ABSTRACT
OBJECTIVE: Personality influences behaviour and decision-making. This may play a particular role in emergency medical personnel (EMP) dealing with critical situations. So far very little is known about personality traits that distinguish paramedics (PM) and emergency physicians (EP) from other medical staff. METHODS: A questionnaire including the ultra-short version of the Hamburg Personality Inventory (HPA) was distributed to EP, PM, medical doctors not practicing emergency medicine (MD) and medical students (MS). RESULTS: 274 EPs, 245 PMs, 48 MDs and 60 MSs returned the questionnaire. Four personality clusters in EPs and PMs were identified and to be found largely independent from demographic and job-related variables. For both groups one cluster revealed personality characteristics that seem particularly suitable for EMP ('resilient crisis manager'). 'Anxious' and 'insecure' personality traits were found in two clusters in PMs and in one cluster in EPs. Mental health problems in the participants or their relatives or the experience of loss increased scores in the dimensions neuroticism and openness. CONCLUSIONS: The personality characteristics of EPs and PMs are not homogenous and do not differ substantially from those of MDs and MSs. 50-70% of EMP can be characterised as 'resilient and stable', up to 30-40% as 'anxious and insecure'. The presence of mental health problems in participants or their relatives or the experience of loss may lead to openness for new experiences and alternative behaviour or--on the other hand--may trigger feelings of insecurity and/or anxiety in emergency situations.
Subject(s)
Allied Health Personnel/psychology , Emergency Medicine , Personality , Physicians/psychology , Adult , Decision Making , Female , Humans , Male , Middle Aged , Personality Inventory , Students, Medical/psychology , Surveys and Questionnaires , Young AdultABSTRACT
The diving accident is a rare incident for an emergency physician which requires special physical and patho-physiological knowledge. With increasing recreational activities and the fascination of diving also for older persons diving accidents are expected to occur more often. There can be several reasons for diving accidents such as the ignorance of the physics of diving, a trauma under water as well as internistical illnesses like heart attach, stroke or hypoglycaemia. The therapy of the underlying illness should not be left aside while dealing with the patient. The careful rescue and the immobilisation are most important for the initial therapy. The patient should receive oxygen, if possible via a demand valve, until a hyperbaric chamber is reached. There is no specific medical therapy for decompression illness. It is very important that a pre-information is sent to the closest hyperbaric chamber as soon as possible since often the chamber needs some time to be properly prepared for usage. In order to receive information regarding the depth where the diving incident occured, the duration of the diving trip and the decompression stops, it is important to secure the diving computer of the victim for the hyperbaric chamber. Also outside diving, decompression illness can occur, for example working in a tunnel under hyperbaric conditions. These accidents have to be treated according to the same guidelines.
Subject(s)
Decompression Sickness/therapy , Diving/injuries , Air Pressure , Barotrauma/pathology , Barotrauma/physiopathology , Decompression Sickness/epidemiology , Decompression Sickness/history , Decompression Sickness/physiopathology , Diving/history , Emergency Medical Services , Germany/epidemiology , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , HumansABSTRACT
Rescue and medical care of people in a drowning accident is a rather rare incident which still needs special attention. The rescue process can be technically challenging and only a well experienced team will be able to act professionally without any time loss. At a first step all team members have to protect themselves. Especially close collaboration of technical and medical rescue teams are of high significance and should be part of future exercises. Hypothermic persons should be protected from further cooling and gently rescued in a horizontally way. If a patient has no circulation continued cardiopulmonary resuscitation and immediate transport as soon as possible to the nearest hospital with an extracorporeal rewarming device is recommended. To avoid any time loss it is essential that the respective hospital is informed immediately and the fastest mode of transport selected. Astonishing cases show that this procedure is very promising even after long time submersion.
