Background The working environment of pre-hospital emergency medicine represents the framework conditions of high-risk organisations. Non-technical skills are an important foundation for successful performance. In Germany, a new job profile - advanced paramedic - was introduced in 2014, which for the first time also recognized non-technical skills in the curriculum. Another special feature is that for the first time it is regulated how non-physicians proceed with selected extended procedures, such as the application of selected medication. The advanced paramedic has a mandatory annual training requirement of 30 hours. Since there are no requirements in terms of content, we investigated whether training of non-technical or technical skills improve the care of a simulated patient. The results should indicate which priorities should be set in training. Methods Teams were randomised while training and debriefing took place depending on the study arm with a focus on technical procedures and non-technical skills. Six months later, we evaluated the performance of the teams in a simulation scenario using “time key item product” score and the use of incident management methods. Results Comparing performance with CRM and technical training, we found no significant difference in TKIP-Score. There was also no difference in the application of incident management methods. Checklists were only used in small numbers. Over half of the teams failed to complete 75% of the required procedures in the scenario. Conclusion It is noticeable that only a few groups carried out all required procedures. Checklists in particular can help. The application of incident management methods should be trained intensively, as their use does not yet appear to be routine. Trial Registration As the study does not include data on real patients, it was not registered with "trial Registration"

Background Checklists are a common tool used in order to mitigate risks caused by human factors and can facilitate the safe induction of anesthesia as well as handovers. SBAR (Situation, Background, Assessment, Recommendation) is a checklist recommended by the WHO and DGAI for handovers, while SOAP-M (Suction, Oxygen, Airway, Pharmaceuticals, Monitoring) is a checklist for the induction of anesthesia. This study investigates the implementation and adoption of these two checklists. Methods We conducted a single-center online survey one year after the implementation of SOAP-M and SBAR at a university hospital's anesthesiology department, using scales from three validated questionnaires to assess safety attitudes as well as the behavior of staff and the perceived usefulness of the checklists. Results Staff with a high score in general attitude towards patient safety, as determined by the safety attitudes questionnaire, considered both checklists useful additions to their work environment. Nurses and physicians (p = 0.102) as well as groups divided according to work experience (p = 0.077) showed no significant differences in using SOAP-M and SBAR. Perceived usefulness was significantly higher (p < 0.001) among users of the checklists, and the same goes for positive reinforcement (p < 0.001), social cues (p = 0.0215) and goal cues (p = 0.0252). Conclusion SOAP-M and SBAR are perceived as useful checklists for patient handovers and anesthesia induction by tertiary referral hospital's employees with high score in general safety attitude and were therefore commonly used one year after their introduction. No significant difference in checklist adoption between occupations as well as groups divided according to work experience could be found. Perceived usefulness is significantly higher among users of the checklist, who feel using the checklists provides more support.

Background High quality of care in prehospital emergency medicine is characterized by guideline-based therapy. The basic prerequisite for this therapy is the availability of the required drugs in accordance with the current guideline recommendations. It is currently unclear whether this is guaranteed nationwide. There is no uniform standard regarding which drugs must be stocked in emergency medical services (EMS) vehicles staffed by physicians in Germany. The aim of the present study is to identify important diagnoses and the drugs required for their therapy. In a second step, medical directors throughout Germany were interviewed about current drugs available in their physician-staffed EMS vehicles and these were compared with the previously defined diagnosis-dependent drug lists. Materials and methods After a structured guideline search, tracer diagnoses were defined and relevant drugs were assigned to them. The levels of evidence and recommendations were also considered. In a second step, this was compared with the current drugs available in physician-staffed EMS vehicles. Results A total of 156 different medications were identified. The median number of medications stocked was 58; the minimum number of medications stocked was 35 at one site, while multiple sites stocked a maximum of 77 medications . Discussion The present study investigated stocked medications in physician-staffed EMS vehicles. Overall, compared to a 2011 study, drug availability has improved. Most of the recommended medications are available in physician-staffed vehicles in Germany. The data from this study can be used by EMS throughout Germany to evaluate their preparedness.

