In-hospital Emergency Medicine Research Articles

[Emergency medicine: what's new in 2023].

Research in prehospital and in-hospital emergency medicine is essential to the development of this discipline. By calling certain practices into question (thrombolysis for minor strokes, use of coagulation factors for patients with severe polytrauma), providing access to new technologies (video-laryngoscopy, POCT troponins in pre-hospital care) or questioning new practices (double defibrillation, pulmonary US in pneumonia), research enables emergency physicians to adapt their day-to-day practice.

Regional Anesthesia for Acute Pain Treatment in Pre-Hospital and In-Hospital Emergency Medicine.

More than half of all emergency department patients seek help for acute pain, which is usually of musculoskeletal origin. Acute pain is often inadequately treated even today, particularly in children and in older patients. In this study, we assess the potential role of regional anesthetic methods in improving the treatment of pain in the preclinical and clinical emergency setting. Pain-related reasons for admission were identified and quantified from emergency admission data. A structured literature search was carried out for clinical studies on the treatment of pain in the emergency setting, and a before-and-after comparison of the pain relief achieved with established vs. newer regional anesthetic methods was performed. 43% of emergency patients presented with acute musculoskeletal pain. The literature search yielded 3732 hits for screening; data on entity-specific pain therapy spectra were extracted from 153 studies and presented for the main pain regions. The degree of pain relief obtained through regional anesthetic procedures, on a nominal rating scale from 0 to 10, was 4 to 7 points for acute back and chest wall pain, >6 for shoulder pain, 5 to 7 for hand and forearm injuries, and >4 for hip fractures. These results were as good as, or better than, those obtained by analgesia/sedation with strong opioids. Modern regional anesthetic techniques can improve acute pain management in the emergency department and, to some extent, in the pre-hospital setting as well. Pain relief with these techniques is quantifiably better than with strong opioids in some clinical situations; moreover, there is evidence of further advantages including process optimization and fewer complications. Data for comparative study remain scarce because of a lack of standardization.

[Position of trauma surgery in emergency medicine].

The decision of the Federal Joint Committee has resulted in the further development of in-hospital emergency medicine through the establishment of central emergency departments and staged emergency care. In addition, the additional training in clinical acute and emergency medicine was established. The aim of this work is on the one hand to make trauma surgeons aware of these structural changes. On the other hand, we would like to evaluate an opinion and discuss the position of trauma surgery in emergency medicine. Aweb-based online survey was conducted at the Trauma Network and Trauma Registry Congress to collect participants' opinions on the position of trauma surgery in emergency medicine. Of 143 congress participants, 98 (67%) responded to the survey. The majority of participants were male (n = 78, 80%), over 40years of age (n = 62, 63%), and in aprofessional position with staff responsibility (n = 73, 75%). Emergency medicine (mean: 84.8; SD: 18.7) and intensive care medicine (mean: 78.3; SD: 20.4) training appears important. On the other hand, subsequent work in these areas appears less important (prehospital emergency medicine: mean: 65.1; SD: 28.0; ICU: mean: 53.7, SD: 30.3); however, activity in an emergency department is rated higher (MW: 87.0; SD: 18.7). There is high agreement that the trauma leader should be atrauma surgeon (mean 87.9; SD: 19.7). Ahigh volume of emergency trauma surgery patients and the care of severely injured patients in designated trauma centers show that trauma surgery expertise is mandatory in acentral emergency department. Senior positions should also be sought to ensure high quality standards.

Kliniksanitäter. Ein interprofessionelles Blended-Learning-Konzept zur Weiterqualifikation von Rettungsdienst- und medizinischem Personal zum Einsatz auf Intensivstationen und in Notaufnahmen während der COVID-19-Pandemie

