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The more diverse the German hospital landscape, the more important it is to define tasks and processes in order to ensure a uniform standard of care at the highest level for the population. With the introduction of additional training in clinical acute and emergency medicine and specifications for inpatient emergency care, important foundations for the necessary structure of emergency rooms have been given.

As part of the SARS-CoV‑2 pandemic, the district of Heinsberg developed into an infectiological epicentre for Germany in February 2020. Our hospital, which is located in the immediate vicinity, reacted very quickly in addition to adapting patient care by implementing an organizational structure for recording SARS-CoV-2-positive employees, patients and their contact persons.The infections recorded in contact tracing were analysed and, based on an exemplary outbreak, infection chains and follow-up processes were evaluated.Comprehensive data on contact types, oropharyngeal swab results for SARS-CoV‑2 and quarantine days were documented and retrospectively evaluated using a self-developed database.Of the 568 employees recorded by in-house contact tracing, 32 employees (1.2%, n = 2567) were detected as SARS-CoV‑2 positive. Of those, 50% (n = 16) tested positive due to contact tracing, 15.6% (n = 5) were recorded by routine smears and 34.4% (n = 11) were returning travellers. The variable PCR results of the control smears from these positive employees were noticeable. In 18.8% (n = 6) of the initially negative control smears, positive PCR results were found in the following control smear. The inhouse contact tracing team was able to detect infection clusters on non-COVID-19 wards at an early stage and, together with clinical hygiene and the public health department, initiated comprehensive measures to limit the spread of the virus. Infection chains could thus be interrupted.The work of the clinic's own contact tracing unit has proven to be an essential part of clinical pandemic management not least against the background of new waves of infection and is indispensable for the detection of local infection clusters.HINTERGRUND: Im Rahmen der SARS-CoV-2-Pandemie entwickelte sich der Kreis Heinsberg im Februar 2020 zu einem infektiologischen Epizentrum für Deutschland. Unser in unmittelbarer Nachbarschaft gelegenes Krankenhaus implementierte neben der Anpassung der Patientenversorgung sofort zusätzlich eine krankenhausinterne Organisationsstruktur zur Erfassung SARS-CoV-2-positiver Mitarbeiter, Patienten und deren Kontaktpersonen.Die im Contact Tracing erfassten Infektionen wurden analysiert und anhand eines beispielhaften Ausbruchs Infektionsketten und Nachverfolgungsprozesse evaluiert.Daten zu Kontakten, Abstrichergebnissen und Quarantänetagen wurden mittels einer eigenen Datenbank dokumentiert und retrospektiv ausgewertet.568 Mitarbeiter wurden vom krankenhausinternen Contact Tracing erfasst. 32 Mitarbeiter (1,2 %, n = 2567) wurden als SARS-CoV-2-positiv erfasst. 50 % (16) davon wurden im Rahmen der Kontaktpersonennachverfolgung positiv getestet, 15,6 % (5) durch Routineabstriche erfasst. 34,4 % (11) waren Reiserückkehrer. Auffällig waren variable PCR-Ergebnisse der Kontrollabstriche dieser positiven Mitarbeiter. Bei 18,8 % (6) wurden bei zunächst negativem Kontrollabstrich im folgenden Kontrollabstrich wieder positive PCR-Ergebnisse gefunden. Das eigene Contact Tracing konnte Infektionshäufungen auf Non-COVID-19-Stationen frühzeitig aufdecken und gemeinsam mit der Klinikhygiene und dem Gesundheitsamt umfassende Maßnahmen zur Begrenzung der Virusausbreitung einleiten. Infektionsketten konnten früh durchbrochen werden.Ein krankenhausinternes Contact Tracing erweist sich vor allem bei nicht auszuschließenden zukünftigen Infektionswellen als ein wesentlicher Bestandteil des klinischen Pandemiemanagements und ist essenziell zur Aufdeckung von lokalen Infektionsclustern.

With the coronavirus disease 2019 (COVID-19) outbreak hospitals prepared for increasing numbers of patients without knowing how patient populations were evolving and what resources would be required. The present study aimed to analyze the impact of the local COVID-19 pandemic on emergency resources of all hospitals in a major urban center (Mönchengladbach) in Germany.This observational multicenter study involved all acute care hospitals (n = 4). Systemic emergency department (ED) parameters from weeks 4-24 in 2020 were compared to the corresponding period in 2019 for each hospital and in a summative data analysis using a logistic regression model.The first regional COVID-19 patients were detected in week 9 of 2020. The cumulative number of ED visits dropped from 34,659 in 2019 to 28,008 in 2020. Weekly ED visits per hospital decreased from week 8 onwards between 38% and 48% per week and hospital and began to rise again after week 16. The pooled data analysis of ED patients showed significant decreases in outpatient visits (20,152 vs. 16,477, p 0.001), hospital admissions (14,507 vs. 11,531, p 0.001), and work-related accidents (2290 vs. 1468, p 0.001). The decrease in ED to ICU admissions showed no significance (2093 vs. 1566, p = 0.255). The decline in ED cases was equally distributed between the medical specialties.The regional COVID-19 outbreak led to significantly reduced ED contacts in a German major urban region after the first COVID-19 cases appeared. Both hospital admissions and the number of ED to ICU admissions decreased, whereas the ratio of emergency outpatients vs. inpatients remained stable. Therefore, it can be assumed that patients with severe medical problems did not seek emergency care. These secondary effects of the pandemic on healthcare and the socioeconomic impact should be analyzed further.HINTERGRUND: Zu Beginn der COVID-19-Pandemie im Jahr 2020 bereiteten sich das Gesundheitssystem und die Krankenhäuser in Deutschland auf höhere Patientenzahlen insgesamt und auch auf die Aufnahme zahlreicher kritisch kranker Patienten vor. Dazu mussten Ressourcen mobilisiert und Prozesse angepasst werden, die sowohl einem neuen Patientenkollektiv als auch der bisherigen Patientenversorgung gerecht werden sollten. Als eine der ersten deutschen Großstädte musste Mönchengladbach entsprechende Maßnahmen treffen, ohne dass die genauen Auswirkungen der Pandemie auf die Zusammensetzung der Patientenpopulationen abgeschätzt werden konnten bzw. bekannt war, ob ausreichend Notfallressourcen zur Verfügung stehen. In dieser Studie wird die Inanspruchnahme der kompletten Krankenhaus-Notfallstrukturen einer deutschen Großstadt zu Beginn der Corona-Pandemie analysiert.In dieser multizentrischen Observationsstudie aller (n = 4) Zentralen Notaufnahmen (ZNA) einer deutschen Großstadt (Mönchengladbach, ca. 274.000 Einwohner) wurde das Patientenaufkommen in den ZNA in den Kalenderwochen (KW) 4–24 im Jahr 2020 mit dem korrespondierenden Zeitraum (KW 4–24) in 2019 verglichen. Die weitere Auswertung erfolgte sowohl für jedes einzelne Krankenhaus als auch im kumulativen Gesamtvergleich in einer logistischen Regressionsanalyse. Aufgrund der voneinander unabhängigen Auswertungen der einzelnen Krankenhäuser wurde eine Bonferroni-Korrektur für das Signifikanzniveau durchgeführt.Die ersten regionalen COVID-19-Patienten wurden in Woche 9 des Jahres 2020 entdeckt. Die kumulative Anzahl der Patienten in der ZNA sank von 34.659 im Jahr 2019 auf 28.008 im Jahr 2020. Die wöchentliche Anzahl pro Krankenhaus nahm ab Woche 8 zwischen 38% und 48% pro Woche und Krankenhaus ab und begann nach Woche 16 wieder zu steigen. Die gepoolte Datenanalyse des Patientenaufkommens in der ZNA zeigte einen signifikanten Rückgang ambulanter Notfallpatienten (20.152 vs. 16.477; p 0,001), Notfallpatienten mit Bedarf zur stationären Behandlung (14.507 vs. 11.531; p 0,001) und der Arbeitsunfälle (2290 vs. 1468; p 0,001). Der Rückgang der Einweisungen von der Notaufnahme auf die Intensivstation zeigte keine Signifikanz (2093 vs. 1566; p = 0,255). Der Rückgang des Patientenaufkommens in den ZNA verteilte sich gleichmäßig auf die medizinischen Fachgebiete.Der regionale COVID-19-Ausbruch führte in einer deutschen Großstadtregion nach dem Auftreten der ersten COVID-19-Fälle zu einem deutlich reduzierten Patientenaufkommen in den ZNA. Auch die Zahl von stationären Aufnahmen und Intensivaufnahmen war rückläufig, während das Verhältnis von ambulanten Notfallpatienten zu stationären Patienten stabil blieb. Daher kann davon ausgegangen werden, dass Patienten mit schweren medizinischen Problemen keine Notfallversorgung aufgesucht haben. Diese sekundären Effekte der Pandemie auf das Gesundheitswesen und die sozioökonomischen Auswirkungen sollten weiter analysiert werden.

