BackgroundLaryngeal tube (LT) application by rescue personnel as an alternate airway during the early stages of out-of-hospital cardiac arrest (OHCA) is still subject of debate. We evaluated ease of handling and efficacy of ventilation administered by emergency medical technicians (EMTs) using LT and bag-valve-mask (BVM) during cardiopulmonary resuscitation of patients with OHCA.MethodsAn open prospective randomized multicenter study was conducted at six emergency medical services centers over 18 months. Patients in OHCA initially resuscitated by EMTs were enrolled. Ease of handling (LT insertion, tight seal) and efficacy of ventilation (chest rises visibly, no air leak) with LT and BVM were subjectively assessed by EMTs during pre-study training and by the attending emergency physician on the scene. Outcome and frequency of complications were compared.ResultsOf 97 eligible patients, 78 were enrolled. During pre-study training EMTs rated efficacy of ventilation with LT higher than with BVM (66.7% vs. 36.2%, p = 0.022), but efficacy of on-site ventilation did not differ between the two groups (71.4% vs. 58.5%, p = 0.686). Frequency of complications (11.4% vs. 19.5%, p = 0.961) did not differ between the two groups.ConclusionsEMTs preferred LT ventilation to BVM ventilation during pre-study training, but on-site there was no difference with regard to efficacy, ventilation safety, or outcome. The results indicate that LT ventilation by EMTs during OHCA is not superior to BVM and cannot substitute for BVM training. We assume that the main benefit of the LT is the provision of an alternative airway when BVM ventilation fails. Training in BVM ventilation remains paramount in EMT apprenticeship and cannot be substituted by LT ventilation.Trial registration ClinicalTrials.gov (NCT01718795).Electronic supplementary materialThe online version of this article (10.1186/s13049-017-0446-1) contains supplementary material, which is available to authorized users.
Patientenzufriedenheit in der präklinischen Notfallmedizin Entwicklung eines standardisierten FragebogensZur Messung der Patientenzufriedenheit wurden in der Vergangenheit unterschiedliche Ansätze etabliert, die von stark subjektiven, ereignisorientierten qualitativen Messmethoden [5] bis zu mehr oder weniger standardisierten Fragebögen reichen [10, 1, 4, 14, 18]. Qualitativ hochwertige Studien verweisen auf die Wichtigkeit der Einbeziehung von Patienten und von Experten bei der Erstellung eines Fragebogens. Standardisierte Fragebögen zur Erfassung der Patientenzufriedenheit in der präho-spitalen Notfallmedizin fehlen gänz-lich. Bereits die Erstellung einer allgemein gültigen Definition von Zufriedenheit erweist sich als schwierig [3, 2]. Aufgrund der Komplexität des Begriffs existieren weltweit zahlreiche Definitionsvorschläge. Die Internationale Organisation für Standardisierung (ISO) definiert Zufriedenheit als den "Grad der Übereinstimmung von Anforderungen und Erwartungen (der Kunden/Patienten) und ihrer Erfüllung" [20]. Zufriedenheit ist stark subjektiv besetzt (kognitive und affektive Erfahrungswerte), hängt aber auch von sozioökonomischen, demographischen oder kulturellen Werthaltungen und Vorgaben ab [21]. Primäres Ziel dieser Studie war es, einen standardisierten, psychometrisch geprüften und validierten Fragebogen zur Evaluierung der Patientenzufriedenheit in der prähospitalen Notfallmedizin zu entwickeln und an einem ersten Notarztstützpunkt einzusetzen. Die Bewertung der Qualität der notfallmedizinischen Versorgung galt als sekundäres Ziel.
Patient satisfaction in out-of-hospital physician-based EMS is generally high. There is room for improvement in areas such as the social skills of dispatchers and EMS-team members and the comfort of the patients during transport. A checklist should be developed for basic articles that patients should take along to hospital and for questions on responsibilities for children, dependent people or pets.
Der Einsatzcode "Allergie, kritisch, Atemnot" (RD-BO-ALLERG) wurde bereits während des Beobachtungszeitraums bei beginnender Insektenstichsaison zurückgenommen und wieder primär mit einem Notarztmittel alarmiert
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