ABSTRACT
BACKGROUND: Airway management with supraglottic airway devices (SGA) in life-threatening emergencies in children is increasingly being used. Different specifications of laryngeal masks (LM) and the laryngeal tube (LT) are commonly used devices for this purpose. We present a literature review and interdisciplinary consensus statement of different societies on the use of SGA in pediatric emergency medicine. MATERIAL AND METHODS: Literature review in the PubMed database and classification of studies according to the criteria of the Oxford Centre for Evidence-based Medicine. Levels and consensus finding within the group of authors. RESULTS: The evidence for successful applications of the various types of LM is significantly higher than for LT application. Reported smaller series of successful applications of LT are currently limited to selected research groups and centers. Especially for children below 10â¯kg body weight there currently exists insufficient evidence for the successful application of the LT and therefore its routine use cannot be recommended. SGAs used for emergencies should have a gastric drainage possibility. DISCUSSION: Considering the scientific data and the large clinical experience with the LM in medical routine and emergency situations in children currently only the LM can be recommended for alternative (i.e., non-intubation) emergency airway management in children. If alternative airway management is part of a local emergency strategy, the LM should be provided in all pediatric sizes (1, 1½, 2, 2½, 3) for out of hospital use and in hospital emergency use and all users should regularly be trained in its application.
Subject(s)
Anesthesia , Anesthesiology , Emergency Medical Services , Emergency Medicine , Laryngeal Masks , Neonatology , Pediatric Emergency Medicine , Physician Executives , Child , Humans , Intubation, Intratracheal , Emergencies , Universities , Airway Management , Critical Care , GermanyABSTRACT
BACKGROUND: In 2016 the first German recommendation for the preclinical use of tourniquets was published. Currently little is known of the frequency of the use of tourniquets in the prehospital setting in Germany. This study evaluated how often a tourniquet is used in a civilian German Helicopter Emergency Medical Service (HEMS). METHOD: After the approval of the scientific working group of the DRF Luftrettung HEMS, the electronic database (HEMSDER) of the DRF Luftrettung HEMS was analyzed for the period 2015-2020 under the abovementioned question. All patients with a tourniquet application were included in the study and a comparison was made with the total trauma cohort and a subgroup analysis between patients who additionally required airway management and patients without additional airway management in the cohort of tourniquet patients. The analysis was mainly descriptive. Parametric test (t-tests and χ2-tests) were used for group comparison. RESULTS: During the study period 67,321 trauma patients were treated and in 866 (1.3% of all trauma patients) a tourniquet was used. The mean age of these patients was 45.9 years (±19.5 years), 710 (84%) were male, 439 (51%) suffered a monotrauma, 296 (34%) suffered multiple trauma, 339 (38%) required a prehospital airway management and 321 (37%) of these were intubated. Significant differences between patients with tourniquet application and the rest of the trauma cohort were detected in general data (monotrauma, polytrauma and high-speed trauma, massive bleeding), vital signs at the scene of the accident (GCS, HF, SpO2) and necessary interventions, such as pressure bandages and use of hemostyptics, tranexamic acid, analgesia, the frequency of intubation and colloidal volume replacement. Due to limitations of the data set we could not obtain information regarding the limb used for the tourniquet, whether a conversion of the tourniquet was carried out and if the tourniquet was used according to the current German trauma guidelines. CONCLUSION: With a frequency of 1.3% the need for a prehospital tourniquet application is low in civilian trauma patients. Monotrauma with isolated extremity injuries represent about half of the patients treated with tourniquets. The other half is represented by multiple injuries or multiple trauma patients who require significantly more invasive measures, such as airway management and more complex on-scene interventions are needed. The available data do not allow any conclusions to be drawn about the location and the quality of the tourniquet application. Future documentation systems should incorporate data on the use of tourniquets, such as the location of use, indications (tactical use/massive bleeding), bleeding control achieved (yes/no) or second tourniquet necessary, conversion (yes/no) and any obvious complications.
