Die einheitliche, standardisierte Dokumentation in der Notaufnahme wurde von der DIVI erstmalig als modularer Kerndatensatz entwickelt und im interoperablen Format definiert. In der präklinischen Notfallversorgung werden bis dato jedoch in Deutschland unterschiedliche Protokolle zur Dokumentation genutzt: Minimaler Notfalldatensatz (MIND) 4.0 und DIVI-Notfalleinsatzprotokoll 6.1. Ziel der vorliegenden Arbeit war eine Aktualisierung und Harmonisierung dieser Datensätze zu einem einheitlichen Kerndatensatz für die präklinische Notfalldokumentation und Herstellung der Interoperabilität mit dem Datensatz Notaufnahme. In einer nationalen Expertengruppe wurden die Datensätze mittels iterativem Konsentierungsprozess aktualisiert und harmonisiert. Nach Definition von Datentypen, Inhalt, Beziehungen und Hierarchie wurde der Kerndatensatz technisch in ein einheitliches XML-Datenschema (XSD) übersetzt. Darüber hinaus erfolgte ein Abgleich der Datenfelder mit den notfallmedizinisch relevanten Registern. Mit dem MIND und dem DIVI-Notfalleinsatzprotokoll in der Version 7.0 steht nun ein einheitlicher Kerndatensatz für die präklinische Notfalldokumentation zur Verfügung. Durch den Abgleich der Datenfelder mit den Registern wird ein direkter Transfer für die Sekundärdatennutzung ermöglicht. Die Harmonisierung von MIND und DIVI-Notfalleinsatzprotokoll zu einem einheitlichen Kerndatensatz stellt einen Meilenstein in der Digitalisierung der Notfallmedizin dar. Der Datensatz bildet eine robuste Grundlage für die strukturierte Informationserfassung, standardisierte Fallübergabe, Leistungsdokumentation, Qualitätssicherung sowie datenbasierte Forschung. Mit der geplanten Überführung in HL7®-FHIR® entsteht eine zukunftsfähige, interoperable Datenbasis für eine nahtlose digitale Rettungskette.

To investigate the effect of heat days on the frequency of emergency medical service (EMS) missions and its specific effect on certain vulnerable populations and diseases. Analysis with temperature data from 107 weather stations and EMS data from the German federal state of Bavaria between 2018 and 2020 was performed. A generalized linear model with a negative binomial distribution was chosen for the analysis and adjusted for regional and temporal confounding. Several models were created to estimate the heat effect and compare the vulnerabilities for the total population and specific subgroups. The outcome of interest was the percent change of EMS missions on heat days. A heat day was defined as a day with temperature ≥ 30 °C. The two days following the heat day were defined as lag days. Our analyses show a significant association between heat days and the number of EMS missions. On heat days, 8,5

Heat events pose a significant risk to public health. Cities are particularly at risk due to the urban heat island effect. The evidence for modifying effects of city characteristics on morbidity outcomes is weak. This research investigates the impact of heat on emergency medical services (EMS) utilization across 25 Bavarian (Germany) cities from 2018 to 2020, as well as the modifying influences of various city characteristics. Using the EMS data linked to the corresponding weather records, we quantified the impact of heat utilizing negative binomial modelling for each city individually. Overall estimates, expressed as the Population Attributable Fraction (PAF), were derived by fixed-effects meta-analysis. We evaluated the potential effect modification of city characteristics such as demographic factors, land use proportions and air pollution, using extended meta-analysis and meta-regression procedures. Datasets from government agencies were used for the indicators. Our dataset included 302,353 EMS operations across 25 cities. We identified a pooled PAF of 9.34