HintergrundDie COVID-19-Pandemie machte eine zeitkritische Erweiterung der personellen Intensiv- und Notaufnahmekapazitäten notwendig.Ziel der ArbeitDiese Arbeit schildert erste Ergebnisse eines Blended-Learning-Konzepts zur Qualifikation von Rettungsdienst- und medizinischem Personal in intensivmedizinischen Maßnahmen zur Zeit der COVID-19-Pandemie.Material und MethodenInterprofessionell erfolgte die Entwicklung und Umsetzung eines 2‑stufigen Blended-Learning-Konzepts (Stufe 1: E‑Learning mit Onlinetutorials, Stufe 2: Praxiseinsatz) in 3 Modulen (Intensivstation, Notaufnahme, innerklinische Notfallmedizin) zur Weiterqualifikation in intensivmedizinischen und -pflegerischen Maßnahmen. Erfasst wurden Einsatzort, durchgeführte Maßnahmen, subjektive Kenntnisstandbewertung der definierten Maßnahmen vor und nach Abschluss der Weiterqualifikation anhand einer 4‑stufigen Likert-Skala, Bewertung der Einsetzbarkeit im Rahmen der COVID-19-Pandemie sowohl durch die Teilnehmenden als auch Praxisanleitenden bzw. supervidierenden Ärzte.ErgebnisseNach 6 Wochen hatten 63 % der 92 angemeldeten Teilnehmenden den Onlinekurs und 29 % zusätzlich ihren Praxiseinsatz (Intensivstation bzw. Notaufnahme) abgeschlossen. Auf Intensivstationen assistierten sie u. a. bei der Vorbereitung von Katheteranlagen, Medikamenten, pflegerischen Tätigkeiten, in Notaufnahmen bei der Triage und der Erstversorgung. Nach Abschluss fühlten sich die Kliniksanitäter signifikant sicherer bei einem Krankenhauseinsatz, der Assistenz der ZVK-Anlage sowie der Tracheostomapflege (p < 0,05). Alle Teilnehmenden willigten ein, im Rahmen der COVID-19-Pandemie zu unterstützen. Die Praxisanleitungen bewerteten die Teilnehmenden in 94 % als einsetzbar.DiskussionBlended-Learning-Konzepte können zeitkritisch medizinisch vorgebildetes Personal für den Einsatz in kritischen Krankenhausbereichen qualifizieren, Pflegekräfte entlasten und für eine personelle Erweiterung der Intensivkapazitäten freisetzen. Die aktuellen Empfehlungen und zukünftigen Pandemiepläne sollten diesbezüglich erweitert werden.

Die Sepsis in der Notfallmedizin - Präklinische und frühe innerklinische Notfalltherapie

Sepsis is a complex life threatening disease whose outcome decisively depends on a fast diagnosis and treatment. Emergency Medicine is confronted with the task to identify theses septic patients reliably and initiate early goal directed therapy and treatment with antibiotics as soon as possible to avoid a dangerous delay and reduce sepsis-related mortality. This article presents a review focused on the early steps of sepsis therapy in pre-hospital and early in-hospital emergency medicine.

The Scandinavian journal of trauma, resuscitation and emergency medicine – grown up at last

The Scandinavian Journal of Trauma, Resuscitation, and Emergency Medicine (SJTREM) was launched in 1994 as Akuttjournalen. From being a national, humble magazine directed to anaesthesiologists working in the Norwegian air ambulance service, the journal has developed to being a peer-reviewed, international journal directed at all health professionals involved in pre- and in-hospital emergency medicine, critical care and trauma management. Over the years, SJTREM has gained valuable experience through both funding several international conferences (i.e. TraumaCare 2002, HLR 2003, The Scandinavian Update on Trauma, Resuscitation, and Emergency Medicine 2005 and 2007 – to mention but a few), and publishing widely on topics in subspecialties covered by its scope [1]. Today, SJTREM is the official journal of The Scandinavian Networking Group on Trauma and Emergency Management (SCANTEM) [2], and 9 more societies involved in trauma, resuscitation, and emergency medicine in Scandinavia. Although primarily directed at the Scandinavian audience, the articles published reflect the journal's considerable international orientation. Our large and distinguished Editorial Board represents several different countries, including UK, Germany, Australia, and the US. When you read this, a new and significant step in the history of SJTREM is achieved. The journal is now published as an open access online journal in cooperation with BioMed Central. This means that articles will be published online immediately upon acceptance (after peer-review) and soon after listed in PubMed Central, the US National Library of Medicine's full-text repository of life science literature, and hence indexed in PubMed. SJTREM has chosen open access publishing for several reasons. Articles are freely and universally accessible online, thus articles are highly visible and read by a wide audience. The authors hold copyright for their work and grant anyone the right to reproduce and disseminate the article provided that it is correctly cited, in accordance with BioMed Central's open access license agreement [3]. Besides PubMed Central, the journal's articles are archived in repositories at the University of Potsdam in Germany, at INIST in France and in e-Depot, the National Library of the Netherlands' digital archive of all electronic publications. Thanks to substantial funding from The Norwegian Air Ambulance Foundation and The Laerdal Foundation for Acute Medicine, all article-processing charges are covered by the journal. The results of scientific research, as well as clinical experience and commentaries published with SJTREM will be available free of charge to the whole emergency medicine community, both authors and readers. The clinical ideology of SJTREM is based on two concepts; The Formula of Survival [4] and The Chain of Survival [5]. The Formula of Survival illustrates how the interaction between medical science, educational efficiency and local organization does affect outcome. All three factors have equal importance, and deserve equal focus. The Chain of Survival emphasizes how all elements and personnel involved, from of injury or illness and throughout the course of the treatment, influence the outcome. Cooperation, communication and collaboration across educational and professional borders are a prerequisite to success. The scientific ideology of SJTREM emphasizes innovation. Although randomized controlled trials (RCT) are accepted as a gold standard, the method has significant limitations in emergency medical research. The interpretation of RCTs conducted in a multi-factorial, low incidence, real time emergency medical world requires caution. The characteristics and number of the study population, setting, connection between cause and effect, and the true implications of the study must be carefully considered. SJTREM believe that the best results in solving problems will be achieved by looking at them from different angles, using various approaches. In this, qualitative and quantitative methods complement each other. We encourage inventiveness and willingness to explore untraditional research methodology. SJTREM has a large and well qualified, international referee board. We operate a closed peer-review system and aim to reach a first decision to accept or reject a manuscript within six weeks of submission. Pre-hospital and immediate in-hospital emergency care involves a broad spectrum of disciplines, specialties and skills, which may differ significantly in structure, resources and operation between different systems and nations. For years, an unsolved issue has been when advanced life support (ALS) should be seen as preferable to basic life support (BLS), especially in trauma patients [6,7]. The line is often drawn on the steps of the emergency department, or in some cases the ALS is withheld until the patients pass the door of super-specialised medical services deep inside the hospital building. SJTREM believe that to clarify this complex issue we require research aiming to separate the impact of organisational structure from patients' patho-physiology and need for emergency medical interventions. Further, the isolated effect of provider competence, and the most effective ways to gain and retain competence must be deeply explored. The Scandinavian Journal of Trauma, Resuscitation, and Emergency Medicine look forward to linking science and everyday work helping us all to build the pre- and in-hospital emergency medical systems for the future.

