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Piontkowski E, Richter H, Bischof J, Herrmann A, Preiser C, Häske D, Joos S, Rieger MA. Versorgungsforschung im Gesundheitsamt – eine explorative Interviewstudie zur wissenschaftlichen Methodenkompetenz im ÖGD in Baden-Württemberg. Gesundheitswesen 2024. [PMID: 38631383 DOI: 10.1055/a-2308-7059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Hintergrund und Ziel der Studie: Ein Ziel des Paktes für den ÖGD (Öffentlicher Gesundheitsdienst) ist die Steigerung der wissenschaftlichen Tätigkeit im ÖGD. Es ist aktuell jedoch unklar, welche wissenschaftlichen Methoden bekannt sind und welche Bedarfe und Bedürfnisse hinsichtlich wissenschaftlicher Kompetenzen bestehen. Diese Arbeit beschäftigt sich mit der Frage, welche Methoden zur Versorgungsforschung im ÖGD in Baden-Württemberg (BW) bekannt sind, angewandt werden und bei welchen Methoden Bedarfe bestehen. Methodik: Es wurden leitfadengestützte Interviews (Fokusgruppen-/Einzelinterviews) mit 12 Personen unterschiedlicher Ebenen (Amtsleitungen, Abteilungsleitungen, Mitarbeitende) aus Gesundheitsämtern in BW geführt, die inhaltsanalytisch in Anlehnung an Kuckartz ausgewertet wurden. Ergebnisse: Die Interviewten nennen heterogene Bedarfe und Kompetenzen. Mitarbeitende äußern häufiger vorhandene Kompetenzen als Leitungspersonen. Kompetenzen, die im Berufsalltag angewandt werden sind z.B. Literaturrecherche oder verschiedene Datenauswertungsmethoden, die vor allem im Bereich der routinemäßig erfassten Daten (z.B. Einschulungsuntersuchung) eingesetzt werden. Bedarfe und Bedürfnisse bestehen vor allem im Bereich der Datenauswertung/-erhebung, werden aber auch im Bereich der Grundlagen geäußert. Vorgaben zur guten wissenschaftlichen Praxis (z.B. Ethikanträge) und zum Publikationsprozess sind eher weniger bekannt. Vielfach wird ein Bedarf nach einem Unterstützungsangebot durch Forschungseinrichtungen oder oberen Behörden genannt. Darüber hinaus werden Aussagen zur Motivation und Hemmnisse für Forschung im ÖGD gemacht. Schlussfolgerung: Diese Studie zeigt heterogene bestehende Methodenkompetenzen sowie Bedarfe und Bedürfnisse auf, die auf die unterschiedlichen Hintergründe und Tätigkeitsbereiche der Befragten zurückzuführen sind. Kompetenzen werden angegeben z.B. im Bereich der Literaturrecherche und der Auswertung vorhandener Daten. Bedarfe gibt es z.B. in Methoden der Datenerhebung/-auswertung sowie in der Grundlagenvermittlung und Vertiefung der vorhandenen Kompetenzen. Es besteht ein Bedarf an Unterstützungsangeboten hinsichtlich wissenschaftlicher Methodenkompetenz für Gesundheitsämter. Es fehlt zudem an Forschungsinfrastruktur (z.B. Software, Literaturzugriff) und gesetzlicher Grundlage für die wissenschaftliche Tätigkeit im ÖGD. Die Ergebnisse können als Grundlage für die Konzeption bedarfsgerechter Fortbildungen für ÖGD-Beschäftigte in BW dienen.
Background and aim of the study: One aim of the pact for the Public Health Service (“Pakt für den ÖGD”) is to increase scientific activity in the Public Health Service (PHS). However, it is currently unclear which scientific methods are known and which needs exist regarding scientific competences in local public health departments. This study deals with the question, which methods related to health services research are known and applied in the PHS and which methods are needed by PHS-employees in the federal state Baden-Württemberg in Germany. Methods: Guideline-based interviews (focus group and individual interviews) were conducted with 12 persons from different hierarchy levels from public health departments in Baden-Württemberg. The interviews were analyzed by content analysis following Kuckartz. Results: The interviewees indicate heterogeneous needs as well as existing methodological competences. Staff members express existing competences more frequently than leaders. Various existing competencies were expressed that are used in the everyday work such as literature research or different methods for data analysis. These are mainly used in the field of routinely collected data (e.g., school entry examination). Needs seem to exist primarily in the area of data analysis and collection, but are also expressed in the area of the basic scientific methods. Topics relating to guidelines for good scientific practice (e.g. ethics proposals) and publications are also rather less known. A need for a support from research institutions or higher authorities is frequently mentioned. In addition, statements were made about motivation and barriers for research in public health departments. Conclusion: This study shows heterogeneous existing methodological competencies as well as needs, that can be attributed to the heterogeneous backgrounds and fields of activity of the interviewees. Competencies are indicated for example in literature research and analysis of existing data. There is a need in methods for example of data collection/analysis as well as in basic scientific methods and deepening of existing skills. Furthermore support offers regarding scientific methodological competence for public health departments are required. There is also a lack of research infrastructure (e.g. software, access to literature) and a legal basis. The results can serve as a basis for the design of demand-oriented methodological programs for employees from the PHS in Baden-Württemberg
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Affiliation(s)
- Emily Piontkowski
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Hannah Richter
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Jonas Bischof
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Anja Herrmann
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Christine Preiser
- Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, Tubingen, Germany
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Germany
| | - David Häske
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung (ZÖGV), Universitätsklinikum Tübingen, Tübingen, Germany
| | - Stefanie Joos
- Institut für Allgemeinmedizin und Interprofessionelle Versorgung, University of Tubingen Faculty of Science, Tubingen, Germany
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Monika A Rieger
- Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, Tubingen, Germany
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Germany
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Siegel A, Hesmert D, Mangold J, Klein A, Häske D, Wössner S, Rieger MA, Joos S, Mahler C. [Health Promotion and Prevention of Non-Communicable Diseases by Public Health Departments in Baden-Württemberg during the COVID-19 Pandemic: Results of an Online Survey]. Gesundheitswesen 2024. [PMID: 38467149 DOI: 10.1055/a-2227-5481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
OBJECTIVES Disease prevention and health promotion are among the core tasks of German public health services (Öffentlicher Gesundheitsdienst - ÖGD), particularly local public health departments (Gesundheitsämter). Little is known about the extent to which the departments were able to continue activities in the field of health promotion and prevention of non-communicable diseases (HPP-NCDs) during the COVID-19 pandemic. Using the example of public health departments in Baden-Württemberg (BW), we therefore investigated how much staff was available to the departments for HPP-NCDs services, how much staff was actually dedicated to HPP-NCDs during the COVID-19 pandemic, which HPP-NCDs activities were carried out during the pandemic, which were cancelled, and which should be resumed as a priority, according to the public health departments. METHODS We developed a largely standardized online questionnaire for the survey of the 38 public health departments in BW. Per department one questionnaire was to be completed. The survey took place from 9/1/2022 to 11/4/2022. The data of this explorative cross-sectional study were analyzed in a descriptive-statistical manner using SPSS, version 28. RESULTS Of the 38 departments, 34 participated in the survey (89%). Departments had a mean of 2.44 full HPP-NCDs staff as planned (median 2.00; SD 1.41; range 0.20-5.00). Under pandemic conditions, a mean of 1.23 full HPP-NCDs staff were deployed (median 0.95; SD 1.24; range 0.00-4.50). Respondents gave examples of 61 HPP-NCDs activities that were conducted under pandemic conditions, and they described 69 HPP-NCDs activities that had to be cancelled. Of the latter, respondents felt that 40 should be resumed as a matter of highest priority. Analysis of the priority activities to be resumed reveals characteristic differences: e. g., resumption of structural prevention activities was viewed more frequently as a matter of hightest priority than resumption of behavioral prevention activities. CONCLUSIONS During the pandemic, local public health departments in BW deployed, on average, actually only half of their full staff allocated as planned to HPP-NCDs. Comparing different categories of HPP-NCDs activities (cancelled during the pandemic) in terms of the relative frequency with which their resumption is viewed as matter of highest priority, characteristic differences can be observed. It remains an open question which conclusions can be drawn from such differences.