Subject(s)
Emergency Medical Services , Multiple Trauma , Tourniquets , Aircraft , Hemorrhage/epidemiology , Hemorrhage/etiology , Hemorrhage/therapy , Humans , Male , Middle Aged , Multiple Trauma/etiology , Multiple Trauma/therapy , Retrospective StudiesABSTRACT
Adequate analgesia is one of the most important measures of emergency care in addition to treatment of vital function disorders and, if indicated, should be promptly undertaken; however, a large proportion of emergency patients receive no or only inadequate pain therapy. The numeric rating scale (NRS) is recommended for pain assessment but is not applicable to every group of patients; therefore, vital signs and body language should be included in the assessment. Pain therapy should reduce the NPRS to <5 points. Ketamine and fentanyl, which have an especially rapid onset of action, and also morphine are suitable for analgesia in spontaneously breathing patients. Basic prerequisites for safe and effective analgesia by healthcare professionals are the use of adequate monitoring, the provision of well-defined emergency equipment, and the mastery of emergency procedures. In a structured competence system, paramedics and nursing personnel can perform safe and effective analgesia.
Subject(s)
Analgesia/methods , Emergency Medicine/methods , Pain/drug therapy , Wounds and Injuries , Emergency Medical Services/methods , Fentanyl , Humans , Ketamine , Pain Management/methods , Pain MeasurementABSTRACT
This article presents the German Armed Forces Strategic Aeromedical Evacuation system. The following factors are described in detail: the path of alert, the used aircrafts, the medical equipment, the medical care personnel with its associated training as well as the aeronautical and medical issues. This military system for long haul intensive care transport offers many medical possibilities in critical care repatriations from deployment areas, as well as disaster relief missions. It has been successfully proven in numerous military and civil operations and continues to have high recognition among all military allies until today. Different priorities and readiness levels build the base for flexible use of various aircraft types and associated personnel, so that almost every scenario can be covered. The ever-changing tasks and needs of the German armed forces require constant adjustment of this air transport system. For the specialist nurse the intensive care of a patient during air transport is a technical and physical challenge.
Subject(s)
Air Ambulances , Critical Care , Military Personnel , Nurses , Transportation , Aircraft , Humans , Transportation of PatientsABSTRACT
BACKGROUND: In Germany more than 110,000 helicopter emergency medical service (HEMS) missions are carried out annually. A considerable number of patients are ventilated during the flight. So far, structured surveys with respect to the ground transport from the helipad to the hospital facility and handover of ventilated patients in the emergency room (ER) are not available in the German-speaking HEMS system. The handover of ventilated HEMS patients in the ER (HOVER I study) explored the use of the helicopter ventilator and medical equipment during the transport from the hospital landing site to the ER. METHOD: After approval by the HEMS operators, emergency medical doctors and HEMS technical crew members (HEMS-TC) of 145 German-speaking HEMS bases were invited to participate in an anonymous online survey (period: 1 February 2018-1 March 2018). Each participant was only allowed to submit the survey once. RESULTS: Data of 569 participants were completely analyzed, with responses from 429 emergency physicians and 140 HEMS-TC (75% from Germany, 13% Switzerland, 11% Austria, 1% Italy and Luxembourg). The most frequent type of aircraft used was the Eurocopter (EC)/Airbus helicopter (H) 135 (60.5%) followed by the EC/H 145 (33%). The majority of the respondents (53%) principally used the helicopter ventilator machine for patient transport from the helipad to the ER, 38% used it depending on the circumstances and 7% never used it. Of the participants 52% always took the emergency backpack for patient transport to the ER, 43% depending on the situation and 5% never took it along. The availability of oxygen or a ventilator at the helipad was considered to be helpful (59% and 45%, respectively), obligatory (25% and 14%, respectively) but was also considered unnecessary by some participants (16% and 40%, respectively). The collection of the HEMS team by a hospital team at the helipad was rated as helpful (64%) or mandatory (19%), 12% considered it to be unimportant and 5% even disturbing. For most respondents (58.5%) the responsibility for the patient ended after a structured handover on reaching the internal hospital target area (e.g. the ER). CONCLUSION: The management of the handover of ventilated emergency patients in German-speaking HEMS is heterogeneously structured. Only approximately 50% of the participants frequently carried the helicopter ventilator and emergency equipment during patient transport to the ER. Depending on the situation, more than 90% of the respondents used the helicopter ventilator and emergency backpack during the transport. The collection of the HEMS team by a hospital team at the helipad was appreciated by the majority of participants. The use of the helicopter ventilator for patient transport to the ER needs to be explored in future studies. The study was registered at the Research Registry ( www.researchregistry.com ) under the following number: researchregistry2925.
