Emergency doctor
An emergency physician is a doctor with an appropriate additional qualification, one with acute, life-threatening illness or injury of a patient with means of transport of the emergency medical service ( ambulance emergency vehicle , ambulance , rescue helicopters ) arrives in the shortest possible time to this and treated him preclinical (in front of a hospital stay). A range of medicines and equipment are available to him to be able to work on site. The emergency doctor works in a team with emergency paramedics or paramedics .
In Austria (especially in Tyrol and Carinthia) there is the organizational form of the emergency doctor task force in the established area, in which several established doctors jointly ensure emergency medical care in one area. These doctors are self-employed specialists or general practitioners with emergency doctor qualifications and appropriate equipment. They are not part of the rescue service and can be requested both directly and from the control centers if necessary.
Delineate these is the (funds) medical emergency ( general medical emergency service in Tyrol, doctors radio service or Ärztenotdienst in the rest of Austria, Switzerland and emergency doctor ) who is not part of the emergency services, but the general medical care outside normal surgery hours ensures. Emergency physicians are not required to have emergency medical training or equipment and may have little or no emergency medical experience.
Statistics for Germany
In Germany, 12 million rescue missions were carried out in 2012/2013: 147 missions per 1000 inhabitants per year. Half is an emergency, half an ambulance. An emergency doctor is called in in 2/5 of the emergencies. 8 million trips per year are carried out with special rights, these require an average of 2.5 minutes of disposition and alerting time, the first aid to arrive at the site needs an average of 8.4 minutes, 95% of all emergencies are reached within 16.9 minutes .
The emergency doctor with special rights needs less than 8 minutes in 25% of cases, less than 11 minutes in 50% of cases, 13 minutes in 75% of cases, less than 16 minutes in 75% of cases and 95% of the time, from the end of the call to the arrival on site Cases under 29 minutes.
On average, the emergency doctor stays on site for 22.3 minutes. An average of 13.3 minutes of transport time and 18.3 minutes of residence time at the transport destination follow. The emergency doctor's call takes an average of 55.7 minutes.
tasks
The tasks of the emergency doctor - in cooperation with other rescue specialists - are:
- the implementation of acute life-saving medical measures
- making the patient fit for transport
- relieving pain
- accompanying and monitoring the seriously injured or seriously ill patient during transport to a suitable hospital
- if necessary, the termination of the relief measures and / or the determination of death
- Issuing a death certificate (provisional or, if necessary, final, depending on the state law)
The emergency doctor is accompanied by specially trained rescue service personnel ( emergency paramedics / paramedics in Germany, emergency paramedics in Austria) and is authorized to issue medical instructions to these personnel.
Indications for use
If certain reporting pictures the dispatches rescue center in addition to the ambulance emergency room. These so-called indication catalogs differ locally in detail, but usually include (example: Emergency doctor indication catalog of the German Medical Association - as of February 22, 2013):
| Functions | Status | example |
|---|---|---|
| awareness | does not respond or does not respond adequately to (loud) speaking and shaking | Traumatic brain injury (TBI), stroke, poisoning, seizure, coma |
| breathing | No normal breathing, pronounced or increasing shortness of breath, respiratory failure | Asthma attack, pulmonary edema, aspiration |
| Cardiovascula | acute chest pain, pronounced or increasing circulatory insufficiency, circulatory arrest | Heart attack, angina pectoris, acute coronary syndrome (ACS), cardiac arrhythmias, hypertonic crisis, shock |
| Other damage affecting vital functions | severe injury, severe bleeding, severe acute pain, acute paralysis | Thoracic / abdominal trauma, TBI, major amputations, bleeding esophageal varices, burns, fractures with significant deformity, impaling injuries, poisoning, stroke |
| pain | acute severe and / or increasing pain | Trauma, heart attack, colic |
Emergency-related indication
- Serious traffic accident with information on injuries
- Other accident with seriously injured people
- Accident with children
- Fires / smoke gas development with reference to personal involvement
- Explosion accidents with reference to personal involvement
- Thermal or chemical accidents with reference to personal involvement
- Electricity or lightning accidents
- Drowning, diving, or ice break-in
- Entrapment or spillage
- Impending suicide
- Fall from height (≥ 3 m)
- Gunshot / stab / blow injuries in the head, neck or torso area
- Hostage-taking, amoklage or other crimes with immediate danger to human life
- Birth that is about to begin or has taken place
- Life-threatening poisoning
In principle, an emergency doctor can be requested at any time if the rescue team present considers this to be justified. This can be the case, for example, if the patient's condition deteriorates or if the situation is more critical than initially assumed or if measures reserved for doctors (e.g. the administration of prescription drugs ) are necessary for treatment .