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Affiliation(s)
- Achim Siegel
- Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Daniela Hesmert
- Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Jasmin Mangold
- Institut für Gesundheitswissenschaften, Abteilung Pflegewissenschaft, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Anika Klein
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung (ZÖGV), Universitätsklinikum Tübingen, Tübingen, Germany
| | - David Häske
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung (ZÖGV), Universitätsklinikum Tübingen, Tübingen, Germany
| | - Sofie Wössner
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung (ZÖGV), Universitätsklinikum Tübingen, Tübingen, Germany
| | - Monika A Rieger
- Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Germany
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung (ZÖGV), Universitätsklinikum Tübingen, Tübingen, Germany
| | - Stefanie Joos
- Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Universitätsklinikum Tübingen, Tübingen, Germany
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung (ZÖGV), Universitätsklinikum Tübingen, Tübingen, Germany
| | - Cornelia Mahler
- Institut für Gesundheitswissenschaften, Abteilung Pflegewissenschaft, Universitätsklinikum Tübingen, Tübingen, Germany
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Häske D, Dorau W, Eppler F, Heinemann N, Metzger F, Schempf B. Prevalence of prehospital pain and pain assessment difference between patients and paramedics: a prospective cross-sectional observational study. Sci Rep 2024; 14:5613. [PMID: 38453981 PMCID: PMC10920866 DOI: 10.1038/s41598-024-56072-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/01/2024] [Indexed: 03/09/2024] Open
Abstract
Adequate analgesia is one of the most important interventions in emergency medicine. However, studies suggest that many patients are undertreated for pain. There can be many reasons why patients assess their pain differently to the paramedics. This study aimed to assess the differences in pain ratings between patients and paramedics and factors influencing them in prehospital emergencies. This prospective cross-sectional observational study included patients treated and transported by paramedics or paramedics and emergency physicians of the German Red Cross in Reutlingen, Germany. This study included 6,365 patients. The prevalence of pain was 49.7%. Among patients with a self-reported numerical rating scale (NRS) > 0, the mean patient pain rating was NRS 4.2 ± 2.7, while the mean paramedic pain rating was NRS 3.6 ± 2.4 (p < 0.001). Approximately 11.8% (n = 751) of patients reported subjectively unbearable pain. Patients reported a mean NRS of 7.7 ± 1.8 for unbearable pain, but a mean NRS of 3.3 ± 2.0 for bearable pain (p < 0.001). The difference in pain ratings between patients and paramedics increased with pain severity. Univariate analysis showed that there were no gender differences, but the difference in pain rating was influenced by patient age (p < 0.001) and paramedic age (p = 0.042). The differences in pain ratings were particularly pronounced for abdominal diseases (p < 0.001) and trauma (p < 0.001). There is a difference in pain ratings between patients and paramedics, which increases with pain severity and appears to be associated with the patient's age and the paramedic's age. To determine the desire and need for analgesics, the question about unbearable pain is a good addition to the NRS.
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Affiliation(s)
- David Häske
- Center for Public Health and Health Services Research, University Hospital Tübingen, Osianderstrasse 5, 72076, Tübingen, Germany.
- German Red Cross, Emergency Medical Service, 72764, Reutlingen, Germany.
| | - Wolfgang Dorau
- German Red Cross, Emergency Medical Service, 72764, Reutlingen, Germany
| | - Fabian Eppler
- German Red Cross, Emergency Medical Service, 72764, Reutlingen, Germany
| | - Niklas Heinemann
- German Red Cross, Emergency Medical Service, 72764, Reutlingen, Germany
| | - Florian Metzger
- German Red Cross, Emergency Medical Service, 72764, Reutlingen, Germany
| | - Benjamin Schempf
- German Red Cross, Emergency Medical Service, 72764, Reutlingen, Germany
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Mangold J, Hesmert D, Siegel A, Klein AJ, Häske D, Wössner S, Rieger MA, Joos S, Mahler C. [Information on health promotion and prevention on the websites of Baden-Württemberg's public health services-a first approach]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:76-84. [PMID: 38078916 PMCID: PMC10776711 DOI: 10.1007/s00103-023-03818-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 12/01/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Health promotion and prevention are core tasks of German public health services (Öffentlicher Gesundheitsdienst). Health communication is, among other things, central to their effectiveness. As the Internet has become an important source of health information and public health services are increasingly in the public eye, their websites are gaining more focus. We therefore investigated how public health services present topics on health promotion and prevention of non-communicable diseases (HPP-NCDs) on their websites. METHODS The websites of the 38 public health service departments in Baden-Wuerttemberg were examined using qualitative content analysis from June to October 2022. The presentation of the HPP-NCDs topic on the websites as well as the relevant measures were documented. For each measure/activity the addressed target group, the topic, and the type of intervention was collected. RESULTS The HPP-NCDs topic is addressed on all websites (n = 38); however, the presentation style is heterogeneous. A total of 243 HPP-NCDs measures/activities were identified across the 38 websites. There was a broad spectrum of topics, target groups, and types of intervention used in the measures/activities presented. DISCUSSION The study shows an extensive but heterogeneous presentation of HPP-NCDs on the websites of public health services. In doing so, they are caught between the requirements of public relations and health information. The use of synergy effects through the joint promotion of nationally relevant informational materials and measures could be beneficial for public health services.
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Affiliation(s)
- Jasmin Mangold
- Institut für Gesundheitswissenschaften, Abteilung Pflegewissenschaft, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 9, 72076, Tübingen, Deutschland.
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung (ZÖGV), Universitätsklinikum Tübingen, Tübingen, Deutschland.
| | - Daniela Hesmert
- Institut für Allgemeinmedizin & Interprofessionelle Versorgung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Achim Siegel
- Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Anika J Klein
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung (ZÖGV), Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - David Häske
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung (ZÖGV), Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Sofie Wössner
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung (ZÖGV), Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Monika A Rieger
- Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Deutschland
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung (ZÖGV), Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Stefanie Joos
- Institut für Allgemeinmedizin & Interprofessionelle Versorgung, Universitätsklinikum Tübingen, Tübingen, Deutschland
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung (ZÖGV), Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Cornelia Mahler
- Institut für Gesundheitswissenschaften, Abteilung Pflegewissenschaft, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 9, 72076, Tübingen, Deutschland
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Häske D, Eppler F, Heinemann N, Schempf B. Patient-reported side effects and satisfaction of pre-hospital analgesia with low-dose esketamine: a cross-sectional study. BMC Emerg Med 2023; 23:130. [PMID: 37924027 PMCID: PMC10625244 DOI: 10.1186/s12873-023-00898-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/20/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Analgesia is a core intervention in emergency medicine. Pain is subjective, so patient-reported experience with pain and analgesia is essential for healthcare professionals. The aim of this study was to evaluate patient-reported side effects and satisfaction associated with pre-hospital analgesia with low-dose esketamine. METHODS This is an observational cross-sectional study conducted as part of quality assurance measures of the German Red Cross Emergency Medical Service, Reutlingen, Germany. The survey was administered to all patients who received prehospital esketamine analgesia from paramedics. Addresses were obtained from medical records and mailed 10 days after the event. Patient feedback was anonymous and could not be linked to operational documentation. RESULTS A total of 201 patients were contacted, and 119 responses were received via the online questionnaire and postal mail (response rate 59%). The mean age of the patients was 68±13 years, with 64.7% (n=77) being female. The main diagnosis reported was fractures of the extremities in 69.7%. Patients reported initial median pain intensity on a Numeric Rating Scale (NRS) of 10 [8-10]. Pain was unbearable for 96.3% of patients. After administration of analgesia, 95.3% were satisfied or very satisfied. Patients reported no side effects in 78.5%, minor side effects in 10.0%, significant but well tolerable side effects in 11.3%, borderline tolerable side effects in 0.2%, and no unbearable side effects. Borderline tolerable nausea was reported in 2% of patients along with dreams in 0.8%. No nightmares were reported. Further analysis showed that patients older than 80 years reported significantly more side effects (p < 0.001) and were thus less satisfied with the analgesia. CONCLUSIONS Both patient perception and analgesia with few side effects were important for both safety and satisfaction. In the present study, low-dose esketamine analgesia was associated with low side effects and high patient satisfaction.
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Affiliation(s)
- David Häske
- Center for Public Health and Health Services Research, University Hospital Tübingen, Osianderstraße 5, 72076, Tübingen, Germany.
- Emergency Medical Service, German Red Cross, Steinenbergstraße 23, Reutlingen, 72764, Germany.
| | - Fabian Eppler
- Emergency Medical Service, German Red Cross, Steinenbergstraße 23, Reutlingen, 72764, Germany
| | - Niklas Heinemann
- Emergency Medical Service, German Red Cross, Steinenbergstraße 23, Reutlingen, 72764, Germany
| | - Benjamin Schempf
- Emergency Medical Service, German Red Cross, Steinenbergstraße 23, Reutlingen, 72764, Germany
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Waydhas C, Deffner T, Gaschler R, Häske D, Hamsen U, Herbstreit F, Hierundar A, Kumpf O, Rohe G, Spiekermann A, Vonderhagen S, Waeschle RM, Riessen R. Sedation, sleep-promotion, and non-verbal and verbal communication techniques in critically ill intubated or tracheostomized patients: results of a survey. BMC Anesthesiol 2022; 22:384. [PMID: 36503427 PMCID: PMC9743767 DOI: 10.1186/s12871-022-01887-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The aim of this survey was to describe, on a patient basis, the current practice of sedation, pharmacologic and non-pharmacologic measures to promote sleep and facilitation of communication in critically ill patients oro-tracheally intubated or tracheostomized. METHODS Cross-sectional online-survey evaluating sedation, sleep management and communication in oro-tracheally intubated (IP) or tracheostomized (TP) patients in intensive care units on a single point. RESULTS Eighty-one intensive care units including 447 patients (IP: n = 320, TP: n = 127) participated. A score of ≤ -2 on the Richmond Agitation Sedation Scale (RASS) was prevalent in 58.2% (IP 70.7% vs. TP 26.8%). RASS -1/0 was present in 32.2% (IP 25.9% vs. TP 55.1%) of subjects. Propofol and alpha-2-agonist were the predominant sedatives used while benzodiazepines were applied in only 12.1% of patients. For sleep management, ear plugs and sleeping masks were rarely used (< 7%). In half of the participating intensive care units a technique for phonation was used in the tracheostomized patients. CONCLUSIONS The overall rate of moderate and deep sedation appears high, particularly in oro-tracheally intubated patients. There is no uniform sleep management and ear plugs and sleeping masks are only rarely applied. The application of phonation techniques in tracheostomized patients during assisted breathing is low. More efforts should be directed towards improved guideline implementation. The enhancement of sleep promotion and communication techniques in non-verbal critically ill patients may be a focus of future guideline development.
