German Emergency Medical Services Research Articles

Prehospital blood transfusion : Opportunities and challenges for the German emergency medical services

Exsanguination is the leading cause of preventable death in severe trauma. Immediate hemorrhage control and transfusion of blood products are critical to maintain oxygen delivery and address trauma-induced coagulopathy. While prehospital blood product transfusion (PHBT) is established in neighboring countries, the fragmented configuration of Germany's emergency medical service (EMS) infrastructure has delayed the adoption of widespread PHBT programmes. This review aims to provide an updated perspective on the evolution, international practices and research needs of PHBT within the German context. This narrative review is based on aPubMed search using the search terms "prehospital" and "blood*". From an initial 4738 articles, 333 were directly related to PHBT and were subjected to further detailed examination. The literature, including referenced studies, was categorized into areas such as history, rationale, international practices, and evidence, and analyzed for quality. The benefit of early blood transfusion in major trauma has been established since WW1, explaining the efforts to initiate this lifesaving intervention as early as possible in the care pathway, including the prehospital field. Recent randomized trials have faced design and recruitment challenges, reflecting the complexity of the research question. These trials have yielded inconclusive results regarding the survival benefits of PHBT in civilian settings. This scenario raises doubts about the capability of randomized trials to resolve questions concerning survival advantages. Despite these difficulties, there is adiscernible trend indicating potential improvements in patient outcomes. In Germany, the incidence of trauma-associated shock stands at 38per 100,000 individuals per year. It is estimated that between 300 and 1800 patients annually possibly benefit from PHBT. Prehospital Blood Transfusion appears to be promising but identifying patient groups most likely to benefit as well as the most suitable blood products remain unresolved issues. In Germany PHBT programs are not yet widely established. Paradoxically, this situation, paired with the extensive German Trauma Registry, provides aprime opportunity for comprehensive prospective cohort studies, addressing the balance between PHBT benefits, logistical feasibility, and implementation strategies. Such studies are essential for establishing guidelines and integrating PHBT efficiently into German trauma care protocols.

Regional differences, repeated use, and costs of emergency medical services in Germany.

Little is known about regional differences regarding the utilization and costs of emergency medical services (EMS) in Germany. Evidence on characteristics of repeated use of EMS is also scarce. To compare German federal states regarding the utilization and costs of EMS and to analyze characteristics of repeated EMS use. We used BARMER health insurance data on more than 1.4million German EMS cases in 2022. We estimated EMS use rates (per 1000 inhabitants) and median reimbursements and costs by EMS type (ground transport with/without emergency physician (EP); helicopter emergency medical services), hospitalization status, and federal state. We applied Poisson regression to estimate incidence rate ratios (IRRs) with 95% confidence intervals (95% CI), capturing relationships between repeated use of EMS and individual characteristics, including care degree and income level. Ground transport EMS use rates varied between federal states by more than 2.6-fold without EP (Bavaria: 84.6; Berlin: 223.2) and 2.1-fold with EP (Bremen: 19.1; Saxony: 41.3). Median reimbursement of ground transport with EP was 132% higher in Schleswig-Holstein (€ 1530) compared with Berlin (€ 660). Approximately one-third of all persons used EMS more than once and accounted for two-thirds of all EMS cases. Repeated EMS use was strongly related to care degree (IRR of care degree5: 3084; 95% CI 3.012-3.158) and low income (IRR: 1.174; 95% CI 1.161-1.189). The substantial regional heterogeneity in terms of utilization and costs of EMS calls for anationwide, consistent regulation of EMS in Germany. Additionally, (outpatient) primary nursing care of persons with severe health impairments and health literacy should be strengthened.

Resilience as Safety Culture in German Emergency Medical Services: Examining Irritation and Burnout.

