Differences in training among prehospital emergency physicians in Germany

Bollinger, Matthias; Mathee, C; Shapeton, Alexander D.; Thal, Serge C.; Russo, Sebastian G.

doi:10.1007/s10049-022-01021-z

Cited by 5 publications

(2 citation statements)

References 28 publications

(25 reference statements)

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“…paramedic system, where metaphorical models grounded in philosophical underpinnings delineate two novel subsystems: the professionally autonomous and the directive paramedic systems, with the latter further divided into rescue and hospital-managed submodels (75). In spite of this relative homogenous subdivision into the English-speaking world, inside the same system, the training could be different leading to various skills (76).…”

Section: Emergency Sta Trainingmentioning

confidence: 99%

Scoop and treat: from an historical controversy to the emergency future

Lansiaux,

Cozzi,

Wacht

et al. 2024

Front. Disaster Emerg. Med.

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Within the intricate narrative of emergency medical services (EMS), there lies a rich and evolving history of innovation and strategy, a saga that weaves through the fabric of prehospital emergency care. At the heart of this narrative is a compelling dichotomy, often whimsically encapsulated as the “stay and play” vs. “scoop and run” philosophies. These seemingly polar approaches to emergency care represent a tapestry of diverse opinions and practices, each tailored to its unique environmental context, clinical demands, and the relative availability of prehospital and hospital resources. Our comprehensive review delves into the historical evolution of these notions, tracing their roots from the ancient world to the present day. We cast a particular focus on the French model of “prehospital medicalization” and the Anglophone “Scoop and Run” approach, exploring their distinct trajectories and influences. Additionally, we turn our gaze to the Israeli system, a unique hybrid shaped by the American prehospital framework yet distinctively molded by the region's enduring conflict. By drawing on an array of interviews, historical records, and scholarly discourse, this document presents an in-depth exploration of the development of prehospital emergency medicine and its pivotal role in contemporary healthcare. Through this investigation, we aim to elucidate the historical tensions surrounding these concepts, shedding light on their implications for the landscape of modern emergency medical services and the intricate web of factors that shape their organization.

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Section: Emergency Sta Trainingmentioning

confidence: 99%

Scoop and treat: from an historical controversy to the emergency future

Lansiaux,

Cozzi,

Wacht

et al. 2024

Front. Disaster Emerg. Med.

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“…2023;153:3533 the many potential confounders which can hardly be determined by means of a retrospective study. Finally, while the overall level of experience seems similar to some other settings [30], an important number of prehospital medical units are staffed with more-experienced physicians, and the generalisation to such systems should be done with caution.…”

Section: Original Articlementioning

confidence: 99%

Association between prehospital physician clinical experience and discharge at scene – retrospective cohort study

Betend,

Suppan,

Chan

et al. 2023

Swiss Med Wkly

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BACKGROUND: Clinical experience has been shown to affect many patient-related outcomes but its impact in the prehospital setting has been little studied. OBJECTIVES:To determine whether rates of discharge at scene, handover to paramedics and supervision are associated with clinical experience. DESIGN, SETTINGS AND PARTICIPANTS: A retrospective study, performed on all prehospital interventions carried out by physicians working in a mobile medical unit (“service mobile d’urgence et de réanimationˮ [SMUR]) at Geneva University Hospitals between 1 January 2010 and 31 December 2019. The main exclusion criteria were phone consultations and major incidents with multiple casualties. EXPOSURE:The exposure was the clinical experience of the prehospital physician at the time of the intervention, in number of years since graduation. OUTCOME MEASURES AND ANALYSIS: The main outcome was the rate of discharge at scene. Secondary outcomes were the rate of handover to paramedics and the need for senior supervision. Outcomes were tabulated and multilevel logistic regression was performed to take into account the cluster effect of physicians. RESULTS: In total, 48,368 adult patients were included in the analysis. The interventions were performed by 219 different physicians, most of whom were male (53.9%) and had graduated in Switzerland (82.7%). At the time of intervention, mean (standard deviation [SD]) level of experience was 5.2 (3.3) years and the median was 4.6 (interquartile range [IQR]: 3.4–6.0). The overall discharge at scene rate was 7.8% with no association between clinical experience and discharge at scene rate. Greater experience was associated with a higher rate of handover to paramedics (adjusted odds ratio [aOR]: 1.17, 95% confidence interval [CI]: 1.13–1.21) and less supervision (aOR: 0.85, 95% CI: 0.82–0.88). CONCLUSION: In this retrospective study, there was no association between level of experience and overall rate of discharge at scene. However, greater clinical experience was associated with higher rates of handover to paramedics and less supervision.

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Grenzen der Substitution ärztlicher Leistungen durch nichtärztliches Rettungsdienstpersonal

Bollinger,

Russo

2023

Notfall Rettungsmed

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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 abstract

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Differences in training among prehospital emergency physicians in Germany

Cited by 5 publications

References 28 publications

Scoop and treat: from an historical controversy to the emergency future

Scoop and treat: from an historical controversy to the emergency future

Association between prehospital physician clinical experience and discharge at scene – retrospective cohort study

Grenzen der Substitution ärztlicher Leistungen durch nichtärztliches Rettungsdienstpersonal

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