D. Rörtgen

Feasibility of Prehospital Teleconsultation in Acute Stroke – A Pilot Study in Clinical Routine

Background 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. Methodology/Principal Findings 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. Conclusions 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. Trial Registration International Standard Randomised Controlled Trial Number Register (ISRCTN) ISRCTN83270177 83270177.

Technical and organisational feasibility of a multifunctional telemedicine system in an emergency medical service – an observational study

We evaluated the technical and organisational feasibility of a multifunctional telemedicine system in an emergency medical service (EMS) from the users 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.

[E-health in emergency medicine - the research project Med-on-@ix].

There is a need for new strategies to face current and future problems in German Emergency Medical Services (EMS). Lack of quality management and increasing costs in the presence of a deficit of EMS physicians are typical challenges, resulting in an increasing deficit in medical care. In addition, information and communication technology used in German EMS is out of date. The physician-powered EMS has to be modernized to increase quality and show measurable evidence of its effectiveness. Otherwise its future existence is at serious risk. Therefore, the project Med-on-@ix was created by the Department of Anaesthesiology at the University Hospital Aachen, Germany. The aim was to develop a new emergency telemedicine service system and to implement it clinically in order to advance medical care and effectiveness in the EMS by process optimization of each scene call. This system offers EMS physicians and paramedics an additional consultation by a specialised centre of competence, thus assuring medical therapy according to evidence-based guidelines. Several prospective studies are conducted to analyse this system in comparison to the conventional EMS.ZusammenfassungEs bedarf neuer Konzepte, um bestehenden und zukünftigen Problemen im Rettungsdienst zu begegnen. Mangelndes Qualitätsmanagement bei steigendem Kostendruck und zunehmendem (Not-)Ärztemangel kann zu messbaren Defiziten in der Notfallversorgung führen. Zudem wird derzeit eine veraltete Informationstechnik eingesetzt. Das Notarztsystem muss einerseits eine Modernisierung und Qualitätssteigerung erfahren, andererseits sind deutlichere Nachweise der Leistungsfähigkeit vonnöten. Nur so kann eine hochwertige Patientenversorgung für die Zukunft gewährleistet werden. Vor diesem Hintergrund wurde die Projektidee Med-on-@ix in Aachen mit dem Ziel entwickelt, die Versorgungsqualität und die Einsatzeffizienz zu steigern. Hierzu wird ein umfassendes notfallmedizinisches Telemedizinsystem entwickelt, das Notärzten und Rettungsdienstpersonal eine zusätzliche Beratung durch ein Kompetenzzentrum bereitstellt. Die leitliniengerechte Behandlung soll dadurch unter direkter Qualitätskontrolle sichergestellt werden. Prospektive Studien am Simulator und im realen Einsatz evaluieren das System im Vergleich mit dem aktuellen Rettungssystem.AbstractThere is a need for new strategies to face current and future problems in German Emergency Medical Services (EMS). Lack of quality management and increasing costs in the presence of a deficit of EMS physicians are typical challenges, resulting in an increasing deficit in medical care. In addition, information and communication technology used in German EMS is out of date. The physician-powered EMS has to be modernized to increase quality and show measurable evidence of its effectiveness. Otherwise its future existence is at serious risk. Therefore, the project Med-on-@ix was created by the Department of Anaesthesiology at the University Hospital Aachen, Germany. The aim was to develop a new emergency telemedicine service system and to implement it clinically in order to advance medical care and effectiveness in the EMS by process optimization of each scene call. This system offers EMS physicians and paramedics an additional consultation by a specialised centre of competence, thus assuring medical therapy according to evidence-based guidelines. Several prospective studies are conducted to analyse this system in comparison to the conventional EMS.

Comparison of manually triggered ventilation and bag-valve-mask ventilation during cardiopulmonary resuscitation in a manikin model

BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSION 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.

