Background: This study comprises an assessment of the potential for telemedical consultations and determination of the need for the on-site presence of a specialized pediatric emergency physician to treat neuropediatric emergencies. Methods: A retrospective evaluation of routine deployment data of the pediatric emergency medical service (KND) in Munich from 01/2017 to 12/2020 was performed. All neurologic deployments of the available protocols for patients up to 18 years of age were evaluated. The marker for necessity of the on-site presence of a pediatric emergency physician was defined by the need for vascular access with subsequent drug administration or the need for airway management. Results: During the study period, 1315 neurologic emergencies responded to by the KND were evaluated. Most of these (95.9%) were due to epileptic seizures. Of the patients, 9.7% received intravenous medication. Mask ventilation or intubation was necessary in 2.1% of cases. Combined, the on-site presence of the KND was therefore necessary in 10% of cases, if it is assumed that intravenous drug administration and airway management in children should be performed by a pediatric emergency physician. In patients aged between >= 3 and < 6 years, on-site attendance by a pediatric emergency physician was required significantly more frequently (19.01%; p < 0.001). The on-site presence of a pediatric emergency physician was less frequently necessary for infection-associated seizures. Conclusion: Neuropediatric emergencies show potential for telemedical consultations/care in up to 90% of cases. Only 10% of all neurologic interventions required invasive measures or airway management at the scene. Establishment of telemedical care by a "tele-pediatric emergency physician" reduces long response/waiting times, expands the potential area of operation, and increases access to qualified pediatric expert help for a larger number of patients.

Introduction: Prehospital pediatric emergencies are rare, time-critical events requiring specialized expertise, yet limited exposure among emergency teams may affect care. Although telemedicine is established in adult emergency care, its role in pediatric prehospital emergencies remains unclear. This study evaluated the applicability of telemedical consultation in this setting. Methods This prospective observational survey included children aged 0–18 years treated by the Munich pediatric prehospital emergency physician service between October 2024 and March 2026. Questionnaires were returned for 627 of 2733 eligible deployments (capture rate 22.9%). After each deployment, pediatric emergency physicians, ambulance crews, and regular emergency physicians assessed whether comparable care could have been provided through telemedical consultation. The primary outcome was the proportion of cases considered suitable for telemedicine. Results Neurological (35.6%), trauma (21.9%), and respiratory (21.2%) emergencies accounted for approximately 78% of cases. Pediatric emergency physicians deemed on-site presence necessary in 81.9% of cases but considered telemedicine feasible in 79.8%, including 82.4% of transports. Feasibility ratings were lower among ambulance crews (63.4%) and regular emergency physicians (65.8%). Critical interventions were uncommon, including advanced airway management in 5.9%, intubation in 2.2%, intraosseous access in 1.3%, anesthesia induction in 0.8% and resuscitation in 1.6%; intravenous access was required in 17.1%. Discussion Prehospital pediatric emergency care shows substantial potential for telemedicine to extend specialist expertise and reduce on-site physician deployment and physician-accompanied transports. It may be particularly suitable for neurological, trauma, and respiratory emergencies. Further studies should assess feasibility, safety, implementation, and outcomes.

BACKGROUND:Intensive care unit (ICU) demand is increasing, while healthcare professional shortages and turnover threaten capacity, care quality, and patient safety. This nationwide survey quantified intention to stay (ITS), leave (ITL), or being undecided among ICU professionals in Germany and assessed associated determinants. METHODS:An anonymous, nationwide, cross-sectional online survey of ICU physicians, registered nurses, and allied health professionals was conducted by the Young German Interdisciplinary Association of Critical Care and Emergency Medicine between December 2024 and February 2025. Primary outcome was ITS in the ICU for at least three years. Determinants were examined using multinomial logistic regression. RESULTS:Of 1524 questionnaires, 1243 were eligible; median ICU experience was 7 years. 51.1% of respondents were physicians, 39.1% registered nurses and 9.8% allied health professionals. Overall, 45.4% reported ITS, 23.2% ITL, and 31.2% were undecided. A 10-point higher job satisfaction was associated with greater ITS versus being undecided (OR 1.34, 95%-CI[1.24-1.45], p < 0.001) and ITL (OR 1.49, 95%-CI[1.37-1.62], p < 0.001). Similarly, higher perceived family-friendliness was associated with greater ITS versus ITL (OR 1.11, 95%-CI[1.02-1.20], p = 0.013). Rotating day-night shift work was associated with higher ITL (OR 0.56, 95%-CI[0.34-0.92], p = 0.021). Association of annual career development dialogues were attenuated after adjustment, consistent with indirect effects via job satisfaction. CONCLUSIONS:More than half of ICU professionals were at risk of leaving intensive care within three years. Job satisfaction and family-friendliness emerged as key correlates of retention. Prospective studies are needed to determine whether these aspects are potentially modifiable factors to improve retention.