development
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In emergency medicine, there was a growing awareness that important medical measures had to be taken on site in order to stabilize the patient for transport to the hospital and to enable optimal subsequent treatment. In June 1957 an ambulance was put into service for the first time in Cologne . Previously, in the same year, Heidelberg University put a mobile operating theater with medical staff into service for the first time. The first emergency doctor vehicle in Germany had been in use in Heidelberg since April 7, 1964 . It served as a model for nationwide first aid. Until then, it was customary to simply admit the patient and transport them to a hospital as quickly as possible, but largely without care. Groundbreaking in the interaction of medical and technical assistance was that of F. Holle, Rainer Fritz Lick and Heinrich Schläfer in 1966 with the support of Karl Seegerer (Chief Fire Director in Munich) and later also Ernst Kern (from September 1969 Director of the University Surgical Clinic and Polyclinic in Würzburg) First "Munich Emergency Doctor Service" launched.
In many countries, non-medical assistants with advanced training have been qualified for this, for example in the paramedic system in the USA or Great Britain . In Germany , Austria and some other European countries (including France ), however, the approach chosen was to deploy doctors directly on site. This development was partly accompanied by further tests, for example the deployment of a complete operations team (with bus and trailer for emergency power generator) in Heidelberg.
Studies on this subject are rare. The use of an emergency doctor often extends the transport time. Either the rescue service crew waits for the emergency doctor to arrive, or examinations are carried out by the emergency doctor, which must be repeated in the target clinic anyway. The use of telemedicine could help solve the problem. Switzerland is interesting in this context . While the canton of Glarus, for example , operates a pure paramedic system based on the ground, the neighboring cantons of canton Zurich and canton St. Gallen operate emergency doctor systems via the organizations Regio 144 and the St. Gallen rescue service . It must be remembered that the Canton Service ambulance in the form of Glarus on a shelf - Rescue helicopters -Stützpunktes Mollis has. But you can see that in Switzerland most emergencies are handled without an emergency doctor. An emergency doctor is only called out for every tenth mission in Switzerland, in Germany for 40% of the missions. For example, pain therapy is in the competence of the paramedic. Calling in an emergency doctor is not felt to be necessary. Medicines may be administered by the paramedic on their own responsibility, and not as part of an emergency competence .
Today, Germany has a tiered ambulance service concept that can respond to requirements with qualified non-medical forces (paramedics, paramedics, paramedics ) and emergency doctors depending on the type of emergency. In the Federal Association of Working Groups of Notärzte Deutschlands e. V. (BAND) meanwhile around 8000 emergency doctors are organized. The rescue service in Austria works in a similar way to the German system.
In the GDR , the emergency medical service was also known as Rapid Medical Help (SMH), derived from the Russian skoraja medizinskaja pomoschtsch .
education
Anyone who works as an emergency doctor must have special qualifications in addition to their medical training. In Germany, depending on the federal state, this is the emergency medical service certificate or the additional designation of emergency medicine . The additional training emergency medicine is in Germany to the most recently updated in January 2006 pattern CPE regulations of the German Medical Association a 2-year training in an area of inpatient care in a training officers ahead of them six months training in intensive care medicine , anesthesiology , or in the emergency room, in addition to participate in 80 Hours of course in general and special emergency treatment as well as under the guidance of a responsible emergency doctor 50 missions in the ambulance or rescue helicopter. The contents of these model further training regulations are implemented differently in the decisive further training regulations of the state medical associations .
In Austria, the cycle or the specialist training must be completed (i.e. the jus practicandi and thus the permission to practice independently) and a special emergency doctor training must be completed.
The training to become an emergency doctor should not be confused with the specialist in emergency medicine required by the German Society for Interdisciplinary Emergency and Acute Medicine (DGINA) . This specialist training, for which there is now a European curriculum, is intended to enable people to work in an interdisciplinary emergency room. Whether - and if so, when - such a specialist will be introduced in Germany is currently not foreseeable.
In Switzerland , working as a ground-based emergency doctor is always linked to working in a clinic; Full-time emergency doctors can only be found at REGA (air rescue). However, these are mostly doctors who leave the clinic for 1–2 years and during this time work exclusively for air rescue before continuing to work in a hospital. Ground-based emergency doctors usually work in a clinic, usually as assistant doctors in anesthesiology or (less often) internal medicine, surgery or pediatrics. Resident doctors in anesthesiology usually become active as emergency doctors from their third year of assistance (rarely, in rural areas, but also after a few months of assistance). At large hospitals there is a REGA rotation position for experienced assistant / emergency physicians for around 6 months, during which they work full-time for air rescue. As soon as the assistant doctor completes his training period, usually five to seven years, with the specialist examination, he is usually promoted to senior physician and from then on only does emergency medical services in exceptional cases (e.g. as chief emergency doctor of an ambulance service).
