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Seeger I, Klausen AD, Günther U, Bienzeisler J, Schnack H, Lubasch JS. [Reasons for non-participation in a patient survey in the context of prehospital emergency medical care by community emergency paramedics - A retrospective observational study]. Z Evid Fortbild Qual Gesundhwes 2024:S1865-9217(24)00055-2. [PMID: 38653638 DOI: 10.1016/j.zefq.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/05/2024] [Accepted: 03/21/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND In order to evaluate whether the new rescue means "community emergency paramedics" (Gemeindenotfallsanitäter [G-NFS]) relieves the emergency medical service (EMS) in the care of low-priority emergencies, the perspective of general practitioners and patients was also surveyed in a written questionnaire as part of an innovation fund project. Recruitment for participation in the study proved to be difficult. The aim of this study is to evaluate why the G-NFS decided against providing information on study participation and what measures would be necessary to include more emergency patients in surveys in the future. METHODS Retrospective analysis of the assignment protocols from April 1, 2021 to June 30, 2022. In addition to patient characteristics, data on treatments, interventions and recommendations to patients as well as reasons for non-participation in the patient survey were collected. RESULTS 5,395 G-NFS protocols that contained information on non-participation were included in the analysis. The average age of the patients was 62.4 years (SD 22.7), and 50.2% were female. 57.4% of the cases were categorised as non-urgent, and 35.2% of the cases required an additional ambulance to be alerted. 404 (7.5%) patients used the EMS more than once, 1,120 (20.8%) did not have sufficient language skills, 1,012 (18.8%) patients declined study participation, and 2,975 (55.1%) patients were not able to participate according to the G-NFS assessment. Dementia/neurocognitive impairment (35%), acute/emergency situation (26.5%), mental health impairment (10.3%), and substance abuse (6.5%) were given as reasons for non-participation from the G-NFS perspective. DISCUSSION The results show that more than half of the patients were unable to take part in a written survey for various reasons, even though there was no need for urgent care. This could be due to a high demand for care and the complex consent procedure. In addition, further resources are required to provide needs-based care for these patients in order to relieve the burden on emergency medical care. Over half of the patients were unable to take part in a written survey for various reasons. Further research is needed to determine what consent procedures are appropriate to facilitate patients' study participation.
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Affiliation(s)
- Insa Seeger
- Oldenburger Forschungsnetzwerk Notfall- und Intensivmedizin, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland.
| | - Andrea Diana Klausen
- Oldenburger Forschungsnetzwerk Notfall- und Intensivmedizin, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - Ulf Günther
- Oldenburger Forschungsnetzwerk Notfall- und Intensivmedizin, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland; Universitätsklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie, Klinikum Oldenburg AöR, Oldenburg, Deutschland
| | - Jonas Bienzeisler
- Institut für Medizinische Informatik, Medizinische Fakultät Uniklinik RWTH Aachen, Aachen, Deutschland
| | - Helge Schnack
- Abteilung Organisationsbezogene Versorgungsforschung, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - Johanna Sophie Lubasch
- Oldenburger Forschungsnetzwerk Notfall- und Intensivmedizin, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
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Metelmann IB, Metelmann B, Metelmann C, Steimle N, Rübsam ML, Krämer B, Krämer S. [Safety aspects of prehospital thoracic emergency procedures: Results of a survey among German emergency physicians]. Z Evid Fortbild Qual Gesundhwes 2022; 174:43-51. [PMID: 36064703 DOI: 10.1016/j.zefq.2022.08.002] [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] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/21/2022] [Accepted: 08/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The safe indication and performance of thoracic emergency procedures are crucial and potentially lifesaving in prehospital emergency care. This study aims to investigate issues of patient safety and quality assurance of prehospital invasive thoracic interventions. The survey does not represent the actual medical care situation but explores reasons for security concerns among emergency physicians. METHODS Using a pre-validated questionnaire, prehospital emergency physicians of three prehospital rescue associations (Zweckverband) in Southwest Saxony, Greifswald, and Vechta, Germany, were queried via the online survey service limesurvey. The survey was conducted between January and March 2022. RESULTS 104 emergency physicians participated (response rate 42.4%) 71 of which fully completed the survey (68%). 79% of the participants stated that they felt safe in performing pleural punction. Common reasons for postponing prehospital thoracic interventions included fear of complications or individual patient characteristics. 90% said that they were familiar with the on-board equipment options, and 60% reported that resources were sufficient to perform double-sided procedures. While in all three regions there is sufficient on-board equipment to perform procedures on two sides, one out of two participants said that lack of equipment deters them from performing prehospital invasive thoracic procedures. Emergency physicians who graduated from trauma courses and/or participate in air rescue are more likely to perform invasive thoracic procedures. More than half of the participants wanted more training in chest tube placement or pleural punction. CONCLUSION Safety in prehospital invasive thoracic procedures needs improvement in structural, procedural, as well as human factors aspects. Safe handling of these rare but vital techniques requires more training. A lack of knowledge of equipment is a significant safety gap. Prehospital ultrasound constitutes a structural element of prehospital diagnostics.