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Affiliation(s)
- Christian Waydhas
- grid.5570.70000 0004 0490 981XRuhr-Universität-Bochum, Universitätsstrasse 150, 44801 Bochum, Germany ,grid.412471.50000 0004 0551 2937Klinik Und Poliklinik Für Chirurgie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Bochum, Bürkle-de-La-Camp-Platz 1, 44789 Bochum, Germany ,Present Address: Klinik Für Unfallchirurgie, Universitätsklinikum, Universitätsmedizin Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Teresa Deffner
- grid.275559.90000 0000 8517 6224Klinik Für Anästhesiologie Und Intensivmedizin, Universitätsklinikum Jena, Bachstrasse 18, 07743 Jena, Germany
| | - Robert Gaschler
- Fakultät Für Psychologie, Lehrgebiet Allgemeine Psychologie: Lernen, Motivation, Emotion, FernUniversität in Hagen, Universitätsstrasse 33, 58084 Hagen, Germany
| | - David Häske
- grid.411544.10000 0001 0196 8249Center for Public Health and Health Services Research, University Hospital Tübingen, Osianderstraße 5, 72076 Tübingen, Germany
| | - Uwe Hamsen
- grid.5570.70000 0004 0490 981XRuhr-Universität-Bochum, Universitätsstrasse 150, 44801 Bochum, Germany ,grid.412471.50000 0004 0551 2937Klinik Und Poliklinik Für Chirurgie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Bochum, Bürkle-de-La-Camp-Platz 1, 44789 Bochum, Germany
| | - Frank Herbstreit
- Klinik Für Anästhesiologie Und Intensivmedizin, Universitätsklinikum, Universitätsmedizin Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Anke Hierundar
- grid.413108.f0000 0000 9737 0454Klinik Für Anästhesiologie Und Intensivtherapie, Universitätsmedizin Rostock, Schillingallee 35, 18057 Rostock, Germany
| | - Oliver Kumpf
- grid.7468.d0000 0001 2248 7639Klinik Für Anästhesiologie Mit Schwerpunkt Operative Intensivmedizin, Campus Charité Mitte Und Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Georg Rohe
- grid.5560.60000 0001 1009 3608University Clinic for Anaesthesiology / Intensive Care Medicine / Emergency Medicine / Pain Medicine, Klinikum Oldenburg, Medical Campus of the University Oldenburg), Rahel Straus - Str. 10, 26133 Oldenburg, Germany
| | - Aileen Spiekermann
- grid.5570.70000 0004 0490 981XRuhr-Universität-Bochum, Universitätsstrasse 150, 44801 Bochum, Germany ,grid.412471.50000 0004 0551 2937Klinik Und Poliklinik Für Chirurgie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Bochum, Bürkle-de-La-Camp-Platz 1, 44789 Bochum, Germany
| | - Sonja Vonderhagen
- Present Address: Klinik Für Unfallchirurgie, Universitätsklinikum, Universitätsmedizin Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Reiner M. Waeschle
- grid.411984.10000 0001 0482 5331Klinik Für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37099 Göttingen, Germany
| | - Reimer Riessen
- grid.411544.10000 0001 0196 8249Department Für Innere Medizin, Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
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Häske D, Dorau W, Heinemann N, Eppler F, Schopp T, Schempf B. Efficacy and safety in ketamine-guided prehospital analgesia for abdominal pain. Intern Emerg Med 2022; 17:2291-2297. [PMID: 36205836 DOI: 10.1007/s11739-022-03091-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/30/2022] [Indexed: 11/05/2022]
Abstract
Abdominal pain is a common reason for presentation in the emergency department and for calling emergency medical services. The complexity of abdominal pain also influences the analgesia strategy. However, there are almost no data on the use of ketamine for abdominal pain. This study aims to analyze the safety and efficacy of using ketamine as an analgesic for abdominal pain. In a retrospective analysis of prehospital patient data within the framework of quality assurance, all cases with ketamine administered by paramedics as analgesia for abdominal pain were analyzed in terms of pain reduction and patient safety and also compared with other analgesic drugs including fentanyl, morphine, and metamizole. From 01/01/2018 to 11/24/2021, 129 datasets were analyzed. The mean patient age was 50 ± 19 years (19-90 years), with 47.3% (n = 61) women. The application of fentanyl was documented as a monotherapy in 10.9% (n = 14), morphine in 2.3% (n = 3), metamizole in 34.1% (n = 44), and ketamine in 52.7% (n = 68) of cases. The pain relief of fentanyl, metamizole, and ketamine differed significantly from each other (p < 0.001), with fentanyl and ketamine being comparable. Looking at the quality assurance definition of successful analgesia (pain on handover NRS < 5 or pain reduction ≥ 2 points), successful analgesia was shown in 92.9% (n = 13) of cases for fentanyl, in 65.9% (n = 44) for metamizole, and 92.6% (n = 68) for ketamine (p < 0.001). Adverse events were not observed in patients treated with ketamine. Analgesia is an important goal in the treatment of patients with abdominal pain. With ketamine, analgesia comparable to fentanyl can be achieved. Ketamine appears to be a safe and effective option for the treatment of patients with abdominal pain in emergency medicine.Trial registration number DRKS00027343, date of registration: 09.12.2021, retrospectively registered.
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Affiliation(s)
- David Häske
- Center for Public Health and Health Services Research, University Hospital Tübingen, 72076, Tübingen, Germany.
- Emergency Medical Service, German Red Cross, 72764, Reutlingen, Germany.
| | - Wolfgang Dorau
- Emergency Medical Service, German Red Cross, 72764, Reutlingen, Germany
| | - Niklas Heinemann
- Emergency Medical Service, German Red Cross, 72764, Reutlingen, Germany
| | - Fabian Eppler
- Emergency Medical Service, German Red Cross, 72764, Reutlingen, Germany
| | - Tobias Schopp
- Emergency Medical Service, German Red Cross, 72764, Reutlingen, Germany
| | - Benjamin Schempf
- Emergency Medical Service, German Red Cross, 72764, Reutlingen, Germany
- Department of Internal Medicine, Cardiology, Angiology and Intensive Care Medicine, Klinikum am Steinenberg, 72764, Reutlingen, Germany
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8
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Häske D, Blumenstock G, Hossfeld B, Wölfl C, Schweigkofler U, Stock JP. The Immo Traffic Light System as a Decision-Making Tool for Prehospital Spinal Immobilization. Dtsch Arztebl Int 2022; 119:753-758. [PMID: 35978468 PMCID: PMC9853232 DOI: 10.3238/arztebl.m2022.0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 01/24/2022] [Accepted: 07/21/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Spinal injuries are difficult injuries to assess yet can be associated with significant neurological damage. To avoid secondary damage, immobilization is considered state of the art trauma care. The indication for spinal immobilization must be assessed, however, for potential complications as well as its advantages and disadvantages. METHODS This systematic review addressing the question of the correct indication for spinal immobilization in trauma patients was compiled on the basis of our previously published analysis of possible predictors from the Trauma Registry of the German Society for Trauma Surgery. A Delphi procedure was then used to develop suggestions for action regarding immobilization based on the results of this review. RESULTS The search of the literature yielded 576 publications. The 24 publications included in the qualitative analysis report of 2 228 076 patients. A decision tool for spinal immobilization in prehospital trauma care was developed (Immo traffic light system) based on the results of the Delphi procedure. According to this system, severely injured patients with blunt trauma, severe traumatic brain injury, peripheral neurological symptoms, or spinal pain requiring treatment should be immobilized. Patients with a statistically increased risk of spinal injury as a result of the four cardinal features (fall >3m, severe trunk injury, supra clavicular injury, seniority [age >65 years]) should only have their spinal motion restricted after weighing up the pros and cons. Isolated penetrating trunk injuries should not be immobilized. CONCLUSION High-quality studies demonstrating the benefit of prehospital spinal immobilization are still lacking. Decision tools such as the Immo traffic light system can help weigh up the pros and cons of immobilization.
