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Pijl M, Op den Buijs J, Landgraf A. Evaluating the Impact of a Risk Assessment System With Tailored Interventions in Germany: Protocol for a Prospective Study With Matched Controls. JMIR Res Protoc 2020; 9:e17584. [PMID: 33001038 PMCID: PMC7563626 DOI: 10.2196/17584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 05/01/2020] [Accepted: 05/19/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND With a worldwide increase in the elderly population, and an associated increase in health care utilization and costs, preventing avoidable emergency department visits and hospitalizations is becoming a global priority. A personal emergency response system (PERS), consisting of an alarm button and a means to establish a live connection to a response center, can help the elderly live at home longer independently. Individual risk assessment through predictive modeling can help indicate what PERS subscribers are at elevated risk of hospital transport so that early intervention becomes possible. OBJECTIVE The aim is to evaluate whether the combination of risk scores determined through predictive modeling and targeted interventions offered by a case manager can result in a reduction of hospital admissions and health care costs for a population of German PERS subscribers. The primary outcome of the study is the difference between the number of hospitalizations in the intervention and matched control groups. METHODS As part of the Sicher Zuhause program, an intervention group of 500 PERS subscribers will be tracked for 8 months. During this period, risk scores will be determined daily by a predictive model of hospital transport, and at-risk participants may receive phone calls from a case manager who assesses the health status of the participant and recommends interventions. The health care utilization of the intervention group will be compared to a group of matched controls, retrospectively drawn from a population of PERS subscribers who receive no interventions. RESULTS Differences in health care utilization and costs between the intervention group and the matched controls will be determined based on reimbursement records. In addition, qualitative data will be collected on the participants' satisfaction with the Sicher Zuhause program and utilization of the interventions offered as part of the program. CONCLUSIONS The study evaluation will offer insight into whether a combination of predictive analytics and case manager-driven interventions can help in avoiding hospital admissions and health care costs for PERS subscribers in Germany living at home independently. In the future, this may lead to improved quality of life and reduced medical costs for the population of the study. TRIAL REGISTRATION Deutsches Register Klinischer Studien (DRKS), DRKS00017328; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017328. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/17584.
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Affiliation(s)
- Marten Pijl
- Collaborative Care Solutions Department, Philips Research, Eindhoven, Netherlands
| | - Jorn Op den Buijs
- Collaborative Care Solutions Department, Philips Research, Eindhoven, Netherlands
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Bürger A, Wnent J, Bohn A, Jantzen T, Brenner S, Lefering R, Seewald S, Gräsner JT, Fischer M. The Effect of Ambulance Response Time on Survival Following Out-of-Hospital Cardiac Arrest. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:541-548. [PMID: 30189973 DOI: 10.3238/arztebl.2018.0541] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 12/30/2017] [Accepted: 05/22/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Out of hospital cardiac arrest (OHCA) is one of the more common causes of death in Germany. Ambulance response time is an important planning parameter for emergency medical services (EMS) systems. We studied the effect of ambulance response time on survival after resuscitation from OHCA. METHODS We analyzed data from the German Resuscitation Registry for the years 2010-2016. First, we used a multivariate logistic regression analysis to determine the effect of ambulance response time (defined as the interval from the alarm to the arrival of the first rescue vehicle) on the hospital-discharge rate (in percent), depending on various factors, including resuscitation by bystanders. Second, we compared faster and slower EMS systems (defined as those arriving on the scene within 8 minutes in more than 75% of cases or in ≤ 75% of cases) with respect to the frequency of resuscitation and the number of surviving patients. RESULTS Our analysis of data from a total of 10 853 patients in the logistical regression model revealed that the rate of hospital discharge was significantly affected by the ambulance response time, bystander resuscitation, past medical history, age, witnessed vs. unwitnessed collapse, the initial heart rhythm, and the site of the collapse. The success of resuscitation was inversely related to the ambulance response time; thus, among patients who did not receive bystander resuscitation, the discharge rate declined from 12.9% at a mean response time of 1 minute and 10 seconds to 6.4% at a mean response time of 9 minutes and 47 seconds. Twelve faster EMS systems and 13 slower ones were identified, with a total of 9669 and 7865 resuscitated patients, respectively. The faster EMS systems initiated resuscitation more frequently and also had a higher discharge rate with good neurological outcome in proportion to the population of the catchment area (7.7 versus 5.6 persons per 100 000 population per year, odds ratio [OR] 0.72, 95% confidence interval [0.66; 0.79], p<0.001). CONCLUSION Rapid ambulance response is associated with a higher rate of survival from OHCA with good neurological outcome. The response time, independently of whether bystander resuscitation measures are provided, ha^ a significant independent effect on the survival rate. In drawing conclusions from these findings, one should bear in mind that this was a retrospective registry study, with the corresponding limitations.
