Automated and app-based activation of first responders for prehospital cardiac arrest: an analysis of 16.500 activations of the KATRETTER system in Berlin.

BACKGROUND: Bystander CPR is one of the main independent factors contributing to better survival after out-of-hospital cardiac arrest. Simultaneously, the rate of bystander CPR in Germany is below the European average. First responder applications (apps) contribute to reducing the time period without CPR (no-flow time) until professional help can arrive on-scene. METHODS: The KATRETTER app was introduced in Berlin as one of the first apps in Europe which do not require any medical qualifications to register as a first responder. The activation of volunteer first responders for suspected cardiac arrest cases through the Berlin Emergency Medical Services integrated control center was evaluated based on data collected between 16 Oct 2020 and 16 Oct 2022. Our descriptive analysis includes the number of registered first responders, number of activations, the number and percentages of accepted activations, as well as all reports where first responders arrived at the scene. RESULTS: As of 15 Oct 2022, a total of 10,102 first responders were registered in the state of Berlin. During this specified period, there were 16.505 activations of the system for suspected out-of-hospital cardiac arrest. In 38.4% of the accepted cases, first responders documented patient contact, and in 34.6% of cases with patient contact, CPR was performed. Only 2% of registered first responders did not have any medical qualifications. CONCLUSIONS: Smartphone-based first responder applications should not be understood as a means of alerting professional help, but rather like a digitally amplified "call for help" in the vicinity of an emergency location. A large number of first responders can be recruited within 24 months, without large-scale public relations work necessary. No qualifications were required to become a first responder, contributing to a low-threshold registration process with the effect of a more widespread distribution of the app and cost reduction during implementation.

[Introduction of emergency paramedic investigators in the context of the COVID-19 pandemic in the Berlin emergency medical service]. / Einführung von NotSan-Erkundern im Rahmen der COVID-19-Pandemie in der Berliner Notfallrettung.

BACKGROUND: It has been shown throughout the COVID-19 pandemic that the condition of a number of patients deteriorates acutely when not monitored. This is set against an increased demand for emergency medical services and the resulting scarcity of resources, which makes it necessary to prioritise inpatient treatment or ensure that patients are provided with appropriate outpatient care. In this context, the Berlin Fire Department has introduced emergency paramedic investigators (NotSan-Erkunder) as an additional operating resource. METHODOLOGY: We assessed all operations from 28.03.2020 to 28.04.2020 during which Emergency Paramedic Investigators of the Berlin emergency services were deployed. A total of 341 operations were included from the 31 days. Alongside data from the dispatch system, all operational documentation was assessed. RESULTS: In 57% of cases, mNACA II patients (outpatient treatment) were identified, in 42% of cases, mNACA III patients (inpatient treatment) were identified, and in 1% of cases, mNACA IV (imminent danger to life) patients were identified. In 51% of cases, the emergency services transported the patient to a hospital, and in 49%, alternative care measures were employed. These included referral to a local physician in 28% of cases. In 11% of cases, patients were referred to on-call services of the Association of Statutory Health Insurance Physicians (KV in German). In 4% of cases, the Berlin Fire Department emergency dispatch center deployed a physician of the KV (KV-ARE investigator). DISCUSSION: The results show that additional operational resources serve an important function during a pandemic with regards to an initial assessment and pilot function. This can help relieve not only the emergency services but also the medical facilities responsible for providing further care. The standardised dispatch enquiry enables the linking with the appropriate codes from the low-priority operational spectrum and support by a Tele-emergency physician lends additional professional competency to the emergency paramedics.

Social defeat leads to changes in the endocannabinoid system: An overexpression of calreticulin and motor impairment in mice.

Prolonged and sustained stimulation of the hypothalamo-pituitary-adrenal axis have adverse effects on numerous brain regions, including the cerebellum. Motor coordination and motor learning are essential for animal and require the regulation of cerebellar neurons. The G-protein-coupled cannabinoid CB1 receptor coordinates synaptic transmission throughout the CNS and is of highest abundance in the cerebellum. Accordingly, the aim of this study was to investigate the long-lasting effects of chronic psychosocial stress on motor coordination and motor learning, CB1 receptor expression, endogenous cannabinoid ligands and gene expression in the cerebellum. After chronic psychosocial stress, motor coordination and motor learning were impaired as indicated the righting reflex and the rota-rod. The amount of the endocannabinoid 2-AG increased while CB1 mRNA and protein expression were downregulated after chronic stress. Transcriptome analysis revealed 319 genes differentially expressed by chronic psychosocial stress in the cerebellum; mainly involved in synaptic transmission, transmission of nerve impulse, and cell-cell signaling. Calreticulin was validated as a stress candidate gene. The present study provides evidence that chronic stress activates calreticulin and might be one of the pathological mechanisms underlying the motor coordination and motor learning dysfunctions seen in social defeat mice.

[The microlaryngeal tube--a new tube for direct laryngoscopy in the ENT field]. / Der Mikrolaryngealtubus--ein neuer Tubus für die direkte Laryngoskopie im HNO-Bereich.

We describe our experience with a new orotracheal tube with low-pressure cuff for anesthesia during endoscopic laryngeal surgery. Twelve consecutive patients (ASA groups II and III) undergoing microlaryngoscopy for diagnostic or operative reasons were intubated orotracheally with the tube. No complications associated with intubation or anesthesia occurred. In comparison with normal armored tubes (i.e. Woodbridge tubes), the microlaryngeal tube gives the surgeon better operating conditions and still permits conventional intermittent positive pressure ventilation without excessive increases in ventilation pressure. The advantages from the low-pressure cuff could only be seen in 7 patients. With this foregoing restriction, we recommend the use of the new microlaryngeal tube for anesthesia during microlaryngoscopy.