Michael Weinlich

Prehospital ultrasound imaging improves management of abdominal trauma

Blunt abdominal trauma with intra‐abdominal bleeding is often underdiagnosed or even overlooked at trauma scenes. The purpose of this prospective, multicentre study was to compare the accuracy of physical examination and prehospital focused abdominal sonography for trauma (PFAST) to detect abdominal bleeding.

WISECOM: A rapidly deployable satellite backhauling system for emergency situations

This paper presents the detailed architecture of the WISECOM system, which can quickly re-establish and provide telecommunication services after a disaster by integrating terrestrial mobile radio networks, such as GSM, WiFi, WiMAX and TETRA, with satellite technologies. The system aims to be a useful tool to be deployed in the early hours after a disaster event, for both the victims and the rescue services who will be able to communicate in a reliable and robust way, improving the coordination of the different teams and reducing the time needed to provide victims with the proper treatment. The paper presents in detail the different services provided by the system taking into account its two different versions, based on two different satellite technologies, Inmarsat BGAN and DVB-RCS. Together with the presentation of the system capabilities, a business model is also proposed. Thereafter, the architecture of the general system and the demonstrators that have been developed are detailed, according to the two versions of the system. The work also presents the outcomes of the tests conducted with a prototype of the system, and of the final project demonstration, which was held in Germany in May 2008 with the involvement of real end-users (fire brigades and civil protection authorities).

Increased authenticity in practical assessment using emergency case OSCE stations

In case of an emergency, a fast and structured patient management is crucial for patient’s outcome. The competencies needed should be acquired and assessed during medical education. The objective structured clinical examination (OSCE) is a valid and reliable assessment format to evaluate practical skills. However, traditional OSCE stations examine isolated skills or components of a clinical algorithm and thereby lack a valid representation of clinical reality. We developed emergency case OSCE stations (ECOS), where students have to manage complete emergency situations from initial assessment to medical treatment and consideration of further procedures. Our aim was to increase the authenticity and validity in the assessment of students’ capability to cope with emergency patients. 45 students participated in a 10-station OSCE with 6 ECOS and 4 traditional OSCE stations. They were assessed using a case-specific checklist. An inter-station and post-OSCE-questionnaire was completed by each student to evaluate both ECOS and traditional OSCE. In this study, we were able to demonstrate that ECOS are feasible as time-limited OSCE stations. There was a high acceptance on both students and examiners side. They rated ECOS to be more realistic in comparison to the traditional OSCE scenarios. The reliability estimated via Crohnbach’s α for the 6 ECOS is high (0.793). ECOS offer a feasible alternative to the traditional OSCE stations with adequate reliability to assess students’ capabilities to cope with an acute emergency in a realistic encounter.

Telemedical assistance for in-flight emergencies on intercontinental commercial aircraft.

We have conducted a three-year prospective study of medical incidents on a commercial airline. A telemedicine service was available via an on-board satellite phone. During the study period there were 3364 medical incidents. The most common incident was collapse (n = 2310, 57%). Telemedicine was used in 323 of the cases (9%). Neurological patients, mostly stroke and seizures, excluding psychiatric diseases, were seen in 27% of the telemedicine cases (n = 83). Most of the cases involved middle-aged people, not the elderly. The group of patients that needed diversion (n = 27) was compared to the cases staying on board (n = 275). None of the patients in the non-diversion group deteriorated. All unstable patients forced a diversion. Doctors on board used the service in more severe cases, whereas laymen used the service in less severe cases. The results of the present study demonstrate the advantage of using simple teleconsultation in cases of medical emergency on board an aircraft.

Mandatory elective course in emergency medicine with instructions by paramedics improves practical training in undergraduate medical education

BACKGROUND Due to the complexity of medical emergencies undergraduate medical training in the integrative course on emergency medicine requires education combining knowledge, practical skills, algorithm-driven behavior and soft skills. New State board regulations on education and licensing of physicians demand a practical implementation of these objectives. MATERIALS AND METHODS The medical faculty of Frankfurt medical school has implemented an obligatory prehospital elective course. A retrospective questionnaire assessed the organization, instructional competence of the paramedics and integration of students in the emergency medical teams. RESULTS Out of a total of 486 students the majority rated the longitudinal curriculum as positive (66% very good and 28% good). The practical experience at a scene was evaluated to be reasonable by 86% and 95% of the students stated that integration into the emergency team was rendered without any difficulties. CONCLUSION A prehospital experience supported by paramedics can serve as a valuable tool in an emergency medicine curriculum.