Subject(s)
Air Ambulances/statistics & numerical data , Emergency Medical Services/statistics & numerical data , Intubation, Intratracheal/statistics & numerical data , Patient Transfer/statistics & numerical data , Austria , Emergency Service, Hospital , Female , Germany , Humans , Male , Oxygen Inhalation Therapy/statistics & numerical data , Patient Transfer/methods , Surveys and Questionnaires , SwitzerlandABSTRACT
INTRODUCTION: The effectiveness of a tourniquet in the case of life-threatening hemorrhages of the extremities is well recognized and led to the recommendations on "Tourniquet" of the German Society of Anaesthesiology and Intensive Care (DGAI) in 2016. The aim of this systematic review was to re-evaluate the current medical literature in relation to the published DGAI recommendations. MATERIAL AND METHODS: Based on the analysis of all studies published from January 2015 until January 2018 in the PubMed databases, the publicized recommendations for action on "Tourniquet" of the DGAI were critically re-evaluated. For this purpose, 17 questions on 6 subjects were formulated in advance. The systematic review followed the PRISMA recommendations and is registered in PROSPERO (International prospective register of systematic reviews, Reg.-ID: CRD42018091528). RESULTS: Of the 284 studies identified with the keywords tourniquet and trauma in the period from January 2015 to January 2018 in PubMed, 50 original papers discussing the prehospital application of tourniquet for life-threatening hemorrhage of the extremities were included. The overall level of evidence is low. No article addressed any of the formulated questions with a prospective randomized interventional study. Scientific deductions could be found only in an indirect way in a descriptive manner. CONCLUSION: The 50 original articles included in this qualitative, systematic review revealed that the recommendations "Tourniquet" of the DGAI published in 2016 are mostly still up to date despite an inhomogeneous study situation. A deviation occurred in the conversion of a tourniquet but due to the short prehospital treatment time in the civilian setting this is of little importance; however, in the future a strict distinction should be made between tourniquets which were placed for tactical reasons and those placed as a medical necessity.
Subject(s)
Emergency Medical Services , Hemorrhage , Tourniquets , Extremities , Hemorrhage/therapy , Humans , Prospective StudiesABSTRACT
Hemorrhage is the single largest cause of avoidable death in trauma patients, whereby in civil emergency medicine in Europe most life-threatening hemorrhages occur in the abdomen and the pelvis. This is one reason why endovascular balloon occlusion of the aorta (EBOA), a procedure especially established in vascular surgery, is increasingly propagated for rapid bleeding control in these patients. This review article provides a comprehensive overview of the technique, indications, contraindications and complications of resuscitative endovascular balloon occlusion of the aorta (REBOA). Additionally, outcomes reported in in the currently available literature are summarized and discussed. From this practical and user-oriented consequences for future successful introduction of REBOA in the field of emergency medicine are deduced.
Subject(s)
Aorta/surgery , Balloon Occlusion/methods , Hemorrhage/therapy , Resuscitation/methods , Endovascular Procedures/methods , Humans , Injury Severity ScoreABSTRACT
The term "shock" refers to a life-threatening circulatory failure caused by an imbalance between the supply and demand of cellular oxygen. Hypovolemic shock is characterized by a reduction of intravascular volume and a subsequent reduction in preload. The body compensates the loss of volume by increasing the stroke volume, heart frequency, oxygen extraction rate, and later by an increased concentration of 2,3-diphosphoglycerate with a rightward shift of the oxygen dissociation curve. Hypovolemic hemorrhagic shock impairs the macrocirculation and microcirculation and therefore affects many organ systems (e.g. kidneys, endocrine system and endothelium). For further identification of a state of shock caused by bleeding, vital functions, coagulation tests and hematopoietic procedures are implemented. Every hospital should be in possession of a specific protocol for massive transfusions. The differentiated systemic treatment of bleeding consists of maintenance of an adequate homeostasis and the administration of blood products and coagulation factors.
