[Childhood emergencies-worsening healthcare bottlenecks for children in a systematic long-term analysis of the EMS system in a German metropolis]. / Der Notfall beim Kind ­ zunehmende Versorgungsengpässe für Kinder in einer systematischen Langzeitanalyse des Rettungssystems einer deutschen Metropole.

BACKGROUND: Children have the right to the best possible medical care. The lack of treatment capacity is rising steadily and increasingly leads to forced centralized allocation of patients by the emergency medical services (EMS) to pediatric emergency departments that are, officially, temporarily "closed". AIM: The aim of this study is to present trends in allocation of pediatric emergency patients in greater Munich. MATERIALS AND METHODS: Retrospective analysis of hospital admissions of children < 18 years of age collected from 01 January 2015 to 31 December 2019 by means of the web-based IT system IVENA eHealth (manis IT, Frankfurt) used by the emergency medical services. The focus of the evaluation is on patients in category II, who are likely to require inpatient admission. RESULTS: During the 5­year observation period, a total of 44,549 pediatric patients < 18 years of age (90.6% of total admissions) were admitted to a children's hospital by the ambulance service as category II (SKII) in the Munich metropolitan area. These patients showed an increase in the relative frequency of forced allocations from 1.7% (2015) to 9.4% (2019). Parallel to this, there is an increasing frequency of time intervals over the years in which all children's hospitals were temporarily closed due to lack of treatment availability, especially in the winter half-year. CONCLUSION: In the examined period from 2015 to 2019, there has been a relevant increase in the number of forced allocations to children's hospitals by the emergency medical services in the Munich area. This observed trend is likely to persist over the coming years, in view of current staff shortages and diminishing hospital capacities.

[Standardized telephone-assisted instructions on resuscitation by laypersons. Feasibility study using video-assisted quality analysis]. / Standardisierte Telefonanweisungen zur Wiederbelebung durch Laienhelfer. Videogestützte Qualitätsanalyse im Rahmen einer Machbarkeitsstudie.

BACKGROUND: Telephone-assisted instructions for cardiopulmonary resuscitation (T-CPR) are highly recommended by the current European Resuscitation Council (ERC) guidelines for resuscitation 2010. AIM: The aim of this study was to analyze the adherence of laypersons to T-CPR instructions given by dispatchers in a mock scenario. The dispatchers adapted international T-CPR instructions to local requirements. MATERIAL AND METHODS: An emergency "collapse in the office" with subsequent T-CPR was simulated for 10 volunteer, untrained administrative staff, as the only single emergency witness and 4 emergency medical service (EMS) dispatchers. Each volunteer was sent to a "colleague" who simulated a sudden cardiovascular event and collapsed unconscious during the description of symptoms. The local lay responder made an emergency call by landline telephone and was connected to the dispatcher. In the course of the simulation the "victim" was replaced by a CPR manikin. RESULTS: Every participant, i.e. 10 out of 10, assessed the victim, recognized the situation and telephoned for help. On the orders of the dispatchers 9 out of the 10 activated the loudspeaker of the telephone but 4 still continued to use the handset. The instructions for positioning were followed by all 10. Correct positioning of the victim required a median of 33[Symbol: see text]s with an interquartile range (IQR) of 30-39[Symbol: see text]s. Breathing control including instructions lasted a median of 54[Symbol: see text]s (IQR 49-60[Symbol: see text]s). Breathing was assessed by 8 out of 10 but only 2 out of 8 achieved a duration of 10[Symbol: see text]s as recommended by the ERC guidelines for resuscitation 2010. After a median of 202[Symbol: see text]s (IQR 196-241[Symbol: see text]s) chest compressions were started by 9 out of 10 and were performed for a median of 63[Symbol: see text]s (IQR 60-69[Symbol: see text]s). A correct technique was used by 7 but with a low rate of 80 compressions/min (IQR 72-86/min). The instructions for ventilation were understood by 9 out of 10. Mouth-to-mouth resuscitation was performed by 7 participants and technically correct by 5 of them. The ventilation cycle of the 7 active participants lasted for a mean of 25[Symbol: see text]s (IQR 24-30[Symbol: see text]s). The mean total duration of the timeframe analyzed was 340[Symbol: see text]s (IQR 334-368[Symbol: see text]s). CONCLUSION: The results demonstrate that the local T-CPR concept for untrained laypersons is feasible in a mock scenario. No substantial errors were observed for the majority of the untrained responders but the simulation also showed that not every emergency witness implemented the instructions according to the dispatcher's expectations. The T-CPR procedure was also more time-consuming than expected; therefore, every standardized T-CPR concept should be tested for local practicability. In accordance with current studies, the results suggest that the focus should be on compression-only CPR instructions in urban settings. Dispatcher education in T-CPR should incorporate videotaped mock-up scenarios with untrained local laypersons.