The stress levels in emergency services are enormous. The resulting stress can range from psychological irritation to burnout. This study examines the importance of resilience in the German EMS and its significance for the risk of irritation and burnout among EMS personnel. A quantitative cross-sectional online survey was conducted among 285 EMS personnel in Germany. Resilience was measured by the RS-13 Scale, irritation by the Irritation Scale (IS), and burnout by the Maslach Burnout Inventory (MBI). Sociodemographic and job-related data were also collected. A classification into resilient groups was used to compare stress levels. More than one-third (39%) of the participants had a low level of resilience. EMS personnel with high levels of resilience had significantly lower scores on the cognitive and emotional irritation dimensions, as well as on the burnout dimensions of emotional exhaustion and cynicism. Resilience plays an important role in the safety culture of emergency services. The results support the hypothesis that high levels of resilience lead to less stress and help people cope better with stress. Almost two-fifths of the participants had lower resilience, underscoring the need for safe communication and targeted measures to strengthen resilience. Regular training, a supportive work environment, and promoting team cohesion and social support can improve emergency responders' mental health and job performance. Future research should develop specific intervention strategies and evaluate their effectiveness to ensure the long-term health of emergency responders and improve the quality of emergency care.

Quality and safety in prehospital airway management – retrospective analysis of 18,000 cases from an air rescue database in Germany

BackgroundPrehospital airway management remains crucial with regard to the quality and safety of emergency medical service (EMS) systems worldwide. In 2007, the benchmark study by Timmermann et al. hit the German EMS community hard by revealing a significant rate of undetected oesophageal intubations leading to an often-fatal outcome. Since then, much attention has been given to guideline development and training. This study evaluated the incidence and special circumstances of tube misplacement as an adverse peri-intubation event from a Helicopter Emergency Medical Services perspective.MethodsThis was a retrospective analysis of a German helicopter-based EMS database from January 1, 2012, to December 31, 2020. All registered patients were included in the primary analysis. The results were analysed using SPSS 27.0.1.0.ResultsOut of 227,459 emergency medical responses overall, a total of 18,087 (8.0%) involved invasive airway management. In 8141 (45.0%) of these patients, airway management devices were used by ground-based EMS staff, with an intubation rate of 96.6% (n = 7861), and alternative airways were used in 3.2% (n = 285). Overall, the rate of endotracheal intubation success was 94.7%, while adverse events in the form of tube misplacement were present in 5.3%, with a 1.2% rate of undetected oesophageal intubation. Overall tube misplacement and undetected oesophageal intubation occurred more often after intubation was carried out by paramedics (10.4% and 3.6%, respectively). In view of special circumstances, those errors occurred more often in the presence of trauma or cardiopulmonary resuscitation, with rates of 5.6% and 6.4%, respectively. Difficult airways with a Cormack 4 status were present in 2.1% (n = 213) of HEMS patients, accompanied by three or more intubation attempts in 5.2% (n = 11).ConclusionsPrehospital airway management success has improved significantly in recent years. However, adverse peri-intubation events such as undetected oesophageal intubation remain a persistent threat to patient safety.Trial registrationThe study was registered in the German Register for Clinical Studies (number DRKS00028068).

Prävalenz ausgewählter Erkrankungen bei prähospitalen Rettungskräften in Deutschland

Prevalence of selected diseases among pre-hospital emergency services personnel in Germany – results of the EMS Health Study 2023 Objective: The health of pre-hospital emergency medical services (EMS) staff is crucial for the provision of high-quality medical care. However, currently only limited data on the health monitoring of German EMS staff is available. The aim of the study was therefore to analyse the 12-month prevalence of selected diseases and symptoms among German EMS staff. Methods: A nationwide survey study was conducted. Questions from the GEDA2019/2020 study were used to collect information on the health status of EMS staff. Subsequently, 12-month prevalences were calculated with the corresponding 95 % confidence intervals (95 % CI). Results: In the end, 1,171 active German EMS staff (67.9 % male/31.9 % female) with a median age of 32.0 years were included in the analysis. The results indicate that excess weight and obesity are common health problems among EMS staff, with men (68.4 % [95 % CI: 64.8 %; 71.4 %]) being more affected than women (45.0 % [95 % CI: 39.9 %; 50.2 %]). The highest 12-month prevalence was calculated for lower back pain (51.8 % [95 % CI: 48.9 %; 54.7 %]), followed by pain in the cervical spine (41.9 % [95 % CI: 39.1 %; 44.8 %]), allergies (34.1 % [95 % CI: 31.4 %; 36.9 %]), hypertension (19.1 % [95 % CI: 16.9 %; 21.5 %]) and depression (16.2 % [95 % CI: 14.2 %; 18.5 %]). Compared to the German general population, the 12-month prevalence of obesity, asthma, COPD, hypertension, elevated blood lipid levels, arthritis, depression and obesity was higher for certain gender and age groups of emergency workers. Conclusion: The result of this study indicate a poor health state among German pre-hospital EMS staff and the need for preventive measures. Keywords: 12-month prevalence – emergency medical services – health – obesity – epidemiology