To recognize emergency medical skills, there is a “SGNOR emergency doctor qualification certificate” in Switzerland, which is issued by the Swiss Society for Emergency and Rescue Medicine. In order to obtain this additional recognition (which is not mandatory for working as an emergency doctor), work in internal medicine (or pediatrics or surgery), anesthesiology and intensive care unit, 50 NACA> = 4 missions (if not accompanied by another doctor), as well as Passing the emergency doctor course (carried out by SGNOR), the ACLS and PALS course is a condition.
Special forms
Medical director of the rescue service
The Medical Director of the Rescue Service (ÄLRD) is medically and organizationally responsible for the concerns of the rescue service in his area, e.g. B. for the definition of the medical equipment (medication etc.), for the training / further education of the staff and for the monitoring of the standards to be observed. The ÄLRD is usually active as an emergency doctor itself.
Head emergency doctor
The emergency doctor in charge (LNA) is deployed as a medical head of operations / specialist advisor in accordance with the law (depending on the federal state) for large-scale operations and disasters . He is then authorized to give instructions to the medical personnel and other doctors and must organize the on-site operation from a medical point of view. In exceptional cases, the chief emergency doctor can also be alerted in precarious medical situations without a major incident being present. As a rule, however, the chief emergency physician does not take part in immediate patient care. In many federal states he is deployed together with the organizational head of the rescue service (OrgL) , who organizes the deployment from a tactical point of view.
Transfer doctor
The transfer doctor in Bavaria is a doctor deployed on a transfer doctor vehicle in accordance with Art. 43 (5) BayRDG for patient transports with ambulances accompanied by a doctor. The prerequisite is the qualification certificate for the emergency medical service or the additional qualification in emergency medicine. The Bavarian State Medical Association may require additional qualifications. However, it has not yet made use of this right.
Pediatrician
In some large cities there are specially qualified emergency teams for child rescue operations. In Munich, the four clinics specializing in paediatrics keep a pediatrician with additional emergency doctor qualification on standby. The pediatric ambulance vehicle is parked in front of the clinic on duty.
There are also newborn emergency doctors who are used to transport newborns. The Society for Neonatology and Pediatric Intensive Care Medicine offers further training for doctors.
Web links
- Catalog of indications for use by an emergency doctor. Federal Medical Association
Individual evidence
- ↑ Services of the rescue service 2012/2013 . In: Reports of the Federal Highway Research Institute , Booklet M 260
- ↑ 50 years of ambulance . Mirror online
- ↑ The ambulance celebrates its 50th anniversary . Mirror online
- ↑ University Clinic Heidelberg: Emergency medical activity
- ^ Rainer F. Lick, Heinrich Schläfer: Accident rescue. Medicine and technology . Schattauer, Stuttgart / New York 1973, ISBN 978-3-7945-0326-1 ; 2nd, revised and expanded edition, ibid 1985, ISBN 3-7945-0626-X , pp. V and VII f.
- ↑ Christian Katzenmeier, Stefania Schrag-Slavu, legal issues of the use of telemedicine in the rescue service, page 163
- ^ REGA base Mollis - base in Glarnerland
- ↑ Newsroom Canton Glarus: Canton Glarus and Rega regulate rescue from the air
- ↑ Regio 144: Regio 144 AG not only operates an ambulance service, but has also been an emergency doctor since it was founded.
- ↑ Extra-hospital activities on site include rescuing people and medical activities such as ventilation, defibrillation, giving infusions, medication and cardiac massages.
- ↑ Kantonsspital St. Gallen Dipl. Paramedic HF
- ↑ Gesundheitsberufe.ch Paramedic HF
- ^ Federal Association of Working Groups of Notärzte Deutschlands BAND e. V. ( Memento from July 31, 2007 in the Internet Archive )
- ↑ Andreas Staufer: Law: Emergency doctor on the side? What then needs to be considered! In: Deutsches Ärzteblatt . No. 13 , March 2018, p. 4–5 ( aerzteblatt.de [accessed June 11, 2018]).
- ↑ Andreas Staufer, Dominik Mittelhammer: The transfer doctor in Bavaria . In: Emergency + Rescue Medicine . tape 14 , no. 4 , May 2011, ISSN 1434-6222 , p. 291-296 , doi : 10.1007 / s10049-010-1384-x .
- ^ Society for Neonatology and Pediatric Intensive Care Medicine (PDF; 743 kB)