[show abstract][hide abstract] ABSTRACT: BACKGROUND: Within cardiopulmonary resuscitation external chest compressions (ECC) are of outstanding importance. Frequent training in Basic Life Support (BLS) may improve the performance, but the perfect method or environment is still a matter of research. The objective of this study was to evaluate whether practical performance and retention of skills in resuscitation training may be influenced by the gender composition in learning groups. METHODS: Participants were allocated to three groups for standardized BLS-training: Female group (F): only female participants; Male group (M): only male participants; Standard group (S): male and female participants. All groups were trained with the standardized 4-step-approach method. Assessment of participants' performance was done before training (t1), after one week (t2) and eight months later (t3) on a manikin in the same cardiac arrest single-rescuer-scenario. Participants were 251 Laypersons (mean age 21; SD 4; range 18--42 years; females 63%) without previous medical knowledge. Endpoints: compression rate 90-110/min; mean compression depth 38--51 mm. Standardized questionnaires were used for the evaluation of attitude and learning environment. RESULTS: After one week group F performed significantly better with respect to the achievement of the correct mean compression depth (F: 63% vs. S: 43%; p = 0.02). Moreover, groups F and S were the only groups which were able to improve their performance concerning the mean compression rate (t1: 35%; t3: 52%; p = 0.04). Female participants felt more comfortable in the female--only environment. CONCLUSIONS: Resuscitation training in gender-segregated groups has an effect on individual performance with superior ECC skills in the female-only learning groups.Female participants could improve their skills by a more suitable learning environment, while male participants in the standard group felt less distracted by their peers than male participants in the male-only group.
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 04/2013; 21(1):30. · 1.68 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND: Still picture transmission was performed using a telemedicine system in an Emergency Medical Service (EMS) during a prospective, controlled trial. In this ancillary, retrospective study the quality and content of the transmitted pictures and the possible influences of this application on prehospital time requirements were investigated. METHODS: A digital camera was used with a telemedicine system enabling encrypted audio and data transmission between an ambulance and a remotely located physician. By default, images were compressed (jpeg, 640 x 480 pixels). On occasion, this compression was deactivated (3648 x 2736 pixels). Two independent investigators assessed all transmitted pictures according to predefined criteria. In cases of different ratings, a third investigator had final decision competence. Patient characteristics and time intervals were extracted from the EMS protocol sheets and dispatch centre reports. RESULTS: Overall 314 pictures (mean 2.77 +/- 2.42 pictures/mission) were transmitted during 113 missions (group 1). Pictures were not taken for 151 missions (group 2). Regarding picture quality, the content of 240 (76.4%) pictures was clearly identifiable; 45 (14.3%) pictures were considered "limited quality" and 29 (9.2%) pictures were deemed "not useful" due to not/hardly identifiable content. For pictures with file compression (n = 84 missions) and without (n = 17 missions), the content was clearly identifiable in 74% and 97% of the pictures, respectively (p = 0.003). Medical reports (n = 98, 32.8%), medication lists (n = 49, 16.4%) and 12-lead ECGs (n = 28, 9.4%) were most frequently photographed. The patient characteristics of group 1 vs. 2 were as follows: median age -- 72.5 vs. 56.5 years, p = 0.001; frequency of acute coronary syndrome -- 24/113 vs. 15/151, p = 0.014. The NACA scores and gender distribution were comparable. Median on-scene times were longer with picture transmission (26 vs. 22 min, p = 0.011), but ambulance arrival to hospital arrival intervals did not differ significantly (35 vs. 33 min, p = 0.054). CONCLUSIONS: Picture transmission was used frequently and resulted in an acceptable picture quality, even with compressed files. In most cases, previously existing "paper data" was transmitted electronically. This application may offer an alternative to other modes of ECG transmission. Due to different patient characteristics no conclusions for a prolonged on-scene time can be drawn. Mobile picture transmission holds important opportunities for clinical handover procedures and teleconsultation.
