Objectives The aim of the study was to analyze helicopter emergency medical service (HEMS) in comparison to EMS, in respect to patient’s mortality and morbidity. Design From a cohort of traumatized patients (n = 1724) prospectively enrolled in the German trauma registry (DGU-R) at Frankfurt University Hospital from 2009 to 2013, 1646 could be analyzed for in-hospital mortality and short-term outcome (GOS) at discharge and compared between HEMS and EMS. Measurements and main results 129 patients (7.8%) died in the hospital. Unadjusted mortality was significantly lower in the HEMS group compared to EMS (p = 0.001). In a multiple logistic regression analysis after adjustment of variables including reanimation and age as the strongest predictors, in-hospital mortality was significantly reduced in HEMS (p = 0.014, OR = 0.21). Further predictors in the multiple logistic regression analysis were GCS > = 8 (p = 0.001), RRsys (p < 0.001), ISS at Head/Neck > = 3 (p = 0.003), and total ISS > = 9 (p < 0.001). Total rescue time and on scene time were associated with mortality (p < 0.001) but not included in the multiple logistic regression model. Without adjustment, short-term outcome (GOS) was significantly improved (p = 0.014). In a linear model, after adjusting for multiple variables including age, ISS Head/Neck > = 3, ISS Extremities > = 3, GCS > = 8, and RRsys as the strongest predictors (p < 0.001), the association remained significant (p = 0.043). Further predictors in the multiple linear regression analysis were total ISS > = 9 (p = 0.002), ISS abdomen (p = 0.001), and ISS Chest (p = 0.011). Conclusions A significant improvement for in-hospital survival for HEMS could be demonstrated. Especially in Germany, with a high number of secondary call outs (about 44%) after EMS has already reached the traumatized patient, HEMS must be the first choice for severely injured trauma patients. Dispatch criteria for immediate alarm of HEMS are recommended under practical considerations.

IMPORTANCE:When patients are disorientated or experience language barriers, it is impossible to activate the emergency response system. In these cases, the delay for receiving appropriate help can extend to several hours.OBJECTIVES:A worldwide emergency call support system (ECSS), including geolocation of modern smartphones (GPS, WLAN and LBS), was established referring to E911 and eCall systems. The system was tested for relevance in quickly forwarding abroad emergency calls to emergency medical services (EMS).DESIGN:To verify that geolocation data from smartphones are exact enough to be used for emergency cases, the accuracy of GPS (global positioning system), Wi-Fi (wireless LAN network) and LBS (location based system) was tested in eleven different countries and compared to actual location. The main objective was analyzed by simulation of emergencies in different countries. The time delay in receiving help in unsuccessful emergency call cases by using the worldwide emergency call support system (ECSS) was measured.RESULTS:GPS is the gold standard to locate patients with an average accuracy of 2.0 ± 3.3 m. Wi-Fi can be used within buildings with an accuracy of 7.0 ± 24.1 m. Using ECSS, the emergency call leads to a successful activation of EMS in 22.8 ± 10.8 min (Median 21 min). The use of a simple app with one button to touch did never cause any delay.CONCLUSIONS AND RELEVANCE:The worldwide emergency call support system (ECSS) significantly improves the emergency response in cases of disorientated patients or language barriers. Under circumstances without ECSS, help can be delayed by 2 or more hours and might have relevant lifesaving effects. This is the first time that Wi-Fi geolocation could prove to be a useful improvement in emergencies to enhance GPS, especially within or close to buildings.

Background: The human resources required on large cruise ships can only be secured with crew members from different countries of origin with different health statuses. Method: The present secondary data analysis is to determine whether there is an increased frequency of treatment for crew members for certain diseases or injuries, or a difference in the frequency of treatment for certain groups and/or countries of origin; whether an increased use of dental procedures could be confirmed, and their average costs. The data were collected over six months in 2015 from a major cruise ship company. Results: There were 1,627 treatments for 1,026 crew members. The illness and injury rates were significantly different both in the occupational groups (p < .001) as well as the countries of origin (p = .004). It was confirmed that dental procedures were most frequent (n = 915 cases), in particular for Asian crew members; in contrast to Germans they had a 1.6-fold higher chance of dental procedures.Conclusions: A mixed calculation for dental and jaw treatments for the crew members and the expected passenger treatments would justify the employment of a dentist on the ship. However, medical follow-up costs for crew members on board could be minimised by a previous thorough assessment of their state of health.

We report on the repatriation of a 28-year old female from Germany, who was involved in a serious bus accident and was transported to the nearest hospital in Oruro, Bolivia. CT scans and x-rays performed in this hospital demonstrated a complete pneumothorax right. Thorax drainage was inserted, which was removed after 5 days. Since the hospital refused to acknowledge the presence of a residual middle-sized pneumothorax on the repatriation day and did not want to insert another tube, the decision was made to repatriate the patient on commercial flight back home to Germany without a thoracic tube.