Zusammenfassung Hintergrund Anästhesiologische Expertise ist in der Kreißsaalumgebung an verschiedensten Punkten der Versorgung erforderlich. Die natürliche Mitarbeitendenfluktuation erfordert hierfür eine ständige Fort- und Weiterbildung. In einer ersten Umfrage unter Lehrenden und Lernenden in der Fachärzt:innenausbildung zeigte sich der Wunsch nach einem einsatzortspezifischen Curriculum. Die vorliegende Studie soll im Sinne der spezifischen Lernzieldefinition die notwendigen Kompetenzen für die anästhesiologische Kreißsaalumgebung beschreiben. Methodik Mittels einer zweistufigen Online-Delphi-Befragung unter deutschlandweit anästhesiologisch Tätigen im Kreißsaal wurden Zielkompetenzen als Items entwickelt. Diese wurden anschließend in einem größeren Kollektiv auf Relevanz und Validität überprüft und konnten nachfolgend gruppiert werden. In die abschließende Befragung konnten 201 Teilnehmende eingeschlossen werden. Ergebnisse In den Priorisierungsprozessen der Delphi-Analyse wurden von den Teilnehmenden nicht priorisierte Kompetenzen, wie z. B. die Neugeborenenversorgung, nicht weiterverfolgt. Nicht alle Faktoren sind darüber hinaus ausschließlich kreißsaalbezogen, wie beispielsweise das Beherrschen des „schwierigen Atemweges“. Nach der Validierung ergab sich ein Kompetenzkatalog mit 8 Skalen mit insgesamt 44 Items (Kayser-Meyer-Olkin-Kriterium 0,88). Schlussfolgerungen Es konnte ein Katalog relevanter allgemeiner Lernziele für Ärzt:innen in Weiterbildung entwickelt werden, der allerdings einer Überprüfung auf Vollständigkeit im Kontext der eigenen Arbeitsumgebung bedarf. Kompetenzen, die auch außerhalb der Kreißsaalumgebung erlernt werden könnten, sollten vor einer Kreißsaalrotation erlernt werden. Dies ermöglicht die Konzentration auf bereichsspezifische Items im Rahmen der Kreißsaaleinarbeitung.

Background As in many medical professions the concept of competence is also relevant for advanced paramedics (NotSan). A way to progressively develop and measure it is pending. Entrustable professional activities (EPA) are proposed as a method of evaluation. The goal of the study was to develop a catalog of relevant operational situations that would form the basis for integration of EPA into training. Method The EPA catalog was developed in a 2-step process using web-based questionnaires. After the results of an eDelphi survey of practical instructors in emergency medical services were collected, the items were combined in a large cohort with respect to relevance. Subsequently, pertinent factors were identified and scales were formed. Results After validation of the results of the eDelphi analysis, 5 scales with 22 items resulted. They cover the areas: "treatment of special clinical pictures-NACA IV", "Communication", "Incorporation of medical devices into patient treatment", "Symptom-oriented action" and "Leading symptom pain". The items account for 59% of the total variance and correspond to a stable factor solution. Conclusion A catalog of relevant operational situations in emergency medical training has been developed, which is suitable for the further development of EPA. These EPA should be used for training and curriculum development across the board and throughout emergency services and scientifically implemented.

Background Cognitive Aids (checklists) are a common tool to improve patient safety. But the factors for their successful implementation and continuous use are not yet fully understood. Recent publications suggest safety culture to play a key role in this context. However, the effects on the outcome of implementation measures remain unclear. Hospitals and clinics that are involved in cognitive aid development and research might have significantly different safety cultures than their counterparts, resulting in skewed assessments of proper implementation. Therefore, the objective of this study was to assess the correlation between cognitive aid implementation and safety attitudes of staff members in early adopting and later adopting clinics. Methods An online survey of the Safety Attitudes Questionnaire (SAQ) was carried out in German anaesthesiology departments during the initial implementation of a new checklist for emergencies during anesthesia (“eGENA” app). Subsequently an analysis between subgroups (“eGENA” app usage and occupation), with Kruskal–Wallis- and Mann–Whitney-U-Tests was carried out for the general SAQ, as well as it six subscales. Results Departments that introduced “eGENA” app (Median 3,74, IQR 0,90) reported a significantly higher median SAQ (U (N eGENA = 6, N non eGENA = 14) = 70,0, z = 2,31, p = 0,02, r = 0,516) than their counterparts (Median 2,82, IQR 0,77) with significant differences in the dimensions teamwork climate, work satisfaction, perception of management and working conditions. Conclusion Early adopters of cognitive aids are likely to show a significantly higher perception of safety culture in the SAQ. Consequently, successful implementation steps from these settings might not be sufficient in different clinics. Therefore, further investigation of the effects of safety culture on cognitive aid implementation should be conducted.