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Affiliation(s)
- Andreas Bürger
- * These two authors share first authorship; Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Klinik am Eichert, ALB FILS Kliniken, Göppingen; Institute for Emergency Medicine and Department of Anesthesiology and Intensive Care Medicine, Kiel Campus, University Hospital Schleswig-Holstein; City of Münster, Fire Department; Intensive Care Transport Mecklenburg-Vorpommern, German Red Cross Parchim; Department of Anesthesiology, Carl Gustav Carus University Hospital, Dresden; Faculty of Medicine, Institute for Research in Operative Medicine, Department of Statistics and Registry Research, Witten/Herdecke University, Cologne, Germany
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Koncz V, Kohlmann T, Bielmeier S, Urban B, Prückner S. [Tele-emergency physician : New care concept in emergency medicine]. Unfallchirurg 2019; 122:683-689. [PMID: 31190107 DOI: 10.1007/s00113-019-0679-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Telemedical concepts, already successfully established in various clinical areas, such as radiology, are increasingly being implemented in the preclinical setting throughout Germany (tele-emergency physician). OBJECTIVE The aim of the article is to present the objectives and requirements as well as the practical implementation and the potential indications for a telemedical emergency system in the preclinical situation. MATERIAL AND METHODS Discussion of scientific facts and expert recommendations, specifically from experiences of the tele-emergency physician (Telenotarzt) project in an urban environment (City of Aachen). In addition, reference is made to a second pilot project in a rural region (Straubing, Bavaria). RESULTS The successful implementation of a prehospital telemedical emergency system requires a specific framework, in particular of a legal and technical nature. In order to achieve optimal process quality it is important to establish a comprehensive concept that takes aspects of patient safety into account. The entire dispatch process in the control center as well as the training of all involved personnel must also be taken into consideration. CONCLUSION With its special structures and processes, the overall concept of the telemedical emergency physician meets the changing challenges in the preclinical healthcare system and opens up new possibilities for patient care that meet the current requirements.
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Affiliation(s)
- Viola Koncz
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwig-Maximilians-Universität, Schillerstr. 53, 80336, München, Deutschland
| | - Thorsten Kohlmann
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwig-Maximilians-Universität, Schillerstr. 53, 80336, München, Deutschland
| | - Stefan Bielmeier
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwig-Maximilians-Universität, Schillerstr. 53, 80336, München, Deutschland
| | - Bert Urban
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwig-Maximilians-Universität, Schillerstr. 53, 80336, München, Deutschland
| | - Stephan Prückner
- Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München, Ludwig-Maximilians-Universität, Schillerstr. 53, 80336, München, Deutschland.
