Rörtgen D, Schaumberg A, Skorning M, Bergrath S, Beckers S K, Coburn M, Brokmann J C, Fischermann H, Nieveler M, Rossaint R
Klinik für Anästhesiologie, Universitätsklinikum Aachen, RWTH Aachen, Pauwelsstrasse 30, Aachen, Germany.
Anaesthesist. 2011 Apr;60(4):312-24. doi: 10.1007/s00101-010-1812-9. Epub 2010 Dec 4.
The emergency medical service (EMS) should work according to criteria of evidence-based medicine. In Germany the EMS of each state is under the control of at least one medical supervisor known as emergency medical directors (EMD) and most states have several different EMDs responsible for one or more provinces of the state. The German Medical Association advises these supervisors to specify the pharmacological resources in store for use in physician powered EMSs. This study examines the pharmacological resources in EMSs which is provided by the EMDs in Germany. Furthermore, a comparison of the inventory analysis of stored drugs was carried out with the requirements according to guidelines for selected tracer diagnoses.
In the period of May 2008 to January 2009 a total of 148 EMDs were contacted and asked to supply drug storage lists for emergency physician-staffed rescue vehicles in their respective jurisdiction. The addresses of all EMDs who could be identified by the federal office of the National Association of Emergency Medical Director, Germany were used over the period. The evaluation was conducted anonymously. The tracer diagnoses "cardiopulmonary resuscitation", "acute coronary syndrome", "status generalized tonic-clonic seizure," "severe asthma attack", "acute exacerbation of chronic obstructive pulmonary disease", "supraventricular tachycardia", "severe brain trauma" and "acute heart failure with signs of hypoperfusion" were selected. Current and established guidelines have been identified with the homepage of the Scientific Medical Societies in Germany and supported by the leading European and International guidelines.
The corresponding lists were returned by 95 different emergency service areas (response rate 64.2%). With a total of 39 groups of substances 142 different drugs could be identified, an average of 54±9.6 and median 55 (range 31-77). Listed are agents giving the provision in percent, for which the comparison with guidelines for tracer diagnoses could show deficits: sodium bicarbonate 75.8%, calcium 50.5%, magnesium 45.3%, noradrenaline 65.3%, adenosine 58.9%, dobutamine 57.9%, lorazepam iv 13.7%, salbutamol 41.1%, ipratropium bromide 13.7% (the last two as liquid preparations for inhalation). With a frequency of about 30-80%, depending on the respective tracer diagnosis, no medical emergency treatment according to the highest level of evidence is possible.
Due to recent treatment recommendations provision with sodium bicarbonate, calcium, magnesium, noradrenaline, adenosine, lorazepam iv, dobutamine and as well with ipratropium bromide and salbutamol (both as liquid preparations for inhalation) should be improved. For the future, a federal uniform minimum standard due to evidence-based principles is desirable.
紧急医疗服务（EMS）应依据循证医学标准开展工作。在德国，每个州的紧急医疗服务由至少一名被称为紧急医疗主任（EMD）的医学主管负责监管，大多数州有几名不同的紧急医疗主任，分别负责该州的一个或多个省份。德国医学协会建议这些主管明确储备的用于医生主导的紧急医疗服务的药物资源。本研究调查了德国紧急医疗主任提供的紧急医疗服务中的药物资源。此外，还根据选定的示踪诊断指南要求，对储存药物的库存分析进行了比较。
在2008年5月至2009年1月期间，共联系了148名紧急医疗主任，要求他们提供各自辖区内配备急诊医生的救援车辆的药物储存清单。在此期间，使用了德国紧急医疗主任全国协会联邦办公室能够识别的所有紧急医疗主任的地址。评估是匿名进行的。选定了“心肺复苏”“急性冠状动脉综合征”“全身强直阵挛性癫痫发作”“严重哮喘发作”“慢性阻塞性肺疾病急性加重”“室上性心动过速”“严重脑外伤”和“伴有灌注不足体征的急性心力衰竭”等示踪诊断。通过德国科学医学协会的主页确定了当前和既定的指南，并得到了欧洲和国际主要指南的支持。
95个不同的紧急服务区返回了相应清单（回复率64.2%）。总共39类物质中可识别出142种不同药物，平均为54±9.6种，中位数为55种（范围31 - 77种）。列出了按百分比提供的药物，与示踪诊断指南相比存在不足的有：碳酸氢钠75.8%、钙50.5%、镁45.3%、去甲肾上腺素65.3%、腺苷58.9%、多巴酚丁胺57.9%、静脉注射劳拉西泮13.7%、沙丁胺醇41.1%、异丙托溴铵13.7%（后两种为吸入液体制剂）。根据各自的示踪诊断，约30% - 80%的情况下，无法按照最高证据水平进行医疗急救治疗。
鉴于近期的治疗建议，应改善碳酸氢钠、钙、镁、去甲肾上腺素、腺苷、静脉注射劳拉西泮、多巴酚丁胺以及异丙托溴铵和沙丁胺醇（两者均为吸入液体制剂）的供应。未来，基于循证原则制定联邦统一的最低标准是可取的。