Rescue Missions with Patients with Psychiatric and Psychosocial Symptoms: An Analysis from Eastern Lower Saxony

Characterization of medical emergencies of patients with psychiatric symptoms or in psychosocial crisis. Analysis of emergency medical services (EMS) mission logs from four German EMS stations of patients aged 12-65 from 2019 to 2020. 23.4% of missions involved patients with psychiatric or psychosocial symptoms (1.6% psychotic, 3.0% suicidal, 7.1% psychosocial crisis, 15.7% intoxicated). On average, these patients were younger than those with other symptoms. 48.9% exhibited additional somatic complaints. The COVID-19 pandemic showed only little impact on the frequency of such emergencies. Psychiatric and psychosocial symptoms account for a significant proportion of rescue missions in our sample. Managing psychiatric and psychosocial emergencies should be an integral part of the training of medical and paramedical staff.

Hospital admissions following emergency medical services in Germany: analysis of 2million hospital cases in 2022.

The use of emergency medical services (EMS) in Germany has increased substantially over the last few decades. While current reform efforts aim to increase effectiveness and efficiency of the German hospital and EMS systems, there is lack of data on characteristics of hospital cases using EMS. To analyze and compare the characteristics of cases hospitalized with and without the use of EMS. The BARMER health insurance data on more than 2million hospital cases admitted in 2022 were analyzed. The distributions of age, clinical complexity (measured by patient clinical complexity levels, PCCL), main diagnoses, costs for EMS and hospital treatment, and multiple severity indicators were described. The overall severity of hospital cases was classified as "low or moderate" or "high" based on acombined severity indicator. All analyses were stratified by use of EMS and EMS type. A total of 28% of all included hospital cases used EMS. Relative to hospital cases without use of EMS, hospital cases with use of EMS were older (physician-staffed ambulance: 75years, interquartile range [IQR]59-84, double-crewed ambulance: 78years, IQR64-85) and had ahigher clinical complexity. The severity of more than 30% of the cases using EMS (except for patient transport service ambulance) was classified as "low or moderate". The distributions of main diagnoses differed by severity and use of EMS. The high proportion of cases with low or moderate severity using EMS may indicate asubstantial potential to avoid the use of EMS in the context of hospital admissions in Germany. Further investigation is required to explore whether the proportion of cases using EMS could be reduced by optimizing preclinical service.

Comparison of Palliative Knowledge and Self-Efficacy Expectation of German Paramedics Between a Rural and an Urban Structured Emergency Medical Service Area.