Objective In the case of an emergency, fast and structured patient management is crucial for a patient's outcome. Every physician and graduate medical student should possess basic knowledge of emergency care and the skills to manage common emergencies. This study determines the effect of a simulation-based curriculum in emergency medicine on students' abilities to manage emergency situations.Methods A controlled, blinded educational trial of 44 final-year medical students was carried out at Frankfurt Medical School; 22 students completed the former curriculum as the control group and 22 the new curriculum as the intervention group. The intervention consists of simulation-based training with theoretical and simulation-based training sessions in realistic encounters based on the Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) and adapted Advanced Trauma Life Support (ATLS) training. Further common emergencies were integrated corresponding to the course objectives. All students faced a performance-based assessment in a 10 station Objective Structured Clinical Examination (OSCE) using checklist rating within a maximum of 4 months after completion of the intervention.Results The intervention group performed significantly better at all of the 10 OSCE stations in the checklist rating (p<0.0001 to p-0.016).Conclusions The simulation-based intervention offers a positively evaluated possibility to enhance students' skills in recognising and handling emergencies. Additional studies are required to measure the long-term retention of the acquired skills, as well as the effect of training in healthcare professionals.

Electrical equipment, such as those collected at municipal collection points or as input for treatment plants usually are a mix of a variety of different kinds of devices, types and models. Most of the devices are of a very complex structure, with casing consisting of mechanical parts and electronic components. These complexities make it difficult to determine the material composition of Waste Electrical and Electronic Equipment (WEEE) composite inputs and make it impossible to determine in practice, the content of certain materials or substances. The project aims at developing a method, database and software that supports and facilitates process selection and facility planning in the recycling of WEEE. With the database it is possible to model different variants of the recycling process. This negates the necessity of extensive pilot plant tests, simulations for the implementation of different input compositions and evaluates the market while taking into account quality-related values.

Das Querschnittsfach Notfallmedizin im Medizinstudium bedarf aufgrund der Komplexität von Notfallsituationen einer interdisziplinären Vermittlung von kognitivem Wissen, praktischen Fertigkeiten, algorithmenorientiertem Handeln und „soft skills“. Die aktuelle Approbationsordnung von 2003 fordert eine praxisorientierte Umsetzung dieser Lehrinhalte.

A prehospital experience supported by paramedics can serve as a valuable tool in an emergency medicine curriculum.

This paper presents the detailed architecture of the WISECOM system, which can quickly re‐establish and provide telecommunication services after a disaster by integrating terrestrial mobile radio networks, such as GSM, WiFi, WiMAX and TETRA, with satellite technologies. The system aims to be a useful tool to be deployed in the early hours after a disaster event, for both the victims and the rescue services who will be able to communicate in a reliable and robust way, improving the coordination of the different teams and reducing the time needed to provide victims with the proper treatment. The paper presents in detail the different services provided by the system taking into account its two different versions, based on two different satellite technologies, Inmarsat BGAN and DVB‐RCS. Together with the presentation of the system capabilities, a business model is also proposed. Thereafter, the architecture of the general system and the demonstrators that have been developed are detailed, according to the two versions of the system. The work also presents the outcomes of the tests conducted with a prototype of the system, and of the final project demonstration, which was held in Germany in May 2008 with the involvement of real end‐users (fire brigades and civil protection authorities). Copyright © 2010 John Wiley & Sons, Ltd.

In case of an emergency, a fast and structured patient management is crucial for patient’s outcome. The competencies needed should be acquired and assessed during medical education. The objective structured clinical examination (OSCE) is a valid and reliable assessment format to evaluate practical skills. However, traditional OSCE stations examine isolated skills or components of a clinical algorithm and thereby lack a valid representation of clinical reality. We developed emergency case OSCE stations (ECOS), where students have to manage complete emergency situations from initial assessment to medical treatment and consideration of further procedures. Our aim was to increase the authenticity and validity in the assessment of students’ capability to cope with emergency patients. 45 students participated in a 10-station OSCE with 6 ECOS and 4 traditional OSCE stations. They were assessed using a case-specific checklist. An inter-station and post-OSCE-questionnaire was completed by each student to evaluate both ECOS and traditional OSCE. In this study, we were able to demonstrate that ECOS are feasible as time-limited OSCE stations. There was a high acceptance on both students and examiners side. They rated ECOS to be more realistic in comparison to the traditional OSCE scenarios. The reliability estimated via Crohnbach’s α for the 6 ECOS is high (0.793). ECOS offer a feasible alternative to the traditional OSCE stations with adequate reliability to assess students’ capabilities to cope with an acute emergency in a realistic encounter.

We have conducted a three-year prospective study of medical incidents on a commercial airline. A telemedicine service was available via an on-board satellite phone. During the study period there were 3364 medical incidents. The most common incident was collapse (n = 2310, 57%). Telemedicine was used in 323 of the cases (9%). Neurological patients, mostly stroke and seizures, excluding psychiatric diseases, were seen in 27% of the telemedicine cases (n = 83). Most of the cases involved middle-aged people, not the elderly. The group of patients that needed diversion (n = 27) was compared to the cases staying on board (n = 275). None of the patients in the non-diversion group deteriorated. All unstable patients forced a diversion. Doctors on board used the service in more severe cases, whereas laymen used the service in less severe cases. The results of the present study demonstrate the advantage of using simple teleconsultation in cases of medical emergency on board an aircraft.