PURPOSE:Emergency training using simulation is a method to increase patient safety in the delivery room. The effect of individual training concepts is critically discussed and requires evaluation. A possible influence factor of success can be the perceived reality of the participants. The objective of this study was to investigate whether the presence in a simulated emergency caesarean section improves subjective effect of the training and evaluation.METHODS:In this observation study, professionals took part in simulated emergency caesarean sections to improve workflow and non-technical skills. Presence was measured by means of a validated questionnaire, effects and evaluation by means of a newly created questionnaire directly after the training. Primary outcome was a correlation between presence and assumed effect of training and evaluation.RESULTS:106 participants (70% of course participants) answered the questionnaires. Reliability of the presence scale was good (Cronbach's alpha 0.72). The presence correlated significantly with all evaluated items of non-technical skills and evaluation of the course. The factor "mutual support" showed a high effect size (0.639), the overall evaluation of the course (0.395) and the willingness to participate again (0.350) a medium effect. There were no differences between the professional groups.CONCLUSION:The presence correlates with the assumed training objectives and evaluation of the course. If training is not successful, it is one factor that needs to be improved.

Background: Teams in anesthesia and intensive care work as high responsibility teams (HRT). Success in this environment partly depends on the use of nontechnical skills which can be learned through simulation-based training. A teamwork context analysis could help to identify training requirements for crew resource management training. Material and methods: We used a multicentric observational cross-sectional study design utilizing survey methodology to evaluate the teamwork context of different work environments, using the 62-item TAKAI inventory. We surveyed anesthesia and intensive care staff from nine hospitals in Germany which provide varying levels of care. Results: In total, 128 people (44.5% male, 53.9% female) from 9 German hospitals participated in the study. The topics "interconnectedness: departments", "interconnectedness: information flow", "dynamics", "polytely", "velocity of the team's movement", "velocity of system changes", "hierarchy" and "hierarchy: leadership", "shared task mental model", "shared team mental model" and all aspects of the scale "adaptive behaviors" were identified as focal aspects to be implemented into Crew-Resource-Management (CRM) training for the evaluated work environments. Conclusion: The TAKAI scales meet quality criteria (Cronbach's alpha> 0.6) and are appropriate for use in the analysis of the teamwork environment. The results indicate many similarities between the work contexts surveyed but also slight differences. TAKAI can be an additional method to design an appropriate simulation training program for HRT in anesthesia and intensive care medicine as there does not seem to be a one-size-fits-all simulation concept. For a special focus on the needs of a work context, the easy to perform TAKAI analysis in the needs analysis step is worthwhile.

BACKGROUND:In our institution, a modified WHO surgical safety checklist was implemented more than ten years ago. In retrospect, we noticed that pediatric anesthesia was underrepresented in our surgical safety checklist modification. Therefore, we added a standardized team briefing (pedSOAP-M) immediately before induction of anesthesia and hypothesized that the use of this checklist was effective to detect relevant errors with potentially harmful consequences.AIMS:The primary aim was to assess the incidence and characteristics of the detected errors, and the secondary aim was to identify factors influencing error detection.METHODS:This prospective observational study was performed between November 2020 and October 2021 in five operation rooms at the Children's Hospital of Hannover Medical School, Germany. The subcategories of the pedSOAP-M checklist were suction, oxygen, airway, pharmaceuticals, and monitoring. Demographic and procedure-related data and the briefing results were documented anonymously and undated, using a standardized case report form.RESULTS:We enrolled 1030 and analyzed 1025 patients (aged 0-18 years). Relevant errors were detected in 111 (10.8%) cases (suction 2.5%, oxygen 3.0%, airway 0.2%, pharmaceuticals 2.4%, monitoring 3.0%). In the pharmaceuticals subcategory, the most common error was entering a wrong patient weight into the perfusor syringe pumps. Experienced anesthetists detected significantly more errors than less experienced ones.CONCLUSION:The briefing tool pedSOAP-M was effective in detecting relevant errors with potentially harmful consequences. The presence of an experienced anesthetist was associated with a higher efficacy of the briefing. Particular attention should be given to entering patient weight into the anesthesia workstation and the perfusor syringe pumps.