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Affiliation(s)
- David Häske
- Center for Public Health and Health Services Research, University Hospital of Tübingen, and German Red Cross Emergency Services Reutlingen,*Center for Public Health and Health Services Research University Hospital of Tübingen Osianderstr. 5 72076 Tübingen, Germany
| | - Gunnar Blumenstock
- Institute of Clinical Epidemiology and Applied Biometry, University Hospital of Tübingen
| | - Björn Hossfeld
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Federal Armed Forces Hospital of Ulm
| | - Christoph Wölfl
- Department for Orthopedic Surgery, Trauma and Sports Traumatology – Hand and Plastic Surgery, Musculoskeletal Center Neuwied, Marienhaus Hospital Neuwied
| | - Uwe Schweigkofler
- Department of Trauma and Orthopedic Surgery, BG Trauma Center, Frankfurt am Main
| | - Jan-Philipp Stock
- Department for Anesthesiology, Intensive Care Medicine, Emergency Medicine, Pain Therapy and Palliative Care, am Steinenberg Hospital, Reutlingen: Jan-Philipp Stock
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9
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Häske D, Schmöckel S. [Development of emergency medical services and paramedics]. Notf Rett Med 2022; 25:153-155. [PMID: 35370454 PMCID: PMC8959070 DOI: 10.1007/s10049-022-01000-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/30/2022]
Affiliation(s)
- David Häske
- DRK Rettungsdienst Reutlingen, Reutlingen, Deutschland.,Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung (ZÖGV) am Universitätsklinikum Tübingen, Osianderstr. 5, 72076 Tübingen, Deutschland
| | - Stefanie Schmöckel
- Studiengang Berufspädagogik für Gesundheit, Fachrichtung Rettung, SRH Wilhelm Löhe Hochschule Fürth, Fürth, Deutschland.,Landesschule Baden-Württemberg gGmbH, Deutsches Rotes Kreuz, Karl-Berner-Str. 6, 72285 Pfalzgrafenweiler, Deutschland
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10
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Häske D, Lefering R, Stock JP, Kreinest M. Correction to: Epidemiology and predictors of traumatic spine injury in severely injured patients: implications for emergency procedures. Eur J Trauma Emerg Surg 2022; 48:1985-1986. [PMID: 35344074 PMCID: PMC9192378 DOI: 10.1007/s00068-022-01914-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- David Häske
- German Red Cross, Emergency Medical Service, Obere Wässere 1, 72764, Reutlingen, Germany. .,Center for Public Health and Health Services Research, University Hospital Tübingen, Tübingen, Germany.
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany
| | - Jan-Philipp Stock
- Department of Anesthesiology, Intensive Care Medicine, Emergency and Pain Medicine, Klinikum am Steinenberg, Reutlingen, Germany
| | - Michael Kreinest
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
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11
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Schempf B, Dorau W, Eppler F, Heinemann N, Metzger M, Häske D. [Best practice-example of a paramedic competence system in the context of user and patient safety: the Reutlinger Weg]. Notf Rett Med 2022; 26:1-12. [PMID: 35261560 PMCID: PMC8890017 DOI: 10.1007/s10049-022-00989-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 11/27/2022]
Abstract
The discussion about the competencies and responsibilities of paramedics has been going on for decades and is the subject of controversial legal debates and currently the focus of political attention due to the heterogeneous country-specific design. However, there are only a few published examples of a so-called competency system for the safe and effective use of prehospital emergency medicine interventions. The practical experience of a competence system is presented. Adequate education and training are crucial for development of competence. A physician-supported quality assurance system creates the opportunity to confirm the competencies of paramedics within the framework of competence checks, monitor the system by means of indicators, and detect weak points at an early stage. Safety culture must be exemplified. Standard operating procedures (SOPs) are the guideline for implementation. In a competence system, certified paramedics can be granted authorization and thus contribute to rapid and efficient patient care, while keeping emergency physicians available for indications requiring their competencies.
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Affiliation(s)
- Benjamin Schempf
- DRK Rettungsdienst Reutlingen, Reutlingen, Deutschland
- Medizinische Klinik II – Kardiologie, Angiologie, internistische Intensivmedizin, Klinikum am Steinenberg, Reutlingen, Deutschland
| | | | - Fabian Eppler
- DRK Rettungsdienst Reutlingen, Reutlingen, Deutschland
| | | | | | - David Häske
- DRK Rettungsdienst Reutlingen, Reutlingen, Deutschland
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Deutschland
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12
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Häske D, Beckers SK, Dieroff M, Gliwitzky B, Hofmann M, Lefering R, Münzberg M. Training Effectiveness and Impact on Safety, Treatment Quality, and Communication in Prehospital Emergency Care: The Prospective Longitudinal Mixed-Methods EPPTC Trial. J Patient Saf 2022; 18:71-76. [PMID: 35093976 DOI: 10.1097/pts.0000000000000969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Emergency training is designed to improve medical care teams' knowledge, practical skills, and treatment procedures in patient care to increase patient safety. This requires effective training, but the multifactorial effects of training are difficult to measure. METHODS We assessed the impact of emergency team training on treatment procedures and quality, processes, technical skills, and nontechnical skills in simulated trauma emergencies in a longitudinal analysis, using videos that were recorded before (t0), immediately after (t1), and 1 year after the training (t2). The training was evaluated with the validated PERFECT checklist, which includes 7 scales: primary assessment, secondary assessment, procedures, technical skills, trauma communication, nontechnical skills, and a global performance scale.The primary end point was the change from before a training intervention (t0) to 1 year after training (t2), measured by a metric point score. The second end point was the impact of the intervention from before training to after and from immediately after training to 1 year later. RESULTS A total of 146 trainings were evaluated. In simulated traumatological emergencies, training participants showed significantly better treatment capacity after 1 year (t0: 28.8 ± 5.6 points versus t2: 59.6 ± 6.6 points, P < 0.001), with greater improvement from t0 to t1 (28.8 ± 5.6 points versus 65.1 ± 7.9 points, P < 0.001). The most significant change from t0 to t2 was seen in the primary assessment, with a mean change of 11.1 ± 5.1, followed by the scale of the procedure (6.1 ± 3.0) and nontechnical skills (6.0 ± 3.0). CONCLUSIONS Team trainings with intensive scenario training and short theoretical inputs lead to a significant improvement in simulated care of severely injured patients, especially in identifying and intervening in life-threatening symptoms, processes, and nontechnical skills, even 1 year after the course. Positive, longitudinally positive effects were also in communication and subjective safety of prehospital health care personnel.
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Affiliation(s)
| | | | - Marc Dieroff
- Fire Service, Emergency Preparedness and Crisis Management, City of Wiesbaden, Wiesbaden
| | | | | | - Rolf Lefering
- Institute for Research in Operative Medicine, University of Witten/Herdecke, Cologne
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13
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Gliwitzky B, Olivieri M, Bathe J, Landsleitner B, Hoffmann F, Hossfeld B, Häske D. Intranasale Analgesie bei Säuglingen und Kleinkindern. Notf Rett Med 2022. [DOI: 10.1007/s10049-021-00958-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Gliwitzky B, Hoffmann F, Olivieri M, Häske D. Die „glorreichen Sieben“ der pädiatrischen Notfallmedizin. Notf Rett Med 2022. [DOI: 10.1007/s10049-021-00956-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Häske D, Gross Z, Atzbach U, Bernhard M, Gather A, Hoedtke J, Hossfeld B, Schele S, Münzberg M. Comparison of manual statements from out-of-hospital trauma training programs and a national guideline on treatment of patients with severe and multiple injuries. Eur J Trauma Emerg Surg 2021; 48:2207-2217. [PMID: 34426883 DOI: 10.1007/s00068-021-01768-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Training programs help establish evidence-based knowledge in prehospital emergency care. This study aimed to compare manual statements from prehospital trauma training programs and evidence-based guidelines on treatment of patients with severe and multiple injuries. METHODS A systematic comparison with the primary endpoint of the highest grades of recommendation (GoR A, "must") of the current version of the German guidelines and recent recommendations of the prehospital trauma training programs International Trauma Life Support (ITLS), Prehospital Trauma Life Support (PHTLS), and Traumamanagement® (TM) based on their official textbooks was done. The recommendations were categorized as agreement or minor or major variation. The comparison was made using a rating system by experts who were blinded to the training programs. If the consensus strength of the experts was < 75%, affected statements were finalized in a Delphi procedure. RESULTS Overall, 92 statements were compared. Fleiss-kappa of the first rating was 0.385 (p < 0.001, 95% CI: 0.376-0.393). Finally, comparable recommendations of the guideline with the training programs in principle agree with the statement of the guidelines were > 90% for all programs. The agreement with GoR A recommendations and each course program were 33.9%, 30.6%, and 35.5% (ITLS, PHTLS, and TM, respectively), p = 0.715. CONCLUSIONS Despite small differences, the training programs showed high degrees of compliance with the guidelines and international agreement with some minor differences. Furthermore, the results did not allow any conclusions regarding the quality of the courses, the didactic methodology, and local adaptability. The practical implementation of the courses is probably even higher and closer to the guidelines.
