Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anaesthesiology has given essential impulses to emergency medicine during the last decades. Therefore emergency medicine has become the "third column" of this speciality. As a "generalist with special skills" the anaesthetist fulfils the requirements of an emergency physician to a high degree. The scientific field of emergency medicine is subjected to a considerable amount of changes and requires qualified training and further education; in this context the guidelines for cardiopulmonary resuscitation are of outstanding importance. In the governmental-controlled emergency care system, the emergency physician and the chief emergency physician are responsible for both the individual treatment of patients and the management of major incidents and catastrophes. Moreover, the interhospital transfer is gaining increasing importance. Even though a high quality standard of the German emergency medicine system can be stated, there are still clear deficits such as the lack of integrated dispatch centers and the lack of the position of a medical physician as emergency care leader in each area. A leading structure for the management of major incidents and disasters is established to a great extent, nevertheless personal and material deficits exist in this field especially considering a rising terroristic threat. In the in-hospital emergency medicine anaesthetists are of essential importance for the interdisciplinary teamwork in the resuscitation room, medical treatment of in-hospital emergencies on the wards and outside on the hospital ground, and for internal as well as external major incidents and disasters. This is not always recognized in public opinion, so that the interdisciplinary integration must be secured and reinforced. ⋯ A major goal is to preserve emergency medicine as the third column of anaesthesiology and to protect achieved standards, to reinforce research in preclinical and clinical emergency medicine, and to take up new challenges in the future.
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Physicians, nurses and many other allied health professions join in intensive care as a team for the treatment of patients whose vital functions are either endangered or impaired. Apart from continuous monitoring, which represents the smallest common denominator of all types of intensive-care treatment, intensive-care therapy also encompasses continuous treatment and support of failing organ functions and likewise continuous intensive nursing. The complexity of intensive-care medicine is a strong argument against intensive-care becoming a medical specialty of its own. ⋯ The present situation in intensive-care medicine is characterised by an increasing tension between new and fascinating medical possibilities (such as right and left ventricular assistance device systems, liver support, pharmacologic treatment of sepsis, avoidance of the complications of critical illness) on the one hand, and limited budgets on the other hand. This conflict is reflected by two basic fears within the population: firstly, the fear that not everything medically possible is being done for the patient due to economic reasons, secondly, a fear of futile treatment at the end of life, merely prolonging inevitable death. Accordingly, ethical questions regarding intensive-care are emerging at all levels of the health system.
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Emergency medical services (EMS) systems represent and important part within our health care system. However rapidly changing basic conditions define the need to reconsider current structures and objectives of the German EMS system and to implement appropriate modifications. The steadily decreasing number of emergency physicians advises to delegate more and more "technical" duties to paramedic personnel. ⋯ For a long period of time the role of the emergency physician has been restricted to the stabilisation of disturbed vital functions. To assure the competitiveness of the German EMS system it will be indispensible to expand our scope of practice. As anesthetists we should not hesitate to take over our new position as "managers in acute care medicine".