Zusammenfassung Hintergrund Eine hohe Versorgungsqualität in der präklinischen Notfallmedizin zeichnet sich durch eine leitliniengerechte Therapie aus. Grundvoraussetzung für diese Therapie ist das Vorhalten der benötigten Medikamente entsprechend den gültigen Leitlinienempfehlungen. Ob dies flächendeckend gewährleistet wird, ist aktuell unklar. Ein einheitlicher Standard zur medikamentösen Ausstattung arztbesetzter Rettungsmittel in Deutschland existiert nicht. Ziel der vorliegenden Arbeit ist die Identifikation von wichtigen Diagnosen und der zu ihrer Therapie benötigten Medikamente. Ein Abgleich dieser Ergebnisse mit der realen Ausstattung arztbesetzter Rettungsmittel ermöglicht die Bewertung hinsichtlich leitliniengerechter Therapieoptionen. Material und Methoden Nach einer strukturierten Leitlinienrecherche wurden Tracerdiagnosen definiert und ihnen relevante Medikamente zugeordnet. Hier wurde auch der Evidenz- und Empfehlungsgrad berücksichtigt. In einem zweiten Schritt wurden Ärztliche Leitungen Rettungsdienst zu der Ausstattung der von ihnen verantworteten Rettungsmittel befragt und die Ergebnisse mit den empfohlenen Medikamenten verglichen. Ergebnisse Insgesamt wurden 156 verschiedene Medikamente identifiziert. Der Median der vorgehaltenen Medikamente beträgt 58 bei einer minimalen Vorhaltung eines Standorts von 35 Medikamenten und maximaler Vorhaltung mehrerer Standorte von 77 Medikamenten. Diskussion In der vorliegenden Erhebung wurden die in Leitlinien empfohlenen Medikamente mit der realen Ausstattung von arztbesetzten Rettungsmitteln verglichen. Insgesamt zeigt sich, verglichen mit einer Studie aus dem Jahr 2011, eine verbesserte Strukturqualität. Die empfohlenen Medikamente werden zu einem hohen Maß prähospital vorgehalten. Die Daten dieser Erhebung können von Rettungsdienstbereichen in ganz Deutschland zur Beurteilung ihrer individuellen Strukturqualität genutzt werden. Graphic abstract

BACKGROUND: The indication of hydroxyethyl starch is currently under critical discussion and albumin 5% (ALB) has an increasing use in the operating theatre. Therefore, ALB is routinely used in neurosurgical procedures and often combined with mannitol 20% (MAN). Purpose of this in-vitro study was to determine the influence of the combination of MAN and ALB on blood coagulation and platelet function. METHODS: Twenty-two healthy volunteers were included into this study and 21 analyzed. Blood was obtained and diluted into five groups: 1) 7% dilution with MAN; 2) 10% dilution with ALB; 3) 17% dilution with isotonic balanced electrolyte solution; 4) 17% dilution with TRAP-test) were used to detect differences within the intervention groups and compared to the control group. RESULTS: The maximum clot firmness in the FIBTEMT degrees` Test (SABIC) decreased under the normal range with the combination of MAN+ALB: 8 mm (5.5-11) compared to CON: 15 mm (12.5-20), P<0.05. Platelet function (ADP test) showed significant decreases for ALB: 51 AUC (40-84) and MAN+ALB: 54 AUC (41-68) compared to CON: 92 AUC (75-101), P<0.05. Except in clotting time all other EXTEMT degrees` tests (SABIC) of MAN+ALB subgroup showed significant impairment on blood coagulation compared to the control group. CONCLUSIONS: In this in-vitro study clinically relevant dilutions of MAN+ALB showed a significant inhibition of blood coagulation and platelet function. Further in-vivo studies are necessary to confirm these results. (Cite this article as: Palmaers T, Hinsenkamp J, Kramer E, Leffler A, Flentje M, Sieg L, et al. Albumin combined with Mannitol impairs whole blood coagulation and platelet function in vitro. J Neurosurg Sci 2021;65:634-41. DOI: 10.23736/S0390-5616.19.04679-4)

