Arntz H R, Klatt S, Stern R, Willich S N, Beneker J
Abteilung für Kardiopulmologie, Freien Universität Berlin.
Anaesthesist. 1996 Feb;45(2):163-70. doi: 10.1007/s001010050251.
The on-scene performance during all missions of the emergency physician-operated rescue helicopter and mobile intensive care unit based at a large-city hospital over a period of 1 year was retrospectively analysed; 2,254 hospital discharge reports were available (92% of the patients treated by the emergency physicians [n = 2,493]). The following parameters were investigated: reliability of the primary diagnosis established by the emergency physician (by comparison with the discharge diagnoses); initial on-scene therapeutic measures; means of transportation (with or without accompanying emergency physician); and level of care of the target hospital.
The most common reasons for a mission were cardiopulmonary diseases (55%), neurological disorders (18%), and traumatic events (7%). The diagnoses, therapeutic measures, and mode of transportation were correct in 2,033 (90%) patients with a discharge report. Severe errors of assessment by the emergency physician were identified in 73 patients (3%): life-threatening conditions were not recognised and/or grossly incorrect therapeutic measures were taken and/or the chosen means of transportation was unsuitable. Relative errors in assessment occurred in 4% (n = 83): the most crucial diagnosis was not made, but the patient was escorted by the emergency physician (without therapeutic errors) to a suitable hospital. In 3% (n = 65) of the cases, the patient's condition was overestimated by the emergency physician as suggested by the obviously exaggerated on-scene therapy. Underestimations of the severity were most common in patients with cardiopulmonary diseases and increased in frequency and severity with increasing age and the presence of a concomitant neurologic deficit. Underestimations of a severe condition in younger patients were extremely rare; overestimations of the severity and consequent overtreatment were particularly common in traumatised patients independent of age.
In the context of quality management measures, a careful evaluation of on-scene diagnoses, therapeutic measures, and decisions made by the emergency physician is a suitable procedure for identifying systematic errors. A high percentage of correct diagnoses and therapy at the emergency site can only be ensured by clinically experienced physicians who constantly deal with patients with acutely life-threatening conditions.
回顾性分析了一家大城市医院的急诊医生操作的救援直升机和移动重症监护单元在1年期间所有任务中的现场表现；共有2254份医院出院报告（占急诊医生治疗患者的92%[n = 2493]）。调查了以下参数：急诊医生确立的初步诊断的可靠性（与出院诊断相比较）；初始现场治疗措施；运输方式（有无急诊医生陪同）；以及目标医院的护理水平。
任务的最常见原因是心肺疾病（55%）、神经系统疾病（18%）和创伤事件（7%）。有出院报告的2033例（90%）患者的诊断、治疗措施和运输方式正确。急诊医生存在严重评估错误的有73例（3%）：未识别出危及生命的情况和/或采取了严重错误的治疗措施和/或选择的运输方式不合适。评估存在相对错误的占4%（n = 83）：未做出最关键的诊断，但患者由急诊医生护送至合适的医院（无治疗错误）。在3%（n = 65）的病例中，急诊医生对患者病情估计过高，现场治疗明显过度即可表明。病情严重程度被低估在心肺疾病患者中最为常见，且随着年龄增长以及伴有神经功能缺损而频率和严重程度增加。年轻患者中严重病情被低估极为罕见；病情严重程度被高估及随之而来的过度治疗在创伤患者中尤为常见，与年龄无关。
在质量管理措施的背景下，仔细评估急诊医生的现场诊断、治疗措施和决策是识别系统错误的合适程序。只有不断处理急性危及生命情况患者的临床经验丰富的医生才能确保急诊现场有高比例的正确诊断和治疗。