Introduction When hospital staff perform cardiopulmonary resuscitation, patients are usually lying on a bed or stretcher, and chest compressions are therefore commonly performed while standing. Current resuscitation guidelines do not provide recommendations regarding standing chest compressions. The aim of this study was to identify a favourable working height for high-quality standing chest compressions. Material and methods This prospective study included ten healthcare professionals and twenty medical students and was conducted in two parts. Firstly, chest compressions were performed at seven different working heights, starting from knee height as a reference mark. Additional heights were set at 10, 15, and 20 cm above (+) and below (-) knee height. Secondly, knee height setting was then evaluated by comparing chest compression quality with two clinically relevant reference conditions: kneeling on the floor and standing at the lowest stretcher height. Results In Part 1, the highest values for the primary outcome measures – mean compression depth (52.7 ± 7.9 mm) and the percentage of correct compression depth (80.6 ± 38.5%) – were achieved at knee height. Working heights of 15 and 20 cm above knee height yielded significantly lower compression depth results than at knee height. In Part 2, no significant differences in chest compression depth were observed between the three evaluated positions. Conclusion Setting the patient’s bed or stretcher to the rescuers’ knee height enables high-quality chest compressions to be delivered while standing. The working height should be adjusted accordingly, with great emphasis placed on avoiding heights that are too high. The findings suggest that the performance of chest compressions while standing may warrant greater attention in future resuscitation guidelines.

BACKGROUND:Telementoring and teleconsultation are increasingly employed for collaboration within the healthcare system. The ArtekMed alliance project has developed a mixed reality (MR) teleconsultation system for intensive care units (ICU) using virtual reality (VR) and augmented reality (AR), facilitating real-time interaction between the real world and its reconstructed virtual model, shared by two or more coworkers. OBJECTIVE:We aimed to explore the feasibility and user acceptance of the ArtekMed MR teleconsultation system in a critical care setting and compare it to a standard teleconsultation system using a simulated video call. METHOD:A randomized cross-over study was conducted in a local simulation center: A remote expert (VR user) solved four clinical scenarios, each involving the treatment of an ICU patient with respiratory failure in collaboration with a local practitioner as facilitator (AR user). They used either the MR system (intervention) or a simulated video call (control). A mixed-methods approach was followed to explore structured pre- and post-trial interviews with qualitative and quantitative analyses including standardized usability scores (NASA Task Load Index, System Usability Scale SUS). RESULTS:Twenty-five professionals with intensive care experience completed 100 simulated scenarios. The ArtekMed system achieved an average SUS score of 66, while the simulated video call system was rated almost excellent (SUS score: 84). In three out of four scenarios, the perceived workload using the MR teleconsultation system did not significantly differ from the workload using the standard video call. Most users rated working with both teleconsultation systems positively and anticipated increased efficiency and feasibility with greater familiarity with the MR system. Common issues included visual impairment due to insufficient graphical resolution and unfamiliarity with handling the equipment. 80% of the participants expressed willingness to incorporate the system into their ICU work. CONCLUSION:Collaboration in the ICU using a real-time MR teleconsultation system was rated as a promising technology by the majority of the participants for future use. Technical imperfections seem to prevent further implementation at this stage. Thus, the MR reconstruction needs improvement before clinical implementation.

Heat is associated with an increase in Emergency Medical Service (EMS) operations. However, different heat definitions in research, including outside air temperature (T), Heat Index (HI) and Universal Thermal Climate Index (UTCI), impair the assessment of heat onthe frequency of EMS operations. Therefore, this study aims to compare (1) the relationship between different heat definitions and the frequency of days defined as heat events, (2) the percentage change in the number of EMS operations per heat definition, and (3) the goodness of model fit of each heat definition. We analyzed data from EMS operations and 106 weather stations in Bavaria, Germany (2018–2020), comparing 40 heat definitions with varying thresholds, percentiles (e.g. 90th percentile), and durations (≥ 1 or ≥ 2 days) based on T, HI, and UTCI. Negative binomial regression models were adjusted for confounders. All definitions indicate significant increased EMS operations during heat events, with effect sizes ranging from 8.3

