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Vorgehaltene Medikamente auf notarztbesetzten Rettungsmitteln in Deutschland

Realität und Erfordernis nach Leitlinien

Stocked medications in emergency physician-based medical services in Germany

Reality and requirements according to guidelines

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Zusammenfassung

Hintergrund

Im Rettungsdienst sollte die Patientenversorgung evidenzbasiert erfolgen. In dieser Studie wurde die medikamentöse Ausstattung notarztbesetzter Rettungsmittel erfasst. Für ausgewählte „Tracer“-Diagnosen wurden die Medikamentenbestände analysiert und mit dem Bedarf nach Leitlinien verglichen.

Methode

Von Mai 2008 bis Januar 2009 wurden alle 148 Ärztlichen Leiter Rettungsdienst (ÄLRD), die bei der Bundesgeschäftsstelle des Bundesverbandes der Ärztlichen Leiter Rettungsdienst Deutschland e. V. registriert sind, angeschrieben und um Übersendung ihrer Medikamentenausstattungslisten gebeten. Die Auswertung erfolgte anonymisiert. Als Tracer-Diagnosen dienten „kardiopulmonale Reanimation (CPR)“, „akutes Koronarsyndrom (ACS)“, „Status generalisierter tonisch-klonischer Krampfanfall“, „schwerer Asthmaanfall“ bzw. „akute Exazerbation einer chronisch obstruktiven Lungenerkrankung (COPD)“, „Schmalkomplextachykardie“, „schweres Schädelhirntrauma (SHT)“ und „akute Herzinsuffizienz mit Zeichen der Hypoperfusion“. Die aktuellen Leitlinien der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. dienten als Grundlage und wurden mit internationalen Leitlinien abgeglichen.

Ergebnisse

Die Rücklaufquote betrug 64,2%; 39 Stoffgruppen und 142 verschiedene Medikamente konnten ermittelt werden. Der Leitlinienabgleich ergab, dass mit einer Häufigkeit von etwa 30–80%, abhängig von der jeweiligen Tracer-Diagnose, keine medikamentöse Akuttherapie nach höchstem Evidenzgrad erfolgen kann.

Schlussfolgerung

Aufgrund aktueller Therapieempfehlungen sollte die Ausstattung mit Noradrenalin, Adenosin, Dobutamin, Natriumbikarbonat, Kalzium, Magnesium, Lorazepam zur i.v.-Applikation sowie mit Ipratropiumbromid und Salbutamol (beide als Fertiginhalat) verbessert werden. Für die Zukunft ist ein bundeseinheitlicher Mindeststandard nach evidenzbasierten Grundlagen anzustreben.

Abstract

Background

The emergency medical service (EMS) should work according to criteria of evidence-based medicine. In Germany the EMS of each state is under the control of at least one medical supervisor known as emergency medical directors (EMD) and most states have several different EMDs responsible for one or more provinces of the state. The German Medical Association advises these supervisors to specify the pharmacological resources in store for use in physician powered EMSs. This study examines the pharmacological resources in EMSs which is provided by the EMDs in Germany. Furthermore, a comparison of the inventory analysis of stored drugs was carried out with the requirements according to guidelines for selected tracer diagnoses.

Method

In the period of May 2008 to January 2009 a total of 148 EMDs were contacted and asked to supply drug storage lists for emergency physician-staffed rescue vehicles in their respective jurisdiction. The addresses of all EMDs who could be identified by the federal office of the National Association of Emergency Medical Director, Germany were used over the period. The evaluation was conducted anonymously. The tracer diagnoses “cardiopulmonary resuscitation”, “acute coronary syndrome”, “status generalized tonic-clonic seizure,” “severe asthma attack”, “acute exacerbation of chronic obstructive pulmonary disease”, “supraventricular tachycardia”, “severe brain trauma” and “acute heart failure with signs of hypoperfusion” were selected. Current and established guidelines have been identified with the homepage of the Scientific Medical Societies in Germany and supported by the leading European and International guidelines.