Emergency medical care for critically ill nontrauma patients (CINT) varies between different emergency departments (ED) and healthcare systems, while resuscitation of trauma patients is always performed within the ED. In many ED CINT are treated and stabilized while in many German smaller hospitals CINT are transferred directly to the intensive care unit (ICU) without performing critical care measures in the ED. Little is known about the resuscitation room management of CINT regarding patient characteristics and outcome although bigger hospitals perform ED resuscitation of CINT in routine care. Against this background we conducted this retrospective analysis of CINT treated by an ED resuscitation room concept in a German 756 bed teaching hospital.The collective of CINT treated within the ED resuscitation room (1 October 2018 to 31 March 2019) was analyzed after ethical approval. After each resuscitation room operation, the team leader filled out a standardized paper-based questionnaire and qualified the patient as a resuscitation room patient this way. Only patients who underwent invasive procedures and were admitted to ICU or died in the ED were included. Patient characteristics, performed critical care measures, short-term outcomes and the comparison of admission characteristics between survivors and non-survivors were evaluated. Additionally, the accordance of ED admission diagnoses and discharge diagnoses were analyzed.Overall, 243 of 19,854 ED patients (1.22%) were treated in the resuscitation room. After exclusion of trauma patients, 193 (0.97%) CINT were included. Overall mortality was 29% (n = 56), 24‑h mortality was 13% (n = 25). Patient characteristics (vital signs, blood gas analysis) differed significantly between survivors and nonsurvivors except for respiratory rate and pain scale. An excerpt of conducted resuscitation room measures was as follows: arterial line n = 78 (40%); noninvasive ventilation n = 60 (31%); endotracheal intubation n = 56 (29%); cardiopulmonary resuscitation n = 19 (10%), central venous line n = 8 (4%). The number of conducted measures differed between survivors and nonsurvivors (median and interquartile range, IQR): 4 (IQR 2) vs. 4 (IQR 3) p = 0.0453. The length of ED stay was 148.2 ± 202.7 min until the patient was admitted to an ICU or died within the ED. ED admission diagnoses matched with hospital discharge diagnoses in 78%.The observed mortality was high and was comparable to patient collectives with septic shock. Nonsurvivors showed significantly more impaired vital parameters and blood gas analysis parameters. Vital parameters together with blood gas analysis might enable ED risk stratification of CINT. Resuscitation room management enables immediate stabilization and diagnostic work-up of CINT even when no ICU bed is available. Furthermore, optimal allocation to specialized ICUs can probably be enabled more accurately after a first diagnostic work-up; however, although a first diagnostic work-up including laboratory tests and computed tomography in many cases was performed, ED admission and hospital discharge diagnoses matched only in 78%.EINLEITUNG: Die Notfallversorgung für kritische Kranke ist in verschiedenen Gesundheitssystemen heterogen organisiert. Während Traumapatienten immer im Schockraum übergeben und stabilisiert werden, erfolgt speziell in der deutschen Grund- und Regelversorgung bei kritisch kranken Nicht-Traumapatienten häufig eine direkte Aufnahme auf die Intensivstation durch den Rettungsdienst. In dieser retrospektiven Studie wurde daher die Schockraumversorgung nichttraumatologischer Patienten in einem 756-Betten-Lehrkrankenhaus analysiert.Schockraumversorgungen kritisch Kranker (01.10.2018 bis 31.03.2019) wurden in Bezug auf Patientencharakteristika, durchgeführte Schockraummaßnahmen und Krankenhaussterblichkeit analysiert. Ferner sollten die Aufnahmecharakteristika zwischen Überlebenden und Nichtüberlebenden evaluiert werden. Aufnahme- und Entlassungsdiagnosen sollten vergleichend ausgewertet werden.Es wurden 243/19.854 Patienten (1,22 %) im Untersuchungszeitraum als Schockraumpatienten behandelt. Nach Ausschluss von Traumapatienten konnten 193 (0,97 %) kritisch kranke nichttraumatologische Patienten eingeschlossen werden. Die Gesamtsterblichkeit lag bei 29 % (n = 56), die 24-h-Sterblichkeit bei 13 % (n = 25). Es wurden im Mittel 4,24 Schockraummaßnahmen (z. B. Intubation, Zentraler Venenkatheter) durchgeführt mit einer Versorgungsdauer in der Notaufnahme von 148 ± 203 min. Die Aufnahmeparameter von Überlebenden und Nichtüberlebenden unterschieden sich signifikant mit Ausnahme von Atemfrequenz und Schmerzskala. Durchgeführte Schockraummaßnahmen bei Überlebenden vs. Nichtüberlebenden: Median 4 (IQR 2) vs. 4 (IQR 3), p = 0,0453. Krankenhausaufnahme- und Entlassungsdiagnosen stimmten in 78 % der Fälle überein.Bei insgesamt hoher Krankenhaussterblichkeit zeigten sich signifikant schlechtere Vital- und Blutgasanalyseparameter bei Aufnahme für das Subkollektiv der Nichtüberlebenden. Ein möglicher Score aus Vital- und Blutgaswerten könnte folglich eine zukünftige Risikostratifizierung für nichttraumatologische Schockraumpatienten ermöglichen. Die nichttraumatologische Schockraumversorgung ermöglicht eine sofortige notfallmedizinische Versorgung und genaue Patientenallokation zu spezialisierten Intensivstationen. Nichtsdestotrotz stimmten Krankenhausaufnahme- und Entlassungsdiagnosen in 78 % überein.