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Affiliation(s)
- David Häske
- Center of Public Health and Health Services Research, University Hospital Tübingen, Tübingen, Germany.,Emergency Medical Service, German Red Cross, Reutlingen, Germany
| | - Zeno Gross
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, University Hospital Heidelberg, Ludwigshafen, Germany
| | - Ulrich Atzbach
- PHTLS, Academy of the German Association of Emergency Medical Services, Lübeck, Germany
| | - Michael Bernhard
- Emergency Department, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Andreas Gather
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, University Hospital Heidelberg, Ludwigshafen, Germany
| | - Jochen Hoedtke
- Asklepios Klinik Barmbek, Department of Anesthesiology, Intensive and Emergency Medicine, Pain Therapy, Hamburg, Germany.,Trauma Management Network, Training Center Schlump, Hamburg, Germany
| | - Björn Hossfeld
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, HEMS 'Christoph 22', Federal Armed Forces Hospital Ulm, Ulm, Germany
| | - Stephan Schele
- Department of Anesthesiology, Intensive and Emergency Medicine, Klinikverbund Allgäu gGmbH, Immenstadt, Germany.,ITLS-International Trauma Life Support Germany e.V., Mölln, Germany
| | - Matthias Münzberg
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, University Hospital Heidelberg, Ludwigshafen, Germany. .,Department of Rescue and Emergency Medicine, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.
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16
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Strobel S, Kiele K, Dorau W, Häske D. [Simple and practical: application of venous port systems by emergency medical services and in the emergency department]. Notf Rett Med 2021; 24:1124-1128. [PMID: 33776558 PMCID: PMC7988373 DOI: 10.1007/s10049-021-00857-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Sabrina Strobel
- Medizinische Klinik I, Klinikum am Steinenberg Reutlingen, Reutlingen, Deutschland
| | - Katrin Kiele
- Hämatologische und Onkologische Praxis Dr. Wacker, Reutlingen, Deutschland
| | - Wolfgang Dorau
- DRK Rettungsdienst Reutlingen, Obere Wässere 1, 72764 Reutlingen, Deutschland
| | - David Häske
- DRK Rettungsdienst Reutlingen, Obere Wässere 1, 72764 Reutlingen, Deutschland
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Affiliation(s)
- M Baubin
- Universitätsklinik für Anästhesie und Intensivmedizin, Tirol Kliniken/Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - D Häske
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung Tübingen, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - A Lechleuthner
- Institut für Schutz und Rettung, Berufsfeuerwehr Köln, Köln, Deutschland
| | - T Luiz
- Digital Healthcare, Fraunhofer IESE , Fraunhofer-Platz 1, 67663 Kaiserslautern, Deutschland
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18
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Häske D, Lefering R, Stock JP, Kreinest M. Epidemiology and predictors of traumatic spine injury in severely injured patients: implications for emergency procedures. Eur J Trauma Emerg Surg 2020; 48:1975-1983. [PMID: 33025171 PMCID: PMC9192373 DOI: 10.1007/s00068-020-01515-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/25/2020] [Indexed: 10/30/2022]
Abstract
PURPOSE This study aimed to identify the prevalence and predictors of spinal injuries that are suitable for immobilization. METHODS Retrospective cohort study drawing from the multi-center database of the TraumaRegister DGU®, spinal injury patients ≥ 16 years of age who scored ≥ 3 on the Abbreviated Injury Scale (AIS) between 2009 and 2016 were enrolled. RESULTS The mean age of the 145,833 patients enrolled was 52.7 ± 21.1 years. The hospital mortality rate was 13.9%, and the mean injury severity score (ISS) was 21.8 ± 11.8. Seventy percent of patients had no spine injury, 25.9% scored 2-3 on the AIS, and 4.1% scored 4-6 on the AIS. Among patients with isolated traumatic brain injury (TBI), 26.8% had spinal injuries with an AIS score of 4-6. Among patients with multi-system trauma and TBI, 44.7% had spinal injuries that scored 4-6 on the AIS. Regression analysis predicted a serious spine injury (SI; AIS 3-6) with a prevalence of 10.6% and cervical spine injury (CSI; AIS 3-6) with a prevalence of 5.1%. Blunt trauma was a predictor for SI and CSI (OR 4.066 and OR 3.640, respectively; both p < 0.001) and fall > 3 m for SI (OR 2.243; p < 0.001) but not CSI (OR 0.636; p < 0.001). Pre-hospital shock was predictive for SI and CSI (OR 1.87 and OR 2.342, respectively; both p < 0.001), and diminished or absent motor response was also predictive for SI (OR 3.171) and CSI (OR 7.462; both p < 0.001). Patients over 65 years of age were more frequently affected by CSI. CONCLUSIONS In addition to the clinical symptoms of pain, we identify '4S' [spill (fall) > 3 m, seniority (age > 65 years), seriously injured, skull/traumatic brain injury] as an indication for increased attention for CSIs or indication for spinal motion restriction.
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Affiliation(s)
- David Häske
- German Red Cross, Emergency Medical Service, Obere Wässere 1, 72764, Reutlingen, Germany. .,Center for Public Health and Health Services Research, University Hospital Tübingen, Tübingen, Germany.
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany
| | - Jan-Philipp Stock
- Department of Anesthesiology, Intensive Care Medicine, Emergency and Pain Medicine, Klinikum am Steinenberg, Reutlingen, Germany
| | - Michael Kreinest
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
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19
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Nolte PC, Häske D, Lefering R, Bernhard M, Casu S, Frankenhauser S, Gather A, Grützner PA, Münzberg M. Training to identify red flags in the acute care of trauma: who are the patients at risk for early death despite a relatively good prognosis? An analysis from the TraumaRegister DGU®. World J Emerg Surg 2020; 15:47. [PMID: 32746874 PMCID: PMC7398082 DOI: 10.1186/s13017-020-00325-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background In the acute care of trauma, some patients with a low estimated risk of death die suddenly and unexpectedly. In this study, we aim to identify predictors for early death within 24 h following hospital admission in low-risk patients. Methods The TraumaRegister DGU® was used to collect records of patients who were primarily treated in a participating hospital between 2004 and 2013 with a RISC II score below 10%. Results During the study period, 64,379 patients met the inclusion criteria. The mean RISC II score was 2.0%, and the mean ISS was 16 ± 9. The overall hospital mortality rate was 2.1%, and 0.5% of patients (n = 301) died within the first 24 h. A SPB of ≤ 90 mmHg was associated with an increased risk of death (p < 0.001). An AIS abdomen score of ≥ 3 was associated with increased risk of death within the first 24 h (p < 0.001). A high risk of early death was also seen in patients with an AIS score (thorax) ≥ 3; 51% of those who died died within the first 24 h (p < 0.005). Death in patients over 60 years was more common after 24 h (p < 0.001). Patients with an ASA score of ≥ 3 were more likely to die after the first 24 h (p < 0.001). Conclusions Indicators predicting a high risk of early death in patients with a low RISC II score include a SPB ≤ 90 mmHg and severe chest and abdominal trauma. Emergency teams involved in the acute care of trauma patients should be aware of these “red flags” and treat their patients accordingly.
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Affiliation(s)
- Philip-C Nolte
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, 67071, Ludwigshafen, Germany
| | - David Häske
- Center for Public Health and Health Services Research, University Hospital Tübingen, 72076, Tübingen, Germany.,German Red Cross, Emergency Medical Service, 72764, Reutlingen, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany
| | - Michael Bernhard
- Emergency Department, University Hospital Duesseldorf, 40225, Duesseldorf, Germany
| | - Sebastian Casu
- Department of Intensive Care and Emergency Medicine, Helios Hospital Salzgitter, 38226, Salzgitter, Germany
| | - Susanne Frankenhauser
- Department of Rescue and Emergency Medicine, BG Trauma Center Ludwigshafen, 67071, Ludwigshafen, Germany
| | - Andreas Gather
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, 67071, Ludwigshafen, Germany
| | - Paul A Grützner
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, 67071, Ludwigshafen, Germany
| | - Matthias Münzberg
- Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, 67071, Ludwigshafen, Germany. .,Department of Rescue and Emergency Medicine, BG Trauma Center Ludwigshafen, 67071, Ludwigshafen, Germany.