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 01/2013; 21(1):3. · 1.68 Impact Factor
[show abstract][hide abstract] ABSTRACT: Medical emergencies in dental practice are generally perceived as being rare. Nonetheless, recent studies have shown that incidents occur on a regular basis. Therefore, patients have the right to expect necessary skills to manage life-threatening situations from every dentist.
To observe students' attitude and self-assessment towards emergency medical care (EMC) and its practical appliance.
Students of dentistry took part in small group sessions for adult and paediatric basic life support. Participants filled out pre-post questionnaires regarding knowledge and attitude towards EMC (6, respectively, 10-point Likert scale). Additionally, feedback was asked for the quality of course and tutors.
Forty dental students in their last 2 years of study registered for the EMC courses. The majority had never attended any first-aid course; the mean age was 25% and 75% were women. A comparison between pre- and post-evaluation showed that the participation in practical training easily enhances the students' awareness of EMC importance as well as self-confidence in managing emergencies. After the course, 71% shared the opinion that retraining should be obligatory for all medical personnel. At the same time, students' self-assessment of confidence for specific tasks got significant upgrades in every aspect.
The evaluation data clearly show the participants' needs to deal with topics of EMC within the curriculum of dentistry. The proposed course is able to change participants' attitudes towards EMC and its importance for their daily practice. The considerable enhancement of self-confidence in performing EMC-techniques might also lead to more willingness to manage emergency situations.
European Journal Of Dental Education 08/2012; 16(3):179-86. · 1.01 Impact Factor
[show abstract][hide abstract] ABSTRACT: PURPOSE AND BACKGROUND: Emergency medical services (EMSs) vary considerably. While some are physician staffed, most systems are run by paramedics. The objective of this randomized, controlled simulation study was to compare the emergency care between physician staffed EMS teams (control group) and paramedic teams that were supported telemedically by an EMS physician (telemedicine group). METHODS: Overall 16 teams (1 EMS physician, 2 paramedics) were randomized to the control group or the telemedicine group. Telemedical functionalities included two-way audio communication, transmission of vital data (numerical values and curves) and video streaming from the scenario room to the remotely located EMS physician. After a run-in scenario all teams completed four standardized scenarios, in which no highly invasive procedures (e.g. thoracic drain) were required, two using high-fidelity simulation (burn trauma, intoxication) and two using standardized patients (renal colic, barotrauma). All scenarios were videotaped and analyzed by two investigators using predefined scoring items. RESULTS: Non case-specific items (31 vs. 31 scenarios): obtaining of 'symptoms', 'past medical history' and 'events' were carried out comparably, but in the telemedicine group 'allergies' (17 vs. 28, OR 7.69, CI 2.1-27.9, p=0.002) and 'medications' (17 vs. 27, OR 5.55, CI 1.7-18.0, p=0.004) were inquired more frequently. No significant differences were found regarding the case-specific items and in both groups no potentially dangerous mistreatments were observed. CONCLUSION: Telemedically assisted paramedic care was feasible and at least not inferior compared to standard EMS teams with a physician on-scene in these scenarios.
[show abstract][hide abstract] ABSTRACT: OBJECTIVE: The quality of external chest compressions (ECC) is of primary importance within basic life support (BLS). Recent guidelines delineate the so-called 4"-step approach" for teaching practical skills within resuscitation training guided by a certified instructor. The objective of this study was to evaluate whether a "media-supported 4-step approach" for BLS training leads to equal practical performance compared to the standard 4-step approach. Materials and methods After baseline testing, 220 laypersons were either trained using the widely accepted method for resuscitation training (4-step approach) or using a newly created "media-supported 4-step approach", both of equal duration. In this approach, steps 1 and 2 were ensured via a standardised self-produced podcast, which included all of the information regarding the BLS algorithm and resuscitation skills. Participants were tested on manikins in the same mock cardiac arrest single-rescuer scenario prior to intervention, after one week and after six months with respect to ECC-performance, and participants were surveyed about the approach. RESULTS: Participants (age 23 +/- 11, 69% female) reached comparable practical ECC performances in both groups, with no statistical difference. Even after six months, there was no difference detected in the quality of the initial assessment algorithm or delay concerning initiation of CPR. Overall, at least 99% of the intervention group (n = 99; mean 1.5 +/- 0.8; 6-point Likert scale: 1 = completely agree, 6 = completely disagree) agreed that the video provided an adequate introduction to BLS skills. CONCLUSIONS: The "media-supported 4-step approach" leads to comparable practical ECC-performance compared to standard teaching, even with respect to retention of skills. Therefore, this approach could be useful in special educational settings where, for example, instructors' resources are sparse or large-group sessions have to be prepared.