Subject(s)
Cardiopulmonary Resuscitation/methods , Emergency Treatment/methods , Hyperthermia, Induced/methods , Hypothermia/etiology , Hypothermia/therapy , Near Drowning/classification , Near Drowning/rehabilitation , Germany , HumansABSTRACT
PURPOSE OF REVIEW: The German emergency medical system is different from the Anglo-American system. Emergency medicine is no distinct specialty in Germany. Physicians are involved in prehospital emergency medicine. This review highlights the historic development of prehospital and hospital emergency medicine in Germany and describes future trends. RECENT FINDINGS: Studies have shown that involvement of specially trained prehospital emergency physicians can result in reduced patient mortality. The in-hospital emergency medicine structure is important for the 'chain of survival' for patients with life-threatening medical conditions. In-hospital emergency medicine has been reorganized in many hospitals during the last few years. New qualification criteria for physicians in emergency departments, therefore, need to be developed. SUMMARY: Economic and quality arguments have initiated the development of departments for emergency medicine in Germany. In the future, this will lead to new qualification criteria for physicians working in these departments.
Subject(s)
Emergency Medical Services , Physician's Role , Anesthesiology/education , Education, Medical, Continuing , Emergency Medicine , Emergency Service, Hospital , Germany , HumansABSTRACT
Germany has a long tradition of having physicians, often anesthesiologists with additional training in emergency medicine, deliver prehospital emergency care. Hospital-based emergency medicine in Germany also differs significantly from the Anglo-American model, and until recently having separate emergency rooms for different departments was the norm. In the past decade, many hospitals have created "centralized emergency departments" [Zentrale Notaufnahme (ZNAs)]. There is ongoing debate about the training and certification of physicians working in the ZNAs and whether Germany will adopt a specialty board certification for emergency medicine.
ABSTRACT
OBJECTIVE: In emergency medicine, suicides and attempted suicides represent a major challenge for emergency physicians (EPs) and paramedics, both in terms of psychiatric and somatic treatment. To date no investigations have been performed to determine prevalence rates, method of suicide or attempted suicide, and the problems faced by EPs when treating these patients. This investigation presents a first evaluation of the complete emergency protocols from a major German city focusing on suicide and parasuicide. METHODS: A retrospective analysis of all EP protocols from 1995 in the city of Hamburg was performed. All protocols were evaluated with respect to suicide parasuicide and suicidal ideation. Demographic data and information on method of suicide or attempted suicide, severity of illness, and underlying psychiatric disorder were extracted from the protocols. RESULTS: A total of 26,347 emergency protocols were evaluated. Suicide and attempted suicide were considered either certain, probable, or possible in 743 cases (2.8%). Suicide was committed in 171 cases and attempted were made by 572 individuals. More men committed suicide in all age groups. By far the highest number of suicide attempts were by young men between 18 and 39 years of age. Hanging was the most commonly used method of completed suicide (41%), followed by jumping from a height (21%). The methods of intoxication with medication (54%) and illegal drugs (17%) clearly prevailed in suicide attempts. Documentation of suicides and attempted suicides was revealed to be unsatisfactory. Underlying psychiatric disorders were scarcely recorded. CONCLUSION: In emergency medicine, the incidence of suicide or the attempt to commit suicide is small, yet disturbing. The frequency assessed may be too low as result of methodology. There is a need to improve the education of emergency physicians and paramedics in this area, and there is a need for data to be collected in a prospective design.
Subject(s)
Emergency Medical Services , Suicide/statistics & numerical data , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Suicide, Attempted/statistics & numerical dataABSTRACT
El cerebrotrac 2500 Plus TM (SRD-Medical Ltda.), es un monitor computarizado de electroencefalografía (EEG), provisto de un análisis digital de tendencia central y ondas electroencefalográficas representadas gráficamente, un tiempo real y análogo para ambos hemisferios, en una pantalla fácil de leer e interpretar. El computador permite a la vez la reproducción visual de otros valores y derivaciones del EEG, así como de electromiografía (EMG) frontal. La utilidad del monitoreo de la profundidad de la anestesia por medio del EEG, ha sido hasta ahora muy controvertida. El uso combinado de una matrix diagnóstica y terapéutica que incluya parámetros hemodinámicos y análisis electroencefalográfico, constituye un nuevo intento de demostrar la utilidad de la monitorización de la actividad cortical cerebral, durante la anestesia general. A continuación se describirán brevemente los métodos de un estudio multicéntrico en el cual participaron más de 600 pacientes