Subject(s)
Shock, Hemorrhagic/therapy , Shock/therapy , Blood Transfusion , Coagulants/therapeutic use , Humans , Resuscitation , Shock/physiopathology , Shock, Hemorrhagic/physiopathologyABSTRACT
Severe bleeding is a typical result of traumatic injuries. Hemorrhage is responsible for almost 50% of deaths within the first 6 h after trauma. Appropriate bleeding control and coagulation therapy depends on an integrated concept of local hemostasis by primary pressure with the hands, compression, and tourniquets accompanied by prevention of hypothermia, acidosis and hypocalcemia. Additionally, permissive hypotension is accepted for suitable patients and tranexamic acid should be administered early. Multiple publications prove that prehospital transfusion of blood products (e. g. red blood cells and plasma) and coagulation factors (e. g. fibrinogen) is feasible and safe, but only required for <5% of polytrauma patients in the civilian setting.
Subject(s)
Emergency Medical Services/methods , Hemorrhage/therapy , Antifibrinolytic Agents/therapeutic use , Hemorrhage/etiology , Hemostasis , Humans , Wounds and Injuries/complications , Wounds and Injuries/therapyABSTRACT
BACKGROUND: The continuous monitoring of vital parameters and subsequent therapy belong to the core duties of anaesthetists during acute trauma resuscitation in the trauma room. Important procedures may include placement of arterial lines and central venous catheters (CVCs). Knowledge of indication, performance and localization of invasive catheterisation of trauma care in Germany is scarce. METHODS: After approval of the German Society of Anaesthesiology and Intensive Care Medicine we conducted an online survey about arterial and central venous catheterisation of severely injured patients with consideration of common practice used by anaesthetists in German trauma rooms. Data are presented in a descriptive manner. RESULTS: Of 843 hospitals invited for the survey, 72 (8.5%) had complete and valid data and were thus included in the analysis. Of these, 47% were supra-regional (level 1) trauma centres, 38% regional trauma centres and 15% local trauma centres. The annual mean injury severity score (ISS) of admitted patients to these hospitals was 21 ± 10. In the trauma room, the responding hospitals place CVCs (49%) and arterial lines (59%) only in haemodynamically unstable patients, whereas 24% (CVC) and 39% (arterial line) do when pathological laboratory tests were confirmed. Standard operating procedures (SOPs) merely exist for placement of either arterial lines (25%) or CVCs (22%) in multiple trauma resuscitation. The decision to perform CVC or arterial line placement is usually (79%) at the discretion of the attending anaesthetist. The preferred anatomical access site for CVCs is the right internal jugular vein (46%) and for arterial lines the radial artery (without side preference) (57%), respectively. Of the responding hospitals, 49% prefer landmark-guided CVC-puncture (91% of arterial lines) instead of 43% using sonographic guidance (9% of arterial lines). Intravascular electrocardiography monitoring for CVC tip detection is used by 36%. CONCLUSION: In Germany, medical indication and schedule of invasive vascular catheterisation of severely injured patients in the trauma room is rarely regulated by SOPs and often performed at the discretion of the attending trauma team. Sonographic assistance during vascular puncture and electrocardiography for CVC tip detection is not as common as in non-emergency anaesthesia. Further studies are required to explore the real necessity and safety of invasive vascular catheterisation in multiple trauma patients in order to improve trauma care.