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 05/2012; 20(1):37. · 1.68 Impact Factor
[show abstract][hide abstract] ABSTRACT: Inter-hospital teleconsultation improves stroke care. To transfer this concept into the emergency medical service (EMS), the feasibility and effects of prehospital teleconsultation were investigated.
Teleconsultation enabling audio communication, real-time video streaming, vital data and still picture transmission was conducted between an ambulance and a teleconsultation center. Pre-notification of the hospital was carried out with a 14-item stroke history checklist via e-mail-to-fax. Beside technical assessments possible influences on prehospital and initial in-hospital time intervals, prehospital diagnostic accuracy and the transfer of stroke specific data were investigated by comparing telemedically assisted prehospital care (telemedicine group) with local regular EMS care (control group). All prehospital stroke patients over a 5-month period were included during weekdays (7.30 a.m.-4.00 p.m.). In 3 of 18 missions partial dropouts of the system occurred; neurological co-evaluation via video transmission was conducted in 12 cases. The stroke checklist was transmitted in 14 cases (78%). Telemedicine group (n = 18) vs. control group (n = 47): Prehospital time intervals were comparable, but in both groups the door to brain imaging times were longer than recommended (median 59.5 vs. 57.5 min, p = 0.6447). The prehospital stroke diagnosis was confirmed in 61% vs. 67%, p = 0.8451. Medians of 14 (IQR 9) vs. 5 (IQR 2) stroke specific items were transferred in written form to the in-hospital setting, p<0.0001. In 3 of 10 vs. 5 of 27 patients with cerebral ischemia thrombolytics were administered, p = 0.655.
Teleconsultation was feasible but technical performance and reliability have to be improved. The approach led to better stroke specific information; however, a superiority over regular EMS care was not found and in-hospital time intervals were unacceptably long in both groups. The feasibility of prehospital tele-stroke consultation has future potential to improve emergency care especially when no highly trained personnel are on-scene.
International Standard Randomised Controlled Trial Number Register (ISRCTN) ISRCTN83270177.
PLoS ONE 01/2012; 7(5):e36796. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: Lenssen, N., Biermann, H., Saša, S., Beckers, S., Felzen, M., Rossaint, R., Kalz, M., Haberstroh, M., Klerkx, J., Elsner, J., & Skorning, M. (2012). EMuRgency – Neue Ansätze zur Reanimationsunterstützung und für Reanimationstraining in der Euregio Maas-Rhein. In B. Bergh, R. Asarnush, & R. Röhring (Eds.), Proceedings NotIT 2012. 1st Symposium of Information and Communication Technologies in Emergency Medicine (pp. 39-42). June, 12-13, 2012, Düsseldorf, Germany:
German Medical Science GMS Publishing House; 2012.
[show abstract][hide abstract] ABSTRACT: Teleconsultation from the scene of an emergency to an experienced physician including real-time transmission of monitoring, audio and visual information seems to be feasible. In preparation for bringing such a system into practice within the research project "Med-on-@ix", a simulation study has been conducted to investigate whether telemedical assistance (TMA) in Emergency Medical Services (EMS) has an impact on compatibility to guidelines and timing.