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Schewe JC, Kappler J, Dovermann K, Graeff I, Ehrentraut SF, Heister U, Hoeft A, Weber SU, Muenster S. Diagnostic accuracy of physician-staffed emergency medical teams: a retrospective observational cohort study of prehospital versus hospital diagnosis in a 10-year interval. Scand J Trauma Resusc Emerg Med 2019; 27:36. [PMID: 30940205 PMCID: PMC6446382 DOI: 10.1186/s13049-019-0617-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 03/20/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In Germany, emergency medical teams are staffed with physicians but evidence regarding their prehospital diagnostic accuracy remains poor. OBJECTIVE To evaluate the out-of-hospital diagnostic accuracy of physician-staffed emergency medical teams (PEMTs). METHODS A retrospective observational cohort study involving the Emergency Medical Service Bonn, Germany, from January to December 2004 and 2014 respectively. A total of 8346 patients underwent medical treatment by PEMTs, of which 1960 adult patients (inclusion criteria: ≥18 years of age, hospital diagnosis available) were included for further analysis. Reasons for non-inclusion: death on scene, outpatient, interhospital transfer, mental illness, false alarm, no hospital medical history available. The overall diagnostic accuracy (correct or false) of PEMTs was measured after matching the prehospital diagnosis with the corresponding diagnosis of the hospital. Secondary outcome measures were incidence of common PEMT diagnoses (acute coronary syndrome (ACS), dyspnea, stroke/intracerebral bleeding), recognition rate of a given disease by PEMTs, and prehospital diagnostic accuracy in elderly patients. RESULTS PEMT calls increased 2-fold over a decade (2004: n = 3151 vs. 2014: n = 5195). Overall diagnostic accuracy of PEMTs increased from 87.5% in 2004 to 92.6% in the year 2014. The incidence of common PEMT diagnoses such as ACS, dyspnea or stroke/intracerebral bleeding increased 2-fold from 2004 to 2014. The recognition rate of a given disease by the PEMT varied between 2004 and 2014: an increase was observed when a stroke/intracerebral bleeding was diagnosed (2004: 67% vs. 2014: 83%; p = 0.054), a decreased rate of recognition occurred when a syncope/collapse was diagnosed (2004: 81% vs. 2014: 56%; p = 0.007) and a sepsis appears to be a rare event for EMS personnel (2004: 0% vs. 2014: 23%). Linear regression analysis revealed that the prehospital diagnostic accuracy decreases in the elderly patient. CONCLUSIONS The overall prehospital diagnostic accuracy of PEMTs improved between the year 2004 and 2014 respectively. Our findings suggest that the incidence of common diseases (ACS, dyspnea stroke/intracerebral bleeding, sepsis) increased over a 10-year period. Diagnostic accuracy of different diseases varied but generally decreased in the elderly patient. Regular training of EMS personnel and public campaigns should be implemented to improve the diagnostic accuracy in the future.
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Affiliation(s)
- Jens-Christian Schewe
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Jochen Kappler
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Katharina Dovermann
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Ingo Graeff
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
- Department of Emergency Medicine, Bonn, University Hospital Bonn, Bonn, Germany
| | - Stefan Felix Ehrentraut
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Ulrich Heister
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
- Emergency Medical Service Bonn, Bonn, Germany
| | - Andreas Hoeft
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Stefan Ulrich Weber
- Department of Anesthesiology, Critical Care and Pain Medicine, Heilig Geist Krankenhaus, Cologne, Germany
| | - Stefan Muenster
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
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Haugland H, Uleberg O, Klepstad P, Krüger A, Rehn M. Quality measurement in physician-staffed emergency medical services: a systematic literature review. Int J Qual Health Care 2019; 31:2-10. [PMID: 29767795 PMCID: PMC6387994 DOI: 10.1093/intqhc/mzy106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 02/14/2018] [Accepted: 04/25/2018] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Quality measurement of physician-staffed emergency medical services (P-EMS) is necessary to improve service quality. Knowledge and consensus on this topic are scarce, making quality measurement of P-EMS a high-priority research area. The aim of this review was to identify, describe and evaluate studies of quality measurement in P-EMS. DATA SOURCES The databases of MEDLINE and Embase were searched initially, followed by a search for included article citations in Scopus. STUDY SELECTION The study eligibility criteria were: (1) articles describing the use of one quality indicator (QI) or more in P-EMS, (2) original manuscripts, (3) articles published from 1 January 1968 until 5 October 2016. The literature search identified 4699 records. 4543 were excluded after reviewing title and abstract. An additional 129 were excluded based on a full-text review. The remaining 27 papers were included in the analysis. Methodological quality was assessed using an adapted critical appraisal tool. DATA EXTRACTION The description of used QIs and methods of quality measurement was extracted. Variables describing the involved P-EMSs were extracted as well. RESULTS OF DATA SYNTHESIS In the included papers, a common understanding of which QIs to use in P-EMS did not exist. Fifteen papers used only a single QI. The most widely used QIs were 'Adherence to medical protocols', 'Provision of advanced interventions', 'Response time' and 'Adverse events'. CONCLUSION The review demonstrated a lack of shared understanding of which QIs to use in P-EMS. Moreover, papers using only one QI dominated the literature, thus increasing the risk of a narrow perspective in quality measurement. Future quality measurement in P-EMS should rely on a set of consensus-based QIs, ensuring a comprehensive approach to quality measurement.
