Schaechinger Ulrich, Rockelein Wolfgang, Perk Alexander, Asbach Patrick, Nerlich Michael
Department of Trauma Surgery, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
Stud Health Technol Inform. 2003;97:147-58.
The German emergency care system is a very sophisticated one. However, negative headlines like "Emergency Patient Tourism" appearing from time to time, have provoked a thorough deficit analysis which revealed two weak points: communication and documentation. The communication system presently used is a rather outdated one employing analogue voice radio between the ambulance cars/helicopters and the dispatch center and telephone communication between the dispatch center and the emergency rooms. To document the emergency case the on-scene physician is required to fill out a form. A survey showed that many of these forms are filled out incompletely and/or inconsistently or are even missing completely. NOAH, which means "Emergency Organization and Administration Aid" ("Notfall Organisations- und Arbeits-Hilfe" in German) intends to address both of these communication and documentation deficits. The on-scene physician is equipped with a mobile ruggedised PC with an internal digital radio-modern. It provides a direct, digital communication channel from the on-scene physician to the emergency physician starting from the first minutes of the treatment of the emergency patient. It also provides an easy-to-fill-out variant of the paper form mentioned above with an on-line help function and visual aids. A typical course of events with the communication part of NOAH is as follows. The on-scene physician is alarmed via NOAH and can obtain details of the emergency during the approach. He can enter the status codes ("on the move","arrived at the emergency scene","arrived at the patient", etc.) with NOAH. During the first minutes of the treatment of the patient the physician enters a so called "First Message", which requires only 10 to 15 seconds. This message contains basic information like sex, age and the injuries of the patient. It helps the dispatch center (if the on-scene physician desires so) to make an informed recommendation where to bring the patient. This message is also forwarded to the emergency room of the destination hospital, where it can help to start appropriate preparations for the patient. When the on-scene physician has enough time, he can already bring up the documentation masks and give further information to the emergency room.
德国的急救系统非常完善。然而，诸如“急诊患者旅游”之类的负面新闻不时出现，引发了全面的缺陷分析，结果发现了两个薄弱环节：沟通和文档记录。目前使用的通信系统相当陈旧，救护车/直升机与调度中心之间采用模拟语音无线电，调度中心与急诊室之间采用电话通信。为记录急诊病例，要求现场医生填写一份表格。一项调查显示，许多此类表格填写不完整和/或不一致，甚至完全缺失。NOAH意为“急救组织与管理辅助工具”（德语为“Notfall Organisations- und Arbeits-Hilfe”），旨在解决这两个沟通和文档记录方面的缺陷。现场医生配备了一台带有内置数字无线电调制解调器的坚固移动电脑。从对急诊患者进行治疗的第一分钟起，它就为现场医生与急诊医生提供了一条直接的数字通信渠道。它还提供了上述纸质表格的一种易于填写的变体，具有在线帮助功能和视觉辅助工具。NOAH通信部分的典型事件过程如下。现场医生通过NOAH接到警报，并可在前往途中获取急诊详情。他可以使用NOAH输入状态代码（“正在途中”“抵达急诊现场”“抵达患者处”等）。在对患者进行治疗的最初几分钟内，医生输入一条所谓的“第一条消息”，这只需10到15秒。这条消息包含患者的性别、年龄和伤势等基本信息。它有助于调度中心（如果现场医生希望如此）就将患者送往何处提出明智的建议。这条消息也会转发到目的地医院的急诊室，在那里有助于为患者开始适当的准备工作。当现场医生有足够时间时，他可以调出文档模板并向急诊室提供更多信息。
