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Realistic assessment of the physican-staffed emergency services in Germany

Realistische Bewertung des Notarztdienstes in Deutschland

  • Notfallmedizin
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Abstract

In Germany the emergency medical services, which include dispatching emergency physicians to the scene, are considered to be among the best in the world. However, the hospitals admitting these patients still report shortcomings in prehospital care. The quality of an emergency medical service depends on both formal qualification and experience in managing such emergencies. Therefore, we determined how frequently emergency medical service physicians in Germany actually encountered complex and demanding emergency situations outside the hospital and how often they had to carry out emergency interventions. We therefore evaluated data from more than 82,000 ground emergency medical service scene calls registered in the MIND (“minimaler Notarztdatensatz”) data base of the state of Baden-Wuerttemberg, Germany and more than 47,000 helicopter emergency medical service scene calls from the “Luftrettungs-, Informations- und Kommunikationssystem” (LIKS) data base of the German ADAC air rescue service. The results, which were unexpectedly distinct, impressively demonstrate that in part emergency medical service staff only encountered some emergencies very rarely. In particular, patients with life-threatening conditions such as acute coronary syndrome, stroke, head trauma, as well as multiple trauma were only treated once every 0.4–14.5 months and cardiopulmonary resuscitation and intubation were only carried out once every 0.5–1.5 months. Furthermore, a time period of 6 months to more than 6 years may pass before a chest tube has to be placed. There are, of course, considerable differences between ground and helicopter emergency medical services. Particularly in areas where the frequency of such emergency cases is low, the clinical experience required to competently manage a demanding emergency situation cannot be gained or maintained just by working in the emergency medical system. As a result of the general pressure to cut costs and also of changes in hospital politics, however, only highly qualified and experienced emergency medical services may survive in Germany in the long term. In addition to formal qualifications and accompanying practice-related courses, future emergency medical service personnel should be drafted from clinical department staff that are experienced in treating severely ill and severely injured patients.

Zusammenfassung

Obwohl das bundesdeutsche Rettungssystem mit dem Einsatz von Notärzten an der Notfallstelle als eines der leistungsstärksten der Welt gilt, wird von aufnehmenden Kliniken immer wieder über Mängel in der prähospitalen Versorgung berichtet. Da neben der formalen Qualifikation die Leistungsfähigkeit eines Notarztsystems von der Routine des eingesetzten Personals im Management entsprechender Notfallsituationen abhängt, wurde unter Berücksichtigung von über 82.000 durch die Minimaler-Notarztdatensatz- (MIND-)Auswertung in Baden-Württemberg erfassten bodengebundenen und über 47.000 durch die Luftrettungs-, Informations- und Kommunikationssystem- (LIKS-)Datenbank der Allgemeiner-Deutscher-Automobil-Club- (ADAC-)Luftrettung dokumentierten luftgestützten Notarzteinsätzen untersucht, wie häufig Notärzte in Deutschland tatsächlich komplexen und anspruchsvollen Notfallsituationen prähospital begegnen bzw. bestimmte Maßnahmen durchführen müssen. Die in ihrer Ausprägung unerwarteten Ergebnisse zeigen eindrucksvoll, dass bundesdeutsche Notarztsysteme entsprechenden Notfallsituationen z. T. nur sehr selten begegnen: Insbesondere vital-bedrohte Patienten mit den Tracerdiagnosen akutes Koronarsyndrom, Apoplex, Schädel-Hirn-Trauma und Polytrauma werden nur alle 0,4–14,5 Monate behandelt. Eine kardiopulmonale Reanimation und eine Intubation werden alle 0,5–1,5 Monate durchgeführt; bis zur Anlage einer Thoraxdrainage vergeht ein Zeitraum von 6 Monaten bis zu über 6 Jahren. Dabei sind allerdings z. T. erhebliche Unterschiede zwischen bodengebundenen und luftgestützten Systemen evident. Gerade an Standorten mit einer geringen Einsatzfrequenz kann durch die ausschließliche Teilnahme am Notarztdienst eine entsprechende zum Management anspruchsvoller Notfallsituationen erforderliche Routine nicht erworben bzw. aufrechterhalten werden. Unter dem allgemeinen Druck, finanzielle Mittel einsparen zu müssen und einer sich ändernden Krankenhauslandschaft wird in Deutschland längerfristig allerdings nur ein hochqualifizierter und routinierter Notarztdienst Bestand haben können. Neben einer formalen Qualifikation und begleitenden praxisrelevanten Kursen sollte zukünftig Personal für den Notarztdienst daher aus klinischen Bereichen, in denen regelhaft schwer erkrankte und schwer verletzte Patienten behandelt werden, gewonnen werden.

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Acknowledgments

The authors would like to thank the ADAC Air Rescue GmbH in Munich, Germany and the State Medical Association of Baden-Wuerttemberg, Stuttgart, Germany, for the data. Our thanks also go to Ms. Sabine Haag and Mr. Harry Bauer MD, Department of Anesthesiology, University of Heidelberg for preparing and statistically analyzing the data.

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Correspondence to A. Gries MD, D.E.A.A..

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Erstpublikation der deutschen Fassung in Notfall und Rettungsmedizin (2005) 8: 391–398.

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Gries, A., Zink, W., Bernhard, M. et al. Realistic assessment of the physican-staffed emergency services in Germany. Anaesthesist 55, 1080–1086 (2006). https://doi.org/10.1007/s00101-006-1051-2

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