Die Simulation nimmt eine immer größer werdende Bedeutung in der notfallmedizinischen Ausbildung ein. Viele Rettungsdienstschulen arbeiten mit Simulatoren oder verfügen sogar über ein eigenes Simulationszentrum. Das klassische Reanimationstraining im Lehrsaal wird zunehmend durch realitätsnahe Fallszenarien abgelöst. Aber: Simulatoren alleine bilden nicht aus! Die Tatsache, einen Simulator in der notfallmedizinischen Ausbildung einzusetzen, bedeutet nicht zwangsläufig einen nachhaltigen Lernerfolg bei den Teilnehmern zu erzielen. Je nachdem welche Fertigkeiten oder Kompetenzen vermittelt werden sollen, scheint es unterschiedliche Anforderungen an eine Simulation zu geben. Es gibt allerdings noch keine wissenschaftliche Evidenz darüber, wie stark Lernende gestresst werden sollten, um einen möglichst positiven Lerneffekt zu erzielen. Um technische Fertigkeiten zu vermitteln und zu üben, können Simulatoren zum Einsatz kommen, die die anatomische bzw. physiologische Realität mit größtmöglicher Genauigkeit abbilden. Sind Soft Skills, Handlungswissen und Entscheidungskompetenzen die Lernziele, so sollte ein Szenario in möglichst wirklichkeitsnahe Rahmenbedingungen eingebettet werden. „Mid-Fidelity-Simulatoren“ scheinen für die notfallmedizinische Ausbildung das größte Spektrum der Kompetenzvermittlung abdecken zu können.

Medical assistance in emergency and intensive care is subject to multiple challenges and bound to various normative conditionalities. Decision-making takes place in situations of urgency in often complex social situations. It is symptom oriented with usually little anamnestic details to draw on, and has to include important moral, legal and socio-political values, goals and rules [5]. Universal access to emergency care is an important common good. Against this background, physicians have to be able to come to well-founded decisions based on medical guidelines and ethics, including professional principles of decision-making and conduct. However, ethical aspects do not play a significant role in training and education of health professionals for emergency care as yet [11]. At the same time, emergency medicine and intensive care offer unique opportunities for educators to include ethics into the clinical training of medical students and health professionals in general. The Department of Anaesthesiology and Operative Intensive Care Medicine of the University Hospital of Giessen along with the Giessen Working Group on Ethics in Medicine and the Dean of Medical Education of Giessen University Medical School decided to close the gap between the importance and the real offer of clinically related training of medical ethics during the clinical years of medical education (3rd to 5th year). A new course element was developed to address ethics within the compulsory training of medical students in emergency and intensive care, based on the "Ulm model" of interactive, case-based seminars in medical ethics [4,7,8]. This article introduces the concept of the course, which has been successfully implemented in 2011. Our evaluation of the first experiences over a period of eight semesters shows that the concept has been received and assessed very positively by the students. This approach to include ethics in clinical training may also be suited to be applied in other clinical disciplines as well as for transfer to other universities and medical schools.

In 2004, the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) responded to the steadily decreasing interest of students in anaesthesiology. The DGAI financed the project "Simulation in Medical Education". In this hitherto unique project simulators applicable to teaching anaesthesiology were acquired for all German medical faculties. The Department of Anaesthesiology of the Justus Liebig University in Giessen also participated in this project. However, it was still a long way from a single simulator to the establishment of a simulation centre. This article describes the development of student teaching in anaesthesiology at the Department of Anaesthesiology during the past decade from the delivery of the simulator by the DGAI until today.

The publisher regrets that it was discovered that the original online version of the above abstract contained errors that were not the fault of the authors. The Publisher decided to ‘resupply’ (repost and replace) the XML and online PDF of the article. Unfortunately the discovery of the errors was too late to correct the printed issue. The author names were listed incorrectly as, ‘E.T.S. Alves, M. Campos, E. Gomes’ and have been corrected to, ‘A. Schaumberg, K. Hardt, I. Greb, M.A. Weigand’, affiliated to University Hospital Giessen and Marburg GmbH, Department of Anesthesiology and Operative Intensive Care Medicine Giessen, Germany. The publisher would like to apologise for any inconvenience caused.