Differences in the German emergency medical service (EMS) can be seen in the countryside in contrast to the city with regard to travel distances to hospitals and in the access routes of EMS-physicians. In order to investigate the success of establishment of palliative crisis cards associated with training and the rural and urban EMS structures, two urban and two rural EMS areas were compared using the Paramedic Palliative Care Test (PARPACT). Methods: The PARPACT includes test items on palliative knowledge (PK, maximum score: 15 points) and palliative self-efficacy expectations (PSE, maximum score: 18 points), as well as items on palliative attitudes in dealing with palliative care patients. We used a 4-point Likert-type scale. For data analysis, nonparametric tests (χ-test and Mann-Whitney U test) were used in addition to descriptive analysis (frequencies, means, medians, standard deviations, and ranges). Results: In total, 291 out of 750 ambulance or EMS personnel participated in the voluntary survey. Rural ambulance or EMS personnel answered the PK-questions correctly more often on average (mean: 11.19, SD: 1.85) than urban ambulance or EMS personnel (mean: 9.18, SD: 2.39; Mann-Whitney U test: U=5040.000, P=.001). In addition, ambulance or EMS personnel with the highest level of training (3-year-trained paramedics) performed better in PK (mean: 10.38, SD: 2.31) than less intensively training ambulance or EMS personnel (mean: 9.58, SD: 2.43; Mann-Whitney U-test: U=8446.500, P=.004). In terms of PSE, rural ambulance or EMS personnel also achieved higher mean PSE-scores (mean: 12.55, SD: 2.60) than urban ambulance or EMS personnel (mean: 9.77, SD: 3.41; Mann-Whitney U-test: U=5148.500, P=.001). Conclusions: Better training in the EMS is associated with improved PK compared to less qualified nonphysician EMS staff. The establishment of palliative crisis cards and the structures in the city alone do not lead to improved knowledge and PSE.

Performance of invasive, non-invasive, and pharmacological measures by emergency physicians in the German emergency medical services. A retrospective cross-sectional study from the rescue association Südwestsachsen

BackgroundEvery citizen in Germany is entitled to qualified emergency medical assistance. Due to annually increasing deployment figures and personnel shortages, it is no longer possible to guarantee 24/7 coverage of all emergency physician locations throughout Germany. Relief can be achieved through changes in the supply structures. Professional field analyses are the basis for the further development of training and care structures.MethodologyAll emergency physician deployments of a location in the rescue association Südwestsachsen that took place between 01.10.2022 and 31.01.2023 were retrospectively evaluated. For this purpose, the analogously created deployment protocols were examined with regard to demographic data as well as the invasive, non-invasive and pharmacological measures performed by emergency physicians.ResultsIn N = 684 emergency missions, n = 471 (100%) invasive or non-invasive measures were performed by an emergency physician. At n = 383 (81.3%), the most frequently performed invasive measure was intravenous (i.v.) access. There were n = 710 (100%) pharmacological measures performed by an emergency physician. The most frequently performed pharmacologic measure was administration of a full electrolyte solution, with n = 223 (31.4%)DiscussionEmergency physician interventions do not necessarily involve invasive, non-invasive, or pharmacologic measures. The emergency paramedic learns a variety of invasive, non-invasive, and pharmacologic measures in his or her training and could contribute to the reduction of emergency physician interventions. An adaptation of prehospital care structures based on evidence-based data and an update of the catalog of indications for emergency physician interventions would be elementary for this goal.

Demand Analysis of a German Emergency Medical Service Feedback System.

The number of emergency medical service (EMS) calls in Germany is continuously increasing. The initial assessment, the pre-hospital care and the choice of hospital for further care by the EMS influences the patient's outcome and are the basis for further care in hospital. However, the EMS does not receive any official feedback on its decisions. This study evaluates the demand for a feedback system from the emergency department (ED) to the EMS, what it should contain, and how it could be integrated in the electronic clinical systems. A semi-structured interview guideline for expert interviews with members of EMS staff (n = 6) and ED staff (n = 17) was developed. A mockup to visualise a possible implementation was designed and included in the interview. There is a significant demand for feedback on pre-diagnosis, pre-hospital care and handover of patients from the EMS to the ED. The EDs are very interested in improving the collaboration with the paramedic services through feedback. A feedback system is strongly desired by various EMS stakeholders and, according to them, could improve both EMS and ED collaboration and overall patient care.