Despite substantial improvements in survival after pediatric intensive care, long-term morbidity remains frequent and insufficiently assessed. No standardized, consensus-based core outcome set (COS) tailored to German-speaking regions exists. This study developed a Pediatric Intensive Care Core Outcome (PIC-CO) set to harmonize outcome assessment and follow-up of PICU survivors for clinical practice and research in German-speaking regions. A modified Delphi process was conducted within the Section of Pediatric Intensive Care and Emergency Medicine (SPIE) of the German Interdisciplinary Association of Intensive Care and Emergency Medicine. A multiprofessional expert panel identified outcome domains and questionnaires. Following internal consensus using predefined criteria, candidate questionnaires and short-term outcomes were submitted to an external Delphi survey distributed to SPIE members. Consensus and acceptance thresholds were defined a priori. Final questionnaire selection and recommendations for follow-up time points were agreed on by the expert panel. Seventeen experts participated in the internal consensus phase. Of 65 evaluated questionnaires, 1–3 questionnaires per domain and 11 short-term outcomes were submitted to the external survey (46 respondents). All short-term outcomes and at least one questionnaire per domain reached acceptance; the majority achieved consensus. The final PIC-CO set comprises seven questionnaires across six domains and 11 short-term outcomes, alongside a structured follow-up schedule. The PIC-CO set provides the first consensus-based, pragmatically implementable COS for pediatric critical care in German-speaking countries, enabling standardized long-term assessment for clinical practice and research. Substantial overlap with international initiatives was observed, with differences mainly related to cognitive assessment and domain structuring.

Background: Implementing recommendations to improve in-hospital resuscitation is a complex process. The extent to which an advisory statement formulating ten theses to improve resuscitation quality in paediatrics is applied in clinical practice across Germany, Austria, and Switzerland (D-A-CH-region) remains unclear. Methods: A web-based cross-sectional survey was conducted among paediatric physicians in the D-A-CH region between November 2022 and May 2023, comprising 50 questions focusing on experience and safety in paediatric emergency management and on the structural conditions at hospitals required to implement the ten theses. Ethics approval was obtained from the Ethics Committee Leipzig, Germany (218/19-ek). Results: Structural recommendations were implemented to varying and often limited degrees: An emergency telephone chain was available in 91% of workplaces, 19% had a Paediatric Early Warning System, and 38% had a designated resuscitation supervisor. Although in-house training was available to 89% of respondents, 31% had not participated in in-house training in the preceding 12 months, and 37% had not attended a certified resuscitation course in the last five years. A total of 48% of respondents reported that structured debriefings following emergency events were rarely or never conducted. Internal guidelines for post-resuscitation care were available in 26% of institutions. Only seven respondents (less than 1%) worked in a setting where all the recommendations surveyed were in place. No significant differences were observed according to hospital size or type. Conclusions: Structural implementation of paediatric resuscitation recommendations remains markedly inadequate across the D-A-CH region, with likely multifactorial causes that are not yet fully understood.

Der frühe Beginn von Reanimationsmaßnahmen ist entscheidend für das Überleben und das neurologische Outcome eines Kindes nach einem Atem-Kreislauf-Stillstand. Für professionelle Ersthelfende ist es essenziell, einen leblosen Patienten früh zu erkennen, rasch zu reagieren sowie Basismaßnahmen konsequent und qualitativ hochwertig durchzuführen: Sicherstellen eines freien Atemwegs, effektive Beatmung und Thoraxkompressionen in hoher Qualität (Frequenz 100–120/min, ausreichende Tiefe mit mindestens einem Dittel des Thoraxdurchmessers, vollständige Entlastung des Thorax, Minimierung von Unterbrechungen). Nach Überprüfung von Bewusstsein und Öffnen der Atemwege wird als Nächstes die Atmung kontrolliert. Wenn keine oder nur insuffiziente Atmung vorliegt, sollen initial 5 Beatmungen erfolgen. Thoraxkompressionen mit Beatmungen im Verhältnis 15:2 schließen sich an. Kann ein Beatmungsbeutel nicht sofort eingesetzt werden, ist unverzüglich mit kontinuierlichen Thoraxkompressionen zu beginnen. Die Beatmungen werden ergänzt, sobald Beutel und passende Beatmungsmaske verfügbar sind. Die erweiterten Reanimationsmaßnahmen umfassen die Analyse des Herzrhythmus, ggf. eine Defibrillation bei pulsloser ventrikulärer Tachykardie oder Kammerflimmern sowie die Medikamentenverabreichung. Da Reanimationen von Kindern und Jugendlichen insgesamt selten sowie mit hoher kognitiver und emotionaler Belastung verbunden sind, ist regelmäßiges Training unerlässlich. Unbedingt sollten auch nichttechnische Fertigkeiten wie Kommunikation, Teamführung und Rollenzuweisung in die Ausbildung integriert werden. Besonders effektiv sind teamorientierte Trainings an Patientensimulatoren, wie sie z. B. in Reanimationskursen des European Resuscitation Council (EPALS/European Paediatric Life Support) angeboten werden.

Bewertung des Potenzials für telemedizinische Konsultationen und Feststellung der Notwendigkeit der Vor-Ort-Anwesenheit eines spezialisierten pädiatrischen Notarztes für die Behandlung neuropädiatrischer Notfälle. Retrospektive Auswertung von Routineeinsatzdaten des Kindernotarztdiensts (KND) in München im Zeitraum von 01/2017 bis 12/2020. Alle neurologischen Einsätze mit verfügbaren Protokollen für Patienten im Alter bis zu 18 Jahren wurden ausgewertet. Als Marker für die notwendige Vor-Ort-Anwesenheit eines Kindernotarztes wurde für die Analyse die Anlage eines Gefäßzugangs mit anschließender Medikamentengabe oder die Notwendigkeit eines Atemwegsmanagements definiert. Während des Studienzeitraums erfolgten insgesamt 1315 neurologische Einsätze des KND. Gründe für die meisten neurologischen Einsätze (95,9