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20
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Trentzsch H, Flake F, Häske D, Hossfeld B, Knapp J, Gotthardt P. [Recommendations for therapy in pandemic times: Acting (and treating) correctly under pressure to act]. Notf Rett Med 2020; 23:382-384. [PMID: 32837304 PMCID: PMC7359438 DOI: 10.1007/s10049-020-00739-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- H. Trentzsch
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336 München, Deutschland
| | - F. Flake
- Notfallvorsorge Oldenburg Nord, Malteser Hilfsdienst e. V., Oldenburg, Deutschland
| | - D. Häske
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung Tübingen, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - B. Hossfeld
- Notfallmedizinisches Zentrum, Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin u. Schmerztherapie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - J. Knapp
- Universitätsklinik für Anästhesiologie und Schmerztherapie, Universitätsspital Bern, Bern, Schweiz
| | - P. Gotthardt
- Klinikum Nürnberg – Klinik für Kardiologie – Zentrale Notaufnahme Süd, Breslauer Str. 201, 90471 Nürnberg, Deutschland
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Häske D, Böttiger BW, Bouillon B, Fischer M, Gaier G, Gliwitzky B, Helm M, Hilbert-Carius P, Hossfeld B, Schempf B, Wafaisade A, Bernhard M. Analgesie bei Traumapatienten in der Notfallmedizin. Notf Rett Med 2019. [DOI: 10.1007/s10049-019-00629-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Häske D, Gaier G, Heinemann N, Schempf B, Renz JU. Minimal training for first responders with the i-gel™ leads to successful use in prehospital cardiopulmonary resuscitation. Resuscitation 2019; 134:167-168. [DOI: 10.1016/j.resuscitation.2018.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/10/2018] [Indexed: 11/26/2022]
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Häske D, Beckers SK, Hofmann M, Lefering R, Preiser C, Gliwitzky B, Grützner PA, Stöckle U, Münzberg M. Performance Assessment of Emergency Teams and Communication in Trauma Care (PERFECT checklist)-Explorative analysis, development and validation of the PERFECT checklist: Part of the prospective longitudinal mixed-methods EPPTC trial. PLoS One 2018; 13:e0202795. [PMID: 30142204 PMCID: PMC6108494 DOI: 10.1371/journal.pone.0202795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/09/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Trainings in emergency medicine are well structured, but examinations are rarely validated. We are evaluating the impact of pre-hospital emergency trainings on participants and patient care and developed and validated a checklist to assess emergency trainings. METHODS We used videos recorded at the time points directly before (t0), directly after (t1), and one year after (t2) training to develop the PERFECT checklist (Performance Assessment of Emergency Teams and Communication in Trauma Care). The videos were assessed using semi-qualitative/linguistic analysis as well as expert panel appraisal and recommendations using the Delphi method. The checklist was tested for validity and reliability. RESULTS The inter-rater reliability (ICC = 0.99) and internal consistency (α = 0.99) were high. Concurrent validity was moderate to high (r = 0.65 -r = 0.93 (p<0.001)). We included scales for procedures, non-technical skills, technical skills and global performance. The procedures were done faster in the mean over the timeline (t0: 2:29, 95%CI 1:54-3:03 min., t1: 1:11, 95%C 0:53-1:30 min, t2: 1:14, 95%CI 0:56-1:31 min.). All experts rated the recorded scenarios at t0 with the lowest sum score (mean 31±8), with a significantly better performance of the teams at t1 (mean 69±7). The performance at t2 (mean 66 ± 13) was slightly lower than at t1, but still better than at t0. At t1 and t2, linguistic analysis showed a change in the team leaders communication behaviour, which can be interpreted as a surrogate parameter for reduced stress. CONCLUSION The PERFECT checklist has a good validity and high reliability for assessing trauma procedures and teamwork.
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Affiliation(s)
- David Häske
- Faculty of Medicine, Eberhard Karls University Tübingen, Tübingen, Germany
- DRK Rettungsdienst Reutlingen, Reutlingen, Germany
| | - Stefan K. Beckers
- Department of Anaesthesiology, Faculty of Medicine, University Hospital RWTH, Aachen, Aachen, Germany
- Emergency Medical Service, Fire Department, City of Aachen, Aachen, Germany
| | | | - Rolf Lefering
- Institute for Research in Operative Medicine, University of Witten/Herdecke, Cologne, Germany
| | - Christine Preiser
- Coordination Centre for Health Services Research, University Hospital Tübingen, Tübingen, Germany
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen, Germany
| | | | - Paul Alfred Grützner
- Department of Trauma and Orthopaedic Surgery, BG Hospital Ludwigshafen, Ludwigshafen, Germany
| | - Ulrich Stöckle
- Department of Traumatology and Reconstructive Surgery, BG Hospital Tübingen, Tübingen, Germany
| | - Matthias Münzberg
- Department of Trauma and Orthopaedic Surgery, BG Hospital Ludwigshafen, Ludwigshafen, Germany
- Centre of interdisciplinary Rescue- and Emergency Medicine, BG Hospital Ludwigshafen, Ludwigshafen, Germany
- * E-mail:
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Schempf B, Schibilsky D, Gaier G, Schadt B, Haase KK, Schlensak C, Häske D. Out of hospital extracorporeal life support (ECLS) implantation in cardiogenic shock after cardiac arrest. Am J Emerg Med 2018; 36:1121.e1-1121.e3. [PMID: 29602666 DOI: 10.1016/j.ajem.2018.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 12/29/2017] [Accepted: 01/03/2018] [Indexed: 11/29/2022] Open
Abstract
We report the use of out-of-hospital extracorporeal life support (ECLS) in a 62-year-old patient with severe cardiogenic shock after cardiac arrest. The patient was successfully stabilized using the ECLS system in the pre-hospital setting. Hospital discharge with a good neurological outcome was possible after 23days.
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Affiliation(s)
- Benjamin Schempf
- Departments of Internal Medicine, Cardiology, Angiology and Intensive Care Medicine, Klinikum am Steinenberg, Steinenbergstrasse 31, 72764 Reutlingen, Germany; DRK Rettungsdienst Reutlingen, Obere Wässere 1, 72764 Reutlingen, Germany.
| | - David Schibilsky
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, 72076 Tübingen, Germany
| | - Gernot Gaier
- Department of Anaesthesiology, Intensive Care Medicine, Emergency and Pain Medicine, Klinikum am Steinenberg, Steinenbergstrasse 31, 72764 Reutlingen, Germany
| | - Benjamin Schadt
- Department of Anaesthesiology, Intensive Care Medicine, Emergency and Pain Medicine, Klinikum am Steinenberg, Steinenbergstrasse 31, 72764 Reutlingen, Germany
| | - Karl Konstantin Haase
- Departments of Internal Medicine, Cardiology, Angiology and Intensive Care Medicine, Klinikum am Steinenberg, Steinenbergstrasse 31, 72764 Reutlingen, Germany
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, 72076 Tübingen, Germany
| | - David Häske
- DRK Rettungsdienst Reutlingen, Obere Wässere 1, 72764 Reutlingen, Germany; Faculty of Medicine, Eberhard Karls Universität Tübingen, Geißweg 5, 72076 Tübingen, Germany
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Gotthardt P, Häske D, Hossfeld B, Knapp J. „Einfach und praktisch“. Notf Rett Med 2018. [DOI: 10.1007/s10049-017-0406-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Häske D, W. Böttiger B, Bouillon B, Fischer M, Gaier G, Gliwitzky B, Helm M, Hilbert-Carius P, Hossfeld B, Meisner C, Schempf B, Wafaisade A, Bernhard M. Analgesia in Patients with Trauma in Emergency Medicine. Dtsch Arztebl Int 2017; 114:785-792. [PMID: 29229039 PMCID: PMC5730701 DOI: 10.3238/arztebl.2017.0785] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 11/29/2016] [Accepted: 07/03/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Suitable analgesic drugs and techniques are needed for the acute care of the approximately 18 200-18 400 seriously injured patients in Germany each year. METHODS This systematic review and meta-analysis of analgesia in trauma patients was carried out on the basis of randomized, controlled trials and observational studies. A systematic search of the literature over the 10-year period ending in February 2016 was carried out in the PubMed, Google Scholar, and Springer Link Library databases. Some of the considered trials and studies were included in a meta-analysis. Mean differences (MD) of pain reduction or pain outcome as measured on the Numeric Rating Scale were taken as a summarizing measure of treatment efficacy. RESULTS Out of 685 studies, 41 studies were considered and 10 studies were included in the meta-analysis. Among the drugs and drug combinations studied, none was clearly superior to another with respect to pain relief. Neither fentanyl versus morphine (MD -0.10 with a 95% confidence interval of [-0.58; 0.39], p = 0.70) nor ketamine versus morphine (MD -1.27 [-3.71; 1.16], p = 0.31), or the combination of ketamine and morphine versus morphine alone (MD -1.23 [-2.29; -0.18], p = 0.02) showed clear superiority regarding analgesia. CONCLUSION Ketamine, fentanyl, and morphine are suitable for analgesia in spontaneously breathing trauma patients. Fentanyl and ketamine have a rapid onset of action and a strong analgesic effect. Our quantitative meta-analysis revealed no evidence for the superiority of any of the three substances over the others. Suitable monitoring equipment, and expertise in emergency procedures are prerequisites for safe and effective analgesia by healthcare professionals..