In the era of organ machine perfusion, experimental models to optimize reconditioning of (marginal) liver grafts are needed. Although the relevance of cytokine signatures in liver transplantation has been analyzed previously, the significance of molecular monitoring during normothermic machine perfusion (NMP) remains elusive. Therefore, we developed a porcine model of cold ischemic liver graft injury after prolonged static cold storage (SCS) and subsequent NMP: Livers obtained from ten minipigs underwent NMP for 6 h directly after procurement (control group) or after 20 h of SCS. Grafts after prolonged SCS showed significantly elevated AST, ALT, GLDH and GGT perfusate concentrations, and reduced lactate clearance. Bile analyses revealed reduced bile production, reduced bicarbonate and elevated glucose concentrations after prolonged SCS. Cytokine analyses of graft perfusate simultaneously demonstrated an increase of pro-inflammatory cytokines such as Interleukin-1α, Interleukin-2, and particularly Interleukin-18. The latter was the only significantly elevated cytokine compared to controls, peaking as early as 2 h after reperfusion (11,012 ng/ml vs. 1,493 ng/ml; p = 0.029). Also, concentrations of High-Mobility-Group-Protein B1 were significantly elevated after 2 h of reperfusion (706.00 ng/ml vs. 148.20 ng/ml; p < 0.001) and showed positive correlations with AST (r2 = 0.846) and GLDH (r2 = 0.918) levels. Molecular analyses during reconditioning of liver grafts provide insights into the degree of inflammation and cell damage and could thereby facilitate future interventions during NMP reducing acute and chronic graft injury.

BACKGROUND: Mannitol is used in the treatment of raised intracranial pressure (ICP). The aim of this study was to investigate whether mannitol (MAN) leads to a relevant deterioration in platelet function in routine neurosurgical procedures.METHODS: Thirty-eight patients undergoing elective craniotomy due to a brain tumor with elevated ICP were included. After induction of anaesthesia a blood sample was taken (T1). The patients then received 1 g-kg-1 MAN within 30 minutes. The second blood sample (T2) was obtained 60 minutes after T1. Blood samples were examined by means of aggregometry (Multiplate®) and PFA-100® tests.RESULTS: No patient had clinical signs of increased bleeding. We could not find any deterioration in the aggregometry using Multiplate®, neither in the adenosinediphosphate (ADP), the arachidonic acid (ASPI), or the thrombin receptor activating protein (TRAP) test. PFA-100® closing times (cT) showed a significant prolongation between T1 and T2: collagen/adenosindiphosphate (COL/ADP) test 79s [70/99] and 91s [81/109]; p=0.002); collagen/epinephrine (COL/EPI) test 109s [92/129] and 122s [94/159]; p=0.0004). A subgroup analysis showed that the patients who received isotonic balanced infusions only, had no prolongation of cT, whereas the patients who received additionally gelatine solution had a significant prolongation. COL/ADP: 78s [70/98] and 91s [82/133]; p=0.0004). COL/EPI: test 111s [92/128] and 127s [103/146]; p=0.0026). Except for individual outliers, the measured values were in the normal range.CONCLUSIONS: In this study, we found no clinically relevant deterioration of platelet function in neurosurgical patients with increased ICP after administration of MAN. Changes that occurred were all within normal ranges.