Background The continuously evolving legislative and reporting requirements during the COVID-19 pandemic posed the demand for establishing an efficient real-time human resources management system at the LMU University Hospital, one of the largest university hospitals in Germany. Developing a system allowing for agile real-time analysis as well as for reporting employees’ COVID-19 vaccination and testing status while ensuring the security of personnel data presented several technical and managerial challenges. Methods We designed and implemented a custom COVID-19 human resources information platform in order to fulfill the LMU University Hospital’s legal requirement to report employees’ vaccination and testing status. We designed the platform as an all-in-one solution for all relevant COVID-19 data, merged from five individual sources. The development process was guided by the principles of findability, accessibility, interoperability and reusability (FAIR) with particular focus on interoperability. Here, we present the platform’s design, cumulative user data and discuss the feasibility of the approach including its intended and unintended outcomes. Results The COVID-19 human resources management platform was the first solution of its kind at the LMU University Hospital, emerging from the specific need for an efficient exterior and interior mandate fulfillment. It served both for operational management purposes as well as for strategic pandemic and hospital management . The immediate dependency on data privacy and regulatory adaptations due to the evolving pandemic situation posed the necessity for regular adaptations to the platform’s structure. Conclusions The presented case reveals how data utilization requires the concurrent and proactive consideration of data security and interoperability against the background of a scalable architecture. Simultaneously, the development of such platforms needs to be open to new cases, functions and sources, thus requiring a dynamic and agile environment.

Das Eckpunktepapier von 2008 definierte Rahmenbedingungen und Ziele der notfallmedizinischen Versorgung und bildete die Grundlage für Strukturanforderungen und Planung. Die Aktualisierung in 2016 erzielte eine enorme Reichweite. Neue Entwicklungen und steigende Inanspruchnahme machten eine weitere Überarbeitung erforderlich. Das Ergebnis wird in diesem Artikel präsentiert. Ein Entwurf wurde von der Core Group an 30 Fachgesellschaften, Institutionen und Organisationen (FIO) versandt, in einem Symposium weiterentwickelt und im Plenum diskutiert. Die Ergebnisse wurden in den finalen Text eingearbeitet und anschließend in einem Online-Abstimmungsverfahren konsentiert. An der Abstimmung beteiligten sich 27 FIO. Der Konsensus beruht auf einer Zustimmungsrate von 91,6

Targeted temperature management (TTM) with therapeutic hypothermia (TH) during aortic arch surgery requires valid estimations of core body temperature. The ear canal and epitympanic region might be an easy-to-assess, noninvasive site for the read-out of supra-aortic, cerebral temperature. This observational cohort study comparatively investigated in-ear temperature and different core body temperature (cBT) measurements during TTM/TH for moderate hypothermic circulatory arrest (mHCA) in aortic arch surgery. In total 24 patients (mean age of 56.8 +/- 17.5 years; six females) were measured using infrared-thermography of the epitympanic region (BTtym), thermistor-based measurements at the esophagus (BTeso; gold standard), at the ear canal (BTear), at the nasopharynx (BTnas), in the bladder (BTves), and in the rectum (BTrec). The data analysis comprised absolute agreement (AA), bias, intraclass correlation coefficient (ICC), and limit of agreement (LoA). The results revealed high AAs of BTtym, BTear, BTnas in reference to BTeso (biases 0.3-0.6 degrees C), with also excellent ICCs > 0.9. BTves and BTrec showed lower AAs, higher biases of + 2.5 degrees C to 3.1 degrees C with moderate ICCs during mHCA. In the phases of rapid temperature changes, the biases and LoAs were higher throughout all BT measurements. Herein, BTtym performed best of all measurement sites. The study informs about the BT dynamics at different body sites during the mHCA procedure. It supports the approach of using minimally invasive in-ear techniques to estimate core body temperature in an intrahospital TTM/TH setting of mHCA.

Background: The spread of the COVID-19 pandemic and the corresponding implementation of measures such as stay-at-home orders and curfews had a major impact on health systems, including emergency medical services. This study examined the effect of the pandemic on call volumes, duration of calls and unanswered calls to the emergency number 112. Method: For this retrospective, descriptive study, 986,650 calls to seven emergency dispatch centres in Bavaria between January 01, 2019 and May 31, 2021 were analysed. The absolute number of calls and calls per 100,000 inhabitants as well as the number of unanswered calls are reported. The Mann‒Whitney U test was used to compare mean call durations between 2019 and 2020/2021 during several periods. Results: Call volume declined during the pandemic, especially during periods with strict lockdown restrictions. The largest decline (−12.9 %) occurred during the first lockdown. The largest reduction in the number of emergency calls overall (−25.3 %) occurred on weekends during the second lockdown. Emergency call duration increased, with the largest increase (+13 s) occurring during the “light” lockdown. The number of unanswered calls remained at a similar level as before the pandemic. Conclusion: This study showed that the studied Bavarian dispatch centres experienced lower call volumes and longer call durations during the first two waves of the COVID-19 pandemic (up to May 2021). Longer call durations could be the result of additional questions to identify potentially infectious patients. The fact that the number of unanswered calls hardly changed may indicate that the dispatch centres were not overwhelmed during the study period.