The anesthesiologist in prehospital and hospital emergency medicine

The German emergency medical system is different from the Anglo-American system. Emergency medicine is no distinct specialty in Germany. Physicians are involved in prehospital emergency medicine. This review highlights the historic development of prehospital and hospital emergency medicine in Germany and describes future trends. Studies have shown that involvement of specially trained prehospital emergency physicians can result in reduced patient mortality. The in-hospital emergency medicine structure is important for the 'chain of survival' for patients with life-threatening medical conditions. In-hospital emergency medicine has been reorganized in many hospitals during the last few years. New qualification criteria for physicians in emergency departments, therefore, need to be developed. Economic and quality arguments have initiated the development of departments for emergency medicine in Germany. In the future, this will lead to new qualification criteria for physicians working in these departments.

[Emergency medicine today].

Anaesthesiology has given essential impulses to emergency medicine during the last decades. Therefore emergency medicine has become the "third column" of this speciality. As a "generalist with special skills" the anaesthetist fulfils the requirements of an emergency physician to a high degree. The scientific field of emergency medicine is subjected to a considerable amount of changes and requires qualified training and further education; in this context the guidelines for cardiopulmonary resuscitation are of outstanding importance. In the governmental-controlled emergency care system, the emergency physician and the chief emergency physician are responsible for both the individual treatment of patients and the management of major incidents and catastrophes. Moreover, the interhospital transfer is gaining increasing importance. Even though a high quality standard of the German emergency medicine system can be stated, there are still clear deficits such as the lack of integrated dispatch centers and the lack of the position of a medical physician as emergency care leader in each area. A leading structure for the management of major incidents and disasters is established to a great extent, nevertheless personal and material deficits exist in this field especially considering a rising terroristic threat. In the in-hospital emergency medicine anaesthetists are of essential importance for the interdisciplinary teamwork in the resuscitation room, medical treatment of in-hospital emergencies on the wards and outside on the hospital ground, and for internal as well as external major incidents and disasters. This is not always recognized in public opinion, so that the interdisciplinary integration must be secured and reinforced. A major goal is to preserve emergency medicine as the third column of anaesthesiology and to protect achieved standards, to reinforce research in preclinical and clinical emergency medicine, and to take up new challenges in the future.

Team performance in the emergency room: assessment of inter-disciplinary attitudes

In-hospital emergency medicine in central Europe relies on inter-disciplinary co-operation. To improve team performance in the emergency room (ER), a questionnaire for assessment of attitudes and judgements in resuscitation procedures was developed. A total of 43 items were evaluated according to a five-point Likert scale. With a response rate of 81%, 143 questionnaires were evaluated. Assessment of data was performed with regard to professional speciality and level in the medical hierarchy. Factorial analysis identified four main factors: Assessment of ‘quality of performance’ (F1), ‘importance of structure’ (F2), ‘quality of team culture’ (F3), and ‘importance of hierarchy’ (F4). Influences from the categories ‘speciality’ and ‘hierarchy’ and from the covariate ‘gender’ on these main factors were evaluated by two-factorial analysis of variance. For all four factors, ‘speciality’ produced significant differences. Surgeons accorded high values to F1 and low values to F2, whereas anaesthesiologists accorded low values to F1 and high values to F2. F3 showed a low ranking from within the ER nursing staff and the residents in internal medicine, whereas F4 received high scores by medical residents and staff members. For F1 and F3, there was a tendency towards hierarchy dependency, whereas no factor was influenced by gender. In conclusion, team performance in the ER is mainly influenced by different perceptions and attitudes of the different disciplines involved in the resuscitation process.