[Mass maritime casualty incidents in German waters: structures and resources]. / Massenanfall von Verletzten auf See in deutschen Gewässern : Strukturen und Ressourcen.

The Central Command for Maritime Emergencies was founded in Germany in 2003 triggered by the fire on board of the cargo ship "Pallas" in 1998. Its mission is to coordinate and direct measures at or above state level in maritime emergency situations in the North Sea and the Baltic Sea. A special task in this case is to provide firefighting and medical care. To face these challenges at sea emergency doctors and firemen have been specially trained. This form of organization provides a concept to counter mass casualty incidents and peril situations at sea. Since the foundation of the Central Command for Maritime Emergencies there have been 5 operations for firefighting units and 4 for medical response teams. Assignments and structure of the Central Command for Maritime Emergencies are unique in Europe.

[Acute subglottic tracheal stenosis after resuscitation]. / Akute subglottische Trachealstenose nach Reanimation.

Following cardiac arrest a 41-year-old patient was resuscitated for 40 min and required mechanical ventilation for 27.5 h. Acute shortness of breath and inspiratory stridor developed 7 days after successful extubation. Bronchoscopy revealed a subtotal tracheal stenosis caused by extensive fibrinous membranes. Local ischaemia caused by cuff pressure seems to be a likely explanation with an additional component of general hypoperfusion and haemodynamic instability which led to gastric bleeding (classification according to Forrest IIc) from ischaemic ulcers.

[Psychiatric emergencies in the physician-based system of a German city]. / Psychiatrische Notfälle im Notarztdienst einer deutschen Grossstadt.

OBJECTIVE: Pre-clinical Psychiatric Emergency Situations (PES) gain more scientific interest. First investigations revealed them to be the third major cause for emergency physician (EP) calls. However, there is still very little data concerning prevalence, diagnosis and therapy. METHODS: A retrospective analysis of all anonymised EP protocols of the year 1995 in the city of Hamburg was performed. Data of each multiple-choice category was evaluated as well as handwritten and personal notes to determine prevalence, diagnoses and therapy of PES. RESULTS: 2550 out of 26,347 protocols (9.7%) revealed to have a psychiatric disturbance as a major cause for the call. The most frequent diagnoses in the overall young (average age: 43.1 +/- 17.6 years) and male (60.3%) population were found to be alcoholic intoxication (34%), state of agitation (23%) and suicide attempts (22%). In 55% the emergencies could be considered as purely psychiatric; in 35% as a combined somatic-psychiatric emergency. A specific psychopharmacological treatment was not performed. CONCLUSIONS: Psychiatric patients are a considerable group in pre-clinical emergency medicine, however, disturbances are much too rarely documented, diagnosed and treated. Training programs are necessary. Psychiatry has to play a more active role in planning and performing these programs.