Simulation often relies on a case-based learning approach and is used as a teaching tool for a variety of audiences. The knowledge transfer goes beyond the mere exchange of soft skills and practical abilities and also includes practical knowledge and decision-making behavior; however, verification of knowledge or practical skills seldom unfolds during simulations. Simulation-based learning seems to affect many learning domains and can, therefore, be considered to be multifactorial in nature. At present, studies examining the effects of learning environments with varying levels of reality on the cognitive long-term retention of students are lacking.The present study focused on the question whether case scenarios with varying levels of reality produce differences in the cognitive long-term retention of students, in particular with regard to the learning dimensions knowledge, understanding and transfer.The study was conducted on 153 students in the first clinical semester at the Justus-Liebig University of Giessen. Students were randomly selected and subsequently assigned, also in a random fashion, to two practice groups, i.e. realistic and unrealistic. In both groups the students were presented with standardized case scenariosconsisting of three case studies, which were accurately defined with a case report containing a detailed description of each scenario and all relevant values so as to ensure identical conditions for both groups. The unrealistic group sat in an unfurnished practice room as a learning environment. The realistic group sat in a furnished learning environment with various background pictures and ambient noise. Students received examination questions before, immediately following and 14 days after the practice. Examination questions were identical at each of the three time points, classified into three learning dimensions following Bloom's taxonomy and evaluated. Furthermore, examination questions were supplemented by a questionnaire concerning the individual perception of reality and own learning success, to be filled in by students immediately after the practice. Examination questions and questionnaires were anonymous but associated with each other.Even with less experienced participants, realistic simulation design led to a significant increase of knowledge immediately after the end of the simulation. This effect, however, did not impact the cognitive long-term retention of students. While the realistic group showed a higher initial knowledge after the simulation, this "knowledge delta" was forgotten within 14 days, putting them back on par with the unrealistic comparison group.It could be significantly demonstrated that 2 weeks after the practice, comprehension questions were answered better than those on pure knowledge. Therefore, it can be concluded that even vaguely realistic simulation scenarios affect the learning dimension of understanding.For simulation-based learning the outcome depends not only on knowledge, practical skills and motivational variables but also on the onset of negative emotions, perception of own ability and personality profile. Simulation training alone does not appear to guarantee learning success but it seems to be necessary to establish a simulation setting suitable for the education level, needs and personality characteristics of the students.

Die Notfallnarkose ist eine zentrale therapeutische Maßnahme in der prähospitalen Notfallmedizin. Das Risiko einer Notfallnarkose ist außerhalb der Klinik deutlich höher als innerklinisch. Die primären Ziele der Notfallnarkose sind Hypnose, Analgesie, Schaffung einer Möglichkeit zur Oxygenierung und Ventilation durch eine Atemwegssicherung. Sekundäre Ziele der Notfallnarkose sind Amnesie, Anxiolyse, Reduktion von Sauerstoffverbrauch und Atemarbeit, Protektion vitaler Organsysteme sowie Vermeidung sekundärer myokardialer und zerebraler Schäden. Eine kritische Überprüfung der Indikationsstellung zur prähospitalen Notfallnarkose hat vor dem Hintergrund von patienten-, einsatz- und anwenderbezogenen Faktoren zu erfolgen. Die Notfallnarkose als Rapid Sequence Induction beinhaltet ein Standardmonitoring, Präoxygenierung, eine standardisierte Vorbereitung der Notfallnarkose (Narkose-/Notfallmedikamente, Atemwegs- und Beatmungsequipment), die Medikamentenapplikation, (wenn nötig) die passagere Aufhebung der HWS-Immobilisation und konsequente manuelle Inline-Stabilisation während des Intubationsmanövers sowie die Atemwegssicherung und die Tubuslagekontrolle. Die Präoxygenierung sollte bei jedem spontanatmenden Notfallpatienten für einen Zeitraum von mindestens 3–4 min mit dichtsitzender Gesichtsmaske und Beatmungsbeutel mit Sauerstoffreservoir und 12–15 l Sauerstoff/min oder Demand-Ventil mit 100 % Sauerstoff erfolgen. Alternativ kann die Präoxygenierung auch mittels nichtinvasiver Beatmung mit 100 % Sauerstoff durchgeführt werden. Die standardisierte Narkosevorbereitung umfasst das Aufziehen und die Kennzeichnung der Narkose- und Notfallmedikamente, die Kontrolle des Beatmungsbeutels inklusive Maske, die Vorbereitung eines Endotrachealtubus inklusive Blockerspritze mit einliegendem Führungsstab, Stethoskop und Fixierungsmaterial, die Bereitstellung alternativer Instrumente zur Atemwegssicherung sowie den Check von Absaugvorrichtung, Beatmungsgerät und Standardmonitoring inklusive Kapnographie. Als Standardmonitoring zur prähospitalen Notfallnarkose sollen das Elektrokardiogramm, die automatische/manuelle Blutdruckmessung und die Pulsoxymetrie zur Anwendung kommen. Eine kontinuierliche Kapnographie erfolgt immer und ohne Ausnahme zur Lagekontrolle der Beatmungshilfen, deren Diskonnektion und Dislokation im Beatmungssystem sowie zum indirekten Monitoring der Hämodynamik. Es sind möglichst zwei periphervenöse Verweilkanülen vor Narkoseeinleitung zu etablieren.