In a controlled simulation study 29 EMS teams (one EMS physician, two paramedics) ran through standardized scenarios (STEMI: ST-elevation myocardial infarction; MT: major trauma) on high-fidelity patient simulators with defined complications (treatable clearly following guidelines). Team assignments were randomized and each team had to complete one scenario with and another without TMA. Analysis was based on videotaped scenarios using pre-defined scoring items and measured time intervals for each scenario.
Adherence to treatment algorithms improved using TMA. STEMI: cathlab informed (9/14 vs. 15/15; p=0.0169); allergies checked prior to acetylsalicylic acid (5/14 vs. 13/15; p=0.0078); analgosedation prior to cardioversion (10/14 vs. 15/15; p=0.0421); synchronized shock (6/14 vs. 14/15; p=0.0052). MT: adequate medication for intubation (3/15 vs. 10/14; p=0.0092); mean time to inform trauma centre 547 vs. 189 s (p=0.0001). No significant impairment of performance was detected in TMA groups.
In simulated setting TMA was able to improve treatment and safety without decline in timing. Nevertheless, further research is necessary to optimize the system for medical, organizational and technical reasons prior to the evaluation of this system in routine EMS.
[show abstract][hide abstract] ABSTRACT: To compare a novel, pressure-limited, flow adaptive ventilator that enables manual triggering of ventilations (MEDUMAT Easy CPR, Weinmann, Germany) with a bag-valve-mask (BVM) device during simulated cardiac arrest.
Overall 74 third-year medical students received brief video instructions (BVM: 57s, ventilator: 126s), standardised theoretical instructions and practical training for both devices. Four days later, the students were randomised into 37 two-rescuer teams and were asked to perform 8min of cardiopulmonary resuscitation (CPR) on a manikin using either the ventilator or the BVM (randomisation list). Applied tidal volumes (V(T)), inspiratory times and hands-off times were recorded. Maximum airway pressures (P(max)) were measured with a sensor connected to the artificial lung. Questionnaires concerning levels of fatigue, stress and handling were evaluated. V(T), pressures and hands-off times were compared using t-tests, questionnaire data were analysed using the Wilcoxon test.
BVM vs. ventilator (mean±SD): the mean V(T) (408±164ml vs. 315±165ml, p=0.10) and the maximum V(T) did not differ, but the number of recorded V(T)<200ml differed (8.1±11.3 vs. 17.0±14.4 ventilations, p=0.04). P(max) did not differ, but inspiratory times (0.80±0.23s vs. 1.39±0.31s, p<0.001) and total hands-off times (133.5±17.8s vs. 162.0±11.1s, p<0.001) did. The estimated levels of fatigue and stress were comparable; however, the BVM was rated to be easier to use (p=0.03).
For the user group investigated here, this ventilator exhibits no advantages in the setting of simulated CPR and carries a risk of prolonged no-flow time.
[show abstract][hide abstract] ABSTRACT: We evaluated the technical and organisational feasibility of a multifunctional telemedicine system in an emergency medical service (EMS) from the user's perspective. The telemedicine system was designed to transmit vital signs data and 12-lead-ECG data, send still pictures and allow voice communication and video transmission from an ambulance. The data were sent to a teleconsultation centre staffed with EMS physicians (tele-EMS physician). The system was used in 157 EMS missions. The applications were used successfully on 80% of missions for real-time vital signs transmission and on 97% for video transmission. The quality of the transmitted still images (n = 64) was: 23% excellent, 50% good, 17% moderate, 9% rather poor and 0% unusable. The quality of the video streaming (n = 36) was: 33% excellent, 56% good, 6% moderate, 6% rather poor and 0% unusable. The tele-EMS physician was able to assist the EMS team in several cases and provided the preliminary information for the hospital in nearly all missions. Use of the telemedical system in EMS is feasible and the quality of the transmitted images and video was satisfactory. However, technical reliability and availability need to be improved prior to routine use.