ZusammenfassungHintergrundDie anästhesiologische Tätigkeit in der Kreißsaalumgebung impliziert die Besonderheiten der 200 %-Letalität, die beschreibt, dass Notfallsituationen Mutter und Kind betreffen können. Ein Umstand, der die Notwendigkeit einer besonderen Sorgfalt in der Mitarbeiterausbildung und -auswahl eindrücklich unterstreicht. Gleichwohl existiert derzeit keine detaillierte Beschreibung der notwendigen Kompetenzen in dieser Arbeitsumgebung. Die vorliegende Studie soll die Ausbildungssituation in der anästhesiologischen Weiterbildung beschreiben und im Hinblick auf die Notwendigkeit eines Curriculums analysieren.MethodikIn einer multizentrischen Beobachtungsstudie wurden Ärzt:innen in Weiterbildung (AiW) und ausbildende Fachärzt:innen (FÄ) nach Methoden der Einarbeitung, Feedbackgabe, übernommenen Tätigkeiten und Bedarf eines Curriculums befragt. Teilnehmende wurden über die Mitgliedsdatenbank der DGAI angeschrieben und konnten onlinebasiert den 11 Items umfassenden Fragebogen beantworten.ErgebnisseInsgesamt wurden 495 Fragebogen (FÄ 329;166 AiW) abgeschlossen. Fachärzt:innen und AiW machen unterschiedliche Angaben zur Durchführung von Abschlussgesprächen (59,6 % vs. 10 %) und der Unterstützung durch ein Curriculum (76,3 % vs. 15,7 %). Unabhängig vom Weiterbildungsjahr werden von AiW Kaiserschnitte unter Supervisionsstufe „Rufweite“ durchgeführt. Die Periduralanästhesie (PDA) ist während der Einarbeitung die am seltensten durchgeführte Maßnahme. Beide Gruppen schätzen den Nutzen bzw. den Wert einer Beschreibung von Lernzielen und der Verfügbarkeit eines Curriculums als hoch ein.SchlussfolgerungDie Unterstützung der Einarbeitung wird von FÄ und AiW teilweise unterschiedlich beantwortet. Einzelne seltene durchgeführte Maßnahmen, wie die PDA, bedürfen künftig einer gesonderten Aufmerksamkeit. Die Beschreibung von Lernzielen und die Curriculumsentwicklung werden ausdrücklich gewünscht.

Liver transplantation is regarded as the gold standard for the treatment of a variety of fatal hepatic diseases. However, unsolved issues of chronic graft failure, ongoing organ donor shortages, and the increased use of marginal grafts call for the improvement of current concepts, such as the implementation of organ machine perfusion. In order to evaluate new methods of graft reconditioning and modulation, translational models are required. With respect to anatomical and physiological similarities to humans and recent progress in the field of xenotransplantation, pigs have become the main large animal species used in transplantation models. After the initial introduction of a porcine orthotopic liver transplant model by Garnier et al. in 1965, several modifications have been published over the past 60 years. Due to specifies-specific anatomical traits, a veno-venous bypass during the anhepatic phase is regarded as a necessity to reduce intestinal congestion and ischemia resulting in hemodynamic instability and perioperative mortality. However, the implementation of a bypass increases the technical and logistical complexity of the procedure. Furthermore, associated complications such as air embolism, hemorrhage, and the need for a simultaneous splenectomy have been reported previously. In this protocol, we describe a model of porcine orthotopic liver transplantation without the use of a veno-venous bypass. The engraftment of donor livers after static cold storage of 20 h - simulating extended criteria donor conditions - demonstrates that this simplified approach can be performed without significant hemodynamic alterations or intraoperative mortality and with regular uptake of liver function (as defined by bile production and liver-specific CYP1A2 metabolism). The success of this approach is ensured by an optimized surgical technique and a sophisticated anesthesiologic volume and vasopressor management. This model should be of special interest for workgroups focusing on the immediate postoperative course, ischemia-reperfusion injury, associated immunological mechanisms, and the reconditioning of extended criteria donor organs.

THEORY:Problems in airway management are rare in anesthesia but when they occur, they have serious consequences for the patient. For this reason, training is recommended for professionals involved in anesthetic care. Here we investigated, if a newly developed technical/ non-technical hybrid airway training would be relevant for daily practice in a tertiary referral hospital.HYPOTHESES:We hypothesized that: (a) both parts of the validated questionnaires meet the quality criteria for the application in anesthesia teams, (b) even though the team regularly deals with airway management, airway management training is relevant to all professions and (c) contents of the developed training can be integrated into the behaviour of the teams.METHOD:In this observational study, 104 professionals took part in a one-day technical/non-technical hybrid airway training programme. Participants received a questionnaire six months after training, based on selected scales of the validated tools; "Training Evaluation Inventory" and "Transfer Climate Questionnaire".RESULTS:The scales of "perceived usefulness", "task cues" and "positive reinforcement" showed good internal consistency and all were rated higher than 3.9 on a 5-point Likert scale (1=complete rejection; 5=fullest approval). The scale "negative reinforcement and punishment" showed satisfactory internal consistency for physicians (rated 2.75 ± 0.8). By removing an item in each case, the scales "attitude towards training" (rated 4.93 ± 0.2) and "extinction" (rated 3.02 ± 0.8) showed satisfactory internal consistency for nurses and anesthetic technicians. "Social Cues" did not meet qualitative criteria. There was no difference in the assessment by the professional groups.CONCLUSIONS:The presented training course was perceived as useful by both professional groups equally, which supported the interprofessional concept. The content was positively reinforced in practice six months after training and is relevant for professionals who are regularly confronted with the topic "airway management". Scales which meet qualitative criteria for only one profession and the scale "social cues" should be reconsidered in the context of an interprofessional team.