Background: The outbreak of the coronavirus disease 2019 (COVID-19) caused by the severe respiratory distress syndrome coronavirus 2 (SARS-CoV-2) led to severe disruption in social life and economics. The present study should analyze the impact of the local COVID-19 epidemic on emergency resources for all hospitals in a major urban center (Moenchengladbach, Germany). Methods: An observational multicenter study was performed involving all four acute care hospitals. Systemic parameters department (ED) parameters from week 4 to 24 in 2020 were compared to the corresponding period in 2019 for each hospital and in a summative data analysis using a logistic regression model. Outcomes: ED visits, ED to hospital admission, ED to Intensive Care Unit (ICU) admission, medical specialties of admitted patients, work related accidents. Results: In week 9/2020 the first SARS-CoV-2 positive patients were detected in our region. All hospitals decided to minimize elective admissions to ensure operational capability for COVID-19 patients. The summative number of ED visits dropped from 34,659 to 28,008. Numbers decreased from week 8 on between 38% and 48% per week per hospital at the maximum and began to rise again from week 16 on. The pooled data analysis showed statistically significant decreases in outpatient ED visits (20,152 vs. 16,477, p=Conclusion: The regional COVID-19 outbreak led to significantly reduced ED contacts after the first COVID-19 cases appeared. Even the admissions to the hospitals and the number of ED to ICU-admissions decreased, which is potentially dangerous, because the ratio of emergency outpatients vs. inpatients remained stable. Therefore, one can assume that patients with severe medical problems did not seek ED care in many cases. The decline of patients was earlier than in other German hospitals and in contrast to the findings in the U.S. and Italy where ED visits and hospital admissions in medical disciplines increased.

Introduction. Emergency department (ED) triage regarding infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is challenging. During the coronavirus disease 2019 (COVID-19) outbreak in Germany, the diagnostic outcomes of critically ill patients admitted to the resuscitation room in the ED of our academic 754-bed hospital should be analyzed. Methods. All resuscitation room patients between March 1st and April 15th 2020 were included in this retrospective study. Every patient with suspicion of SARS-CoV-2 infection received a pharyngeal swab for real-time polymerase chain reaction (rt-PCR), divided in the clinical subgroups of “highly suspicious for COVID-19” and “COVID-19 as differential diagnosis.” All respiratory and infectious symptoms were included as at least “differential diagnosis” as an expanded suspicion strategy. Results. Ninety-five patients were included (trauma n=14, critically ill n=81). Of 3 highly suspicious patients, 2 had rt-PCR positive pharyngeal swabs. In 39 patients, COVID-19 was defined as differential diagnosis, and 3 were positive for SARS-CoV-2. Of them, pharyngeal swabs were positive in 1 case, while in 2 cases, only tracheal fluid was rt-PCR positive while the pharyngeal swabs were negative. In one of these 2 cases, chest computed tomography (CT) was also negative for ground-glass opacities but showed a pulmonary abscess and pulmonary embolism. Conclusion. We recommend an expanded suspicion strategy for COVID-19 due to unexpected diagnostic outcomes. Personal protective equipment should be used in every resuscitation room operation due to unexpected cases and initial knowledge gaps. Furthermore, tracheal fluid should be tested for SARS-CoV-2 in every intubated patient due to cases with negative pharyngeal swabs and negative chest CT.

In 2014, a telemedicine system was established in 24-h routine use in the emergency medical service (EMS) of the city of Aachen. This study tested whether the diagnostic concordance of the tele-EMS physician reaches the same diagnostic concordance as the on-site-EMS physician. The initial prehospital diagnoses were compared to the final hospital diagnoses. Data were recorded retrospectively from the physicians’ protocols as well as from the hospital administration system and compared. Also, all diagnostic misconcordance were analysed and reviewed in terms of logical content by two experts. There were no significant differences between the groups in terms of demographic data, such as age and gender, as well as regarding the hospital length of stay and mortality. There was no significant difference between the diagnostic concordance of the systems, except the diagnosis “epileptic seizure”. Instead, in these cases, “stroke” was the most frequently chosen diagnosis. The diagnostic misconcordance “stroke” is not associated with any risks to patients’ safety. Reasons for diagnostic misconcordance could be the short contact time to the patient during the teleconsultation, the lack of personal examination of the patient by the tele-EMS physician, and reversible symptoms that can mask the correct diagnosis.

Die telemedizinische Vernetzung zwischen medizinischem Personal und Spezialisten hat sich in der prahospitalen Notfallmedizin – wie auch in anderen medizinischen Bereichen – als vorteilhaft erwiesen. In der Notfallmedizin haben sich telemedizinische Teilkomponenten entwickelt, die fur jeweils einzelne Krankheitsbilder anwendbar sind. Neu hingegen ist ein System, das ein breites notfallmedizinisches Spektrum als erganzendes Strukturelement des existierenden boden- und luftgebundenen Rettungssystems abdecken kann. Es wird dargestellt, warum Telemedizin in der Notfallmedizin notwendig und sinnvoll ist, und die wichtigsten Strukturmerkmale werden erlautert. Ein aus unterschiedlichen Hard- und Softwarekomponenten bestehendes System (Telenotarzt-Arbeitsplatz, Server-Infrastruktur, mobile und im Rettungswagen fest verbaute Ubertragungseinheit) gewahrleistet die Verfugbarkeit medizinischer Daten und den sicheren Datentransfer (Sprache, Echtzeit-Vitalparameter-Kurven und Werte, Fotos, Videostream, 12-Kanal-EKG etc.) in Echtzeit. Basis fur eine sichere Telemedizin sind die Strukturempfehlungen der Deutschen Gesellschaft fur Anasthesiologie und Intensivmedizin. Anwendbar ist die Telemedizin bei unterschiedlichsten Krankheitsbildern und Indikationen. Jedoch unterliegt das System auch Grenzen und Limitationen. Schlussfolgerungen Telemedizin in der prahospitalen Phase ist sicher, erreicht im Vergleich zum konventionellen Notarztsystem eine bessere Dokumentationsqualitat, verkurzt die arztliche Bindungszeit um 50 %, reduziert die Gesamtzahl der arztlich begleiteten Rettungsdiensteinsatze und zeigt eine mindestens gleichwertige medizinische Versorgungsqualitat.