Currently arbitrary, inconsistent and non-evidence-based age cutoffs are used in the literature to classify pediatric emergencies. None of these classifications have valid medical rationale. This leads to confusion and poor comparability of the different study results. To clarify this problem, this paper presents a systematic review of the commonly used age limits from 115 relevant articles. In the literature search 6226 articles were screened. To be included, the articles had to address the following three topics: "health services research in emergency medicine", "pediatrics" and "age as a differentiator". Physiologic and anatomic principles with reference to emergency medicine were used to solve the problem to create a medically based age classification for the first time.The Munich Age Classification System (MACS) presented in this paper is thus consistent with previous literature and is based on medical evidence. In the future, MAC should lead to ensure that a uniform classification is used. This will allow a better comparability of study results and enable meta-analyses across studies.

Zusammenfassung Hintergrund Schmerzen sind ein häufiger Behandlungsgrund in der prähospitalen Notfallmedizin. In Bayern delegieren die Ärztlichen Leiter Rettungsdienst (ÄLRD) bei subjektiv nichttolerablen Schmerzen nach isoliertem Extremitätentrauma an Notfallsanitäter (NotSan) landesweit einheitlich die Kurzinfusion von 7,5 mg des Opioidanalgetikums Piritramid. Methode Die Routineeinsatzdokumentation aller Einsätze im bayerischen Rettungsdienst mit Heranziehungen des Delegationsalgorithmus „Isolierte Extremitätenverletzung“ der ÄLRD nach § 4 Abs. 2 Nr. 2c Notfallsanitätergesetz wurde über einen 2‑Jahres-Zeitraum ausgewertet. Evaluiert wurden der Effekt auf die Schmerzintensität nach der numerischen Rating-Skala (NRS) und dem Vorliegen nichttolerabler Schmerzen, Auswirkungen auf die Vitalfunktionen sowie die Notwendigkeit von bestimmten weitergehenden Interventionen. Ergebnisse Bei 7151 identifizierten Einsätzen erfolgte in 6097 Fällen eine eigenständige Analgesie durch NotSan entlang der Delegation der ÄLRD. Die Schmerzintensität nach der NRS konnte von im Median 7 (Interquartilsabstand [IQR] 2) auf 3 (IQR 2, p < 0,001) gesenkt und in 96,9 % ein aus Patientensicht tolerables Niveau erreicht werden. In 9,4 % der Fälle wurde ein Notarzt nachgefordert und in 5,0 % eine ergänzende Analgesie verabreicht. Etwa jeder zehnte Patient erhielt Sauerstoff. Atemwegsinterventionen waren in wenigen Einzelfällen notwendig, eine Antagonisierung nur nach höheren als den delegierten Opiatdosen. Schlussfolgerung Eine vom ÄLRD delegierte und von NotSan eigenständig durchgeführte Opiatgabe senkt das Schmerzniveau relevant. Wesentliche Hinweise auf eine Patientengefährdung fanden sich nicht. Durch dieses Verfahren konnten in Bayern jährlich geschätzt ca. 2500 Notarzteinsätze vermieden werden.