Results

The corresponding lists were returned by 95 different emergency service areas (response rate 64.2%). With a total of 39 groups of substances 142 different drugs could be identified, an average of 54±9.6 and median 55 (range 31–77). Listed are agents giving the provision in percent, for which the comparison with guidelines for tracer diagnoses could show deficits: sodium bicarbonate 75.8%, calcium 50.5%, magnesium 45.3%, noradrenaline 65.3%, adenosine 58.9%, dobutamine 57.9%, lorazepam iv 13.7%, salbutamol 41.1%, ipratropium bromide 13.7% (the last two as liquid preparations for inhalation). With a frequency of about 30–80%, depending on the respective tracer diagnosis, no medical emergency treatment according to the highest level of evidence is possible.

Conclusion

Due to recent treatment recommendations provision with sodium bicarbonate, calcium, magnesium, noradrenaline, adenosine, lorazepam iv, dobutamine and as well with ipratropium bromide and salbutamol (both as liquid preparations for inhalation) should be improved. For the future, a federal uniform minimum standard due to evidence-based principles is desirable.

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Literatur

  1. Ahnefeld FW, Dick W, Schuster HP (2000) Anforderung an die Ausstattung im Rettungsdienst. Notfall Rettungsmed 3:64–71

    Article  Google Scholar 

  2. Alldredge BK, Gelb AM, Isaacs SM et al (2001) A comparison of lorazepam, diazepam and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med 345:631–637

    Article  PubMed  CAS  Google Scholar 

  3. Antman EM, Cohen M, Mccabe C et al (2002) Enoxaparin is superior to unfractionated heparin for preventing clinical events at 1-year follow-up of TIMI 11B and ESSENCE. Eur Heart J 23:308–314

    Article  PubMed  CAS  Google Scholar 

  4. Antman EM, Louwerenburg HW, Baars HF et al (2002) Enoxaparin as adjunctive antithrombin therapy for ST-elevation myocardial infarction: results of the ENTIRE-Thrombolysis in Myocardial Infarction (TIMI) 23 Trial. Circulation 105:1642–1649

    Article  PubMed  CAS  Google Scholar 

  5. Arntz HR, Bossaert L, Filippatos GS (2005) European Resuscitation Council guidelines for resuscitation 2005. Section 5. Initial management of acute coronary syndromes. Resuscitation 67 (Suppl 1):87–96

    Article  Google Scholar 

  6. Bateman ED, Hurd SS, Barnes PJ et al (2008) Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 31:143–178

    Article  PubMed  CAS  Google Scholar 

  7. Behrendt H (2008) In: Zahlenspiegel Rettungsdienst – Eine Übersicht über die wichtigsten Kennzahlen im Rettungsdienst, 1. Aufl. Mendel, Witten, S 23, Abb. 1. ISBN: 978-3-930670-44-4

  8. Blomstrom-Lundqvist C, Scheinman MM, Aliot EM et al (2003) ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias – Executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. J Am Coll Cardiol 42:1493–1531

    Article  PubMed  Google Scholar 

  9. Bratton SL, Chestnut RM, Ghajar J et al (2007) Guidelines for the management of severe traumatic brain injury. I. Blood pressure and oxygenation. J Neurotrauma 24 (Suppl 1):7–13

    Google Scholar 

  10. Bratton SL, Chestnut RM, Ghajar J et al (2007) Guidelines for the management of severe traumatic brain injury. II. Hyperosmolar therapy. J Neurotrauma 24 (Suppl 1):14–20

    Google Scholar 

  11. Bratton SL, Chestnut RM, Ghajar J et al (2007) Guidelines for the management of severe traumatic brain injury. IX. Cerebral perfusion thresholds. J Neurotrauma 24 (Suppl 1):59–64

    Google Scholar 

  12. Bundesgeschäftsstelle des Bundesverbandes der ÄLRD Deutschland e.V. (2010) http://www.bgs-aelrd.de

  13. Cock HR, Schapira AH (2002) A comparison of lorazepam and diazepam as initial therapy in convulsive status epilepticus. QJM 95:225–231

    Article  PubMed  CAS  Google Scholar 

  14. Cooper DJ, Myles PS, Mcdermott FT et al (2004) Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial. JAMA 291:1350–1357

    Article  PubMed  CAS  Google Scholar 

  15. Daly C, Clemens F, Lopez-Sendon JL et al (2006) The impact of guideline compliant medical therapy on clinical outcome in patients with stable angina: findings from the Euro Heart Survey of stable angina. Eur Heart J 27:1298–1304

    Article  PubMed  Google Scholar 

  16. Dickstein K, Cohen-Solal A, Filippatos G et al (2008) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail 10:933–989

    Article  PubMed  Google Scholar 

  17. Diener HC, Putzki N (2008) Leitlinien für die Diagnostik und Therapie in der Neurologie, 4. überarb. Aufl. Thieme, Stuttgart, S 654 ff.