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Affiliation(s)
- Isabella B Metelmann
- Klinik und Poliklinik für Viszeral, Transplantations-, Thorax- und Gefäßchirurgie, Bereich Thoraxchirurgie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland.
| | - Bibiana Metelmann
- Klinik für Anästhesie, Intensiv-, Notfall- und Schmerzmedizin, Universitätsmedizin Greifswald KöR, Greifswald, Deutschland
| | - Camilla Metelmann
- Klinik für Anästhesie, Intensiv-, Notfall- und Schmerzmedizin, Universitätsmedizin Greifswald KöR, Greifswald, Deutschland
| | - Nina Steimle
- Klinik und Poliklinik für Viszeral, Transplantations-, Thorax- und Gefäßchirurgie, Bereich Thoraxchirurgie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | - Marie-Luise Rübsam
- Klinik für Anästhesie, Intensiv-, Notfall- und Schmerzmedizin, Universitätsmedizin Greifswald KöR, Greifswald, Deutschland; Malteser Lohne e.V., Landkreis Vechta, Lohne, Deutschland
| | - Bernd Krämer
- Rettungszweckverband Südwestsachsen, Plauen, Deutschland
| | - Sebastian Krämer
- Klinik und Poliklinik für Viszeral, Transplantations-, Thorax- und Gefäßchirurgie, Bereich Thoraxchirurgie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
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Akbas S, Castellucci C, Nehls F, Müller SM, Spahn DR, Kaserer A. [Prehospital Pain Management: Overview and Potential Improvements]. Praxis (Bern 1994) 2022; 111:157-162. [PMID: 35232256 DOI: 10.1024/1661-8157/a003810] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Prehospital Pain Management: Overview and Potential Improvements Abstract. Pain is a frequent issue in the prehospital setting. Rapid and adequate analgesia has a positive effect on the physiological and psychological condition of patients. However, up to 43 % of patients still suffer insufficient analgesia. Several studies have identified some factors that contribute to this problem; these factors can be patient- and intervention-specific or dependent on the staff on duty. In order to improve prehospital analgesia in the future, structural and organizational changes as well as the implementation of new methods and therapies are essential.
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Affiliation(s)
- Samira Akbas
- Institut für Anästhesiologie, Universität Zürich und Universitätsspital Zürich, Zürich
| | - Clara Castellucci
- Institut für Anästhesiologie, Universität Zürich und Universitätsspital Zürich, Zürich
| | - Franziska Nehls
- Institut für Anästhesiologie, Kantonsspital Winterthur, Winterthur
| | - Stefan Matthias Müller
- Schutz & Rettung Zürich, Institut für Anästhesiologie und Intensivmedizin, Stadtspital Triemli, Zürich
| | - Donat R Spahn
- Institut für Anästhesiologie, Universität Zürich und Universitätsspital Zürich, Zürich
| | - Alexander Kaserer
- Institut für Anästhesiologie, Universität Zürich und Universitätsspital Zürich, Zürich
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Günther A, Schmid S, Weidlich-Wichmann U, Bleidorn J, Buhr-Riehm B, Schubert R, Schwartze J, Schneider N, Hasseler M. [Emergency care in nursing homes in the City of Braunschweig: A cross-sectoral view with indicators from deaths, resuscitation, emergency department visits and EMS deployment]. Z Evid Fortbild Qual Gesundhwes 2019; 141-142:1-10. [PMID: 30922714 DOI: 10.1016/j.zefq.2019.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 02/01/2019] [Accepted: 02/28/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION General survey of emergency care in nursing homes in the City of Braunschweig. METHODS Retrospective analysis of data from death registry, resuscitation registry and further routine data from the local health authorities and the emergency medical services (EMS). RESULTS 30 nursing homes with 3,100 beds (mean: 103; range: 35-250) were included; operators of nursing homes were 18 non-profit organizations; 7 private (local); 5 private (nationwide). Among the inhabitants of these 30 nursing homes 880 deaths occurred, 406 (46 %) in hospital; 4,895 EMS deployments for emergency care; 4,493 (92 %) resulting in emergency department visits; 19 CPRs. EMS deployments without a physician order per bed 1.0 (0.4-1.6); emergency department visits per bed 1.4 (0.7-3.1); rate of EMS deployments without physicians order / emergency department visits 70 % (41-96 %); deaths per bed 0,29 (0.12-0.48); rate of deaths in hospital 46 % (0-62 %); CPRs per 1,000 beds 6.1 (0-28); CPR failure rate 22 (0-83) per 1,000 deaths per year. EMS deployment without physician order was significantly more frequent in privately (nationwide) operated nursing homes 1.2 (1.0-1.4). In the entire urban region, the incidence of EMS deployment without a physician order was 0.2 per inhabitant per year and the rate of hospital deaths was 64 %. CONCLUSION Compared to the entire population of the City of Braunschweig, EMS deployment was more frequent in nursing homes. The chance of hospital death or failed CPR was slightly lower. There are large variations between the different nursing homes. Indicators from routine data can provide guidance for more specific surveys but do not allow benchmarking.
