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Incidence of invasive medical procedures in emergency medical services. Considerations regarding emergency paramedics
No full textThe 'Notfallsanitater' is a new paramedic-based profession to be introduced into the German emergency medical service. This article discusses the invasive medical procedures to be performed by the 'Notfallsanitater' considering the indications and incidence of these procedures. The incidence of invasive procedures within the district of Gottingen over a time period of 12 months was evaluated analyzing all medical databases used for electronic record keeping of medical emergencies, e.g. EPen, DIVIDOK-Online for the year 2013. A total of 23,118 emergencies where evaluated. In 28 % (n = 6400) of the cases 1 of 32 emergency physicians was called in. The incidence of invasive procedures, considering only the emergency physician-based emergencies, ranged from 76 % (n = 4053) for establishing an i.v. access line to 0.06 % for staunching severe hemorrhage. In 5.8 % (n = 309) of cases the airway was invasively secured and 3,1 % (n = 166) of the patients received non-invasive ventilation. An intraosseous cannulation or a needle thoracostomy was performed each in 0.3 % (n = 16) of cases. In 0.15 % (n = 8) treatment with an external pacemaker was started. In over 90 % of the cases the first ambulance arrived on the scene in less than 10 min. Emergency physicians, if called, arrived at the scene in less than 15 min in over 90 % of the cases. The procedures differ substantially with respect to the incidence, invasiveness and the potential to treat life-threatening conditions. Learning and retention of skills can be assumed only for some invasive procedures. Thus, the catalogue of procedures should be carefully reviewed in order to adapt it to current developments in emergency medicine
Grenzen der Substitution ärztlicher Leistungen durch nichtärztliches Rettungsdienstpersonal : Eine systematische Literaturrecherche zum Erfolg der präklinischen endotrachealen Intubation durch nichtärztliches Rettungsdienstpersonal und Notärzte
No full textZusammenfassung
Hintergrund
Die Regierungskommission für eine moderne und bedarfsgerechte Krankenhausversorgung hat in ihrer neunten Stellungnahme eine weitgehende Substitution des Notarztdiensts durch nichtärztliches Rettungsdienstpersonal empfohlen. Insbesondere bei hochinvasiven, potenziell lebensrettenden Maßnahmen stellt sich die Frage, inwieweit eine Substitution durch nichtärztliches Rettungsdienstpersonal möglich ist. Um dies zu evaluieren, führten wir eine systematische Literaturrecherche zur endotrachealen Intubation durch Notärzte und nichtärztliches Rettungsdienstpersonal durch und verglichen die Ergebnisse miteinander.
Methode
Wir führten eine systematische Literaturrecherche in pubmed.gov (National Center for Biotechnology Information, U.S. National Library of Medicine, Rockville Pike, Bethesda, MD, USA) zu „first pass success“, Gesamterfolgsrate und unerkannten ösophagealen Fehlintubationen von präklinischen endotrachealen Intubationen durch nichtärztliches Rettungsdienstpersonal und Notärzte durch. Suchworte waren „prehospital“ und „intubation“ und „success“. Eingeschlossen wurden prospektive und retrospektive Studien, deren Daten aus dem gleichen Rettungsdienstsystem stammten. Die Ergebnisse wurden narrativ ausgewertet.
Ergebnisse
Wir erhielten insgesamt 523 Ergebnisse, von denen 8 Studien die Einschlusskriterien erfüllten. Auch in grundsätzlich Paramedic-basierten Rettungsdienstsystemen werden Notärzte eingesetzt, wie 7 der eingeschlossenen Studien zeigen. Notarztgeführte Rettungsmittel hatten einen hohen Intubationserfolg, auch wenn die Intubation durch nichtärztliches Rettungsdienstpersonal erfolgte. Der Intubationserfolg von nicht notarztgeführten Rettungsmitteln war deutlich schlechter. Die Qualifikation des eingesetzten notärztlichen Personals hatte einen deutlichen Einfluss auf den Intubationserfolg in den untersuchten Studien.
Schlussfolgerung
Hochinvasive Maßnahmen, wie z. B. die endotracheale Intubation, benötigen eine entsprechende Expertise. Eine Substitution dieser Maßnahmen durch Notfallsanitäter ist problematisch. Es wird daher auch weiterhin eine hohe Anzahl bodengebundener Notärzte nötig sein. Anforderungen an die Qualifikation des eingesetzten notärztlichen Personals sollten erhöht werden.
Graphic abstractAbstract
Background
In their ninth statement, the government commission on modern and need-based hospital care endorsed extensive replacement of prehospital emergency physician’s attendance in emergency medical services by paramedics. However, in highly invasive and potentially life-saving procedures, it seems questionable to what extent these can be performed satisfactorily by paramedics. We performed a systematic literature review on prehospital endotracheal intubation by paramedics and prehospital emergency physicians and compared the results in order to evaluate this question.
Methods
We performed a systematic literature review on pubmed.gov (National Center for Biotechnology Information, U.S. National Library of Medicine, Rockville Pike, Bethesda MD, USA) regarding first pass success, overall success and unrecognized oesophageal intubations by paramedics and prehospital emergency physicians. We used the keywords “prehospital”, “intubation” and “success”. We included prospective and retrospective studies that provided data from the same emergency medical service systems. The results were displayed in a table and a narrative synthesis of the results was used.