  18. Diener HC, Putzki N (2005) Leitlinien für Diagnostik und Therapie in der Neurologie, 3. überarb. Aufl. Thieme, Stuttgart, S 20 ff.

  19. Genzwurker H, Lessing P, Ellinger K et al (2007) Infrastructure of emergency medical services. Comparison of physician-staffed ambulance equipment in the state of Baden-Wuerttemberg in 2001 and 2005. Anaesthesist 56:665–672

    Article  PubMed  CAS  Google Scholar 

  20. Gries A, Zink W, Bernhard M et al (2006) Realistic assessment of the physician-staffed emergency services in Germany. Anaesthesist 55:1080–1086

    Article  PubMed  CAS  Google Scholar 

  21. Hamm CW (2004) Leitlinien: Akutes Koronarsyndrom (ACS). Teil 1: ACS ohne persistierende ST-Hebung. Z Kardiol 93:72–90

    Article  PubMed  CAS  Google Scholar 

  22. Hamm CW (2004) Leitlinien: Akutes Koronarsyndrom (ACS). Teil 2: Akutes Koronarsyndrom mit ST-Hebung. Z Kardiol 93:324–341

    Article  PubMed  CAS  Google Scholar 

  23. Knuth P (2001) Welche Voraussetzungen sind für die Ausstattung von Rettungsmitteln zu erfüllen? Notarzt 17:28–34

    Article  Google Scholar 

  24. Kushner FG, Hand M, Smith SC Jr et al (2009) 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (updating the 2005 Guideline and 2007 Focused Update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 120:2271–2306

    Article  PubMed  Google Scholar 

  25. Lelgemann M, Ollenschlager G (2006) Evidence based guidelines and clinical pathways: complementation or contradiction? Internist (Berl) 47:690, 692–697

    Google Scholar 

  26. Mckay SE, Howie CA, Thomson AH et al (1993) Value of theophylline treatment in patients handicapped by chronic obstructive lung disease. Thorax 48:227–232

    Article  PubMed  CAS  Google Scholar 

  27. Messelken M, Martin J, Milewski P (1998) Ergebnisqualität in der Notfallmedizin, Versuch einer Standortbestimmung. Notfall Rettungsmed 1:143–149

    Article  Google Scholar 

  28. Moecke H, Stratmann D (1995) Empfehlungen der Bundesärztekammer zum „Ärztlichen Leiter Rettungsdienst“. Notarzt 11:99

    Google Scholar 

  29. Murciano D, Auclair MH, Pariente R et al (1989) A randomized, controlled trial of theophylline in patients with severe chronic obstructive pulmonary disease. N Engl J Med 320:1521–1525

    Article  PubMed  CAS  Google Scholar 

  30. Nationale VersorgungsLeitlinie (NVL) „Asthma“ und NVL „COPD“ (S3-Leitlinien) (2010) http://www.copd.versorgungsleitlinien.de bzw. http://www.asthma.versorgungsleitlinien.de

  31. Nieminen MS, Bohm M, Cowie MR et al (2005) Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology. Eur Heart J 26:384–416

    Article  PubMed  Google Scholar 

  32. Nolan JP, Deakin CD, Soar J et al (2005) European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support. Resuscitation 67 (Suppl 1):39–86

    Article  Google Scholar 

  33. Nolan JP, Deakin CD, Soar J et al (2005) European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support. Resuscitation 67 (Suppl 1):39–86

    Article  Google Scholar 

  34. Parameswaran K, Belda J, Rowe BH (2000) Addition of intravenous aminophylline to beta2-agonists in adults with acute asthma. Cochrane Database Syst Rev 4:CD002742