Overconfidence effects and learning motivation refreshing BLS: An observational questionnaire study

Aim of the studyRegular refresher skill courses are necessary to maintain competence in basic life support. The utilization of these training programs strongly depends on the motivation to learn. Learning motivation may be affected by overconfidence and clinical tribalism, as they both imply a higher competence compared to others, and therefore, a lower demand for training. This study aimed to assess how overconfidence in basic life support competencies affects learning motivation. MethodsWe conducted a cross-sectional, observational, multicenter, anonymous online questionnaire survey using validated psychometric tests for healthcare professionals in Germany. Further, we tested participants’ knowledge and attitude regarding international basic life support guidelines. The study was conducted between March and April 2022, and healthcare providers from 22 German emergency medical services and hospitals at all levels were assessed. ResultsOf 2,000 healthcare professionals assessed, 407 completed the assessment (response rate, 20.4%). We confirmed the presence of overconfidence and clinical tribalism (identity differentiation between social groups) among the 407 physicians, nurses, and emergency medical service providers who completed the survey. Three different learning-motivation groups emerged from cluster analysis: “experts” (confident and motivated), “recruitables” (overconfident and motivated), and “unawares” (overconfident and unmotivated). The three groups were present in all professional groups, independent of the frequency of exposure to cardiac arrest and educational level. ConclusionsThese findings showed the presence of overconfidence effects and different learning motivation types in individuals learning basic life support, even in instructors.

Arbeitsunfähigkeit bei präklinischen Rettungskräften in Deutschland

ZusammenfassungHintergrundFür Krankenstandanalysen ist die Ermittlung von Arbeitsunfähigkeit ein zentraler Ansatz. Dennoch liegen für Arbeitsunfähigkeit und damit assoziierte Faktoren im deutschen präklinischen Rettungsdienst bisher noch keine Daten vor.Ziel der ArbeitZiel dieser Analyse war es, den Anteil der Rettungskräfte in Deutschland mit mindestens einer Arbeitsunfähigkeit in den letzten 12 Monaten und damit assoziierte Faktoren zu identifizieren.Material und MethodenEs handelt sich um eine bundesweite Befragungsstudie mit Rettungskräften. Assoziationen zwischen der Arbeitsunfähigkeit und soziodemografischen, gesundheitsbezogenen sowie berufsspezifischen Faktoren wurde mittels multivariabler logistischer Regression, unter Berechnung von Odds-Ratio (OR) und dazugehörigen 95 % Konfidenzintervallen (95 % KI) identifiziert.ErgebnisseIn diese Analyse eingeschlossen wurden 2298 deutsche Rettungskräfte. 60,10 % der weiblichen sowie 58,98 % der männlichen Befragten gaben mindestens eine Arbeitsunfähigkeit in den letzten 12 Monaten an. Eine Arbeitsunfähigkeit war unter anderem signifikant mit dem Schulabschluss (Abitur: OR: 0,51 [95 % KI 0,30–0,88]; p = 0,016; Referenz: Hauptschulabschluss) und den wöchentlichen Arbeitsstunden (OR: 1,01 [95 % KI 1,00–1,02]; p = 0,003) assoziiert. Auch das Arbeitsumfeld, die Dienstjahre sowie verschiedene physische und psychische Beschwerden in den letzten 12 Monaten zeigten eine signifikante Assoziation mit einer Arbeitsunfähigkeit.DiskussionDiese Analyse weist darauf hin, dass unter anderem chronische Krankheiten, der Bildungsabschluss, das Einsatzgebiet sowie die Anzahl der Dienstjahre und wöchentlichen Arbeitsstunden bei den teilnehmenden Rettungskräften mit Arbeitsunfähigkeitstagen in den letzten 12 Monaten assoziiert waren.

Second Victims among German Emergency Medical Services Physicians (SeViD-III-Study)