Zusammenfassung Hintergrund Wie in vielen medizinischen Berufen wird auch bei den NotfallsanitäterInnen (NotSan) der Kompetenzbegriff verwendet. Eine Möglichkeit, diese Kompetenz schrittweise entwickeln und messen zu können, steht aus. Ten Cate et al. schlagen hier das Konzept der „entrustable professional activities“ (EPA) vor. Ziel der Studie war, einen Katalog von relevanten Einsatzsituationen zu entwickeln, der die Grundlage für eine EPA-Integration in die Ausbildung ermöglicht. Methode Die Erarbeitung des EPA-Katalogs erfolgte über ein 2‑stufiges Verfahren mittels webbasierter Fragebögen. Nach einer eDelphi-Analyse mit Praxisanleitenden im Rettungsdienst, wurden die Items in einem großen Kollektiv hinsichtlich der Relevanz validiert. Anschließend wurden Faktoren identifiziert und Skalen gebildet. Ergebnisse Nach Validierung der Ergebnisse der eDelphi-Analyse ergaben sich fünf Skalen mit 22 Items. Sie umfassen die Bereiche „Behandlung spezieller Krankheitsbilder-NACA IV“, „Kommunikation“, „Einbinden von Medizinprodukten in die Patientenbehandlung“, „symptomorientiertes Handeln“ und „Leitsymptom Schmerz“. Die Items beschreiben 59 % der Gesamtvarianz und entsprechen einer stabilen Faktorenlösung. Schlussfolgerung Es konnte ein Katalog von relevanten Einsatzsituationen in der NotSan-Ausbildung entwickelt werden, der sich zur weiteren Entwicklung von EPA eignet. Diese sollten flächendeckend und organisationsübergreifend einheitlich genutzt werden. Die Nutzung sollte didaktisch wissenschaftlich begleitet werden.

Zusammenfassung Hintergrund Eine Kompetenzüberprüfung von Notfallsanitätern (NFS) ist durch die Ärztlichen Leiter Rettungsdienst (ÄLRD) empfohlen. Die Umsetzung erfolgt individuell im Rettungsdienstbereich. Ziel der Studie ist die Beschreibung der aktuellen Situation als Diskussionsbeitrag für Weiterentwicklungen. Methode In der Zeit von Sept. 2019 bis Mai 2020 wurden die ÄLRD zu ihren verfügbaren Ressourcen, der Art der Kompetenzüberprüfung, der Konsequenzen und Bewertung der eigenen Arbeit befragt. Ergebnisse Siebzig ÄLRD sind im Mittel für 311 NFS zuständig. Die Überprüfung wird in 87,1% von Praxisanleitern (PA) unterstützt. Am häufigsten werden Fallszenarien eingesetzt. 10% überprüfen nicht. Die ÄLRD bewerten ihre eigene Arbeit mit der Schulnote befriedigend und nennen mangelnde Ressourcen als Haupthinderungsgrund. Bei Nichtbestehen werden Wiederholungsprüfungen angeboten und der Einsatz als Transportführer ausgesetzt. Schlussfolgerung In vielen Bereichen findet eine Überprüfung nach Vorgaben des Pyramidenprozesses II statt. Einzelne Bereiche überprüfen die Kompetenz nicht oder wenden nichtgeeignete Prüfungsformate an. Die Praxisanleiter leisten einen wichtigen Beitrag. Übergreifende Konzepte mit Transparenz und Qualität sind weiterzuentwickeln, um Konsequenzen aus Überprüfungen zu rechtfertigen. Bundesweite Konzepte können ÄLRD entlasten und die Einsatzflexibilität der Mitarbeiter erhöhen.