Advanced life support under special circumstances: part 1

ZusammenfassungAuf Basis des internationalen Konsensus zu den Reanimationsmaßnahmen „International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations“ des International Liaison Commitee on Resuscitation (ILCOR) wurde in den aktuellen Leitlinien (Guidelines 2005) des ERC die praktische Umsetzung der Basis- und erweiterten Maßnahmen der Herz-Lungen-Wiederbelebung publiziert. Dabei wurden spezielle Situationen berücksichtigt, in denen es zu Kreislaufstillständen kommen kann. In dieser zweiteiligen Übersicht sollen essenzielle Informationen über notwendige Modifikationen der Reanimationsmaßnahmen und erforderliche Zusatzmaßnahmen bei Ertrinken, Asthma, Anaphylaxie und Vergiftungen erörtert werden. Im 2. Teil folgen Elektrolytentgleisungen, Hypothermie sowie Kreislaufstillstände bei Schwangerschaft, nach Trauma, Stromunfall und herzchirurgischen Eingriffen.AbstractBased on the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR), guidelines were published for managing basic and advanced life-saving procedures in the event of cardiac arrest. The fact that special circumstances sometimes must be considered in patient treatment resulted in a separate chapter. This first part of a two-part article reviews essential information as well as necessary modifications of the standard advanced life support algorithm in cases of life-threatening drowning, asthma, anaphylaxis, and poisoning. The second part will deal with electrolyte disorders, hypothermia, electrical emergencies, trauma, cardiac arrest during pregnancy, and cardiac surgery.Based on the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR), guidelines were published for managing basic and advanced life-saving procedures in the event of cardiac arrest. The fact that special circumstances sometimes must be considered in patient treatment resulted in a separate chapter. This first part of a two-part article reviews essential information as well as necessary modifications of the standard advanced life support algorithm in cases of life-threatening drowning, asthma, anaphylaxis, and poisoning. The second part will deal with electrolyte disorders, hypothermia, electrical emergencies, trauma, cardiac arrest during pregnancy, and cardiac surgery.

„E-Health“ in der Notfallmedizin – das Forschungsprojekt Med-on-@ix@@@E-health in emergency medicine – the Research project Med-on-@ix

There is a need for new strategies to face current and future problems in German Emergency Medical Services (EMS). Lack of quality management and increasing costs in the presence of a deficit of EMS physicians are typical challenges, resulting in an increasing deficit in medical care. In addition, information and communication technology used in German EMS is out of date. The physician-powered EMS has to be modernized to increase quality and show measurable evidence of its effectiveness. Otherwise its future existence is at serious risk. Therefore, the project Med-on-@ix was created by the Department of Anaesthesiology at the University Hospital Aachen, Germany. The aim was to develop a new emergency telemedicine service system and to implement it clinically in order to advance medical care and effectiveness in the EMS by process optimization of each scene call. This system offers EMS physicians and paramedics an additional consultation by a specialised centre of competence, thus assuring medical therapy according to evidence-based guidelines. Several prospective studies are conducted to analyse this system in comparison to the conventional EMS.ZusammenfassungEs bedarf neuer Konzepte, um bestehenden und zukünftigen Problemen im Rettungsdienst zu begegnen. Mangelndes Qualitätsmanagement bei steigendem Kostendruck und zunehmendem (Not-)Ärztemangel kann zu messbaren Defiziten in der Notfallversorgung führen. Zudem wird derzeit eine veraltete Informationstechnik eingesetzt. Das Notarztsystem muss einerseits eine Modernisierung und Qualitätssteigerung erfahren, andererseits sind deutlichere Nachweise der Leistungsfähigkeit vonnöten. Nur so kann eine hochwertige Patientenversorgung für die Zukunft gewährleistet werden. Vor diesem Hintergrund wurde die Projektidee Med-on-@ix in Aachen mit dem Ziel entwickelt, die Versorgungsqualität und die Einsatzeffizienz zu steigern. Hierzu wird ein umfassendes notfallmedizinisches Telemedizinsystem entwickelt, das Notärzten und Rettungsdienstpersonal eine zusätzliche Beratung durch ein Kompetenzzentrum bereitstellt. Die leitliniengerechte Behandlung soll dadurch unter direkter Qualitätskontrolle sichergestellt werden. Prospektive Studien am Simulator und im realen Einsatz evaluieren das System im Vergleich mit dem aktuellen Rettungssystem.AbstractThere is a need for new strategies to face current and future problems in German Emergency Medical Services (EMS). Lack of quality management and increasing costs in the presence of a deficit of EMS physicians are typical challenges, resulting in an increasing deficit in medical care. In addition, information and communication technology used in German EMS is out of date. The physician-powered EMS has to be modernized to increase quality and show measurable evidence of its effectiveness. Otherwise its future existence is at serious risk. Therefore, the project Med-on-@ix was created by the Department of Anaesthesiology at the University Hospital Aachen, Germany. The aim was to develop a new emergency telemedicine service system and to implement it clinically in order to advance medical care and effectiveness in the EMS by process optimization of each scene call. This system offers EMS physicians and paramedics an additional consultation by a specialised centre of competence, thus assuring medical therapy according to evidence-based guidelines. Several prospective studies are conducted to analyse this system in comparison to the conventional EMS.