Background Checklists are a powerful tool for reduction of mortality and morbidity. Checklists structure complex processes in a reproducible manner, optimize team interaction, and prevent errors related to human factors. Despite wide dissemination of the checklist, effects of checklist use in the prehospital emergency medicine are currently unclear. The aim of the study was to demonstrate that participants achieve higher adherence to guideline-recommended actions, manage the scenario more time-efficient, and thirdly demonstrate better adherence to the ABCDE-compliant workflow in a simulated ROSC situation. Methods CHIPS was a prospective randomized case–control study. Professional emergency medical service teams were asked to perform cardiopulmonary resuscitation on an adult high-fidelity patient simulator achieving ROSC. The intervention group used a checklist which transferred the ERC guideline statements of ROSC into the structure of the ‘ABCDE’ mnemonic. Guideline adherence (performance score, PS), utilization of process time (items/minute) and workflow were measured by analyzing continuous A/V recordings of the simulation. Pre- and post-questionnaires addressing demographics and relevance of the checklist were recorded. Effect sizes were determined by calculating Cohen’s d . The level of significance was defined at p < 0.05. Results Twenty scenarios in the intervention group (INT) and twenty-one in the control group (CON) were evaluated. The average time of use of the checklist (CU) in the INT was 6.32 min (2.39–9.18 min; SD = 2.08 min). Mean PS of INT was significantly higher than CON, with a strong effect size ( p = 0.001, d = 0.935). In the INT, significantly more items were completed per minute of scenario duration (INT, 1.48 items/min; CON, 1.15 items/min, difference: 0.33/min (25%), p = 0.001), showing a large effect size ( d = 1.11). The workflow did not significantly differ between the groups ( p = 0.079), although a medium effect size was shown ( d = 0.563) with the tendency of the CON group deviating stronger from the ABCDE than the INT. Conclusion Checklists can have positive effects on outcome in the prehospital setting by significantly facilitates adherence to guidelines. Checklist use may be time-effective in the prehospital setting. Checklists based on the ‘ABCDE’ mnemonic can be used according to the ‘do verify’ approach. Team Time Outs are recommended to start and finish checklists.

INTRODUCTION:Since the beginning of the pandemic in spring 2020, inpatient healthcare has been under enormous burden, which is reflected especially in overworked staff, imprecise bed planning and/or data transfer. According to the recommendation of the Science Council, university clinics should play a controlling role in regional healthcare and act in conjunction with surrounding hospitals and practices. METHODS:In September 2021, 31 representatives from 18 university hospitals were invited to a hybrid Delphi study with a total of 4 survey rounds to discuss criteria for effective inpatient care in a pandemic situation, which were extracted from previous expert interviews. Criteria that were classified as very important/relevant by≥75% of the participants in the first round of the survey (consensus definition) were then further summarized in 4 different small groups. In a third Delphi round, all participants came together again to discuss the results of the small group discussions. Subsequently, these were prioritized as Optional ("can"), Desirable ("should") or Necessary ("must") recommendations. RESULTS:Of the invited clinical experts, 21 (67.7%) participated in at least one Delphi round. In an online survey (1st Delphi round), 233 criteria were agreed upon and reduced to 84 criteria for future pandemic management in four thematic small group discussions (2nd Delphi round) and divided into the small groups as follows: "Crisis Management and Crisis Plans" (n=20), "Human Resources Management and Internal Communication" (n=16), "Regional Integration and External Communication" (n=24) and "Capacity Management and Case & Care" (n=24). In the following group discussion (3rd Delphi round), the criteria were further modified and agreed upon by the experts, so that in the end result, there were 23 essential requirements and recommendations for effective inpatient care in a pandemic situation. CONCLUSION:The results draw attention to key demands of clinical representatives, for example, comprehensive digitization, standardization of processes and better (supra) regional networking in order to be able to guarantee needs-based care even under pandemic conditions. The present consensus recommendations can serve as guidelines for future pandemic management in the inpatient care sector.