Die Wissensvermittlung durch Simulation geht über die reine Vermittlung von Soft Skills und praktischer Fertigkeiten hinaus und umfasst auch Handlungswissen und Entscheidungsverhalten. Die Überprüfung des Wissens oder praktischer Fertigkeiten erfolgt jedoch eher selten im Rahmen von Simulationen. Der Lernerfolg durch eine Simulation scheint viele Bereiche des Lernens zu betreffen und daher multifaktoriell zu sein. Studien, die ausschließlich die Auswirkungen von unterschiedlich realitätsnahen Lernumgebungen auf das kognitive Langzeitbehalten von Studierenden untersuchen, gibt es bisher nicht.

Task: In a multi-tiered process, a new established working committee of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) was supposed to create a national catalogue of the leaning objectives in anaesthesiology, also to include subject-specific parts applicable to intensive care medicine, emergency and pain medicine. To this end, both contents and method had to undergo revision. Methods: A total of eight work steps were carried out. After establishing an overview in the shape of a mind map, the catalogues of learning objectives already existing at the German universities were reviewed and the mind map was supplemented accordingly. After deciding on an electronic tabular format, own learning-objective operationalisations and competence levels were defined. Individual learning objectives were then elaborated in the previously defined operationalisation semantics, in conformity with the mind-map template. Framework formulations, an introduction and the incorporation of recommendations for conveying and examining the contents finally completed the catalogue. Results: Altogether, a detailed volume with over 800 items was created which, after its adoption by the executive committee of the DGAI, was immediately made available to all university locations as a working tool. Indications given with regard to the conveyance and examination of the learning objectives were intended to support the development of curricular frameworks at the faculties. Outlook: Some faculties have implemented and already made experiences with the catalogue of learning objectives. First evaluations are forthcoming. The structure and some of the developmental steps of the catalogue of learning objectives may serve as an essential blueprint for the current elaboration of the new model statues for the further qualification for board-certified anaesthesiologists and the additional qualification in the field of emergency medicine.

Im Rettungsdienst sollte die Patientenversorgung evidenzbasiert erfolgen. In dieser Studie wurde die medikamentöse Ausstattung notarztbesetzter Rettungsmittel erfasst. Für ausgewählte „Tracer“-Diagnosen wurden die Medikamentenbestände analysiert und mit dem Bedarf nach Leitlinien verglichen.