Subject(s)
Anesthesia/methods , Vascular Access Devices , Wounds and Injuries/therapy , Anatomic Landmarks , Blood Pressure Determination , Catheterization, Central Venous/methods , Critical Care , Electrocardiography , Germany , Health Care Surveys , Humans , Resuscitation , Trauma Centers/statistics & numerical data , Ultrasonography, Interventional/statistics & numerical dataABSTRACT
BACKGROUND: As a part of the European Union Naval Force - Mediterranean Operation Sophia (EUNAVFOR Med), the Federal Republic of Germany is contributing to avoid further loss of lives at sea by supplying two naval vessels. In the study presented here we analyse the medical requirements of such rescue missions, as well as the potential benefits of various additional monitoring devices in identifying sick/injured refugees within the primary onboard medical assessment process. METHODS: Retrospective analysis of the data collected between May - September 2015 from a German Naval Force frigate. Initial data collection focused on the primary medical assessment and treatment process of refugees rescued from distress at sea. Descriptive statistics, uni- and multivariate analysis were performed. The study has received a positive vote from the Ethics Commission of the University of Ulm, Germany (request no. 284/15) and has been registered in the German Register of Clinical Studies (no. DRKS00009535). RESULTS: A total of 2656 refugees had been rescued. 16.9 % of them were classified as "medical treatment required" within the initial onboard medical assessment process. In addition to the clinical assessment by an emergency physician, pulse rate (PR), core body temperature (CBT) and oxygen saturation (SpO2) were evaluated. Sick/injured refugees displayed a statistically significant higher PR (114/min vs. 107/min; p < .001) and CBT (37.1 °C vs. 36.7 °C; p < .001). There was no statistically significant difference in SpO2-values. The same results were found for the subgroup of patients classified as "treatment at emergency hospital required". However, a much larger difference of the mean PR and CBT (35/min resp. 1.8 °C) was found when examining the subgroups of the corresponding refugee boats. A cut-off value of clinical importance could not be found. Predominant diagnoses have been dermatological diseases (55.4), followed by internal diseases (27.7) and trauma (12.1 %). None of the refugees classified as "healthy" within the primary medical assessment process changed to "medical treatment required" during further observation. CONCLUSIONS: The initial medical assessment by an emergency physician has proved successful. PR, CBT and SpO2 didn't have any clinical impact to improve the identification of sick/injured refugees within the primary onboard assessment process.
Subject(s)
Emergency Medical Services/methods , Health Status Disparities , Mental Disorders/therapy , Refugees , Registries , Relief Work/organization & administration , Adolescent , Adult , Aged , Child , Child, Preschool , Cross-Sectional Studies , Female , Germany/epidemiology , Humans , Infant , Male , Mediterranean Sea/ethnology , Mental Disorders/ethnology , Middle Aged , Retrospective Studies , Risk Factors , Socioeconomic Factors , Triage , Young AdultABSTRACT
BACKGROUND: Securing the airway is the top priority in trauma resuscitation. The most important factor for successful endotracheal intubation (ETI) is good visualization of the vocal cords. The aim of this study was to summarize the practical experiences with the C-MAC® video laryngoscope as initial device in out-of-hospital airway management of trauma patients. METHODS: The C-MAC® video laryngoscope uses standard Macintosh shaped laryngoscope blades. At the Helicopter Emergency Medical Service (HEMS) Christoph 22 it is used as the initial device for every out-of-hospital ETI. All prehospital data on ETI involving trauma patients were documented for a period of 17 months. RESULTS: A total of 116 out-of-hospital ETIs were enrolled in this study (overall success rate 100 %). In 88.8 % the first attempt was successful, whereas in 10.3 % a second and in 0.9 % a third ETI attempt was necessary. No patient required alternative airway devices or surgical airway interventions. The results of a subgroup with an immobilized cervical spine (n = 17) did not show any increased difficulties. CONCLUSION: The use of the C-MAC® video laryngoscope by experienced anesthesiologists in an out-of-hospital setting seems to be a safe method even in patients with an immobilized cervical spine. Adverse laryngoscopy results (C/L III and IV) were reduced compared to other studies.
