European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Comparative Study
Helicopters as part of a regional EMS system--a cost-effectiveness analysis for three EMS regions in Germany.
With increasing health care costs the use of rescue helicopters is being questioned on the grounds of expense. No data exist on the cost-effectiveness of the use of rescue helicopters as part of a regional EMS. The end-point of this study was to analyse the cost-effectiveness of a 15 min response time (state regulation) of advanced life support (ALS) equipment provided by helicopter (1,575,000 DM annual costs) versus a ground-based ambulance (1,004,000 DM annual costs) in three EMS systems (50 km radius) with differing demographic and geographic features in Germany. ⋯ In model 2 each region had its existing helicopter withdrawn and replaced with six ALS cars. This made response times longer and increased expenditure. In conclusion, the additional use of rescue helicopters in EMS regions (50 km radius) remains cost-effective up to an ALSC:helicopter cost ratio of 1:6.
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Recognition of tissue hypoxia or cumulative oxygen debt is of fundamental importance for the triage and resuscitation of critically ill patients during the 'golden hour' in the emergency department. Vital signs, shock index and invasive monitoring of mean arterial pressure and central venous pressure have limited roles in evaluating cumulative oxygen debt and systemic oxygen balance in an acute critical illness. ⋯ Organ-specific oxygenation indices such as gastric tonometry and renal function can supplement indicators of systemic oxygen balance to detect ischaemia-hypoxia of non-vital organs. Systemic oxygenation and organ-specific indices can guide the choice of therapy to optimize resuscitation of the macro- and microcirculation in critically ill patients in the emergency department.
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A case of a person struck by lightning is presented in which treatment consisted of 60 min of resuscitation, followed by a 3 day period of artificial ventilation. Persons who are struck by lightning might benefit from prolonged resuscitation efforts, since patients such as this one, as well as similar cases described in the literature, have survived without major sequelae. In our opinion, on-the-spot advanced life support, hypothermia and a moderate rehydration policy contributed to this patient's successful resuscitation.
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Differences in the success rates of the pre-hospital or in-hospital resuscitation attempts seem to be attributable to the skill of the various rescuers. Whereas the definite success rate for pre-hospital resuscitation is 7%, the corresponding rate for in-hospital settings is 15%. In this context, the resuscitation skills and the self-assessment of CPR methods of hospital staff were investigated. ⋯ CPR skills of hospital staff are inadequate, mainly because of lack of manual dexterity. Obviously the special skills learned in CPR courses are lost in spite of a positive self-assessment after a relatively short time. The results, however, do not suggest completely inadequate handling of CPR procedures in a hospital setting. Indeed, an increasing rate of successful resuscitations inside the hospital (up to 27%) has been reported in the literature. As a consequence of our findings, refresher courses in specific CPR techniques must be demanded, which should be made compulsory for nursing staff every 2 years.
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Malignant arrhythmia, which is responsible for most of the out-of-hospital cardiac arrests, is ventricular fibrillation (VF). The best treatment of VF is a controlled electric shock on the chest administered in a short delay. ⋯ The delegation of defibrillation to ambulance crew members however implies a specific teaching, training and a medical control. The Brussels experience shows that semi-automatic external defibrillation by EMT-Ds (SAED) is feasible when criteria for applying SAED in the pre-hospital phase are applicable.