Quantifying changes in ambient NOx, O3 and PM10 concentrations in Austria during the COVID-19 related lockdown in spring 2020.

During spring 2020, unprecedented changes in local and regional emissions have occurred around the globe due to governmental restrictions associated with COVID-19. Many European countries including Austria issued partial curfews or stay-at-home order policies, which have impacted ambient air quality through reductions in non-essential transportation and energy consumption of industrial sites and work places. Here, we analyse the effect of these measures on ambient concentrations of nitrogen oxides (NOx), ozone (O3) and particulate matter (PM10) during the first nationwide lockdown in Austria (16.03.2020 to 14.04.2020). To ensure a robust analysis, the Austrian domain is divided into four individual subsectors contingent on regional climate. For air quality analysis a novel method is applied for filtering days with comparable weather conditions during the 2020 lockdown and spring 2017 to 2019. In general, our analysis shows decreasing pollutant concentrations, although in magnitude dependent on pollutant and regional subdomain. Largest reductions are found for NOx reaching up to -68% at traffic sites reflecting the substantial decrease in non-essential transport. Changes in the O3 concentrations at background sites show a rather weak response to NOx declines varying between roughly -18 to +8% for both the median and the upper tail of the distribution. Occasional site level increases in O3 concentrations can be attributed to comparably weak titration during night-time. PM10 concentrations show the smallest response among air pollutants, attributable to manifold precursor sources not affected by the lockdown measures. However, our analysis indicates also a shift of PM10 distributions at traffic sites closer to distributions observed at background sites. Supplementary Information: The online version contains supplementary material available at 10.1007/s11869-022-01232-w.

[Statement of the Austrian Society for Anesthesiology, Resuscitation and Intensive Care Medicine (ÖGARI) on the use of laryngeal tubes by ambulancemen and paramedics]. / Stellungnahme der Österreichischen Gesellschaft für Anästhesiologie, Reanimation und Intensivmedizin (ÖGARI) zum Einsatz des Larynxtubus durch Rettungs- und Notfallsanitäter.

Due to an increasing number of severe complications reported during the prehospital application of laryngeal tubes, the Austrian Society for Anesthesiology, Resuscitation and Intensive Care Medicine (ÖGARI) is prompted to formulate a respective statement. With regard to the current training situation and the applicable laws, ÖGARI recommends to convert the "Emergency Competence for Endotracheal Intubation (NKI)" for emergency paramedics into an "Emergency Competence for Extraglottic Airway Management, (NK-EGA)". Training should include at least 40 h of theoretical instruction, hands-on training on the manikin to secure mastery of the methodology and at least 20 successful applications under clinically elective conditions in adult patients under direct medical supervision. Here, depending on local conditions, both laryngeal mask and laryngeal tube can be used. In the prehospital environment, the device must be used which has been trained as mentioned above. Only 2nd generation EGA should be used. After successful EGA placement timely cuff pressure monitoring and gastric suction should be performed. The use of an EGA by ambulance-men cannot be recommended; these have to be limited to bag-mask ventilation.

Correction to: S(+)-ketamine : Current trends in emergency and intensive caremedicine.

Correction to: Wien Klin Wochenschr 2017 https://doi.org/10.1007/s00508-017-1299-3 The article S(+)-ketamine Current trends in emergency and intensive caremedicine, written by Helmut Trimmel, Raimund Helbok, Thomas Staudinger, Wolfgang Jaksch, Brigitte Messerer, Herbert Schöchl and Rudolf Likar, was ….

[Reform of emergency physician training in Austria : Finally up to date?] / Reform der Notarztausbildung in Österreich : Endlich zeitgemäß?