Results
A total of 523 publications were identified, of which 8 studies were included for further investigation. Even in paramedic-based emergency medical service systems, prehospital emergency physicians are often an integrated part of regular response, as 7 of the 8 enclosed studies demonstrate. Emergency physician-led teams had a higher success rate for intubation, even when intubation was performed by the paramedic. Intubation success rates of non-emergency-physician-led teams was poor. The qualification of the emergency physicians had a high impact on intubation success rates in the investigated studies.
Conclusion
Highly invasive procedures, like endotracheal intubation, need sufficient expertise. Performance of these procedures by paramedics is therefore likely problematic. Involvement of ground-based prehospital emergency physicians will therefore still be needed in the future. The qualifications required for prehospital emergency physicians should be raised to meet the demands.Zusammenfassung
Hintergrund
Die Regierungskommission für eine moderne und bedarfsgerechte Krankenhausversorgung hat in ihrer neunten Stellungnahme eine weitgehende Substitution des Notarztdiensts durch nichtärztliches Rettungsdienstpersonal empfohlen. Insbesondere bei hochinvasiven, potenziell lebensrettenden Maßnahmen stellt sich die Frage, inwieweit eine Substitution durch nichtärztliches Rettungsdienstpersonal möglich ist. Um dies zu evaluieren, führten wir eine systematische Literaturrecherche zur endotrachealen Intubation durch Notärzte und nichtärztliches Rettungsdienstpersonal durch und verglichen die Ergebnisse miteinander.
Methode
Wir führten eine systematische Literaturrecherche in pubmed.gov (National Center for Biotechnology Information, U.S. National Library of Medicine, Rockville Pike, Bethesda, MD, USA) zu „first pass success“, Gesamterfolgsrate und unerkannten ösophagealen Fehlintubationen von präklinischen endotrachealen Intubationen durch nichtärztliches Rettungsdienstpersonal und Notärzte durch. Suchworte waren „prehospital“ und „intubation“ und „success“. Eingeschlossen wurden prospektive und retrospektive Studien, deren Daten aus dem gleichen Rettungsdienstsystem stammten. Die Ergebnisse wurden narrativ ausgewertet.
Ergebnisse
Wir erhielten insgesamt 523 Ergebnisse, von denen 8 Studien die Einschlusskriterien erfüllten. Auch in grundsätzlich Paramedic-basierten Rettungsdienstsystemen werden Notärzte eingesetzt, wie 7 der eingeschlossenen Studien zeigen. Notarztgeführte Rettungsmittel hatten einen hohen Intubationserfolg, auch wenn die Intubation durch nichtärztliches Rettungsdienstpersonal erfolgte. Der Intubationserfolg von nicht notarztgeführten Rettungsmitteln war deutlich schlechter. Die Qualifikation des eingesetzten notärztlichen Personals hatte einen deutlichen Einfluss auf den Intubationserfolg in den untersuchten Studien.
Schlussfolgerung
Hochinvasive Maßnahmen, wie z. B. die endotracheale Intubation, benötigen eine entsprechende Expertise. Eine Substitution dieser Maßnahmen durch Notfallsanitäter ist problematisch. Es wird daher auch weiterhin eine hohe Anzahl bodengebundener Notärzte nötig sein. Anforderungen an die Qualifikation des eingesetzten notärztlichen Personals sollten erhöht werden.
Graphic abstractAbstract
Background
In their ninth statement, the government commission on modern and need-based hospital care endorsed extensive replacement of prehospital emergency physician’s attendance in emergency medical services by paramedics. However, in highly invasive and potentially life-saving procedures, it seems questionable to what extent these can be performed satisfactorily by paramedics. We performed a systematic literature review on prehospital endotracheal intubation by paramedics and prehospital emergency physicians and compared the results in order to evaluate this question.
Methods
We performed a systematic literature review on pubmed.gov (National Center for Biotechnology Information, U.S. National Library of Medicine, Rockville Pike, Bethesda MD, USA) regarding first pass success, overall success and unrecognized oesophageal intubations by paramedics and prehospital emergency physicians. We used the keywords “prehospital”, “intubation” and “success”. We included prospective and retrospective studies that provided data from the same emergency medical service systems. The results were displayed in a table and a narrative synthesis of the results was used.
Results
A total of 523 publications were identified, of which 8 studies were included for further investigation. Even in paramedic-based emergency medical service systems, prehospital emergency physicians are often an integrated part of regular response, as 7 of the 8 enclosed studies demonstrate. Emergency physician-led teams had a higher success rate for intubation, even when intubation was performed by the paramedic. Intubation success rates of non-emergency-physician-led teams was poor. The qualification of the emergency physicians had a high impact on intubation success rates in the investigated studies.
Conclusion
Highly invasive procedures, like endotracheal intubation, need sufficient expertise. Performance of these procedures by paramedics is therefore likely problematic. Involvement of ground-based prehospital emergency physicians will therefore still be needed in the future. The qualifications required for prehospital emergency physicians should be raised to meet the demands
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Perioperative Infusionstherapie im Kindesalter : Eignen sich Infusionssysteme mit Laufratenbeschränkung für die Kinderanästhesie?
No full text- …