Hintergrund In der prahospitalen Notfallmedizin – wie auch in anderen medizinischen Bereichen – hat sich die telemedizinische Vernetzung zwischen medizinischem Personal und fachspezifischen Spezialisten als vorteilhaft fur die Versorgungsqualitat erwiesen. In der Notfallmedizin wurden jedoch bisher ausschlieslich fur das jeweils im Fokus stehende Krankheitsbild geeignete Telemedizinteilkomponenten genutzt. Daher wurde in Aachen weltweit erstmalig ein holistisches Telemedizinkonzept fur das gesamte notfallmedizinische Spektrum als erganzendes Strukturelement des existierenden boden- und luftgebundenen Rettungssystems entwickelt.

BACKGROUND As a consequence of increasing emergency medical service (EMS) missions requiring an EMS physician on site, we had implemented a unique prehospital telemedical emergency service as a new structural component to the conventional physician-based EMS in Germany. OBJECTIVE We sought to assess the utilization, safety, and technical performance of this telemedical emergency service. METHODS We conducted a retrospective analysis of all primary emergency missions with telemedical consultation of an EMS physician in the City of Aachen (250,000 inhabitants) during the first 3 operational years of our tele-EMS system. Main outcome measures were the number of teleconsultations, number of complications, and number of transmission malfunctions during teleconsultations. RESULTS The data of 6265 patients were analyzed. The number of teleconsultations increased during the run-in period of four quarters toward full routine operation from 152 to 420 missions per quarter. When fully operational, around the clock, and providing teleconsultations to 11 mobile ambulances, the number of teleconsultations further increased by 25.9 per quarter (95% CI 9.1-42.6; P=.009). Only 6 of 6265 patients (0.10%; 95% CI 0.04%-0.21%) experienced adverse events, all of them not inherent in the system of teleconsultations. Technical malfunctions of single transmission components occurred from as low as 0.3% (95% CI 0.2%-0.5%) during two-way voice communications to as high as 1.9% (95% CI 1.6%-2.3%) during real-time vital data transmissions. Complete system failures occurred in only 0.3% (95% CI 0.2%-0.6%) of all teleconsultations. CONCLUSIONS The Aachen prehospital EMS is a frequently used, safe, and technically reliable system to provide medical care for emergency patients without an EMS physician physically present. Noninferiority of the tele-EMS physician compared with an on-site EMS physician needs to be demonstrated in a randomized trial.

Hintergrund Prahospitale telemedizinische Verfahren fuhren bei akutem Koronarsysndrom (AKS) und Schlaganfall zur Outcomeverbesserung. Die Studie untersucht die Verfugbarkeit und Performanz von Live-Vitaldaten- und 12-Kanal-EKG-Ubertragung mittels unterschiedlicher Mobilfunkprovider in einem stadtischen Rettungsdienstbereich.

Introduction Telemedical concepts in emergency medical services (EMS) lead to improved process times and patient outcomes, but their technical performance has thus far been insufficient; nevertheless, the concept was transferred into EMS routine care in Aachen, Germany. This study evaluated the system’s technical performance and compared it to a precursor system. Methods The telemedicine system was implemented on seven ambulances and a teleconsultation centre staffed with experienced EMS physicians was established in April 2014. Telemedical applications included mobile vital data, 12-lead, picture transmission and video streaming from inside the ambulances. The tele-EMS physician filled in a questionnaire regarding the technical performance of the applications, background noise and assessed clinical values of the transmitted pictures and videos after each mission between 15 May 2014–15 October 2014. Results Teleconsultation was established during 539 emergency cases. In 83% of the cases ( n = 447), only the paramedics and the tele-EMS physician were involved. Transmission success rates ranged from 98% (audio connection) to 93% (12-lead electrocardiogram (ECG) transmission). All functionalities, except video transmission, were significantly better than the pilot project ( p Discussion The multifunctional system is now sufficient for routine use and is the most reliable mobile emergency telemedicine system compared to other published projects. Dropouts were due to user errors and network coverage problems. These findings enable widespread use of this system in the future, reducing the critical time intervals until medical therapy is started.

Health informatics applications reduce time intervals in acute coronary syndromes, but their impact on guideline adherence is unknown. This pre–post intervention study compared guideline adherence between telemedically supported (n = 101, April 2014–July 2015) and conventional on-scene care (n = 120, January 2014–March 2014) in acute coronary syndrome. A multivariate logistic regression was performed for dependent variables: adverse events 0 versus 0, p = NA; electrocardiogram 101 versus 120, p = NA; acetylic salicylic acid 91 versus 102, p = 0.21; heparin 92 versus 112, p = 0.99; morphine 96 versus 107, p = 0.33; oxygen 83 versus 102, p = 0.92; glyceroltrinitrate 55 versus 90, p = 0.038; correct destination: 100 versus 119, p = 1.0. The time from ambulance arrival to hospital arrival was prolonged with telemedicine: 48.7 ± 11 min versus 35.5 ± 8.1 min, p < 0.001. Guideline adherence showed no differences except for glyceroltrinitrate. Prolonged time requirements are critical, though explainable. However, this approach enables a timely and high-quality backup strategy if only paramedics are on-scene.