Subject(s)
Emergency Medical Services/methods , Intubation, Intratracheal/instrumentation , Intubation, Intratracheal/statistics & numerical data , Laryngoscopes , Resuscitation/instrumentation , Wounds and Injuries/nursing , Adult , Equipment Design , Equipment Failure Analysis , Female , Humans , Laryngoscopes/statistics & numerical data , Male , Middle Aged , Resuscitation/methods , Treatment Outcome , Video-Assisted Surgery/instrumentation , Video-Assisted Surgery/methodsABSTRACT
Blast injuries may result from a variety of causes but the biomechanical impact and pathophysiological consequences do not differ between domestic or industrial accidents or even terrorist attacks. However, this differentiation relevantly affects the tactical procedures of the rescue teams. Focusing on further detonations, top priority is given to the personal safety of all rescue workers. The rareness of blast injuries in a civilian setting results in a lack of experience on the one hand but on the other hand the complexity of blast injuries to the human body places high demands on the knowledge and skills of the entire rescue team for competent treatment. The purpose of this article is to explain the physicochemical principles of explosions and to convey tactical and medical knowledge to emergency medical services.
Subject(s)
Blast Injuries/therapy , Emergency Medical Services , Head Injuries, Penetrating/therapy , Humans , Mass Casualty Incidents , TerrorismABSTRACT
BACKGROUND: Pre-hospital tracheal intubation (TI) is an important but difficult procedure with the potential to produce hypoxaemia. The aim of this study was to determine the incidence of desaturation episodes during out-of-hospital rapid sequence induction (RSI) and TI by the medical team of a German Helicopter Emergency Medical Service (HEMS). METHODS: We performed a prospective study at HEMS 'CHRISTOPH 22'. TI was performed as RSI according to a standard protocol. Desaturation was defined as a reduction in SpO(2) below 90% or a reduction of more than 10% from baseline SpO(2) when initial values were less than 90%. RESULTS: The RSI/TI manoeuvre was attempted in 150 patients [107 male (71.3%); median age 40 years (IQR 21-61); overall success rate 100%]. The incidence of desaturation episodes was 13.3% with a median duration of 50 sec. (IQR 30-92) and a median SpO(2) decrease of 24 ± 10%. Upon hospital admission, all patients had SpO(2) values ≥ 96%. In the desaturation group the duration of successful TI was significantly longer [median 85 sec. (IQR 60-119) vs. median 63 sec. (IQR 48-70); P < 0.01], and the number of patients with a baseline SpO(2) ≥ 90% was significantly lower (65.0% vs. 88.5%; P < 0.01). Among patients with difficult to manage airway, those with desaturation were significantly younger, and technical problems were significantly more frequent. CONCLUSION: The incidence of episodes of desaturation during pre-hospital RSI/TI at HEMS Ulm is relatively low, and the duration of such episodes is short.
Subject(s)
Airway Management/methods , Emergency Medical Services/methods , Hypoxia/epidemiology , Hypoxia/etiology , Intubation, Intratracheal/adverse effects , Adult , Aged , Anesthesiology , Female , Germany/epidemiology , Humans , Laryngoscopy , Male , Middle Aged , Oximetry , Oxygen/blood , Physicians , Prospective Studies , Treatment Outcome , Wounds and Injuries/therapy , Young AdultABSTRACT
BACKGROUND: Intraosseous infusion has become established as a fast and safe alternative to conventional vascular access in emergency situations. Originally the use of intraosseous access was limited to children up to 6 years of age and to adults for cardiopulmonary resuscitation but this limitation has now been removed. The aim of this study was to obtain data on mission reality regarding the use of intraosseous access in the prehospital setting against the background of the expanded recommendations on the use of the intraosseous infusion. METHODS: An analysis of rescue missions by all rescue helicopters of the ADAC (German Automobile Club) Air Rescue as well as the German Air Rescue Service (58 helicopter emergency medical service bases) over a 4 year period from January 2005 to December 2008 was carried out. RESULTS: A total of 247,454 rescue missions were carried out during the study period and in 525 patients (0.2% of the total study collective) an intraosseous access was established. There was a significant increase in the intraosseous infusion rate from 0.1% to 0.4% (p<0.05). Furthermore, there was a significant increase in its use in elderly patients and in patients with lower National Advisory Committee for Aeronautics (NACA) scores (2005 vs. 2008): 92.4% vs. 42.9% of all intraosseous infusions in patients ≤ 6 years of age (p<0.05) and 74.4% vs. 42.9% of all intraosseous infusions in patients with NACA score VI/VII (p<0.05). The proportion of trauma patients in the total study collective was 33% and there was no significant change in the frequency of trauma cases over the study period but there was a remarkable increase of intraosseous infusions in trauma patients in the last year of the study period compared to the previous years (38% in 2008 vs. 27-30% in 2005-2007). Furthermore, there was an increase in the number of different drug groups used for intraosseous infusion over the study period. CONCLUSIONS: The expanded indication recommendations for the use of intraosseous infusion in the prehospital setting enter more and more mission reality in air rescue services in Germany.