Abstract Background Not all patients who call the ambulance service are subsequently transported to hospital. In 2018, a quarter of deployments of an emergency ambulance in Bavaria were not followed by patient transport. This study describes factors that influence patient transport rates. Method This is a retrospective cross-sectional study based on data from all Integrated Dispatch Centres of the Free State of Bavaria in 2018. Included were ambulance deployments without emergency physician involvement, which were subdivided into ambulance deployments without transport and ambulance deployments with transport. The proportion of transported patients were determined for the primary reasons for deployment and for the different community types. On-scene time was compared for calls with and without patient transport. Differences were tested for statistical significance using Chi2 tests and the odds ratio was calculated to determine differences between groups. Results Of 510,145 deployments, 147,621 (28.9%) could be classified as ambulance deployments without transport and 362,524 (71.1%) as ambulance deployments with transport.The lowest proportion of patients transported was found for activations where the fire brigade was involved (“fire alarm system” 0.6%, “fire with emergency medical services” 5.4%) and “personal emergency response system active alarm” (18.6%). The highest transport rates were observed for emergencies involving “childbirth/delivery” (96.9%) and “trauma” (83.2%). A lower proportion of patients is transported in large cities as compared to smaller cities or rural communities; in large cities, the odds ratio for emergencies without transport is 2.02 [95% confidence interval 1.98–2.06] referenced to rural communites. The median on-scene time for emergencies without transport was 20.8 min (n = 141,052) as compared to 16.5 min for emergencies with transport (n = 362,524). The shortest on-scene times for emergencies without transport were identified for activations related to “fire alarm system” (9.0 min) and “personal emergency response system active alarm” (10.6 min). Conclusion This study indicates that the proportion of patients transported depends on the reason for deployment and whether the emergency location is urban or rural. Particularly low transport rates are found if an ambulance was dispatched in connection with a fire department operation or a personal emergency medical alert button was activated. The on-scene-time of the rescue vehicle is increased for deployments without transport. The study could not provide a rationale for this and further research is needed. Trial registration This paper is part of the study “Rettungswageneinsatz ohne Transport” [“Ambulance deployment without transport”] (RoT), which was registered in the German Register of Clinical Studies under the number DRKS00017758.

BACKGROUND:To date, no detailed analysis of pediatric emergencies treated in emergency departments (ED) exists. However, in the context of capacity planning and upcoming emergency care reform in Germany, these data are urgently needed. METHODS:Retrospective, multicenter cross-sectional study for the period 01 July 2013 to 01 June 2014 of pediatric cases in emergency departments in Munich. RESULTS:A total of 103,830 cases were analyzed (age: 6.9 ± 5.4 years, boys/girls 55%/45%). A total of 85.9% of cases were treated as outpatients, 12.4% (9.6 per 100,000 children) were admitted to normal and 1.7% (1.0 per 100,000 children) to intensive care. However, the real bed requirements exceeded these guideline numbers, with an absolute requirement of 4.9 ICU beds and 35.1 normal ward beds per day. Load peaks were seen on Wednesday and Friday afternoons and on weekends. Every 8th patient who presented to an ED as a self-referral was treated as an inpatient. CONCLUSION:Capacity planning for inpatient emergency care of pediatric patients requires planning for more beds than can be expected on a population basis. The availability of panel physician care influences patient volume in the EDs. Initial medical assessment tools for treatment need and urgency are needed to distribute patients. The pediatric emergency centers planned as part of the current reform of emergency care must be adequately staffed and financed in order to be able to handle-in close cooperation with statutory health insurance-accredited medical care-the expected demand for care.

Schmerzen sind ein häufiger Behandlungsgrund in der prähospitalen Notfallmedizin. In Bayern delegieren die Ärztlichen Leiter Rettungsdienst (ÄLRD) bei subjektiv nichttolerablen Schmerzen nach isoliertem Extremitätentrauma an Notfallsanitäter (NotSan) landesweit einheitlich die Kurzinfusion von 7,5 mg des Opioidanalgetikums Piritramid. Die Routineeinsatzdokumentation aller Einsätze im bayerischen Rettungsdienst mit Heranziehungen des Delegationsalgorithmus „Isolierte Extremitätenverletzung“ der ÄLRD nach § 4 Abs. 2 Nr. 2c Notfallsanitätergesetz wurde über einen 2‑Jahres-Zeitraum ausgewertet. Evaluiert wurden der Effekt auf die Schmerzintensität nach der numerischen Rating-Skala (NRS) und dem Vorliegen nichttolerabler Schmerzen, Auswirkungen auf die Vitalfunktionen sowie die Notwendigkeit von bestimmten weitergehenden Interventionen. Bei 7151 identifizierten Einsätzen erfolgte in 6097 Fällen eine eigenständige Analgesie durch NotSan entlang der Delegation der ÄLRD. Die Schmerzintensität nach der NRS konnte von im Median 7 (Interquartilsabstand [IQR] 2) auf 3 (IQR 2, p < 0,001) gesenkt und in 96,9