Objective: Emergency medical services are characterized by a high pressure to act. Dealing with trainees is a challenge. It is known, that the use of power in education subsists: power can be applied in a participative and restrictive way. We investigated the transferability of existing scales to the education system of Emergency medical service trainees. We hypothesized: a restrictive (a) and participative (b) use of power, can be demonstrated in Emergency medical service training, (c) the use of power by educators, who are responsible for theoretical learning, and instructors, who accompany trainees in real-life emergencies, are different and (d) the assessed participatory and restrictive use of power by trainers is negatively correlated. Methods: In a cross-sectional study, 206 trainees of Emergency medical service schools completed a questionnaire. The survey consists of 35 power related items regarding medical educators and practical instructors. Differences in the dimensions of power application were tested. The effect size and the correlation between power dimension were calculated. Results: The reliability of the scales was .92 (practical instructor) and .89 (medical educator) by removing one item. All subscales showed values with higher Cronbach’s alpha than .68. Application of participative power differs (p<.00) between practical instructors (mean 64.7; SD 20.3) and medical educators (mean 55.3; SD 17.8). The participatory and the restrictive use of power correlated for medical educators significant negatively (r=-.48; p<.01). Conclusion: In both educator and instructor groups the use of participative power had a greater agreement that the use of restrictive techniques. The practical instructors used participative power slightly more often that did educators due to the dependency on the trainee as a team member. The context of the scales partially overlaps with other descriptions such as leadership and instructor quality.

Zusammenfassung Hintergrund Eine Kompetenzuberprufung von Notfallsanitatern (NFS) ist durch die Arztlichen Leiter Rettungsdienst (ALRD) empfohlen. Die Umsetzung erfolgt individuell im Rettungsdienstbereich. Ziel der Studie ist die Beschreibung der aktuellen Situation als Diskussionsbeitrag fur Weiterentwicklungen. Methode In der Zeit von Sept. 2019 bis Mai 2020 wurden die ALRD zu ihren verfugbaren Ressourcen, der Art der Kompetenzuberprufung, der Konsequenzen und Bewertung der eigenen Arbeit befragt. Ergebnisse Siebzig ALRD sind im Mittel fur 311 NFS zustandig. Die uberprufung wird in 87,1% von Praxisanleitern (PA) unterstutzt. Am haufigsten werden Fallszenarien eingesetzt. 10% uberprufen nicht. Die ALRD bewerten ihre eigene Arbeit mit der Schulnote befriedigend und nennen mangelnde Ressourcen als Haupthinderungsgrund. Bei Nichtbestehen werden Wiederholungsprufungen angeboten und der Einsatz als Transportfuhrer ausgesetzt. Schlussfolgerung In vielen Bereichen findet eine uberprufung nach Vorgaben des Pyramidenprozesses II statt. Einzelne Bereiche uberprufen die Kompetenz nicht oder wenden nichtgeeignete Prufungsformate an. Die Praxisanleiter leisten einen wichtigen Beitrag. ubergreifende Konzepte mit Transparenz und Qualitat sind weiterzuentwickeln, um Konsequenzen aus uberprufungen zu rechtfertigen. Bundesweite Konzepte konnen ALRD entlasten und die Einsatzflexibilitat der Mitarbeiter erhohen. Abstract Background A competence review of paramedics is recommended by medical directors of rescue services (MDRS). The implementation occurs individually in the rescue service area. The aim of the study is the description of the current situation as a contribution to the discussion for further developments. Methods Using a developed protocol by the authors, from Sept. 2019 to May 2020 MDRS were surveyed regarding their available resources, the type of competence review, the consequences and the evaluation of their own work. Results Seventy MDRS are responsible for an average of 311 paramedics. The review is supported by paramedic instructors in 87.1%. The most frequent used method is case scenario. In 10%, no review is conducted. The MDRS rate their own work with a satisfying grade and cite lack of resources as the main obstacle. If a competence review is failed, retests are offered and the assignment as a transport leader is suspended. Discussion In many areas, a review takes place according to specification of the pyramid process II. Individual areas do not check competence or use suitable examination formats. The paramedic instructors make an important contribution. The development of cross-department concepts with transparency and quality must be further developed in order to justify the consequences of review. Nationwide concepts can relieve the workload of the MDRS and increase the flexibility of the professionals in all areas.