Subject(s)
Air Ambulances , Emergency Medical Services/statistics & numerical data , Infusions, Intraosseous/statistics & numerical data , Rescue Work , Adolescent , Adult , Age Factors , Aged , Attitude of Health Personnel , Child , Child, Preschool , Female , Germany , Guidelines as Topic , Humans , Infant , Infusions, Intraosseous/methods , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
BACKGROUND: Definitive airway control by endotracheal intubation (ETI) is standard of care in pre-hospital airway management. However, there are specific factors that may influence and complicate ETI. METHODS: Prospective, descriptive study at three German Helicopter Emergency Medical Services (HEMS) over a 1-yr period. We examined the success and complication rate for field intubation performed by trauma anaesthetists. RESULTS: In 342 patients (9.3%) ETI was performed. The overall success rate was 100%; in 87.4% the first attempt was successful, whereas in 11.1% a second and in 1.5% a third ETI attempt was necessary. No patient required a surgical intervention. Limited access to the patient was found upon arrival at the scene in 20.2% of the patients and in 9.6% of the patients at the time of ETI attempt. An orotracheal ETI technique was used in all patients. In the patients in whom only one ETI attempt was necessary for successful intubation, the assessment of ETI conditions was rated 'very good' or 'good' in 94.7%, but in those requiring a second or third ETI attempt this was reduced to 68.6 and 20.0%, respectively. Difficulties encountered during ETI included blood (19.9%), vomit/debris (15.8%) and secretions (13.8%) in the upper airway; anatomical reasons (11.7%), patient position (9.6%) and surrounding conditions (9.1%), making laryngoscopy more difficult. CONCLUSIONS: Despite various factors increasing the difficulties in managing the airway in the field, definitive airway control by ETI seems to be safe practice.
Subject(s)
Air Ambulances , Intubation, Intratracheal/methods , Adolescent , Adult , Aged , Emergencies , Emergency Medical Services/methods , Female , Germany , Humans , Intubation, Intratracheal/adverse effects , Laryngoscopy , Male , Middle Aged , Prospective Studies , Risk Factors , Wounds and Injuries/therapyABSTRACT
Due to the changed task spectrum of the German Federal Armed Forces with participation in international deployments for UN and NATO the concept of Aeromedical Evacuation (MedEvac) gained a new quality for the Air Force as well as for the Medical Corps. The transport of mostly severely injured or critically ill patients requires both, medical equipment which has to be permanently adapted to the national standard, and qualified intensive-care-personnel. At present, the aircrafts used for such deployments are four C-160 Transall, one CL-601 Challenger and two Airbus A310, which, if necessary, can be equipped with one or more intensive-care "patient transportation units" (PTU). Contrary to the two other aircrafts, the CL-601 Challenger is only equipped for the intensive-care transport of one individual patient. The PTU corresponds to the technical equipment of the intensive care unit of a level-1-trauma centre and ensures an intensive-care therapy on highest level also during longer transportation. The work with this equipment, the characteristics of the long-distance air transport and the special situation of the military deployment causes special demands on the qualifications of the assigned personnel. Primarily planned for the repatriation of injured or ill soldiers, in the mean time, this concept is also essential for the medevac of civilian victims after mass casualties worldwide.