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

Aim Demographic changes, decreasing availability of general practitioners, and at least regional shortage of qualified emergency medical service (EMS) physicians led to increasing arrival times and quality problems. Telemedical solutions could help to solve some of the problems. Methods Overall safety and feasibility of prehospital telemedically guided care was already proven in two research projects from 2007 to 2013.1–3 Their results led to implementation of a multifunctional mobile telemedicine system in the city of Aachen, Germany. From 04/2014 to 03/2015 all ambulances were equipped with a telemedicine system connected to a teleconsultation centre staffed with anesthesiologists experienced in emergency care. Audio, real-time vital data, 12-lead-ECG, picture transmission, and video streaming from ambulances was accomplished with encrypted and parallelized transmission using. Mission numbers prior and after implementation were compared to evaluate systematic influence. Results From 04/2014 to 06/2016 overall 4.901 EMS missions were supported and guided telemedically: n=4.151 emergency missions (85%) and n=750 (15%) inter-hospital transfers. Prior to implementation (04/2013–03/2014) 17.305 solely ambulance missions (68.7%) and 7.882 ambulance plus EMS physician unit missions were performed (31.3%). After implementation (04/2015–03/2016) 20.102 ambulance missions (76%) and 6.360 ambulance plus EMS physician missions (24%) were conducted which revealed a significant difference between both phases, p Conclusion The implementation of a telemedicine system into routine care led to a significant decrease in conventional on-scene physician missions as well as to an overall decrease in physician guided EMS cases. Therefore, the approach can be judged resource optimising and holds a potential for economic improvements although highly qualified physicians carry out the service. References Brokmann JC, Conrad C, Rossaint R, Bergrath S, Beckers SK, Tamm M, Czaplik M, Hirsch F. Treatment of acute coronary syndrome by telemedically supported paramedics compared with physician-based treatment of acute coronary syndrome: a prospective, interventional, multicentre trial. J Med Internet Res2016;18(12):e314doi:10.2196/jmir.6358 Felzen F, Brokmann JC, Beckers SK, Hirsch H, Tamm M, Rossaint R, Bergrath S. Technical performance of a multifunctional prehospital telemedicine system in routine emergency medical care – an observational study. Journal of Telemedicine and Telecare2016; pii: 1357633X16644115. Bergrath S, Reich A, Rossaint R, Rortgen R, Gerber J, Fischermann H, Beckers SK, Brokmann JC, Schulz JB, Leber C, Fitzner C, Skorning M. Feasibility of Prehospital Teleconsultation in Acute Stroke – a pilot study in clinical routine. PLoS ONE2012;7(5):e36796. Conflict of interest None declared. Funding None declared.

Purpose and background Emergency medical services (EMSs) vary considerably. While some are physician staffed, most systems are run by paramedics. The objective of this randomized, controlled simulation study was to compare the emergency care between physician staffed EMS teams (control group) and paramedic teams that were supported telemedically by an EMS physician (telemedicine group). Methods Overall 16 teams (1 EMS physician, 2 paramedics) were randomized to the control group or the telemedicine group. Telemedical functionalities included two-way audio communication, transmission of vital data (numerical values and curves) and video streaming from the scenario room to the remotely located EMS physician. After a run-in scenario all teams completed four standardized scenarios, in which no highly invasive procedures (e.g. thoracic drain) were required, two using high-fidelity simulation (burn trauma, intoxication) and two using standardized patients (renal colic, barotrauma). All scenarios were videotaped and analyzed by two investigators using predefined scoring items. Results Non case-specific items (31 vs. 31 scenarios): obtaining of ‘symptoms', ‘past medical history' and ‘events' were carried out comparably, but in the telemedicine group ‘allergies' (17 vs. 28, OR 7.69, CI 2.1–27.9, p =0.002) and ‘medications' (17 vs. 27, OR 5.55, CI 1.7–18.0, p =0.004) were inquired more frequently. No significant differences were found regarding the case-specific items and in both groups no potentially dangerous mistreatments were observed. Conclusion Telemedically assisted paramedic care was feasible and at least not inferior compared to standard EMS teams with a physician on-scene in these scenarios.

Prehospital hypertensive emergencies and urgencies are common, but evidence is lacking. Telemedically supported hypertensive emergencies and urgencies were prospectively collected (April 2014-March 2015) and compared retrospectively with a historical control group of on-scene physician care in the emergency medical service of Aachen, Germany. Blood pressure management and guideline adherence were evaluated. Telemedical (n=159) vs conventional (n=172) cases: blood pressure reductions of 35±24 mm Hg vs 44±23 mm Hg revealed a group effect adjusted for baseline differences (P=.0006). Blood pressure management in categories: no reduction 6 vs 0 (P=.0121); reduction ≤25% (recommended range) 113 vs 110 patients (P=.2356); reduction >25% to 30% 13 vs 29 (0.020); reduction >30% 12 vs 16 patients (P=.5608). The telemedical approach led to less pronounced blood pressure reductions and a tendency to improved guideline adherence. Telemedically guided antihypertensive care may be an alternative to conventional care especially for potentially underserved areas.

To compare a novel, pressure-limited, flow adaptive ventilator that enables manual triggering of ventilations (MEDUMAT Easy CPR, Weinmann, Germany) with a bag-valve-mask (BVM) device during simulated cardiac arrest.Overall 74 third-year medical students received brief video instructions (BVM: 57s, ventilator: 126s), standardised theoretical instructions and practical training for both devices. Four days later, the students were randomised into 37 two-rescuer teams and were asked to perform 8min of cardiopulmonary resuscitation (CPR) on a manikin using either the ventilator or the BVM (randomisation list). Applied tidal volumes (V(T)), inspiratory times and hands-off times were recorded. Maximum airway pressures (P(max)) were measured with a sensor connected to the artificial lung. Questionnaires concerning levels of fatigue, stress and handling were evaluated. V(T), pressures and hands-off times were compared using t-tests, questionnaire data were analysed using the Wilcoxon test.BVM vs. ventilator (mean±SD): the mean V(T) (408±164ml vs. 315±165ml, p=0.10) and the maximum V(T) did not differ, but the number of recorded V(T)200ml differed (8.1±11.3 vs. 17.0±14.4 ventilations, p=0.04). P(max) did not differ, but inspiratory times (0.80±0.23s vs. 1.39±0.31s, p0.001) and total hands-off times (133.5±17.8s vs. 162.0±11.1s, p0.001) did. The estimated levels of fatigue and stress were comparable; however, the BVM was rated to be easier to use (p=0.03).For the user group investigated here, this ventilator exhibits no advantages in the setting of simulated CPR and carries a risk of prolonged no-flow time.

Background In German emergency medical services (EMS), the analgesia is restricted to physicians. In this prospective, interventional, multicentre trial, complications with and quality of telemedically delegated analgesia were evaluated. Methods If prehospital analgesia was necessary, five telemedically equipped paramedic ambulances from four different districts could consult a telemedicine centre. Analgesics were delegated based on a predefined algorithm. Telemedically assisted cases were compared with local historical regular EMS missions using matched pairs. The primary outcome was the frequency of therapeutic complications (respiratory/circulatory insufficiency, allergic reactions). Secondary outcomes were quality of analgesia (11-point numerical rating scale, NRS) and the frequency of nausea/vomiting. Results Analgesia was necessary in 106 telemedically assisted missions. In 23 cases, the telemedical procedure was used until an EMS physician arrived. Of the remaining 83 cases, 80 could be matched to comparable controls. Complications did not occur in either the study group or the control group (0 vs. 0; p = N/A). Complete NRS documentation was noted in 65/80 (study group) and 32/80 (control group) cases (p