Patient care in the prehospital emergency setting is error-prone. Wu's publications on the second victim syndrome made very clear that medical errors may lead to severe emotional injury on the caregiver's part. So far, little is known about the extent of the problem within the field of prehospital emergency care. Our study aimed at identifying the prevalence of the Second Victim Phenomenon among Emergency Medical Services (EMS) physicians in Germany. Web-based distribution of the SeViD questionnaire among n = 12.000 members of the German Prehospital Emergency Physician Association (BAND) to assess general experience, symptoms and support strategies associated with the Second Victim Phenomenon. In total, 401 participants fully completed the survey, 69.1% were male and the majority (91.2%) were board-certified in prehospital emergency medicine. The median length of experience in this field of medicine was 11 years. Out of 401 participants, 213 (53.1%) had experienced at least one second victim incident. Self-perceived time to full recovery was up to one month according to 57.7% (123) and more than one month to 31.0% (66) of the participants. A total of 11.3% (24) had not fully recovered by the time of the survey. Overall, 12-month prevalence was 13.7% (55/401). The COVID-19 pandemic had little effect on SVP prevalence within this specific sample. Our data indicate that the Second Victim Phenomenon is very frequent among prehospital emergency physicians in Germany. However, four out of ten caregivers affected did not seek or receive any assistance in coping with this stressful situation. One out of nine respondents had not yet fully recovered by the time of the survey. Effective support networks, e.g., easy access to psychological and legal counseling as well as the opportunity to discuss ethical issues, are urgently required in order to prevent employees from further harm, to keep healthcare professionals from leaving this field of medical care and to maintain a high level of system safety and well-being of subsequent patients.

Recovery-stress levels in paramedics during the first two waves of the SARS-CoV-2 pandemic

The balance between stress perception and recovery of emergency medical service personnel during service and leisure time is an essential indicator of mental and physical health. It ensures success in emergency medical care and is also ahealth policy and economic factor for any organization. The aim of the study was to evaluate the recovery stress level of paramedics in the first and second waves of the SARS-CoV‑2 pandemic. The quantitative cross-sectional study included 1936 records of responders (334women and 1602 men, mean age 34.9 ± 10.5years). The online survey during the SARS-CoV‑2 pandemic was performed during the first wave in 2020 and the second wave in 2021. The short form EBF-24/A (test version S2) of the recovery stress questionnaire according to Kallus was analyzed. During the course of the two survey phases, the dimensions stress increased significantly (t1: 2.52 ± 0.98 and t2: 2.88 ± 1.04points, p < 0.001) and recovery decreased significantly (t1: 2.98 ± 0.90 and t2: 2.64 ± 0.89points, p < 0.001). Similar results were found for the corresponding subscales with the exception of the subscale "restful sleep" of the dimension recovery (t1: 2.81 ± 1.36 and t2: 2.72 ± 1.36points). During the SARS-CoV‑2 pandemic, which has been ongoing since the beginning of 2020, the stress experienced by emergency responders increased from the first to the second wave, while the perception of recovery for emergency responders decreased. The study presents the current situation of recovery stress in German emergency medical service employees and allows predictions about performance and health in pandemic situations.

Fairness or efficiency-Managing this conflict in emergency medical services location planning

Every patient should have equal access to fast and qualified assistance by emergency medical services (EMS). Most location planning models for EMS only consider efficiency criteria such as maximum coverage. Especially in metropolitan regions, the heterogeneous distribution of demand leads to unequal service availability: city centers receive higher coverage than suburban areas. To address this issue, we extend existing location planning models by two fairness criteria: the Rawlsian criterion, which maximizes the coverage of the least-covered demand area, and the Gini coefficient, which minimizes differences in coverage between demand areas. We consider both fairness criteria using the ϵ-constraint method and apply both criteria to the case of a German EMS provider. By generating the Pareto front, we analyze the trade-offs between efficiency and fairness. We find that managing the conflict between fairness and efficiency especially in a metropolitan region offers more beneficial solutions with respect to both criteria than generally assumed. We show that it is possible to greatly improve fairness by giving up only a small amount of coverage.

Preliminary and Final Postmortem Examination and Death Certificate in the Emergency Medical Services in Germany: Heterogeneous Process Flows and Inadequate Standards

Inconsistent regulations and laws can lead to misunderstandings and incorrect procedures. In this study we would like to evaluate the heterogeneity of the different processes of postmortem examination and death certification in the German emergency medical services. An e-mail with a survey link was sent to 212 medical directors of emergency services. The questions were answered online. The response rate was 47%. Regulated procedures were evident in 58% of the cases. Issue of provisional death certificate comprised 64%, postmortem examination 45%; 19.4% of emergency physicians were required to do the final post-mortem. In 41% of the cases, the application protocol was considered sufficient as a form of documentation. 45% of the participants evaluated the respective legal regulation as sufficient. Questions and concerns arose, especially when medical directors of EMS believed that the state-specific regulations were not sufficient (p<0.001). The results show that the obligatory post-mortem examination in Germany is heterogeneous in its processing procedures. More than half of the participants rate the existing legal regulations as inadequate. As a result, it is not uncommon for queries and complaints to arise, but above all for uncertainties to arise in everyday practice. Our results suggest that uniform legislation and clearly defined processes are desirable.