Journal of telemedicine and telecare 09/2011; 17(7):371-7. · 0.92 Impact Factor
[show abstract][hide abstract] ABSTRACT: Cardiopulmonary resuscitation (CPR) mastery continues to challenge medical professionals. The purpose of this study was to determine if an emotional stimulus in combination with peer or expert feedback during pre-course assessment effects future performance in a single rescuer simulated cardiac arrest.
First-year medical students (n=218) without previous medical knowledge were randomly assigned to one of the study groups and asked to take part in a pre-course assessment: Group 1: after applying an emotionally activating stimulus an expert (instructor) gave feedback on CPR performance (Ex). Group 2: after applying the same stimulus feedback was provided by a peer from the same group (Pe); Group 3: standard without feedback (S). Following pre-course assessment, all subjects received a standardized BLS-course, were tested after 1 week and 6 months later using single-rescuer-scenario, and were surveyed using standardized questionnaires (6-point-likert-scales: 1=completely agree, 6=completely disagree).
Participants exposed to stimulus demonstrated superior performance concerning compression depth after 6 months independent of feedback-method (Ex: 65.85% [p=0.0003]; Pe: 57.50% [p=0.0076] vs. 21.43%). The expert- more than the peer-group was emotionally more activated in initial testing, Ex: 3.26 ± 1.35 [p ≤ 0.0001]; Pe: 3.73 ± 1.53 [p=0.0319]; S: 4.25 ± 1.37) and more inspired to think about CPR (Ex: 2.03 ± 1.37 [p=0.0119]; Pe: 2.07 ± 1.14 [p=0.0204]; S: 2.60 ± 1.55). After 6 months this activation effect was still detectable in the expert-group (p=0.0114).
The emotional stimulus approach to BLS-training seems to impact the ability to provide adequate compression depth up to 6 months after training. Furthermore, pre-course assessment helped to keep the participants involved beyond initial training.
[show abstract][hide abstract] ABSTRACT: To investigate if paper-based documentation in the authors' emergency medical service (EMS) satisfies scientific requirements.
From 1 July 2007 to 28 February 2008, data from all paper-based protocols of a physician-run EMS in Aachen, Germany, were transferred to a SQL database (n=4815). Database queries were conducted after personal data had been anonymised. Documentation ratios of 11 individual parameters were analysed at two points in time (T1, scene; T2, arrival in emergency department). The calculability of the Mainz Emergency Evaluation Score (MEES, embracing seven vital parameters) was investigated. The calculability of the Revised Trauma Score (RTS) was also determined for all trauma patients (n=408). Fisher's exact test was used to compare differences in ratios at T1 versus T2.
The documentation ratios of vital parameters ranged from 99.33% (Glasgow Coma Scale, T1) to 40.31% (respiratory rate, T2). The calculability of the MEES was poor (all missions: 28.31%, T1; 22.40%, T2; p<0.001). In missions that required cardiopulmonary resuscitation (n=87), the MEES was calculable in 9.20% of patients at T1 and 29.89% at T2 (p<0.001). In trauma missions, the RTS was calculable in 37.26% at T1 and 27.70% at T2 (p=0.004).
Documentation of vital parameters is carried out incompletely, and documentation of respiratory rate is particularly poor, making calculation of accepted emergency scores infeasible for a significant fraction of a given test population. The suitability of paper-based documentation is therefore limited. Electronic documentation that includes real-time plausibility checks might improve data quality. Further research is warranted.
Emergency Medicine Journal 04/2011; 28(4):320-4. · 1.65 Impact Factor
[show abstract][hide abstract] ABSTRACT: External chest compressions (ECC) are essential components of resuscitation and are usually performed without any adjuncts in professional healthcare. Even for healthcare professionals during in-hospital and out-of-hospital resuscitation poor performance in ECC has been reported in recent years. Although several stand-alone devices have been developed none has been implemented as a standard in patient care. The aim of this study was to examine if the use of a mechanical device providing visual feedback and audible assistance during ECC improves performance of healthcare professionals following minimal and simplified instructions.