During the last 20 years Austrian prehospital emergency medical services (EMS) have significantly improved. The structure and organization of Austrian EMS comply with European standards but training requirements for prehospital EMS physicians are insufficient when compared with other countries. Although some EMS systems follow the German or Swiss postgraduate training concepts, the legal requirements in Austria defining the scope of mandatory training for physicians in the prehospital setting are only minimal. Thus, besides board certification as a general practitioner or specialist of any discipline, the only formal requirement is a 1-week theoretical course comprising some manikin simulations. Experience in anesthesia or intensive care medicine is still not mandatory. The Austrian Society of Anesthesiology, Resuscitation and Intensive Care Medicine (ÖGARI) drafted a reform paper in 2009, which was adapted by the Austrian Chamber of Physicians, section of emergency medicine, and subsequently presented to the Austrian Ministry of Health. Due to the slowness of the legislation process, the relevant § 40 of the Austrian Physician 's Act is still unchanged. In the meantime, Austrian specialist training regulations were restructured in 2015 with significant consequences. Due to changes in the residency programs, board certification and subsequent full working permit becomes more difficult to obtain, thus further aggravating the shortage of emergency physicians in Austria. In order to counteract the threatening shortage of prehospital EMS physicians, the ÖGARI section of emergency medicine was requested by the Ministry of Health to develop a reasonable model for how physicians could be qualified and subsequently employed in EMS prior to full board certification. Presently, the Austrian Ministry of Health, the Chamber of Physicians and medical societies are in discussion on whether this approach might fit into the legal framework. This manuscript details the development and present status as well as key points of an ongoing discussion on how high-quality EMS care in Austria can be safeguarded in the future or could even make it impossible.

[Intensive care treatment of traumatic brain injury in multiple trauma patients : Decision making for complex pathophysiology]. / Intensivtherapie des Schädel-Hirn-Traumas beim Mehrfachverletzten : Entscheidungsfindung bei komplexer Pathophysiologie.

Traumatic brain injury (TBI) and hemorrhagic shock due to uncontrolled bleeding are the major causes of death after severe trauma. Mortality rates are threefold higher in patients suffering from multiple injuries and additionally TBI. Factors known to impair outcome after TBI, namely hypotension, hypoxia, hypercapnia, acidosis, coagulopathy and hypothermia are aggravated by the extent and severity of extracerebral injuries. The mainstays of TBI intensive care may be, at least temporarily, contradictory to the trauma care concept for multiple trauma patients. In particular, achieving normotension in uncontrolled bleeding situations, maintenance of normocapnia in traumatic lung injury and thromboembolic prophylaxis are prone to discussion. Due to an ongoing uncertainty about the definition of normotensive blood pressure values, a cerebral perfusion pressure-guided cardiovascular management is of key importance. In contrast, there is no doubt that early goal directed coagulation management improves outcome in patients with TBI and multiple trauma. The timing of subsequent surgical interventions must be based on the development of TBI pathology; therefore, intensive care of multiple trauma patients with TBI requires an ongoing and close cooperation between intensivists and trauma surgeons in order to individualize patient care.

[Thermal injuries in the OEAMTC air rescue service. Epidemiological characteristics of burns/scalds in children and adults]. / Thermische Verletzungen in der ÖAMTC-Luftrettung. Einsatzcharakteristika bei Verbrennungen/Verbrühungen von Kindern und Erwachsenen.

BACKGROUND: Few data exist on the epidemiological characteristics of thermal injuries in prehospital emergency care, especially in the context of air rescue. Therefore, this study aimed to analyze the epidemiology of pediatric and adult thermal injuries in the helicopter emergency medical service (HEMS) run by the Austrian Automobile Motorcycle Touring Club (OEAMTC) air rescue service from an almost nationwide sample. METHODS: All OEAMTC-HEMS rescue missions flown for thermal injuries in 2009 were retrospectively reviewed. Primary (n=88) and secondary missions (n=17) were collated and all primary missions were analyzed in detail. RESULTS: In total 71 out of 16,100 (0.4 %) primary HEMS rescue missions were for patients suffering from burns or scalds (children n=27, adults n=44). The proportion of major burns (burns covering >20 % of the total body surface area) was 40.7 % in children and 54.5 % in adults, 44 (62 %) burn/scald injuries were related to the head/neck, 37 (52.1 %) to the upper limbs and 10 (14.1 %) to the anogenital region. More than half of the victims (63.4%) suffered potentially life-threatening injury. CONCLUSIONS: In HEMS thermal injuries are infrequent but mostly life-threatening. Differences in epidemiological characteristics of pediatric and adult burns/scalds may have important operational, training and public health implications.