Higher chance of survival in patients with out-of-hospital cardiac arrest attributed to poisoning

Aim of the studyDescription and comparison of cohort characteristics and outcome of adult patients with out-of-hospital cardiac arrest (OHCA) attributed to poisoning (P-OHCA) versus patients with OHCA attributed to other medical causes (NP-OHCA). MethodsWe included all patients who received cardiopulmonary resuscitation after OHCA between January 2011 and December 2020 from German emergency medical services with good data quality in the German Resuscitation Registry. Exclusion criteria: patients < 18 years of age or OHCA attributed to trauma, drowning, intracranial bleeding or exsanguination. ResultsPatients with P-OHCA (n = 574) were significantly younger compared to NP-OHCA (n = 40,146) (median age of 43 (35–54) years vs. 73 (62–82) years; p < 0.001). Cardiac arrest in P-OHCA patients was significantly less often witnessed by bystanders (41.8 % vs. 66.2 %, p < 0.001). Asystole was the predominant initial rhythm in P-OHCA patients (73.5% vs. 53.7%, p < 0.001) while ventricular fibrillation (VF) and pulseless electrical activity (PEA) were less common (9.2% vs. 25.1% and 16.2 % vs. 20.5%, p < 0.001). P-OHCA had a higher chance of survival with good neurological outcome at hospital discharge (15.2 vs. 8.8 % p < 0.001) and poisoning was an independent protective prognostic factor in multivariate analysis (OR 2.47, 95%-CI [1.71–3.57]). P-OHCA patients with initial PEA survival with good neurological outcome was comparable to initial VF (34.3 % vs. 37.7%). ConclusionPatients in the P-OHCA group had a significantly higher chance of survival with good neurological outcome and PEA as initial rhythm was as favourable as initial VF. Therefore, in P-OHCA patients resuscitation efforts should be extended.

The prevalence of diseases in German emergency medical services staff: A survey study

For the general German population, the GEDA study is the main health monitoring study. Since nothing comparable is existing regarding the health of emergency medical services (EMS) staff, the aim of the present study was to estimate the 12-months prevalence of socially relevant diseases and symptoms among German pre-hospital EMS staff. This was a nationwide survey study. For retrieval of information on the health status of participating EMS staff items from the GEDA2014/2015 study were used. Afterwards, 12-months prevalence or proportions and corresponding 95% confidence intervals (95% CI) were calculated. Overall, 2,313 German pre-hospital EMS staff (42.6% female/57.2% male) with a median age of 25.0 (min. 18.0; max. 63.0) years were included into the final analysis. Obesity based on BMI was present in 25.9% (95% CI: 23.5%; 28.4%) of male compared to 15.7% (95% CI: 13.5%; 18.1%) of female study participants. Highest 12-months prevalence in the full study sample were calculated for lower back pain (41.1% [95%: 39.1%; 43.2%]), cervical pain (32.9% [95% CI: 30.9%; 34.8%]), allergies (32.6% [95% CI: 30.7%; 34.6%], depression (13.7% [95% CI: 12.4%; 15.2%]), and hypertension (11.5% [95% CI: 10.3%; 12.9%]). The 12-months prevalence in specific age-/gender-groups were higher for asthma, depression, hypertension, increased blood lipids, and osteoarthritis among study participants compared to the general German population (GEDA study) with the same age and gender (ratio ≥ 1.5). This study indicates that the prevalence of obesity, depression, hypertension, and other disorders is high among study participants and disease prevention measures for pre-hospital EMS staff are needed.