Die konsequente Nutzerorientierung in der Entwicklung des Telemedizinischen Rettungsassistenzsystems (TRAS) ist zentrale Strategie des Projekts Med-on-@ix. Zur optimalen Einpassung des Systems in die Arbeitsablaufe des Rettungsdienstes erfolgte in allen Projektphasen ein konsequenter Dialog mit den Nutzergruppen. Diese Studie befasst sich mit der Evaluation des Systems durch die Aachener Rettungsassistenten im Anschluss an eine 10-monatige Praxisphase. Ein Fragebogen aus insgesamt 14 offenen und geschlossenen Fragen diente der Identifikation positiver und negativer Auswirkungen der Systemeinfuhrung aus Sicht der Rettungsassistenten. Anschliesend wurden in einer 45-minutigen Gruppendiskussion Fragen vonseiten der Rettungsdienstmitarbeiter geklart und ein Feedback an die Systementwickler eingeholt. 83,9% der Befragten hielten den Einsatz eines Telenotarztes generell fur sinnvoll. Positiv hervorgehoben wurden insbesondere die Verbesserung der fachlichen Unterstutzung bei kritischen Entscheidungen, eine leitlinienkonformere Versorgung, die Erhohung der Diagnosesicherheit sowie der schnellere Datenaustausch und -zugriff durch das TRAS. Optimierungsmoglichkeiten wurden bezuglich der Ausgestaltung des technischen Systems und der Kommunikationsablaufe im Einsatz identifiziert. Das Potenzial des TRAS wurde von den Rettungsassistenten bestatigt. Der Einsatz des Telenotarztes kann aus Sicht der Befragten Qualitat und Effizienz der Notfallversorgung steigern. Der Verbesserungsbedarf (Miniaturisierung der Technik und Intensivierung der Schulungsmasnahmen) muss im Nachfolgeprojekt „TemRas – Telemedizinisches Rettungsassistenzsystem“ fokussiert werden.

We evaluated the technical and organisational feasibility of a multifunctional telemedicine system in an emergency medical service (EMS) from the user's perspective. The telemedicine system was designed to transmit vital signs data and 12-lead-ECG data, send still pictures and allow voice communication and video transmission from an ambulance. The data were sent to a teleconsultation centre staffed with EMS physicians (tele-EMS physician). The system was used in 157 EMS missions. The applications were used successfully on 80% of missions for real-time vital signs transmission and on 97% for video transmission. The quality of the transmitted still images ( n = 64) was: 23% excellent, 50% good, 17% moderate, 9% rather poor and 0% unusable. The quality of the video streaming ( n = 36) was: 33% excellent, 56% good, 6% moderate, 6% rather poor and 0% unusable. The tele-EMS physician was able to assist the EMS team in several cases and provided the preliminary information for the hospital in nearly all missions. Use of the telemedical system in EMS is feasible and the quality of the transmitted images and video was satisfactory. However, technical reliability and availability need to be improved prior to routine use.

Telemedizin erhalt in immer mehr Bereiche der Medizin Einzug und zeigt ein starkes Marktwachstum. In der Notfallmedizin sind Systeme, die eine Vernetzung zweier stationarer Einrichtungen ermoglichen (interklinische Systeme) von den Systemen zu unterscheiden, die eine Vernetzung mit einem mobilen Partner ermoglichen (z. B. Rettungswagen). Fur die 12-Kanal-EKG-Ubertragung an einen beratenden Kardiologen wurde gezeigt, dass therapierelevante Zeitintervalle verkurzt werden konnen. Eine strukturierte telemedizinische Vorabinformation beim Schlaganfall kann die Zeit bis zur Bildgebung verkurzen und die Lyserate erhohen. Im interklinischen Bereich sind ebenfalls Telemedizinsysteme eingefuhrt worden, deren Nutzen beim akuten Schlaganfall mittlerweile wissenschaftlich belegt ist. Auch in Deutschland kann praklinische Telemedizin rechtssicher erfolgen, jedoch sind vielfaltige Aufgaben zu bewaltigen, bevor sie als Bestandteil der Regelversorgung im Notfall zur Anwendung kommen kann. Neben der technischen Weiterentwicklung ist der wissenschaftliche Nachweis zu erbringen, unter welchen Bedingungen durch Telemedizin die Versorgungsqualitat und letztlich das Outcome verbessert werden konnen.

External chest compressions (ECC) are essential components of resuscitation and are usually performed without any adjuncts in professional healthcare. Even for healthcare professionals during in-hospital and out-of-hospital resuscitation poor performance in ECC has been reported in recent years. Although several stand-alone devices have been developed none has been implemented as a standard in patient care. The aim of this study was to examine if the use of a mechanical device providing visual feedback and audible assistance during ECC improves performance of healthcare professionals following minimal and simplified instructions. In a prospective, randomized cross-over study 81 healthcare professionals performed ECC for 3 min (in the assumed setting of a secured airway) twice on a manikin (Skillreporter ResusciAnne®, with PC-Skillreporting System Version 1.3.0, Laerdal, Stavanger, Norway) in a mock cardiac arrest scenario. Group 1 (n=40) performed ECC with the device first followed by classic ECC and group 2 (n=41) in the opposite order. Minimal instructions were standardized and provided by video instruction (1 min 38 s). Endpoints were achievement of a mean compression rate between 90 and 110/min and a mean compression depth of 40–50 mm. In addition participants had to answer questionnaires about demographic data, professional experience and recent recommendations for ECC as well as their impression of the device concerning the ease of use and their personal level of confidence. Data were analyzed for group-related and inter-group differences using SAS (Version 9.1.3, SAS Institute, Cary, NC). A total of 81 healthcare professionals regularly involved in resuscitation attempts in pre-hospital or in-hospital settings took part in the study with no differences between the groups: females 35.8% (n=52), emergency medical technicians 32.1% (n=26), anesthesia nurses 32.1% (n=26), physicians (anesthesiology) 45% (n=29). In group 1 33 out of 40 (82.5%; 99.7±4.82/min; 95% confidence interval 95% CI: 98.1–101.2/min) reached the correct range for compression rate and 29/40 (72.5%; 44.0±4.95 mm; 95% CI: 42.4–45.6 mm) the correct compression depth using the assisting device. Afterwards they conducted classic ECC without the device and deteriorated significantly: correct compression rate was achieved by 12/40 (30%, p≤0.0001; 110.6±11.0/min (95% CI: 107.1–114.1/min), while 25/40 (62.5%; 44.5±5.63 mm; 95% CI: 42.6–46.3 mm) met the correct compression depth. Group 2 performed poorer in ECC without assistance and 5/41 (12.2%; 104.5±21.35/min; 95% CI: 97.8–111.3/min) reached the correct rate whereas 21/41 (51.2%; 39.6±7.61 mm; 95% CI: 37.2–42.0 mm) compressed to the appropriate depth. Using the device there was a significant improvement in the second evaluation with 34/41 (82.9%, p≤0.0001; 101.7±4.68/min; 95% CI: 100.2–103.2/min) reaching the correct rate and 36/41 (87.8%, p≤0.0001; 43.9±4.16 mm; 95% CI: 42.6–45.2 mm) the correct depth. The tested device is easy to use after instruction of less than 3 min and improves ECC performance of healthcare professionals in simulated cardiac arrest with respect to compression depth as well as compression rate.