[Anesthetist's briefing check. Tool to improve patient safety in the operating room]. / "Briefing-Check" anästhesie. Werkzeug zur verbesserung der patientensicherheit im OP.

Adverse events are not unusual in a more and more complex anesthesiological environment. The main reasons for this are an increasing workload, economic pressure, growing expectations of patients and deficits in planning and communication. However, these incidents mostly do not refer to medical deficits but to flaws in non-technical skills (team organisation, task orientation, decision making and communication). The introduction of the WHO Safe Surgery Checklist depicted that a structural approach can improve the situation. However, it is still questionable if this measure is strong enough and recent publications revealed initial criticisms. Furthermore, remaining security gaps could be found even though the checklist was implemented in the anesthesiological practice of a big teaching hospital. Therefore, an additional checklist was developed to implement an anesthesia briefing in the daily routine. The main objective was to establish a security check before induction similar to the aeronautical pre-flight check. Additionally, this measure should improve coordination of the anesthesiology team. Working through the checklist, doctors and nurses are guided to focus on conjoint patient care prior to induction of anesthesia. In a web-based survey the general attitude of coworkers towards patient safety, as well as the acceptability of the new briefing check was scrutinised at two times: directly before implementation of the checklist and 1 year after. The results (84 % of medical and 97 % of healthcare staff answered the questionnaires) showed improvements with high relevance to parameters associated with awareness concerning safety issues and team coordination. In conclusion, it appears that patient safety can be significantly improved with little time effort of 3-5 min per patient. A prospective trial will be conducted to confirm the impact of this measure on improvements in patient safety.

The epidemiology of amputation injuries in the Austrian helicopter emergency medical service: a retrospective, nationwide cohort study.

PURPOSE: Data on the epidemiological characteristics of traumatic amputations in prehospital emergency care, especially in the context of air rescue, are scarce. Therefore, we aimed to describe the epidemiology of total and subtotal amputation injuries encountered by the OEAMTC helicopter emergency medical service (HEMS) in Austria, based on an almost nationwide sample. METHODS: We retrospectively reviewed all HEMS rescue missions flown for amputation injuries in 2009. Only primary missions were analyzed. RESULTS: In total, 149 out of 16,100 (0.9 %) primary HEMS rescue missions were for patients suffering from amputation injuries. Among these, HEMS physicians diagnosed 63.3 % (n = 94) total and 36.9 % (n = 55) subtotal amputations, with both groups showing a predominance of male victims (male:female ratios were 8:1 and 6:1, respectively).The highest rate occurred among adults between 45 and 64 years of age (35.6 %, n = 53). The most common causes were working with a circular saw (28.9 %, n = 43) and processing wood (16.8 %, n = 25). The majority of the cases included digital amputation injuries (77.2 %, n = 115) that were mainly related to the index finger (36.2 %, n = 54). One hundred forty patients (94.0 %) showed a total GCS of more than 12. Amputations were most prevalent in rural areas (84.6 %, n = 126) and between Thursday and Saturday (55.0 %, n = 82). The replantation rate after primary air transport was low (28 %). CONCLUSIONS: In the HEMS, amputation injuries are infrequent and mostly not life-threatening. However, HEMS crews need to maintain their focus on providing sufficient and fast primary care while facilitating rapid transport to a specialized hospital. The knowledge of the epidemiological characteristics of amputation injuries encountered in the HEMS gained in this study may be useful for educational and operational purposes.

Equipment for pre-hospital airway management on Helicopter Emergency Medical System helicopters in central Europe.