Digital systems to support emergency medical service : AGermany-wide cross-sectional survey on current availability, utilization and existing challenges

Increasing requirements for documentation, cross-sectoral communication and quality management are leading to increased organizational effort in emergency medical services (EMS). On the one hand, the use of digital information systems in prehospital settings can help to support emergency physicians and paramedics in these tasks and on the other hand, it opens new treatment options such as telemedical care for patients. This work attempts to provide acomprehensive picture of the current use of digital systems for ambulance services in Germany. To do so, the study investigated how widespread various information and communication systems currently are at local EMS stations and ambulances, how they are used by emergency personnel, how they are assessed by users and what challenges currently exist for further expansion and greater acceptance of the users. The cross-sectional study was conducted as anationwide, exploratory online survey among emergency physicians and paramedic professionals in July and August 2020 covering 24different questions. Participation was called for on the Internet, at EMS stations and in hospital emergency departments. Subsequent data analysis was performed using descriptive statistical methods. Solutions considered included digital documentation and hospital prenotification, interdisciplinary care capacity notification, real-time telehealth services and digital radio units. In total, 821 responses of participants from 481 different EMS stations from 382 cities nationwide were included in the evaluation. The availability of the 16systems surveyed varies significantly throughout Germany, depending on the federal state and application. While basic equipment such as radio units or navigation devices are available on almost all surveyed ambulances, the share which has real-time telehealth applications at their disposal is just 6%. Aproportion of 72% reported the usage of any type of digital documentation and 41% used adigital tool for prenotification of emergency rooms in at least one hospital. The emergency staff surveyed were generally open to new technologies and resulting possibilities, such as having an electronic patient care record or transmitting patient data digitally to emergency room. Almost all participants see abenefit in the use of information technology in ambulance service, although slightly more than half considered current implementation as unsatisfactory. Challenges are particularly evident with regard to reliability, hardware, useability and interoperability with third parties, such as dispatch centres and hospitals. Although information technology systems in German EMS are no longer in their infancy, there is still along way to go before prehospital emergency care can be considered as extensively and adequately digitalized. Amore holistic perspective and networked implementation of all systems and processes involved in emergency response operations can help improve and further spread digital solutions for prehospital emergency care. Incorporating field experience into the development process could contribute to increasing functionality and user acceptance.

COVID-19: acceptance and compliance of PPE (personal protective equipment) and rules for hygiene and reducing contacts in German emergency medical services-a nationwide survey

HintergrundDie COVID-19-Pandemie (coronavirus disease-2019) hat auch den deutschen Rettungsdienst deutlich belastet und gefordert. Die persönliche Schutzausrüstung (PSA) und die AHA-L-Regel (Abstand halten, Hygiene beachten, Maske tragen, regelmäßig lüften) spielen hierbei eine wichtige Rolle, um eine Verbreitung der COVID-19-Infektionen zu reduzieren.ZielMit dieser Studie möchten wir die Akzeptanz und Compliance von PSA und Schutzmaßnahmen beim Rettungsdienstpersonal in Deutschland in Pandemiezeiten evaluieren.MethodeÜber 270 ÄLRD wurden angeschrieben. Diese wurden gebeten, eine webbasierte Onlineumfrage an die Rettungswachen weiterzuleiten. Die Teilnehmer wurden zu Akzeptanz und Compliance im Alltag, in der Rettungswache, im Einsatz ohne COVID-19, im Einsatz mit COVID-19 befragt.ErgebnisseEs haben n = 1295 Personen teilgenommen. Die Akzeptanz und Compliance von PSA und Schutzmaßnahmen ist insgesamt hoch. Die geringste Akzeptanz und Compliance findet sich bei den Fragen Akzeptanz (MW = 4,16; ±1,01) und Compliance (MW = 4,26; ±0,89) in der Rettungswache.FazitWir empfehlen gezielte Schulungsmaßnahmen in Bezug auf PSA in Pandemien und die Bereitstellung von entsprechenden Räumlichkeiten zur konfliktlosen Einhaltung der AHA-L-Regeln.