Im Rettungsdienst sollte die Patientenversorgung evidenzbasiert erfolgen. In dieser Studie wurde die medikamentose Ausstattung notarztbesetzter Rettungsmittel erfasst. Fur ausgewahlte „Tracer“-Diagnosen wurden die Medikamentenbestande analysiert und mit dem Bedarf nach Leitlinien verglichen. Von Mai 2008 bis Januar 2009 wurden alle 148 Arztlichen Leiter Rettungsdienst (ALRD), die bei der Bundesgeschaftsstelle des Bundesverbandes der Arztlichen Leiter Rettungsdienst Deutschland e. V. registriert sind, angeschrieben und um Ubersendung 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 Schadelhirntrauma (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. Die Rucklaufquote betrug 64,2%; 39 Stoffgruppen und 142 verschiedene Medikamente konnten ermittelt werden. Der Leitlinienabgleich ergab, dass mit einer Haufigkeit von etwa 30–80%, abhangig von der jeweiligen Tracer-Diagnose, keine medikamentose Akuttherapie nach hochstem Evidenzgrad erfolgen kann. 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. Fur die Zukunft ist ein bundeseinheitlicher Mindeststandard nach evidenzbasierten Grundlagen anzustreben.

BACKGROUND The aim of this study was to examine documentation quality in physician staffed emergency medical services (EMS). This study compared simulated on-site care with the associated patient records written by EMS physicians. METHODS For this study two standardized simulated case scenarios, ST segment elevation myocardial infarction (STEMI) and major trauma with traumatic brain injury were designed by an expert committee. Overall 29 EMS teams each consisting of 1 EMS physician and 2 paramedics ran through the scenarios on high fidelity patient simulators and each scenario was videotaped. The scenarios were stopped after 12 min for STEMI and after 14 min for major trauma independent of the actions carried out and each EMS physician then had 10 min to document this initial phase on standardized protocol sheets. The videotaped scenarios were analyzed by two independent investigators. Documentation of predefined contents and all drug dosages were checked against the simulated on-site care. The data were evaluated and classified as correct, incorrect or missing documentation although action performed. RESULTS Written consent for data analysis was provided by 28 teams. Overall 20 parameters and actions in the STEMI scenario and 16 in the major trauma scenario as well as all drug dosages were evaluated. For the scenario STEMI 469 actions were analyzed of which 271 (58%) were correct, 94 (20%) incorrect and 104 (22%) had missing documentation. A total of 140 medications were administered of which 31 (22%) were documented incorrectly and 14 (10%) were not documented. For major trauma 401 actions were analyzed of which 244 (61%) were correct, 101 (25%) incorrect and 56 (14%) had missing documentation. In this scenario the teams administered 138 medications of which 31 (22%) were documented incorrectly and 16 (12%) were not documented. Infused amounts of crystalloids and colloids were mostly documented correctly in this case (35 correct /6 incorrect/8 not documented). Documentation of several clinical parameters was carried out predominantly correctly, e.g. initial blood pressure (STEMI: 25/2/1, major trauma: 21/4/2) and initial ECG rhythm (STEMI: 27/0/1, major trauma: 26/0/1). Documentation of other clinically relevant parameters was often performed incorrectly: 12-lead ECG in STEMI (5/9/12) and capnometry in major trauma (9/4/7). No team used a pain scale to assess the level of pain in the STEMI scenario but 12 EMS physicians documented an accordant value (numerical rating scale) on the patient records. Furthermore some parameters could be identified where documentation was mostly missing although they were measured, e.g. onset of symptoms in STEMI (5/4/15) and reduced level of consciousness and bradypnea in major trauma (9/2/17). CONCLUSION Patient safety can be reduced if relevant preclinical data are not transmitted correctly to the admitting hospital. Therefore there is a need to improve documentation quality in EMS. Electronic documentation, training of EMS staff and quality management programs might offer solutions. Because of the small sample size further studies are needed to evaluate the validity of these results.

To investigate if paper-based documentation in the authors' emergency medical service (EMS) satisfies scientific requirements.From 1 July 2007 to 28 February 2008, data from all paper-based protocols of a physician-run EMS in Aachen, Germany, were transferred to a SQL database (n=4815). Database queries were conducted after personal data had been anonymised. Documentation ratios of 11 individual parameters were analysed at two points in time (T1, scene; T2, arrival in emergency department). The calculability of the Mainz Emergency Evaluation Score (MEES, embracing seven vital parameters) was investigated. The calculability of the Revised Trauma Score (RTS) was also determined for all trauma patients (n=408). Fisher's exact test was used to compare differences in ratios at T1 versus T2.The documentation ratios of vital parameters ranged from 99.33% (Glasgow Coma Scale, T1) to 40.31% (respiratory rate, T2). The calculability of the MEES was poor (all missions: 28.31%, T1; 22.40%, T2; p0.001). In missions that required cardiopulmonary resuscitation (n=87), the MEES was calculable in 9.20% of patients at T1 and 29.89% at T2 (p0.001). In trauma missions, the RTS was calculable in 37.26% at T1 and 27.70% at T2 (p=0.004).Documentation of vital parameters is carried out incompletely, and documentation of respiratory rate is particularly poor, making calculation of accepted emergency scores infeasible for a significant fraction of a given test population. The suitability of paper-based documentation is therefore limited. Electronic documentation that includes real-time plausibility checks might improve data quality. Further research is warranted.

Introduction: Quality of external chest compression (ECC) is a key component of Basic Life Support. Different approaches to improve rescuers’ performance have been evaluated, but few attempts have been made to invent simple devices to improve performance. This study evaluates a new visual feedback system for ECC for healthcare professionals. Methods: Ninety-three healthcare professionals volunteered (14 emergency medical technicians, 45 paramedics, 34 physicians; age 32 ± 7.2 (range 21–61); 72% male) in this randomized cross-over study. All subjects were tested on a manikin (Skillreporter ResusciAnne ® , Laerdal, Stavanger, Norway) in identical mock cardiac arrest scenario and asked to perform 2 min of continuous ECC (secured airway): Group A( n = 46): ECC with device first, followed by ECC without device a minimum of 45 min later; group B (n = 47): vice versa. Primary endpoints: mean compression rate 90–120 min−1; mean compression depth 38–51 mm. Data were analyzed using repeated measure logistic regression model for binary categorized endpoints and repeated measure ANOVA test for continuous endpoints. Results: Correct compression depth was achieved by 45.2% of subjects (95%-CI: 30.5–64.9 mm) without vs. 73.1% (95%-CI: 40.3–57.4 mm) with device (p < 0.001); correct compression rate was achieved by 62.4% (95%-CI: 78–147.8 min−1) without vs. 94.6% (95%-CI: 87.3–126.6 min−1) with device (p < 0.001). Overall, 85% of the subjects thought the feedback system was helpful and 80.6% would use it if available. Conclusions: The new visual feedback device significantly improved ECC performance (compression rate and depth) by healthcare professionals in simulated cardiac arrest. Most participants found the device easy to use.

