Frank Pajonk

Psychologische Konzepte und Möglichkeiten der Krisenintervention in der Notfallmedizin

ZusammenfassungNotärzte, Rettungsfachpersonal und das Personal der Notaufnahme sind im Rahmen ihrer notfallmedizinischen Tätigkeit mit einer Vielzahl von Krisensituationen konfrontiert, die ihre Arbeitsbedingungen erheblich erschweren und den Einsatz verlängern können. Der vorliegende Beitrag hat das Ziel, einen Überblick über akute psychische Krisen und die Möglichkeiten einer primären psychologischen Krisenintervention unmittelbar in der Notfallsituation durch das Notfallpersonal zu geben. Hierzu werden zunächst der Begriff der Krise definiert und die Erklärungsmodelle für das Entstehen einer Krise dargestellt, um daraus sinnvolle, unmittelbar hilfreiche Möglichkeiten einer Krisenintervention entwickeln zu können. Ein weiterer Schwerpunkt liegt darauf, interaktionelle Aspekte zwischen Helfer und Patient transparenter zu machen, deren Verständnis zur raschen Entscheidung und Hilfe in einer Krisensituation wesentlich ist.AbstractEmergency physicians, paramedics and the staff of the emergency room are confronted with a multitude of psychological crises situations while treating various pre-clinical emergency situations or emergencies in an emergency room. Crises may complicate considerably the working conditions and may prolong the diagnostic and therapeutic process on scene. This article aims to give an overview on crises and possibilities of a primary crisis intervention by the emergency staff. Therefore, crisis is first defined and models for the emergence of a crisis situation are described in order to explain the development of sensible and immediately helpful strategies for crisis intervention in the emergency setting. Further emphasis is set on the importance of understanding the interaction between patient and staff which is essential for a quick perception of the situation and a speedy decision making process on scene.

Psychosozialer Notfall – Erregungszustände, Aggression und gewalttätiges Verhalten im Notarzt– und Rettungsdienst

A state of agitation occurs in 15-25% of all patients with mental disorder who are seen by pre-hospital emergency physicians (EPs) in the German emergency medical system. Additionally, there is an unknown number of calls due to injury subsequent to violence. Aggression against EPs and paramedics, however, is rare. This paper gives an overview on the models for the onset of aggression, the single stages of agitation and violence, and the stage-dependent steps for de-escalation and crisis intervention in the emergency situation. Action has to be determined but unexcited and, depending on the situation, swift but well coordinated, including psychopharmacotherapy.

Suicide and suicidality in emergency medicine

Emergency physicians, paramedics and the staff of the emergency room play an increasingly important role in the medical and psychological emergency treatment of patients after suicide attempts, as well as in the crisis intervention of persons with acute suicidal tendency. This article aims to give an overview of prevalence rates, method of suicide or attempted suicide, and the problems faced by EPs when treating these patients. In addition, concepts are presented which allow for an adequate risk assessment of suicidality and showing possibilities of primary crisis intervention.

[Substance-abuse related emergencies--illegal drugs, part I].

For the first time since the year 2000 the number of death due to substance abuse of illegal drugs has increased in Germany in 2007 (+8 % compared to 2006). Emergency situations due to drug abuse are frequent, particular in big cities. They may be, however, difficult to diagnose and/or treat for an emergency physician on scene because of a lack of diagnostic tools, the local and personal surroundings, and the unknown number and nature of drugs. Many drug intoxications must be considered suicidal. On the other hand, drug intoxications may mask (other) life-threatening conditions. Emergency situations due to withdrawal offer the possibility to motivate patients to take advantage of specialist-guided abstinence programs.

Alcohol-related disorders in the preclinical medicine

Alcohol is the most frequently abused drug in Germany. Approximately 50.000 individuals die annually due to alcohol-related disorders. Emergency situations due to alcohol intoxications, abuse or dependence are frequent reasons for calls for emergency physicians and paramedics. Agitation, suicidal intent, trauma and a multitude of degenerative and other somatic disorders may further complicate diagnosis and treatment on scene. The motivation of patients to participate in withdrawal programs should be built and strengthened already in emergency medicine.