Luiz T, Hees K, Ellinger K
Institut für Anästhesiologie und Operative Intensivmedizin, Klinikum der Stadt Mannheim.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1997 Dec;32(12):726-33. doi: 10.1055/s-2007-995143.
In Germany emergency patients are currently treated both by certified emergency physicians as well as by family doctors and general practitioners.
1.) We evaluated the cooperation between the regional rescue service centres of the general practitioners' acute response service and the EMS system in Baden-Württemberg, a German "Land" (province), with about 10 million inhabitants. 2.) We analysed the management of patients who had been initially treated by the general practitioners' acute response service or by family doctors and had then to be further stabilised by the emergency physicians of our mobile intensive care unit (MICU).
1.) Joint rescue service centres of the two organisations exist in only 12 of a total of 37 areas. Although lacking adequate emergency equipment, practitioners often treat vitally compromised patients without the assistance of the EMS system. 2.) 97 out of 105 jobs were further analysed (acute response service: n = 45; family doctors: n = 52). Suspected myocardial infarction (n = 32) and acute heart failure (n = 15) were the most common emergencies. Emergency management before the emergency physician arrived often did not meet common standards (lack of ECG monitoring, oxygen treatment, venous access, pain relief). Until the emergency physician arrived 40% of the patients had been left alone by their doctor. Moreover, medical documentation had to be classified as insufficient in 70%.
Prehospital treatment of medical emergencies is impeded by the lack of cooperation between the involved organisations. Family doctors and general practitioners should not treat emergencies without the help of the local MICU. Solutions of these problems are presented.
在德国，目前急诊患者由获得认证的急诊医生以及家庭医生和全科医生进行治疗。
1.）我们评估了全科医生急性反应服务的区域救援服务中心与德国巴登 - 符腾堡州（约有1000万居民）的急救医疗服务（EMS）系统之间的合作。2.）我们分析了最初由全科医生急性反应服务或家庭医生治疗，随后需要由我们移动重症监护病房（MICU）的急诊医生进一步稳定病情的患者的管理情况。
1.）在总共37个区域中，只有12个区域存在这两个组织的联合救援服务中心。尽管缺乏足够的急救设备，但从业者经常在没有EMS系统协助的情况下治疗生命垂危的患者。2.）对105项工作中的97项进行了进一步分析（急性反应服务：n = 45；家庭医生：n = 52）。疑似心肌梗死（n = 32）和急性心力衰竭（n = 15）是最常见的急诊情况。在急诊医生到达之前的急救管理往往不符合通用标准（缺乏心电图监测、氧气治疗、静脉通路、止痛措施）。直到急诊医生到达，40%的患者被其医生独自留下。此外，70%的医疗记录被归类为不充分。
相关组织之间缺乏合作阻碍了医疗紧急情况的院前治疗。家庭医生和全科医生在没有当地MICU帮助的情况下不应治疗急诊患者。本文提出了解决这些问题的方案。