There is a need for new strategies to face current and future problems in German Emergency Medical Services (EMS). Lack of quality management and increasing costs in the presence of a deficit of EMS physicians are typical challenges, resulting in an increasing deficit in medical care. In addition, information and communication technology used in German EMS is out of date. The physician-powered EMS has to be modernized to increase quality and show measurable evidence of its effectiveness. Otherwise its future existence is at serious risk. Therefore, the project Med-on-@ix was created by the Department of Anaesthesiology at the University Hospital Aachen, Germany. The aim was to develop a new emergency telemedicine service system and to implement it clinically in order to advance medical care and effectiveness in the EMS by process optimization of each scene call. This system offers EMS physicians and paramedics an additional consultation by a specialised centre of competence, thus assuring medical therapy according to evidence-based guidelines. Several prospective studies are conducted to analyse this system in comparison to the conventional EMS.

Based on the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR), guidelines were published for managing basic and advanced life-saving procedures in the event of cardiac arrest. The fact that special circumstances for cardiac arrest must be considered resulted in a separate chapter. This two-part article reviews essential information as well as necessary modifications of the standard advanced life support algorithm in cases of electrolyte disorders, hyperthermia and hypothermia, cardiac arrest in pregnancy, trauma, electrical emergencies and cardiac surgery. Part 1 has already dealt with life-threatening drowning, asthma, anaphylaxis and poisoning.

Based on the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR), guidelines were published for managing basic and advanced life-saving procedures in the event of cardiac arrest. The fact that special circumstances sometimes must be considered in patient treatment resulted in a separate chapter. This first part of a two-part article reviews essential information as well as necessary modifications of the standard advanced life support algorithm in cases of life-threatening drowning, asthma, anaphylaxis, and poisoning. The second part will deal with electrolyte disorders, hypothermia, electrical emergencies, trauma, cardiac arrest during pregnancy, and cardiac surgery. Language: de

Journal of medical internet research : JMIR 18(12), e314 (2016). doi:10.2196/jmir.6358, Published by Healthcare World, Richmond, Va.

Ersthelferalarmierungssystems bei vermutetem prahospitalem Herz-KreislaufStillstand zu untersuchen [4]. In diesen Fallen wurde durch die Rettungsleitstelle zusatzlich zur Alarmierung des Rettungsdiensts und evtl. der „first responder“ (Feuerwehr, Polizei) eine Ersthelferortung und -alarmierung durchgefuhrt. Randomisiert und fur die Disponenten verblindet erfolgten entweder nur die Ortung (Kontrollgruppe) oder Ortung mit Alarmierung der Ersthelfer (Interventionsgruppe) in einem Umkreis von 500 m zum Notfallort taglich zwischen 6.00 und 23.00 Uhr. Folgende Ursachen eines Herz-Kreislauf-Stillstands wurden zuvor ausgeschlossen: Trauma, Suizid, Ertrinken und Intoxikation. Kinder im Alter unter 8 Jahren wurden nicht in die Studie aufgenommen. Primarer Endpunkt der Studie war die Rate an „Bystander“-initiierten kardiopulmonalen Reanimationen (CPR) vor Ankunft des Rettungsdiensts oder der First responder. Als sekundare Parameter wurden u. a. der erste registrierte Herzrhythmus, die Nutzung von Telefon-Reanimation, die Rate des „return of spontaneous circulation“ (ROSC) und das Dreisigtageuberleben berichtet. Die Daten wurden der Rettungsdienst- und First-responder-Dokumentation sowie dem schwedischen Reanimationsregister (Swedish Cardiac Arrest Registry) entnommen.

Scandinavian journal of trauma, resuscitation and emergency medicine : SJTREM 21, 54 (2013). doi:10.1186/1757-7241-21-54, Published by BioMed Central, London

Scandinavian journal of trauma, resuscitation and emergency medicine : SJTREM 21, 3 (2013). doi:10.1186/1757-7241-21-3, Published by BioMed Central, London

Hintergrund Die konsequente Nutzerorientierung in der Entwicklung des Telemedizinischen Rettungsassistenzsystems (TRAS) ist zentrale Strategie des Projekts Med-on-@ix. Zur optimalen Einpassung des Systems in die Arbeitsablaufe des Rettungsdienstes erfolgte in allen Projektphasen ein konsequenter Dialog mit den Nutzergruppen. Diese Studie befasst sich mit der Evaluation des Systems durch die Aachener Rettungsassistenten im Anschluss an eine 10-monatige Praxisphase.

Background Teleconsultation from the scene of an emergency to an experienced physician including real-time transmission of monitoring, audio and visual information seems to be feasible. In preparation for bringing such a system into practice within the research project "Med-on-@ix", a simulation study has been conducted to investigate whether telemedical assistance (TMA) in Emergency Medical Services (EMS) has an impact on compatibility to guidelines and timing. Material and methods In a controlled simulation study 29 EMS teams (one EMS physician, two paramedics) ran through standardized scenarios (STEMI: ST-elevation myocardial infarction; MT: major trauma) on high-fidelity patient simulators with defined complications (treatable clearly following guidelines). Team assignments were randomized and each team had to complete one scenario with and another without TMA. Analysis was based on videotaped scenarios using pre-defined scoring items and measured time intervals for each scenario. Results Adherence to treatment algorithms improved using TMA. STEMI: cathlab informed (9/14 vs. 15/15; p =0.0169); allergies checked prior to acetylsalicylic acid (5/14 vs. 13/15; p =0.0078); analgosedation prior to cardioversion (10/14 vs. 15/15; p =0.0421); synchronized shock (6/14 vs. 14/15; p =0.0052). MT: adequate medication for intubation (3/15 vs. 10/14; p =0.0092); mean time to inform trauma centre 547 vs. 189s ( p =0.0001). No significant impairment of performance was detected in TMA groups. Conclusions In simulated setting TMA was able to improve treatment and safety without decline in timing. Nevertheless, further research is necessary to optimize the system for medical, organizational and technical reasons prior to the evaluation of this system in routine EMS.

PLoS one 7(5), e36796 (2012). doi:10.1371/journal.pone.0036796, Published by PLoS [u.a.], Lawrence, Kan.

Scandinavian journal of trauma, resuscitation and emergency medicine 23(1), 31 (2015). doi:10.1186/s13049-015-0110-6, Published by BioMed Central, London