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Affiliation(s)
- Andreas Günther
- Stabsstelle Ärztlicher Leiter Rettungsdienst, Feuerwehr, Stadt Braunschweig, Deutschland.
| | - Sybille Schmid
- Stabsstelle Ärztlicher Leiter Rettungsdienst, Feuerwehr, Stadt Braunschweig, Deutschland
| | | | - Jutta Bleidorn
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Deutschland
| | | | | | - Jonas Schwartze
- Peter L. Reichertz Institut für Medizininformatik, Braunschweig, Deutschland
| | - Nils Schneider
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Deutschland
| | - Martina Hasseler
- Abteilung Allgemeinmedizin & Versorgungsforschung, Medizinische Fakultät Heidelberg, Deutschland
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Günther A, Harding U, Gietzelt M, Gradaus F, Tute E, Fischer M. [An urban EMS at the start of a cross-sectoral quality management system: prioritized implementation of the 2010 ERC recommendations and long-term survival after cardiac arrest]. Z Evid Fortbild Qual Gesundhwes 2015; 109:714-24. [PMID: 26699260 DOI: 10.1016/j.zefq.2015.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 06/09/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Due to limited resources, the 2010 European Resuscitation Council (ERC) guidelines could not be fully implemented in the Emergency Medical Services (EMS) of Brunswick, Germany. This is why implementation was prioritized according to local conditions. Thus, prehospital therapeutic hypothermia, mechanical chest compression and feedback systems were not established. Clinical data and long-term results were assessed by a QM system and room for improvement was identified. METHODS All attempted resuscitations from 2011 until 2014 were recorded and compared against the German Resuscitation Registry. Outcomes of adult patients following non-traumatic cardiac arrest were analyzed by year. RESULTS 812 resuscitations were attempted (incidence 81.2/100,000 inhabitants/year). In the two years following full implementation since 2013 the discharge rate from hospital was 16.4 %, the discharge rate with a favorable neurologic outcome was 14.1 %, the 1-year survival rate was 14.4 % in 2013. A significant improvement of risk-adjusted ROSC rate during the investigation period was demonstrated. The discharge rates remained unchanged; the increase in the discharge rates paralleled the increase in CPR incidence. EMS response times were remarkably shorter. CONCLUSION The implementation of the ERC guidelines chosen appears to be generally safe. Fast EMS response contributed to superior results. All links of the chain of survival showed room for improvement, especially the proportion of lay rescuer CPR and telephone-assisted CPR. The high CPR incidence might indicate room for improvement in prevention. Access to resuscitation care can hardly be evaluated. Age-related access to pre-hospital resuscitation seems to be appropriate.
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Affiliation(s)
- Andreas Günther
- Ärztlicher Leiter Rettungsdienst, Berufsfeuerwehr Braunschweig, Braunschweig, Deutschland Klinik für Anästhesiologie, Städtisches Klinikum Braunschweig, Braunschweig, Deutschland.
| | - Ulf Harding
- Zentrale Notfallaufnahme, Klinikum Wolfsburg, Wolfsburg, Deutschland Rettungsdienst, Berufsfeuerwehr Braunschweig, Braunschweig, Deutschland, Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte e.V
| | - Matthias Gietzelt
- Medizinische Informatik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Frank Gradaus
- Medizinische Intensivstation, Medizinische Klinik II, Städtisches Klinikum Braunschweig, Rettungsdienst, Berufsfeuerwehr Braunschweig, Braunschweig, Deutschland
| | - Erik Tute
- Peter L. Reichertz Institut für Medizinische Informatik, Medizinische Hochschule Hannover und Technische Universität Braunschweig, Braunschweig, Deutschland
| | - Matthias Fischer
- Klinik für Anästhesie, Operative Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinik am Eichert Göppingen, Göppingen, Deutschland
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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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