BACKGROUND: For advanced out-of-hospital airway management, skilled personnel and adequate equipment are key prerequisites. There are little data on the current availability of airway management equipment and standards of medical staff on Helicopter Emergency Medical System (HEMS) helicopters in central Europe. METHODS: An internet search identified all HEMS helicopters in Austria, Switzerland and Luxembourg. We identified 15 HEMS helicopter bases in Switzerland, 28 in Austria and three in Luxembourg. A questionnaire was sent to all bases, asking both for the details of the clinical background and experience of participating staff, and details of airway management equipment carried routinely on board. RESULTS: Replies were received from 14 helicopter bases in Switzerland (93%), 25 bases in Austria (89%) and all three bases in Luxembourg. Anaesthesiologists were by far the most frequent attending physicians (68-85%). All except one bases reported to have at least one alternative supraglottic airway device. All bases had capnometry and succinylcholine. All bases in the study except two in Austria had commercial pre-packed sets for a surgical airway. All helicopters were equipped with automatic ventilators, although not all were suitable for non-invasive ventilation (NIV; Switzerland: 43%, Austria: 12%, Luxembourg: 100%). Masks for NIV were rarely available in Switzerland (two bases; 14%) and in Austria (three bases; 12%), whereas all three bases in Luxembourg carried those masks. CONCLUSION: Most HEMS helicopters carry appropriate equipment to meet the demands of modern advanced airway management in the pre-hospital setting. Further work is needed to ensure that appropriate airway equipment is carried on all HEMS helicopters.

[Neuroanaesthesia. Principles of optimized perioperative management]. / Neuroanästhesie. Grundlagen der perioperativen Betreuung.

Because of the high vulnerability of the brain as a primary target, neuroanaesthesia requires a close look at basic physiological principles and factors of influence during surgery and subsequent intensive care. Anticipatory management is crucial for anaesthesia within the scope of neurosurgical interventions: essential components of anaesthesia management must already be prepared before the surgical procedure. Intracranial compliance and pressure determine the patient's fate; accordingly they have to be assessed correctly and measured continuously. Advanced methods of monitoring allow sophisticated and individually focused treatment thus contributing to patient safety. Only few pharmacologic approaches have been proven with solid evidence, yet some new studies have revealed interesting brain protective effects of pharmacological and/or adjuvant therapeutic measures. For the treatment of intracranial hypertension, osmotherapy is still of the highest value. Decompressive craniotomy seems to have become a promising alternative, although this must be judged to date as a last resort therapy. Perioperative care of patients with complex intracranial pathologies thus needs a close interaction and cooperation between the operation theatre and intensive care units in the sense of continuous track anaesthesia.

[Vasopressin for therapy of persistent traumatic hemorrhagic shock: The VITRIS.at study]. / Vasopressin zur Therapie eines therapierefraktären traumatisch-hämorrhagischen Schocks: Die VITRIS.at-Studie.

While fluid management is established in controlled hemorrhagic shock, its use in uncontrolled hemorrhagic shock is being controversially discussed, because it may worsen bleeding. In the irreversible phase of hemorrhagic shock that was unresponsive to volume replacement, airway management and catecholamines, vasopressin was beneficial due to an increase in arterial blood pressure, shift of blood away from a subdiaphragmatic bleeding site towards the heart and brain and decrease of fluid resuscitation requirements. The purpose of this multicenter, randomized, controlled, international trial is to assess the effects of vasopressin (10 IU IV) vs. saline placebo IV (up to 3 injections at least 5 min apart) in patients with prehospital traumatic hemorrhagic shock that persists despite standard shock treatment. The study will be carried out by helicopter emergency medical service teams in Austria, Germany, Czech Republic, Portugal, the Netherlands and Switzerland. Inclusion criteria are adult trauma patients with presumed traumatic hemorrhagic shock (systolic arterial blood pressure <90 mmHg) that does not respond to the first 10 min of standard shock treatment (endotracheal intubation, fluid resuscitation and use of vasopressors) after arrival of the first emergency physician at the scene. The time window for randomization will close after 30 min of shock treatment. Exclusion criteria are terminal illness, no intravenous access, age <18 years, injury >60 min before randomization, cardiac arrest before randomization, presence of a do-not-resuscitate order, untreated tension pneumothorax, untreated cardiac tamponade, or known pregnancy. Primary study end-point is the hospital admission rate, secondary end-points are hemodynamic variables, fluid resuscitation requirements and hospital discharge rate.