The study aimed to find out which combination of airway management and electrotherapy results in the lowest no-flow-time rate when used by inexperienced medical personnel.Materials and methods: From December 2009 to January 2010, 36 volunteers were studied during several voluntary resuscitation workshops for medical students in their 9th and 10th semester without any previous emergency medical experience. They first received a three-hour individual training session in theory and practice of airway control and electrotherapy before working through several practice exercises in small groups. Afterwards the volunteers were exposed to a standardised resuscitation scenario (ventricular fibrillation) using the “Resusci Anne” simulator from Laerdal. In a randomised sequence, either a laryngeal tube or an endotracheal tube was used for airway control. Adhesive pads (AP) or hard paddles (P) were used for electrotherapy. The defibrillator used was a LifePak 20 from Medtronic. The sequences were recorded with video cameras so that they could be evaluated in terms of time and quality.Results and interpretation: With defibrillation the no-flow-time rate could be reduced highly significantly (mean P 25.76 s, mean AP 13.59 s, p < 0.0005) by using the adhesive pads. Regarding airway management the use of the laryngeal tube (LT) proved clearly superior to endotracheal intubation (ET) (mean ET 13.53 s, mean LT 6.32 s, p < 0.0005).In an emergency situation it is necessary to use especially simple tools1. Even though endotracheal intubation and defibrillation with hard paddles are established as gold standards2, we were able to show clearly that sources of error can be reduced even for untrained personnel by using the combination of laryngeal tube and adhesive pads.3 At the same time the no-flow-time rate can be reduced significantly. In our opinion, implementation of these two alternative procedures in regular emergency service procedure is entirely to be recommended. The study aimed to find out which combination of airway management and electrotherapy results in the lowest no-flow-time rate when used by inexperienced medical personnel. Materials and methods: From December 2009 to January 2010, 36 volunteers were studied during several voluntary resuscitation workshops for medical students in their 9th and 10th semester without any previous emergency medical experience. They first received a three-hour individual training session in theory and practice of airway control and electrotherapy before working through several practice exercises in small groups. Afterwards the volunteers were exposed to a standardised resuscitation scenario (ventricular fibrillation) using the “Resusci Anne” simulator from Laerdal. In a randomised sequence, either a laryngeal tube or an endotracheal tube was used for airway control. Adhesive pads (AP) or hard paddles (P) were used for electrotherapy. The defibrillator used was a LifePak 20 from Medtronic. The sequences were recorded with video cameras so that they could be evaluated in terms of time and quality. Results and interpretation: With defibrillation the no-flow-time rate could be reduced highly significantly (mean P 25.76 s, mean AP 13.59 s, p < 0.0005) by using the adhesive pads. Regarding airway management the use of the laryngeal tube (LT) proved clearly superior to endotracheal intubation (ET) (mean ET 13.53 s, mean LT 6.32 s, p < 0.0005). In an emergency situation it is necessary to use especially simple tools1. Even though endotracheal intubation and defibrillation with hard paddles are established as gold standards2, we were able to show clearly that sources of error can be reduced even for untrained personnel by using the combination of laryngeal tube and adhesive pads.3 At the same time the no-flow-time rate can be reduced significantly. In our opinion, implementation of these two alternative procedures in regular emergency service procedure is entirely to be recommended.

A 58-year-old man was suffered multiple trauma in a traffic accident. Besides fractures of the extremities, the clinical investigation showed an unstable pelvic injury which was stabilized in the resuscitation room by means of a pneumatic pelvic sling. In a CT of the trunk active bleeding from the liver was detected as well as free liquid in the small pelvis. The dorsal and ventral pelvic rings were anatomically repositioned. An emergency laparotomy was carried out with the pelvic sling still in position and the pelvic injury was stabilized with external fixation afterwards. This case demonstrates that unstable pelvic injuries can be stabilized by applying a pneumatic pelvic sling in the resuscitation room and that anatomical repositioning of the dorsal and ventral pelvic rings becomes possible in a simple way. Further diagnosis and treatment can thus be initiated without delay.

Ein 58-jähriger Mann wird im Rahmen eines Verkehrsunfalls polytraumatisiert. Die klinische Untersuchung ergibt neben Frakturen der Extremitäten eine instabile Beckenverletzung, die im Schockraum mittels pneumatischer Beckenschlinge stabilisiert wird. Die Computertomographie des Körperstammes zeigt eine aktive Blutung aus der Leber und freie Flüssigkeit im kleinen Becken. Der vordere und hintere Beckenring stellen sich anatomisch reponiert dar. Mit weiterhin angelegter Beckenschlinge erfolgt die Notfall-Laparotomie, erst im Anschluss daran die Stabilisierung der Beckenverletzung mittels Fixateur externe. Durch Anlegen einer pneumatischen Beckenschlinge im Schockraum – das zeigt die vorliegende Kasuistik – können instabile Beckenverletzungen stabilisiert werden. Somit ist auf einfache Weise eine anatomische Reposition des dorsalen und ventralen Beckenringes möglich und der Patient kann ohne Zeitverzögerung der weiteren Diagnostik und Therapie zugeführt werden.