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Affiliation(s)
- Helge Haugland
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Oddvar Uleberg
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål Klepstad
- Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anaesthesiology and Intensive Care, St. Olav University Hospital, Trondheim, Norway
| | - Andreas Krüger
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marius Rehn
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway
- Department of Health Studies, University of Stavanger, Stavanger, Norway
- Division of Emergencies and Critical Care, Department of Anaesthesia, Oslo University Hospital, Oslo, Norway
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Tavares V, Carron PN, Yersin B, Taffé P, Burnand B, Pittet V. The probability of having advanced medical interventions is associated with age in out-of-hospital life-threatening situations. Scand J Trauma Resusc Emerg Med 2016; 24:103. [PMID: 27554262 PMCID: PMC4995648 DOI: 10.1186/s13049-016-0294-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 08/17/2016] [Indexed: 01/11/2023] Open
Abstract
Background The use of out-of-hospital emergency medical services by old and very old individuals is increasing. These patients frequently require complex evaluation and decision-making processes to determine a strategy of care, therapeutic choices or withdrawal of care in life-threatening situations. During out-of-hospital missions, thorough decision-making is difficult because of the limited amount of time and lack of direct access to medical charts or to pre-existing advance directives. In this setting, age may be used as a proxy to determine strategy of care, therapeutic choices or withdrawal of care, particularly in relation to advanced medical interventions. We aimed to determine how an emergency physician’s initiation of out-of-hospital advanced medical interventions varies with the patient’s age. Methods We performed a retrospective analysis of the missions conducted by the emergency physicians-staffed emergency medical services in a Swiss region. We used logistic regression analysis to determine whether the probability of receiving an advanced medical intervention was associated with the patient’s age. Results Among 21,922 out-of-hospital emergency adult missions requiring an emergency physician, the probability of receiving an advanced medical intervention decreased with age. It was highest among those aged 18 – 58 years and significantly lower among those aged ≥ 89 years (OR = 0.66; 95 % CI: 0.53 – 0.82). The probability of cardiopulmonary resuscitation attempts progressively decreased with age and was significantly lower for the three oldest age deciles (80 – 83, 84 – 88 and ≥ 89 years). Conclusion The number of out-of-hospital advanced medical interventions significantly decreased for patients aged ≥ 89 years. It is unknown whether this lower rate of interventions was related only to age or to other medical characteristics of these patients, such as the number or severity of comorbidities. Thus, further studies are needed to confirm whether this observation corresponds to underuse of advanced medical interventions in very old patients.