Hemodynamic monitoring using PiCCO system in a 10 months old infant suffering from serious burn injury.

In this study, authors present a case report of a 10 months old patient with burn injuries involving 20.5 % body surface area, grades 2a and 2b. According to the continuous monitoring of hemodynamic parameters by PiCCO (Pulsion Medical Systems, Munich, Germany), fluid therapy was successfully managed. Despite of an increasing EVLWI (extravascular lung water index) it was possible to preserve the child from lung edema and subsequent artificial lung ventilation by the early targeted therapeutic interventions. Moreover, the study analyzes the possibilities and indications of less invasive hemodynamic monitoring supplied by PiCCO in children (Tab. 2, Fig. 3, Ref. 7). Full Text (Free, PDF) www.bmj.sk.

Penile block in children, our first experience.

Penile block has been in use in penile surgery as a technique for perioperative analgesia for 25 years. The authors reintroduced penile block on the Department of Paediatric Anaesthetics and Intensive Care at the University Children's Hospital in Bratislava, Slovakia in June 2004 after 8 years. This prospective open observational study presents their experience with penile block for elective penile surgery in 96 paediatric patients (Tab. 3, Ref. 14).

[Polytrauma and air rescue. A retrospective analysis of trauma care in eastern Austria exemplified by an urban trauma center]. / Polytrauma und Luftrettung. Eine retrospektive Analyse der Versorgung im Osten Osterreichs am Beispiel eines urbanen Traumazentrums.

OBJECTIVE: The aim of this study was a retrospective analysis of polytraumatized patients who were treated by a helicopter emergency medical service (HEMS) crew. This study was performed to evaluate the level of prehospital care provided for severely injured patients. Special consideration was given to treatment strategies of specific injuries which led to multiple injuries, defined as "polytrauma." METHODS: From September 1992 to April 2001 data of 386 patients treated in the Department of Traumatology of the University of Vienna were collected. A total of 104 patients (26.9%) were transported by helicopter directly from the accident scene. This collective was analyzed demographically; relevant prehospital data such as therapeutic interventions and the early clinical course were examined. RESULTS: The mean Injury Severity Score (ISS) was 36.9: 70 (67.3%) patients were male and 34 (32.7%) female; the median age was 36.1 years. Traffic accidents were the most frequent trauma mechanism (78.9%) followed by falls from height (17.3%). The mean period between trauma and trauma emergency room was 0.73 h; 77 (74.0%) patients were intubated and mechanically ventilated at the scene and all patients received analgosedation. The mean preclinical fluid load was 1673 ml. The mean duration of treatment in the emergency room was 53 min. The mean length of intensive care was 8.6 days and the mortality rate was 19.2% within the first 24 h. CONCLUSION: Major trauma is an important cause for requesting a primary HEMS mission. As the results of this study show, immediate and invasive interventions at the scene lead to an improvement of vital functions at admission. For the patients' further course of treatment, the choice of a trauma center seems to be important, too.

[Emergency respirator therapy in intermediate altitude with the Ambu Matic]. / Notfallrespiratortherapie in mittlerer Höhenlage mit dem Ambu Matic.

Portable emergency ventilators are commonly used in a pre-hospital setting in the transport of critically ill patients also in hypobaric environments. The aim of our trial was to evaluate the influence of moderate altitude at 2700 m compared to 171 m altitude on minute ventilation and blood gas analysis in healthy volunteers during mechanical ventilation with the Ambu Matic ventilator. At 2700 m altitude, the delivered minute volume increased by 13.8%. paCO2 decreased by 9.2% (p < 0.01 for all reported changes). No statistical change in paO2 at 2700 m altitude was observed. These changes are of sufficient magnitude and importance to require monitoring of minute volume to prevent volutrauma or barotrauma.