    PubMed  Google Scholar 

  35. Paschen HR (2002) Ausstattung von Rettungsmitteln. Notfall Rettungsmed 5:410

    Article  Google Scholar 

  36. Prasad K, Al-Roomi K, Krishnan PR et al (2005) Anticonvulsant therapy for status epilepticus. Cochrane Database Syst Rev:CD003723

    Google Scholar 

  37. Rabe KF, Hurd S, Anzueto A et al (2007) Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 176:532–555

    Article  PubMed  Google Scholar 

  38. Rickels E, Von Wild KRH, Wenzlaff P, Bock WJ (2006) Schädel-Hirn-Verletzung – Epidemiologie und Versorgung: Ergebnisse einer prospektiven Studie, 1. Aufl. Zuckschwerdt, Germering bei München

  39. Rodrigo GJ, Rodrigo C (2000) First-line therapy for adult patients with acute asthma receiving a multiple-dose protocol of ipratropium bromide plus albuterol in the emergency department. Am J Respir Crit Care Med 161:1862–1868

    PubMed  CAS  Google Scholar 

  40. Ross AM, Molhoek P, Lundergan C et al (2001) Randomized comparison of enoxaparin, a low-molecular-weight heparin, with unfractionated heparin adjunctive to recombinant tissue plasminogen activator thrombolysis and aspirin: second trial of Heparin and Aspirin Reperfusion Therapy (HART II). Circulation 104:648–652

    Article  PubMed  CAS  Google Scholar 

  41. Schmid MC, Deisenberg M, Strauss H et al (2006) Equipment of a land-based emergency medical service in Bavaria: a questionnaire. Anaesthesist 55:1051–1057

    Article  PubMed  CAS  Google Scholar 

  42. Simoons M, Krzeminska-Pakula M, Alonso A et al (2002) Improved reperfusion and clinical outcome with enoxaparin as an adjunct to streptokinase thrombolysis in acute myocardial infarction. The AMI-SK study. Eur Heart J 23:1282–1290

    Article  PubMed  CAS  Google Scholar 

  43. Statistisches Bundesamt (2008) http://www.destatis.de, Stand 31.12.2008

  44. Travers A, Jones AP, Kelly K et al (2001) Intravenous beta2-agonists for acute asthma in the emergency department. Cochrane Database Syst Rev 2:CD002988

    PubMed  Google Scholar 

  45. Treiman DM, Meyers PD, Walton NY et al (1998) A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med 339:792–798

    Article  PubMed  CAS  Google Scholar 

  46. Wenzel V, Krismer AC, Arntz HR et al (2004) A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation. N Engl J Med 350:105–113

    Article  PubMed  CAS  Google Scholar 

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Danksagung

Die Autoren danken allen ÄLRD, die die Medikamentenlisten ihres Zuständigkeitsbereichs zur Verfügung gestellt haben.

Interessenkonflikt

Diese Studie wurde im Rahmen des Forschungsprojektes Med-on-@ix durchgeführt. Das Forschungsprojekt wird vom Bundesministerium für Wirtschaft und Technologie, Förderkennzeichen 01MB07022, gefördert. Die P3 Communications GmbH und die Philips Medizingeräte GmbH bringen zusätzlich zur öffentlichen Förderung Eigenmittel ein.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Universitätsklinikum Aachen, RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland

    D. Rörtgen, M. Skorning, S. Bergrath, S.K. Beckers, M. Coburn, J.C. Brokmann, H. Fischermann, M. Nieveler & R. Rossaint

  2. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Giessen und Marburg GmbH, Standort Giessen, Deutschland

    A. Schaumberg

  3. Ärztlicher Leiter Rettungsdienst Stadt Aachen, Berufsfeuerwehr Aachen, Aachen, Deutschland

    J.C. Brokmann

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  1. D. Rörtgen
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Correspondence to D. Rörtgen.

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Rörtgen, D., Schaumberg, A., Skorning, M. et al. Vorgehaltene Medikamente auf notarztbesetzten Rettungsmitteln in Deutschland. Anaesthesist 60, 312–324 (2011). https://doi.org/10.1007/s00101-010-1812-9

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