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Affiliation(s)
- Vania Tavares
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Bertrand Yersin
- Emergency Department, Lausanne University Hospital, CH-1011, Lausanne, Switzerland
| | - Patrick Taffé
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Valérie Pittet
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
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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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Brokmann JC, Rossaint R, Bergrath S, Valentin B, Beckers SK, Hirsch F, Jeschke S, Czaplik M. [Potential and effectiveness of a telemedical rescue assistance system. Prospective observational study on implementation in emergency medicine]. Anaesthesist 2015; 64:438-45. [PMID: 26036316 DOI: 10.1007/s00101-015-0039-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 04/10/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The demographic change and an increasing multimorbidity of patients represent increasing challenges for the adequate prehospital treatment of emergency patients. The incorporation of supplementary telemedical concepts and systems can lead to an improved guideline-conform treatment. Beneficial evidence of telemedical procedures is only known for isolated disease patterns; however, no mobile telemedical concept exists which is suitable for use in the wide variety of different clinical situations. AIM This article presents a newly developed and evaluated total telemedical concept (TemRas) that encompasses organizational, medical and technical components. The use of intelligent and robust communication technology and the implementation of this add-on system allows the telemedical support of the rescue service for all emergencies. METHODS After development of the telemedical rescue assistance system, which includes organizational, medical and technical components, a telemedical centre and six ambulances in five different districts in North-Rhine Westphalia were equipped with this new tool. During the evaluation phase of 1 year in the routine emergency medical service the rate of complications as well as differences between urban and rural areas were analyzed with respect to different target parameters. RESULTS Between August 2012 and July 2013 a total of 401 teleconsultations were performed during emergency missions and 24 during secondary interhospital transfers. No complications due to teleconsultation were observed. The mean duration (±SD) of teleconsultations was longer in rural areas than in urban areas with 28.6±12.0 min vs. 25.5±11.1 min (p < 0.0001). In 63.2% of these missions administration of medications was delegated to the ambulance personnel (52.0% urban vs. 73.6% rural, p < 0.0001). The severity of ailments corresponded to scores of III and VI in the National Advisory Committee for Aeronautics (NACA) classification. CONCLUSION Emergency medical care of patients with support by a telemedical system is technically feasible, safe for the patient and allows medical treatment independent of spatial availability of a physician in different emergency situations.
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Affiliation(s)
- J C Brokmann
- Zentrale Notaufnahme, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland,
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Fischer M, Breil M, Ihli M, Messelken M, Rauch S, Schewe JC. [Mechanical resuscitation assist devices]. Anaesthesist 2014; 63:186-97. [PMID: 24569931 DOI: 10.1007/s00101-013-2265-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In Germany 100,000-160,000 people suffer from out-of-hospital cardiac arrest (OHCA) annually. The incidence of cardiopulmonary resuscitation (CPR) after OHCA varies between emergency ambulance services but is in the range of 30-90 CPR attempts per 100,000 inhabitants per year. Basic life support (BLS) involving chest compressions and ventilation is the key measure of resuscitation. Rapid initiation and quality of BLS are the most critical factors for CPR success. Even healthcare professionals are not always able to ensure the quality of CPR measures. Consequently in recent years mechanical resuscitation devices have been developed to optimize chest compression and the resulting circulation. In this article the mechanical resuscitation devices currently available in Germany are discussed and evaluated scientifically in context with available literature. The ANIMAX CPR device should not be used outside controlled trials as no clinical results have so far been published. The same applies to the new device Corpuls CPR which will be available on the market in early 2014. Based on the current published data a general recommendation for the routine use of LUCAS™ and AutoPulse® CPR cannot be given. The preliminary data of the CIRC trial and the published data of the LINC trial revealed that mechanical CPR is apparently equivalent to good manual CPR. For the final assessment further publications of large randomized studies must be analyzed (e.g. the CIRC and PaRAMeDIC trials). However, case control studies, case series and small studies have already shown that in special situations and in some cases patients will benefit from the automatic mechanical resuscitation devices (LUCAS™, AutoPulse®). This applies especially to emergency services where standard CPR quality is far below average and for patients who require prolonged CPR under difficult circumstances. This might be true in cases of resuscitation due to hypothermia, intoxication and pulmonary embolism as well as for patients requiring transport or coronary intervention when cardiac arrest persists. Three prospective randomized studies and the resulting meta-analysis are available for active compression-decompression resuscitation (ACD-CPR) in combination with an impedance threshold device (ITD). These studies compared ACD-ITD-CPR to standard CPR and clearly demonstrated that ACD-ITD-CPR is superior to standard CPR concerning short and long-term survival with good neurological recovery after OHCA.