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Affiliation(s)
| | - Bernd W. Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne
| | - Bertil Bouillon
- Department of Orthopedics, Trauma Surgery, and Sports Injuries, Cologne Hospitals, University of Witten/Herdecke
| | - Matthias Fischer
- Department of Anesthesiology, Surgical Intensive Care, Emergency Medicine, and Pain Therapy, Hospital am Eichert, ALB FILS Hospitals, Göppingen
| | - Gernot Gaier
- Department of Anesthesiology and Surgical Intensive Care, Hospital am Steinenberg, Reutlingen
| | | | - Matthias Helm
- Department of Anaesthesiology and Intensive Care Medicine, Section Emergency Medicine, Federal Armed Forces Hospital, Ulm, Germany
| | - Peter Hilbert-Carius
- Department of Anesthesiology, Intensive Care, and Emergency Medicine, Bergmannstrost BG Hospital, Halle
| | - Björn Hossfeld
- Department of Anaesthesiology and Intensive Care Medicine, Section Emergency Medicine, Federal Armed Forces Hospital, Ulm, Germany
| | - Christoph Meisner
- Institute for Clinical Epidemiology and Applied Biometrics, University of Tübingen
| | - Benjamin Schempf
- Department of Medicine II – Cardiology, Angiology, Intensive Care, Hospital am Steinenberg, Reutlingen
| | - Arasch Wafaisade
- Department of Orthopedics, Trauma Surgery, and Sports Injuries, Cologne Hospitals, University of Witten/Herdecke
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Häske D, Beckers SK, Hofmann M, Lefering R, Grützner PA, Stöckle U, Papathanassiou V, Münzberg M. Subjective safety and self-confidence in prehospital trauma care and learning progress after trauma-courses: part of the prospective longitudinal mixed-methods EPPTC-trial. Scand J Trauma Resusc Emerg Med 2017; 25:79. [PMID: 28806988 PMCID: PMC5557465 DOI: 10.1186/s13049-017-0426-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/02/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Prehospital trauma care is stressful and requires multi-professional teamwork. A decrease in the number of accident victims ultimately affects the routine and skills and underlines the importance of effective training. Standardized courses, like PHTLS, are established for health care professionals to improve the prehospital care of trauma patients. The aim of the study was to investigate the subjective safety in prehospital trauma care and learning progress by paramedics in a longitudinal analysis. METHODS This was a prospective intervention trial and part of the mixed-method longitudinal EPPTC-trial, evaluating subjective and objective changes among participants and real patient care as a result of PHTLS courses. Participants were evaluated with pre/post questionnaires as well as one year after the course. RESULTS We included 236 datasets. In the pre/post comparison, an increased performance could be observed in nearly all cases. The result shows that the expectations of the participants of the course were fully met even after one year (p = 0.002). The subjective safety in trauma care is significantly better even one year after the course (p < 0.001). Regression analysis showed that (ABCDE)-structure is decisive (p = 0.036) as well as safety in rare and common skills (both p < 0.001). Most skills are also rated better after one year. Knowledge and specific safety are assessed as worse after one year. CONCLUSION The courses meet the expectations of the participants and increase the subjective safety in the prehospital care of trauma patients. ABCDE-structure and safety in skills are crucial. In the short term, both safety in skills and knowledge can be increased, but the courses do not have the power to maintain knowledge and specific subjective safety issues over a year. TRIAL REGISTRATION German Clinical Trials Register, ID DRKS00004713 , registered 14. February 2014.
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Affiliation(s)
- David Häske
- Faculty of Medicine, Eberhard Karls University Tübingen, 72076 Tuebingen, Germany
| | - Stefan K. Beckers
- Department of Anesthesiology, University Hospital RWTH, Aachen, 52074 Aachen, Germany
- Emergency Medical Service, Fire Department, City of Aachen, 52057 Aachen, Germany
| | - Marzellus Hofmann
- Faculty of Health, University of Witten/Herdecke, 58448 Witten, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine, University of Witten/Herdecke, 51109 Cologne, Germany
| | - Paul A. Grützner
- Department of Trauma Surgery and Orthopedics, BG Hospital Ludwigshafen, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
| | - Ulrich Stöckle
- Department of Traumatology and Reconstructive Surgery, BG Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Vassilios Papathanassiou
- Institute of Medical Psychology, University Hospital of the Saarland and Medical Faculty of the University of Saarland, /Saar, 66421 Homburg, Germany
| | - Matthias Münzberg
- Department of Trauma Surgery and Orthopedics, BG Hospital Ludwigshafen, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, D-67071 Ludwigshafen, Germany
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Schempf B, Casu S, Häske D. [Prehospital analgesia by emergency physicians and paramedics : Comparison of effectiveness]. Anaesthesist 2017; 66:325-332. [PMID: 28258297 DOI: 10.1007/s00101-017-0288-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/30/2016] [Accepted: 02/09/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND In some German emergency medical service districts, analgesia is performed by paramedics without support of emergency physicians on scene. With regard to safety and effectiveness, paramedics should not be overshadowed by emergency physicians. OBJECTIVES Is prehospital analgesia performed by paramedics under medical supervision or emergency physicians comparable regarding processes and effectiveness in the case of isolated limb injury? MATERIAL AND METHODS As a retrospective analysis of patients with isolated limb injury, analgesia performed by paramedics and by emergency physicians was analyzed. In addition to pain reduction, prescribed monitoring, and further airway maneuvers, vital parameters (Glasgow coma scale, systolic blood pressure, heartrate and respiratory rate, oxygen saturation) were recorded at the beginning and end of prehospital treatment. RESULTS Pain was reduced from NRS 8 ± 1 to NRS 2 ± 1 in the paramedic group, and from NRS 8 ± 2 to NRS 2 ± 2 in the physician group, so the mean pain reduction was 6 ± 2 in the paramedic-group and 5 ± 2 in the physician group (p < 0.001). Adequate analgesia was found in 96.9% in the physician group and 91.7% in the paramedic group (p = 0.113). ECG monitoring and oxygen administration according to SOP was significantly more frequent in the paramedic group than in the physician group (p < 0.001). Respiratory frequency was significantly more frequent in the physician group than in the paramedic group (p < 0.001). CONCLUSIONS The study shows, with a given indication, that German paramedics can independently perform safe and successful analgesia under medical supervision.
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Affiliation(s)
- B Schempf
- LNA-Gruppe Kreis Reutlingen, Reutlingen, Deutschland. .,Medizinische Klinik II - Kardiologie, Angiologie, internistische Intensivmedizin, Klinikum am Steinenberg, Steinenbergstraße 31, 72764, Reutlingen, Deutschland.
| | - S Casu
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Kliniken des Main-Taunus-Kreises GmbH, Bad Soden, Deutschland
| | - D Häske
- DRK Rettungsdienst Reutlingen, Reutlingen, Deutschland.,Medizinische Fakultät, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
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Häske D, Beckers SK, Hofmann M, Lefering R, Gliwitzky B, Wölfl CC, Grützner P, Stöckle U, Dieroff M, Münzberg M. Quality of Documentation as a Surrogate Marker for Awareness and Training Effectiveness of PHTLS-Courses. Part of the Prospective Longitudinal Mixed-Methods EPPTC-Trial. PLoS One 2017; 12:e0170004. [PMID: 28107394 PMCID: PMC5249224 DOI: 10.1371/journal.pone.0170004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 12/25/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Care for severely injured patients requires multidisciplinary teamwork. A decrease in the number of accident victims ultimately affects the routine and skills. PHTLS ("Pre-Hospital Trauma Life Support") courses are established two-day courses for medical and non-medical rescue service personnel, aimed at improving the pre-hospital care of trauma patients worldwide. The study aims the examination of the quality of documentation before and after PHTLS courses as a surrogate endpoint of training effectiveness and awareness. METHODS This was a prospective pre-post intervention trial and was part of the mixed-method longitudinal EPPTC (Effect of Paramedic Training on Pre-Hospital Trauma Care) study, evaluating subjective and objective changes among participants and real patient care, as a result of PHTLS courses. The courses provide an overview of the SAMPLE approach for interrogation of anamnestic information, which is believed to be responsible for patient safety as relevant, among others, "Allergies," "Medication," and "Patient History" (AMP). The focus of the course is not the documentation. RESULTS In total, 320 protocols were analyzed before and after the training. The PHTLS course led to a significant increase (p < 0.001) in the "AMP" information in the documentation. The subgroups analysis of "allergies" (+47.2%), "drugs" (+38.1%), and "medical history" (+27.8%) before and after the PHTLS course showed a significant increase in the information content. CONCLUSION In summary, we showed that PHTLS training improves documentation quality, which we used as a surrogate endpoint for learning effectiveness and awareness. In this regard, we demonstrated that participants use certain parts of training in real life, thereby suggesting that the learning methods of PHTLS training are effective. These results, however, do not indicate whether patient care has changed.