Praktikum im Rettungsdienst mit Anleitung durch Rettungsassistenten

BACKGROUND Due to the complexity of medical emergencies undergraduate medical training in the integrative course on emergency medicine requires education combining knowledge, practical skills, algorithm-driven behavior and soft skills. New State board regulations on education and licensing of physicians demand a practical implementation of these objectives. MATERIALS AND METHODS The medical faculty of Frankfurt medical school has implemented an obligatory prehospital elective course. A retrospective questionnaire assessed the organization, instructional competence of the paramedics and integration of students in the emergency medical teams. RESULTS Out of a total of 486 students the majority rated the longitudinal curriculum as positive (66% very good and 28% good). The practical experience at a scene was evaluated to be reasonable by 86% and 95% of the students stated that integration into the emergency team was rendered without any difficulties. CONCLUSION A prehospital experience supported by paramedics can serve as a valuable tool in an emergency medicine curriculum.

Significant acceleration of emergency response using smartphone geolocation data and a worldwide emergency call support system

Importance When patients are disorientated or experience language barriers, it is impossible to activate the emergency response system. In these cases, the delay for receiving appropriate help can extend to several hours. Objectives A worldwide emergency call support system (ECSS), including geolocation of modern smartphones (GPS, WLAN and LBS), was established referring to E911 and eCall systems. The system was tested for relevance in quickly forwarding abroad emergency calls to emergency medical services (EMS). Design To verify that geolocation data from smartphones are exact enough to be used for emergency cases, the accuracy of GPS (global positioning system), Wi-Fi (wireless LAN network) and LBS (location based system) was tested in eleven different countries and compared to actual location. The main objective was analyzed by simulation of emergencies in different countries. The time delay in receiving help in unsuccessful emergency call cases by using the worldwide emergency call support system (ECSS) was measured. Results GPS is the gold standard to locate patients with an average accuracy of 2.0 ± 3.3 m. Wi-Fi can be used within buildings with an accuracy of 7.0 ± 24.1 m. Using ECSS, the emergency call leads to a successful activation of EMS in 22.8 ± 10.8 min (Median 21 min). The use of a simple app with one button to touch did never cause any delay. Conclusions and relevance The worldwide emergency call support system (ECSS) significantly improves the emergency response in cases of disorientated patients or language barriers. Under circumstances without ECSS, help can be delayed by 2 or more hours and might have relevant lifesaving effects. This is the first time that Wi-Fi geolocation could prove to be a useful improvement in emergencies to enhance GPS, especially within or close to buildings.

Medical treatment rates on shore for crew members of cruise ships

ABSTRACT Background: The human resources required on large cruise ships can only be secured with crew members from different countries of origin with different health statuses. Method: The present secondary data analysis is to determine whether there is an increased frequency of treatment for crew members for certain diseases or injuries, or a difference in the frequency of treatment for certain groups and/or countries of origin; whether an increased use of dental procedures could be confirmed, and their average costs. The data were collected over six months in 2015 from a major cruise ship company. Results: There were 1,627 treatments for 1,026 crew members. The illness and injury rates were significantly different both in the occupational groups (p < .001) as well as the countries of origin (p = .004). It was confirmed that dental procedures were most frequent (n = 915 cases), in particular for Asian crew members; in contrast to Germans they had a 1.6-fold higher chance of dental procedures.Conclusions: A mixed calculation for dental and jaw treatments for the crew members and the expected passenger treatments would justify the employment of a dentist on the ship. However, medical follow-up costs for crew members on board could be minimised by a previous thorough assessment of their state of health.

Air Repatriation With a Medium-sized Pneumothorax Without Thoracic Tube: A Special Case of a Repatriation Accompanied by an Experienced Surgeon

We report on the repatriation of a 28-year old female from Germany, who was involved in a serious bus accident and was transported to the nearest hospital in Oruro, Bolivia. CT scans and x-rays performed in this hospital demonstrated a complete pneumothorax right. Thorax drainage was inserted, which was removed after 5 days. Since the hospital refused to acknowledge the presence of a residual middle-sized pneumothorax on the repatriation day and did not want to insert another tube, the decision was made to repatriate the patient on commercial flight back home to Germany without a thoracic tube.

Praktikum im Rettungsdienst mit Anleitung durch Rettungsassistenten@@@Mandatory elective course in emergency medicine with instructions by paramedics improves practical training in undergraduate medical education: Curriculare Lehrveranstaltung im Querschnittsbereich Notfallmedizin

BACKGROUND Due to the complexity of medical emergencies undergraduate medical training in the integrative course on emergency medicine requires education combining knowledge, practical skills, algorithm-driven behavior and soft skills. New State board regulations on education and licensing of physicians demand a practical implementation of these objectives. MATERIALS AND METHODS The medical faculty of Frankfurt medical school has implemented an obligatory prehospital elective course. A retrospective questionnaire assessed the organization, instructional competence of the paramedics and integration of students in the emergency medical teams. RESULTS Out of a total of 486 students the majority rated the longitudinal curriculum as positive (66% very good and 28% good). The practical experience at a scene was evaluated to be reasonable by 86% and 95% of the students stated that integration into the emergency team was rendered without any difficulties. CONCLUSION A prehospital experience supported by paramedics can serve as a valuable tool in an emergency medicine curriculum.