In a prospective, randomized cross-over study 81 healthcare professionals performed ECC for 3 min (in the assumed setting of a secured airway) twice on a manikin (Skillreporter ResusciAnne®, with PC-Skillreporting System Version 1.3.0, Laerdal, Stavanger, Norway) in a mock cardiac arrest scenario. Group 1 (n=40) performed ECC with the device first followed by classic ECC and group 2 (n=41) in the opposite order. Minimal instructions were standardized and provided by video instruction (1 min 38 s). Endpoints were achievement of a mean compression rate between 90 and 110/min and a mean compression depth of 40-50 mm. In addition participants had to answer questionnaires about demographic data, professional experience and recent recommendations for ECC as well as their impression of the device concerning the ease of use and their personal level of confidence. Data were analyzed for group-related and inter-group differences using SAS (Version 9.1.3, SAS Institute, Cary, NC).
A total of 81 healthcare professionals regularly involved in resuscitation attempts in pre-hospital or in-hospital settings took part in the study with no differences between the groups: females 35.8% (n=52), emergency medical technicians 32.1% (n=26), anesthesia nurses 32.1% (n=26), physicians (anesthesiology) 45% (n=29). In group 1 33 out of 40 (82.5%; 99.7±4.82/min; 95% confidence interval 95% CI: 98.1-101.2/min) reached the correct range for compression rate and 29/40 (72.5%; 44.0±4.95 mm; 95% CI: 42.4-45.6 mm) the correct compression depth using the assisting device. Afterwards they conducted classic ECC without the device and deteriorated significantly: correct compression rate was achieved by 12/40 (30%, p≤0.0001; 110.6±11.0/min (95% CI: 107.1-114.1/min), while 25/40 (62.5%; 44.5±5.63 mm; 95% CI: 42.6-46.3 mm) met the correct compression depth. Group 2 performed poorer in ECC without assistance and 5/41 (12.2%; 104.5±21.35/min; 95% CI: 97.8-111.3/min) reached the correct rate whereas 21/41 (51.2%; 39.6±7.61 mm; 95% CI: 37.2-42.0 mm) compressed to the appropriate depth. Using the device there was a significant improvement in the second evaluation with 34/41 (82.9%, p≤0.0001; 101.7±4.68/min; 95% CI: 100.2-103.2/min) reaching the correct rate and 36/41 (87.8%, p≤0.0001; 43.9±4.16 mm; 95% CI: 42.6-45.2 mm) the correct depth.
The tested device is easy to use after instruction of less than 3 min and improves ECC performance of healthcare professionals in simulated cardiac arrest with respect to compression depth as well as compression rate.
Der Anaesthesist 03/2011; 60(8):717-22. · 0.85 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of this study was to examine documentation quality in physician staffed emergency medical services (EMS). This study compared simulated on-site care with the associated patient records written by EMS physicians.
For this study two standardized simulated case scenarios, ST segment elevation myocardial infarction (STEMI) and major trauma with traumatic brain injury were designed by an expert committee. Overall 29 EMS teams each consisting of 1 EMS physician and 2 paramedics ran through the scenarios on high fidelity patient simulators and each scenario was videotaped. The scenarios were stopped after 12 min for STEMI and after 14 min for major trauma independent of the actions carried out and each EMS physician then had 10 min to document this initial phase on standardized protocol sheets. The videotaped scenarios were analyzed by two independent investigators. Documentation of predefined contents and all drug dosages were checked against the simulated on-site care. The data were evaluated and classified as correct, incorrect or missing documentation although action performed.