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Affiliation(s)
- David Häske
- Faculty of Medicine, Eberhard Karls University Tübingen, Tuebingen, Germany
| | - Stefan K. Beckers
- Department of Anesthesiology, University Hospital RWTH, Aachen, Aachen, Germany
- Emergency Medical Service, Fire Department, City of Aachen, Aachen, Germany
| | | | - Rolf Lefering
- Institute for Research in Operative Medicine, University of Witten/Herdecke, Cologne, Germany
| | | | - Christoph C. Wölfl
- Department of Orthopedics, Trauma Surgery and Sports Traumatology, Hospital Hetzelstift, Neustadt, Germany
| | - Paul Grützner
- Department of Trauma and Orthopedic Surgery, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany
| | - Ulrich Stöckle
- Department of Traumatology and Reconstructive Surgery, BG Hospital Tuebingen, Tuebingen, Germany
| | - Marc Dieroff
- Fire Service, Emergency Preparedness and Crisis Management, City of Wiesbaden, Wiesbaden, Germany
| | - Matthias Münzberg
- Department of Trauma and Orthopedic Surgery, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany
- * E-mail:
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Casu S, Häske D. Severe sepsis and septic shock in pre-hospital emergency medicine: survey results of medical directors of emergency medical services concerning antibiotics, blood cultures and algorithms. Intern Emerg Med 2016; 11:571-6. [PMID: 26719078 DOI: 10.1007/s11739-015-1371-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/07/2015] [Indexed: 01/18/2023]
Abstract
Delayed antibiotic treatment for patients in severe sepsis and septic shock decreases the probability of survival. In this survey, medical directors of different emergency medical services (EMS) in Germany were asked if they are prepared for pre-hospital sepsis therapy with antibiotics or special algorithms to evaluate the individual preparations of the different rescue areas for the treatment of patients with this infectious disease. The objective of the survey was to obtain a general picture of the current status of the EMS with respect to rapid antibiotic treatment for sepsis. A total of 166 medical directors were invited to complete a short survey on behalf of the different rescue service districts in Germany via an electronic cover letter. Of the rescue districts, 25.6 % (n = 20) stated that they keep antibiotics on EMS vehicles. In addition, 2.6 % carry blood cultures on the vehicles. The most common antibiotic is ceftriaxone (third generation cephalosporin). In total, 8 (10.3 %) rescue districts use an algorithm for patients with sepsis, severe sepsis or septic shock. Although the German EMS is an emergency physician-based rescue system, special opportunities in the form of antibiotics on emergency physician vehicles are missing. Simultaneously, only 10.3 % of the rescue districts use a special algorithm for sepsis therapy. Sepsis, severe sepsis and septic shock do not appear to be prioritized as highly as these deadly diseases should be in the pre-hospital setting.
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Affiliation(s)
- Sebastian Casu
- Center for Critical and Emergency Care, Department of Anesthesiology, Intensive Care and Pain Management, Hospital of Main-Taunus-District, Teaching Hospital of J.-W. Goethe University Medical School, Kronberger Str. 36, 65812, Bad Soden, Germany.
| | - David Häske
- Faculty of Medicine, Eberhard Karls University Tübingen, Geissweg 5, 72076, Tuebingen, Germany
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Häske D, Schempf B, Gaier G, Niederberger C. Prähospitale Analgosedierung durch Rettungsassistenten. Anaesthesist 2014; 63:209-16. [DOI: 10.1007/s00101-014-2301-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 01/15/2014] [Accepted: 01/22/2014] [Indexed: 11/25/2022]
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Häske D, Beckers SK, Hofmann M, Wölfl CG, Gliwitzky B, Grützner P, Stöckle U, Münzberg M. The effect of paramedic training on pre-hospital trauma care (EPPTC-study): a study protocol for a prospective semi-qualitative observational trial. BMC Med Educ 2014; 14:32. [PMID: 24528532 PMCID: PMC3930288 DOI: 10.1186/1472-6920-14-32] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 02/13/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Accidents are the leading cause of death in adults prior to middle age. The care of severely injured patients is an interdisciplinary challenge. Limited evidence is available concerning pre-hospital trauma care training programs and the advantage of such programs for trauma patients. The effect on trauma care procedures or on the safety of emergency crews on the scene is limited; however, there is a high level of experience and expert opinion. METHODS I - Video-recorded case studies are the basis of an assessment tool and checklist being developed to verify the results of programs to train participants in the care of seriously injured patients, also known as "objective structured clinical examination" (OSCE). The timing, completeness and quality of the individual measures are assessed using appropriate scales. The evaluation of team communication and interaction will be analyzed with qualitative methods and quantified and verified by existing instruments (e.g. the Clinical Team Scale). The developed assessment tool is validated by several experts in the fields of trauma care, trauma research and medical education. II a) In a German emergency medical service, the subjective assessment of paramedics of their pre-hospital care of trauma patients is evaluated at three time points, namely before, immediately after and one year after training. b) The effect of a standardized course concept on the quality of documentation in actual field operations is determined based on three items relevant to patient safety before and after the course. c) The assessment tool will be used to assess the effect of a standardized course concept on procedures and team communication in pre-hospital trauma care using scenario-based case studies. DISCUSSION This study explores the effect of training on paramedics. After successful study completion, further multicenter studies are conceivable, which would evaluate emergency-physician staffed teams. The influence on the patients and prehospital measures should be assessed based on a retrospective analysis of the emergency room data. TRIALS REGISTRATION German Clinical Trials Register, ID DRKS00004713.
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Affiliation(s)
- David Häske
- Faculty of Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Stefan K Beckers
- Department of Anaesthesiology, University Hospital RWTH Aachen, 52057 Aachen, Germany
- Emergency Medical Service, Fire Department, City of Aachen, 52057 Aachen, Germany
| | - Marzellus Hofmann
- Faculty of Health, University of Witten/Herdecke, 58448 Witten, Germany
| | - Christoph G Wölfl
- Department of Trauma and Orthopedic Surgery, BG Hospital Ludwigshafen, 67071 Ludwigshafen, Germany
| | | | - Paul Grützner
- Department of Trauma and Orthopedic Surgery, BG Hospital Ludwigshafen, 67071 Ludwigshafen, Germany
| | - Ulrich Stöckle
- Department of Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tuebingen, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Matthias Münzberg
- Department of Trauma and Orthopedic Surgery, BG Hospital Ludwigshafen, 67071 Ludwigshafen, Germany
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Häske D, Kreinest M, Wölfl CG, Frank C, Brodermann G, Horter J, Suda AJ, Gliwitzky B, Beckers SK, Stöckle U, Münzberg M. [Practice report: Structured training to improve quality of care in emergency medical service. On-scene supervision: A new approach to emergency medical service training in Wiesbaden and Rheingau-Taunus-Kreis?]. Z Evid Fortbild Qual Gesundhwes 2013; 107:484-9. [PMID: 24238026 DOI: 10.1016/j.zefq.2013.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 06/16/2013] [Accepted: 06/27/2013] [Indexed: 11/28/2022]
Abstract
In recent years, the emergency medical services in Wiesbaden and the Rheingau-Taunus district made great efforts to standardise structures. Since there are only few established procedures in the annual examinations for paramedics, there is reason to assume that treatment procedures for patients have not been standardised either. Materials and equipment are not handled uniformly, and employee satisfaction has significantly decreased over the last few years. To solve these problems, all paramedics undergo standardised and structured trainings. These training courses make use of the internationally accepted PHTLS (Pre-Hospital Trauma Life Support) and AMLS (Advanced Life Support Medial) programmes. In addition, practising skills and handling the equipment as well as on-scene supervision is to be established in practical training sessions.
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Affiliation(s)
- David Häske
- Eberhard Karls Universität Tübingen, Medizinische Fakultät; DBRD Akademie GmbH, Arbeitsgruppe PHTLS Deutschland, Offenbach a.d. Queich
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Häske D, Schempf B, Gaier G, Niederberger C. Performance of the i-gel™ during pre-hospital cardiopulmonary resuscitation. Resuscitation 2013; 84:1229-32. [PMID: 23648215 DOI: 10.1016/j.resuscitation.2013.04.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 03/26/2013] [Accepted: 04/25/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Current cardiopulmonary resuscitation (CPR) guidelines recommend airway management and ventilation whilst minimising interruptions to chest compressions. We have assessed i-gel™ use during CPR. METHODS In an observational study of i-gel™ use during CPR we assessed the ease of i-gel™ insertion, adequacy of ventilation, the presence of a leak during ventilation, and whether ventilation was possible without interrupting chest compressions. RESULTS We analysed i-gel™ insertion by paramedics (n=63) and emergency physicians (n=7) in 70 pre-hospital CPR attempts. There was a 90% first attempt insertion success rate, 7% on the second attempt, and 3% on the third attempt. Insertion was reported as easy in 80% (n=56), moderately difficult in 16% (n=11), and difficult in 4% (n=3). Providers reported no leak on ventilation in 80% (n=56), a moderate leak in 17% (n=12), and a major leak with no chest rise in 3% (n=2). There was a significant association between ease of insertion and the quality of the seal (r=0.99, p=0.02). The i-gel™ enabled continuous chest compressions without pauses for ventilation in 74% (n=52) of CPR attempts. There was no difference in the incidence of leaks on ventilation between patients having continuous chest compressions and patients who had pauses in chest compressions for ventilation (83% versus 72%, p=0.33, 95% CI [-0.1282, 0.4037]). Ventilation during CPR was adequate during 96% of all CPR attempts. CONCLUSIONS The i-gel™ is an easy supraglottic airway device to insert and enables adequate ventilation during CPR.
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Affiliation(s)
- David Häske
- Emergency Medical Service, German Red Cross, Obere Wässere 1, 72764 Reutlingen, Germany.
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