Background Blunt abdominal trauma with intra-abdominal bleeding is often underdiagnosed or even overlooked at trauma scenes. The purpose of this prospective, multicentre study was to compare the accuracy of physical examination and prehospital focused abdominal sonography for trauma (PFAST) to detect abdominal bleeding. Methods Six rescue centres took part in the study from December 2002 to December 2003, including 230 patients with suspected abdominal injury. The accuracy of physical examination at the scene and PFAST were compared. Later examinations in the emergency department (ultrasonography and/or computed tomography) were used as the reference standard. Results The complete protocol and follow-up was obtained in 202 patients. The sensitivity, specificity and accuracy of PFAST were 93 per cent, 99 per cent and 99 per cent, respectively, compared with 93 per cent, 52 per cent and 57 per cent for physical examination at the scene. Scanning with PFAST occurred a mean(s.d.) 35(13) min earlier than ultrasound in the emergency department. Abdominal bleeding was detected in 14 per cent of patients. Using PFAST led to a change in either prehospital therapy or management in 30 per cent of patients, and a change to admitting hospital in 22 per cent. Conclusion In this study, PFAST was a useful and reliable diagnostic tool when used as part of surgical triage at the trauma scene.

Zwölf Jahre nach Vorlage der ersten Version des DIVI-Notarzteinsatzprotokolls [1] und vier Jahre nach Veröffentlichung der Version 4.0 [2] ist nun eine neue Version erarbeitet worden, in die die Erfahrungen und Kritik aus den vergangenen Jahren eingeflossen sind. Es reiht sich ein in die anderen Dokumentationsinstrumente der DIVI, das Rettungsdienstprotokoll [3] und das Intensivtransportprotokoll [4].

Three-dimensional cell cultures (spheroids) of biopsies of human duodenum were used to develop a new noninvasive method for studying intercellular and intracellular mechanisms. Through examinations of intracellular pH regulation, high functional similarity to native tissue could be shown, as already evidenced morphologically. A special microperfusion chamber was developed to fix individual spheroids physically to a nylon net, via laminar perfusion flow through the chamber. A significant improvement over current fixation methods was shown by the increase of cell viability almost up to 100%. Viability of the spheroids was confirmed by trypan blue exclusion, by a LIVE/DEAD viability/cytotoxicity kit, and by BCECF distribution. Intracellular pH was measured by use of the pH-sensitive fluorescence dye BCECF. To investigate the intracellular pH regulation, spheroid-like vesicles were acidified by NH4Cl prepulse technique. The subsequent active intracellular pH recovery was blocked with Na+-free Krebs Henseleit (KH) solution, with amiloride KH (inhibitor of the Na+−H+-exchanger), or with H2DIDS KH (inhibitor of the HCO3 −−Cl−-exchanger and Na+−HCO3 −-cotransporter). The intracellular pH of the spheroids was 7.31±0.05. pHi-backregulation after acidification was prevented by sodium-free buffer, amiloride, and H2DIDS. These experiments indicated the presence of a Na+−H+-exchanger and a Na+−HCO3 −-cotransporter. In conclusion, the human duodenal spheroid is an excellent physiological system for in vitro studies of the human duodenum.

development of IBD, our results could further lead to new therapeutical approaches.

A fast scanning Langmuir probe system (LPS) for ASDEX-Upgrade's divertor plasma investigations was designed, manufactured and operated. Profiles of ion saturation current density, Jsat, electron temperature, Ted, electron density, Ned, floating potential, Vfl, and Mach number have been recorded for ohmic (OH) and low/medium power neutral beam heated (NI) discharges. In these cases the probe can access both divertor legs, allowing comparison of plasma parameters in the two divertors and investigations of the private flux region. Strong divertor asymmetries, complex plasma flow patterns and changes in the power flow to the divertor targets, depending on ion gradB drift direction, density and divertor geometry, have been observed.

A new divertor was installed in ASDEX Upgrade and went into operation in spring of 1997. The divertor was designed to handle heat fluxes relevant to ITER-like scenarios. For this, the tiles expected to receive the maximum load (strike point modules) are hardened by the use of carbon fibre composites covering about 20% of the total divertor area. The maximum heat flux detected by thermography in a H-mode discharge is only 4 MW/m2 or below for a total input power of 20 MW without radiating mantle, except some ELMs showing a moderately higher heat flux. A broad distribution of the power load found in the measured poloidal distribution of the heat flux as well as the energy distribution, shows that less than half of the power flowing into the divertor is received by the strike point modules. The remaining power is loaded to other tiles of the divertor, particularly the transition module and parts of the roof baffle near to the strike point modules. The reconstructed radiation pattern reveals that the fraction of power radiated outside the divertor is comparable for both geometries. But the radiated fraction inside the divertor is increased by 10–15% in the Lyra shaped divertor.