Written consent for data analysis was provided by 28 teams. Overall 20 parameters and actions in the STEMI scenario and 16 in the major trauma scenario as well as all drug dosages were evaluated. For the scenario STEMI 469 actions were analyzed of which 271 (58%) were correct, 94 (20%) incorrect and 104 (22%) had missing documentation. A total of 140 medications were administered of which 31 (22%) were documented incorrectly and 14 (10%) were not documented. For major trauma 401 actions were analyzed of which 244 (61%) were correct, 101 (25%) incorrect and 56 (14%) had missing documentation. In this scenario the teams administered 138 medications of which 31 (22%) were documented incorrectly and 16 (12%) were not documented. Infused amounts of crystalloids and colloids were mostly documented correctly in this case (35 correct /6 incorrect/8 not documented). Documentation of several clinical parameters was carried out predominantly correctly, e.g. initial blood pressure (STEMI: 25/2/1, major trauma: 21/4/2) and initial ECG rhythm (STEMI: 27/0/1, major trauma: 26/0/1). Documentation of other clinically relevant parameters was often performed incorrectly: 12-lead ECG in STEMI (5/9/12) and capnometry in major trauma (9/4/7). No team used a pain scale to assess the level of pain in the STEMI scenario but 12 EMS physicians documented an accordant value (numerical rating scale) on the patient records. Furthermore some parameters could be identified where documentation was mostly missing although they were measured, e.g. onset of symptoms in STEMI (5/4/15) and reduced level of consciousness and bradypnea in major trauma (9/2/17).
Patient safety can be reduced if relevant preclinical data are not transmitted correctly to the admitting hospital. Therefore there is a need to improve documentation quality in EMS. Electronic documentation, training of EMS staff and quality management programs might offer solutions. Because of the small sample size further studies are needed to evaluate the validity of these results.
Der Anaesthesist 03/2011; 60(3):221-9. · 0.85 Impact Factor
[show abstract][hide abstract] ABSTRACT: HintergrundIn dieser Simulationsstudie sollten mithilfe der videobasierten Fehleranalyse die Inhalte einer papierbasierten notärztlichen
Dokumentation mit der Einsatzrealität verglichen werden.
MethodeZwei standardisierte Szenarien [ST-Elevations-Myokardinfarkt (STEMI) und Polytrauma] wurden von 29Notarztwagen- (NAW-)Teams
am Simulator absolviert. Die Szenarien wurden nach 12 bzw. 14min beendet. Jeder Notarzt erhielt danach 10min zur Dokumentation.
Videobasiert wurden ausgewählte Dokumentationsmerkmale und alle applizierten Medikamente hinsichtlich der Übereinstimmung
von simulierter Einsatzrealität und Dokumentation überprüft.
ErgebnisseInsgesamt 20Dokumentationsmerkmale bzw. Aktionen beim STEMI und 16 beim Polytrauma wurden ausgewertet (exklusive Medikationen).
STEMI-Szenario: insgesamt 469Aktionen; 271 (58%) wurden korrekt, 94 (20%) nichtkorrekt und 104 (22%) überhaupt nicht dokumentiert,
obwohl die Aktion durchgeführt worden ist. Es erfolgten 140Medikationen, davon wurden 31 (22%) „nichtkorrekt“ und 14 (10%)
trotz Applikation „nicht dokumentiert“. Polytraumaszenario: 401 analysierte Aktionen; 244 (61%) wurden korrekt und 101 (25%)
nichtkorrekt dokumentiert. Bei 56 (14%) unterblieb die Dokumentation trotz Durchführung der Maßnahme bzw. Aktion. Bei 138
applizierten Medikationen wurde bei 31 (22%) eine „nichtkorrekte“ und bei 16 (12%) eine „fehlende“ Dokumentation festgestellt.
SchlussfolgerungVerbesserungen der Dokumentationsqualität müssen erreicht werden. Elektronische Dokumentationssysteme könnten hierbei in Zukunft
unterstützen. Dazu sind weitere Studien erforderlich.
BackgroundThe aim of this study was to examine documentation quality in physician staffed emergency medical services (EMS). This study
compared simulated on-site care with the associated patient records written by EMS physicians.