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Affiliation(s)
- M Fischer
- Klinik für Anästhesiologie, Operative Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinik am Eichert der ALB FILS Kliniken, Eicherstr. 3, 73035, Göppingen, Deutschland,
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Pittet V, Burnand B, Yersin B, Carron PN. Trends of pre-hospital emergency medical services activity over 10 years: a population-based registry analysis. BMC Health Serv Res 2014; 14:380. [PMID: 25209450 PMCID: PMC4169798 DOI: 10.1186/1472-6963-14-380] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 09/05/2014] [Indexed: 11/10/2022] Open
Abstract
Background The number of requests to pre-hospital emergency medical services (PEMS) has increased in Europe over the last 20 years, but epidemiology of PEMS interventions has little be investigated. The aim of this analysis was to describe time trends of PEMS activity in a region of western Switzerland. Methods Use of data routinely and prospectively collected for PEMS intervention in the Canton of Vaud, Switzerland, from 2001 to 2010. This Swiss Canton comprises approximately 10% of the whole Swiss population. Results We observed a 40% increase in the number of requests to PEMS between 2001 and 2010. The overall rate of requests was 35/1000 inhabitants for ambulance services and 10/1000 for medical interventions (SMUR), with the highest rate among people aged ≥ 80. Most frequent reasons for the intervention were related to medical problems, predominantly unconsciousness, chest pain respiratory distress, or cardiac arrest, whereas severe trauma interventions decreased over time. Overall, 89% were alive after 48 h. The survival rate after 48 h increased regularly for cardiac arrest or myocardial infarction. Conclusion Routine prospective data collection of prehospital emergency interventions and monitoring of activity was feasible over time. The results we found add to the understanding of determinants of PEMS use and need to be considered to plan use of emergency health services in the near future. More comprehensive analysis of the quality of services and patient safety supported by indicators are also required, which might help to develop prehospital emergency services and new processes of care.
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Affiliation(s)
- Valérie Pittet
- Institute of social & preventive medicine (IUMSP), Lausanne University Hospital, Route de la Corniche 10, CH-1010 Lausanne, Switzerland.
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[Cardiac arrest in spectators in German football stadiums. Precautionary measures, frequency and short-term outcome]. Anaesthesist 2014; 63:636-42. [PMID: 25047159 DOI: 10.1007/s00101-014-2354-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Provision of medical care is an important element of safety precautions for visitors of sports arenas. The organizational requirements are especially high if cardiac arrest occurs; how this scenario is managed may thus serve as the ultimate indicator of the quality of stadium medical care. The objectives of this study were to analyze the structures and the resources available for the medical care of spectators in German professional soccer stadiums and to identify the frequency and the primary resuscitation success of cardiac arrest. MATERIAL AND METHODS In 2011 a questionnaire-based survey was performed among the clubs of the first and second German soccer leagues regarding medical care of spectators during the seasons 2008/2009 and 2009/2010. The focus was on the qualifications of emergency teams, the equipment and the incidence of cardiac arrest. RESULTS A total of 15 stadiums were included (38%) in the survey. The mean number of physicians and emergency medical technicians on site was 0.6/10,000 seats and 16/10,000 seats, respectively. Of the latter, a mean of 82% (minimum 20% and maximum 100%) had received training with automatic external defibrillators. In 87% of the stadiums regular advanced life support training (ALS) was required. The mean number of defibrillators per stadium was 2.8/10,000 seats (minimum 1.3 and maximum 3.8) including 1.7 automatic defibrillators (minimum 0.4 and maximum 2.8). For patient transport, a mean of 0.65 ALS ambulance vehicles per 10,000 seats (minimum 0.14 and maximum 1.46) were available on site. In all stadiums staff members were connected via mobile radio communication with the stadium medical control room. A total of 52 cardiac arrests (=0.25/100,000 spectators) were recorded of which 96% of the patients were transported to hospitals with spontaneous circulation. CONCLUSIONS Cardiac arrests are not a rare occurrence in German soccer stadiums. The participating stadiums are overall well prepared for such incidents in terms of organization, staff and technology and due to short response times, the resuscitation success by far surpasses that of the standard emergency medical services. These findings may in addition serve as a motivational example to start resuscitation early in public information campaigns.