Erweiterte kardiopulmonale Reanimation in besonderen Situationen@@@Advanced life support under special circumstances: Teil 1@@@Part 1

ZusammenfassungAuf Basis des internationalen Konsensus zu den Reanimationsmaßnahmen „International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations“ des International Liaison Commitee on Resuscitation (ILCOR) wurde in den aktuellen Leitlinien (Guidelines 2005) des ERC die praktische Umsetzung der Basis- und erweiterten Maßnahmen der Herz-Lungen-Wiederbelebung publiziert. Dabei wurden spezielle Situationen berücksichtigt, in denen es zu Kreislaufstillständen kommen kann. In dieser zweiteiligen Übersicht sollen essenzielle Informationen über notwendige Modifikationen der Reanimationsmaßnahmen und erforderliche Zusatzmaßnahmen bei Ertrinken, Asthma, Anaphylaxie und Vergiftungen erörtert werden. Im 2. Teil folgen Elektrolytentgleisungen, Hypothermie sowie Kreislaufstillstände bei Schwangerschaft, nach Trauma, Stromunfall und herzchirurgischen Eingriffen.AbstractBased on the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR), guidelines were published for managing basic and advanced life-saving procedures in the event of cardiac arrest. The fact that special circumstances sometimes must be considered in patient treatment resulted in a separate chapter. This first part of a two-part article reviews essential information as well as necessary modifications of the standard advanced life support algorithm in cases of life-threatening drowning, asthma, anaphylaxis, and poisoning. The second part will deal with electrolyte disorders, hypothermia, electrical emergencies, trauma, cardiac arrest during pregnancy, and cardiac surgery.Based on the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR), guidelines were published for managing basic and advanced life-saving procedures in the event of cardiac arrest. The fact that special circumstances sometimes must be considered in patient treatment resulted in a separate chapter. This first part of a two-part article reviews essential information as well as necessary modifications of the standard advanced life support algorithm in cases of life-threatening drowning, asthma, anaphylaxis, and poisoning. The second part will deal with electrolyte disorders, hypothermia, electrical emergencies, trauma, cardiac arrest during pregnancy, and cardiac surgery.

[Advanced cardiopulmonary resuscitation under special circumstances: part 2].

Based on the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR), guidelines were published for managing basic and advanced life-saving procedures in the event of cardiac arrest. The fact that special circumstances for cardiac arrest must be considered resulted in a separate chapter. This two-part article reviews essential information as well as necessary modifications of the standard advanced life support algorithm in cases of electrolyte disorders, hyperthermia and hypothermia, cardiac arrest in pregnancy, trauma, electrical emergencies and cardiac surgery. Part 1 has already dealt with life-threatening drowning, asthma, anaphylaxis and poisoning.ZusammenfassungAuf Basis des Internationalen Konsensus zu den Reanimationsmaßnahmen „International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations“ des „International Liaison Commitee on Resuscitation“ (ILCOR) wurde in den aktuellen Leitlinien (Guidelines 2005) des ERC die praktische Umsetzung der Basis- und erweiterten Maßnahmen der Herz-Lungen-Wiederbelebung publiziert.Dabei wurden spezielle Situationen berücksichtigt, in denen es zum Herzstillstand kommen kann. Im ersten Teil dieses zweiteiligen Weiterbildungsbeitrags wurden bereits Ertrinken, Asthma, Anaphylaxie und Vergiftungen behandelt. In diesem zweiten Teil sollen essenzielle Informationen über notwendige Modifikationen der Reanimationsmaßnahmen und erforderliche Zusatzmaßnahmen bei Elektrolytentgleisungen, Hyper- und Hypothermie sowie Kreislaufstillstände bei Schwangerschaft, nach Trauma, Stromunfall und herzchirurgischen Eingriffen erörtert werden.AbstractBased on the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR), guidelines were published for managing basic and advanced life-saving procedures in the event of cardiac arrest. The fact that special circumstances for cardiac arrest must be considered resulted in a separate chapter. This two-part article reviews essential information as well as necessary modifications of the standard advanced life support algorithm in cases of electrolyte disorders, hyperthermia and hypothermia, cardiac arrest in pregnancy, trauma, electrical emergencies and cardiac surgery. Part 1 has already dealt with life-threatening drowning, asthma, anaphylaxis and poisoning.