MethodsFor this study two standardized simulated case scenarios, ST segment elevation myocardial infarction (STEMI) and major trauma
with traumatic brain injury were designed by an expert committee. Overall 29 EMS teams each consisting of 1 EMS physician
and 2 paramedics ran through the scenarios on high fidelity patient simulators and each scenario was videotaped. The scenarios
were stopped after 12min for STEMI and after 14min for major trauma independent of the actions carried out and each EMS
physician then had 10min to document this initial phase on standardized protocol sheets. The videotaped scenarios were analyzed
by two independent investigators. Documentation of predefined contents and all drug dosages were checked against the simulated
on-site care. The data were evaluated and classified as correct, incorrect or missing documentation although action performed.
ResultsWritten consent for data analysis was provided by 28 teams. Overall 20 parameters and actions in the STEMI scenario and 16
in the major trauma scenario as well as all drug dosages were evaluated. For the scenario STEMI 469 actions were analyzed
of which 271 (58%) were correct, 94 (20%) incorrect and 104 (22%) had missing documentation. A total of 140 medications were
administered of which 31 (22%) were documented incorrectly and 14 (10%) were not documented. For major trauma 401 actions
were analyzed of which 244 (61%) were correct, 101 (25%) incorrect and 56 (14%) had missing documentation. In this scenario
the teams administered 138 medications of which 31 (22%) were documented incorrectly and 16 (12%) were not documented. Infused
amounts of crystalloids and colloids were mostly documented correctly in this case (35 correct /6 incorrect/8 not documented).
Documentation of several clinical parameters was carried out predominantly correctly, e.g. initial blood pressure (STEMI:
25/2/1, major trauma: 21/4/2) and initial ECG rhythm (STEMI: 27/0/1, major trauma: 26/0/1). Documentation of other clinically
relevant parameters was often performed incorrectly: 12-lead ECG in STEMI (5/9/12) and capnometry in major trauma (9/4/7).
No team used a pain scale to assess the level of pain in the STEMI scenario but 12 EMS physicians documented an accordant
value (numerical rating scale) on the patient records. Furthermore some parameters could be identified where documentation
was mostly missing although they were measured, e.g. onset of symptoms in STEMI (5/4/15) and reduced level of consciousness
and bradypnea in major trauma (9/2/17).
ConclusionPatient safety can be reduced if relevant preclinical data are not transmitted correctly to the admitting hospital. Therefore
there is a need to improve documentation quality in EMS. Electronic documentation, training of EMS staff and quality management
programs might offer solutions. Because of the small sample size further studies are needed to evaluate the validity of these
KeywordsDocumentation–Emergency medical services–Computer simulation–Video recording
Der Anaesthesist 01/2011; 60(3):221-229. · 0.85 Impact Factor
[show abstract][hide abstract] ABSTRACT: Zusammenfassung Telemedizin erhält in immer mehr Bereiche der Medizin Einzug und zeigt ein starkes Marktwachstum. In der Notfallmedizin sind
Systeme, die eine Vernetzung zweier stationärer Einrichtungen ermöglichen (interklinische Systeme) von den Systemen zu unterscheiden,
die eine Vernetzung mit einem mobilen Partner ermöglichen (z. B. Rettungswagen). Für die 12-Kanal-EKG-Übertragung an einen
beratenden Kardiologen wurde gezeigt, dass therapierelevante Zeitintervalle verkürzt werden können. Eine strukturierte telemedizinische
Vorabinformation beim Schlaganfall kann die Zeit bis zur Bildgebung verkürzen und die Lyserate erhöhen. Im interklinischen
Bereich sind ebenfalls Telemedizinsysteme eingeführt worden, deren Nutzen beim akuten Schlaganfall mittlerweile wissenschaftlich
belegt ist. Auch in Deutschland kann präklinische Telemedizin rechtssicher erfolgen, jedoch sind vielfältige Aufgaben zu bewältigen,
bevor sie als Bestandteil der Regelversorgung im Notfall zur Anwendung kommen kann. Neben der technischen Weiterentwicklung
ist der wissenschaftliche Nachweis zu erbringen, unter welchen Bedingungen durch Telemedizin die Versorgungsqualität und letztlich
das Outcome verbessert werden können.