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Neukamm J, Gräsner JT, Schewe JC, Breil M, Bahr J, Heister U, Wnent J, Bohn A, Heller G, Strickmann B, Fischer H, Kill C, Messelken M, Bein B, Lukas R, Meybohm P, Scholz J, Fischer M. The impact of response time reliability on CPR incidence and resuscitation success: a benchmark study from the German Resuscitation Registry. Crit Care 2011; 15:R282. [PMID: 22112746 PMCID: PMC3388696 DOI: 10.1186/cc10566] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Accepted: 11/24/2011] [Indexed: 11/24/2022] Open
Abstract
Introduction Sudden cardiac arrest is one of the most frequent causes of death in the world. In highly qualified emergency medical service (EMS) systems, including well-trained emergency physicians, spontaneous circulation may be restored in up to 53% of patients at least until admission to hospital. Compared with these highly qualified EMS systems, markedly lower success rates are observed in other systems. These data clearly show that there are considerable differences between EMS systems concerning treatment success following cardiac arrest and resuscitation, although in all systems international guidelines for resuscitation are used. In this study, we investigated the impact of response time reliability (RTR) on cardiopulmonary resuscitation (CPR) incidence and resuscitation success by using the return of spontaneous circulation (ROSC) after cardiac arrest (RACA) scores and data from seven German EMS systems participating in the German Resuscitation Registry. Methods Anonymised patient data after out-of-hospital cardiac arrest gathered from seven EMS systems in Germany from 2006 to 2009 were analysed with regard to socioeconomic factors (population, area and EMS unit-hours), process quality (RTR, CPR incidence, special CPR measures and prehospital cooling), patient factors (age, gender, cause of cardiac arrest and bystander CPR). End points were defined as ROSC, admission to hospital, 24-hour survival and hospital discharge rate. χ2 tests, odds ratios and the Bonferroni correction were used for statistical analyses. Results Our present study comprised 2,330 prehospital CPR patients at seven centres. The incidence of sudden cardiac arrest ranged from 36.0 to 65.1/100,000 inhabitants/year. We identified two EMS systems (RTR < 70%) that reached patients within 8 minutes of the call to the dispatch centre 62.0% and 65.6% of the time, respectively. The other five EMS systems (RTR > 70%) reached patients within 8 minutes of the call to the dispatch centre 70.4% up to 95.5% of the time. EMS systems arriving relatively later at the patients side (RTR < 70%) initiate CPR less frequently and admit fewer patients alive to hospital (calculated per 100,000 inhabitants/year) (CPR incidence (1/100,000 inhabitants/year) RTR > 70% = 57.2 vs RTR < 70% = 36.1, OR = 1.586 (99% CI = 1.383 to 1.819); P < 0.01) (admitted to hospital with ROSC (1/100,000 inhabitants/year) RTR > 70% = 24.4 vs RTR < 70% = 15.6, OR = 1.57 (99% CI = 1.274 to 1.935); P < 0.01). Using ROSC rate and the multivariate RACA score to predict outcomes, we found that the two groups did not differ, but ROSC rates were higher than predicted in both groups (ROSC RTR > 70% = 46.6% vs RTR < 70% = 47.3%, OR = 0.971 (95% CI = 0.787 to 1.196); P = n.s.) (ROSC RACA RTR > 70% = 42.4% vs RTR < 70% = 39.5%, OR = 1.127 (95% CI = 0.911 to 1.395); P = n.s.) Conclusion This study demonstrates that, on the level of EMS systems, faster ones more often initiate CPR and increase the number of patients admitted to hospital alive. Furthermore, we show that, with very different approaches, all centres that adhere to and are intensely trained according to the 2005 European Resuscitation Council guidelines are superior and, on the basis of international comparisons, achieve excellent success rates following CPR.
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Affiliation(s)
- Jürgen Neukamm
- Department of Anesthesiology and Intensive Care, Klinik am Eichert, Eichertstrasse 3, D-73035 Göppingen, Germany
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Büttner J. Delta-MEES is not very practical. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:94-5; author reply 95. [PMID: 21373277 DOI: 10.3238/arztebl.2011.0094b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hinkelbein J. Analyses are indispensable. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:94-95. [PMID: 21373276 PMCID: PMC3047719 DOI: 10.3238/arztebl.2011.0094a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Jochen Hinkelbein
- *Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937 Köln, Germany,
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Kohlund E. Far from reality. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:95; author reply 95. [PMID: 21373278 PMCID: PMC3047721 DOI: 10.3238/arztebl.2011.0095a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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