appropriate to the special needs of sick children.
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Affiliation(s)
- Jochen Meyburg
- Abteilung Allgemeine Pädiatrie, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Heidelberg, Germany.
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Prähospitale geburtshilfliche Notfälle in einem bodengebundenen städtischen Notarztsystem. Anaesthesist 2009; 58:353-61. [DOI: 10.1007/s00101-009-1510-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Knapp J, Bernhard M, Hainer C, Sikinger M, Brenner T, Schlechtriemen T, Gries A. Besteht ein Zusammenhang zwischen der Einschätzung der Vitalgefährdung und der notfallmedizinischen Erfahrung des Notarztes? Anaesthesist 2008; 57:1069-74. [DOI: 10.1007/s00101-008-1454-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- J Knapp
- Sektion Notfallmedizin, Klinik für Anaesthesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Deutschland.
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