Subscribe to RSS
DOI: 10.1055/s-0043-122219
Einsatz von Notärzten in Ländern mit Paramedic-System
Disposition of Emergency Physicians in Countries with a Paramedic SystemPublication History
Publication Date:
12 December 2017 (online)
Zusammenfassung
In manchen Nachbarländern mit ursprünglich Paramedic-basiertem Rettungssystem wurde in den letzten Jahrzehnten der Bedarf nach einer prähospitalen notärztlichen Kompetenz erkannt. Ausgangsbedingungen und Lösungen waren dabei durchaus unterschiedlich. Dieser Beitrag beschreibt die Entwicklung in Großbritannien, Dänemark und den Niederlanden. Der Vergleich der Systeme kann bei der Bestimmung der aktuellen und zukünftigen Stellung des Notarztes in unserem deutschen Rettungssystem helfen.
Abstract
In some of our neighbouring countries with a primary paramedic-based rescue system, the need for the competency of a pre-hospital emergency physician was identified during the recent decades. Original conditions and solutions revealed to be quite different. This article describes the development in Great Britain, Denmark and the Netherlands. A comparison of the systems may help to assess the current and future role of the emergency physician in the German rescue system.
-
Literatur
- 1 Fischer M, Kehrberger E, Marung H. et al. Eckpunktepapier 2016 zur notfallmedizinischen Versorgung der Bevölkerung in der Prähospitalphase und in der Klinik. Notfall Rettungsmed 2016; 19: 387-395 doi:10.1007/s10049-016-0187-0
- 2 Fischer M, Kamp J, Garcia-Castrillo Riesgo L. et al. Comparing emergency medical service systems–a project of the European Emergency Data (EED) Project. Resuscitation 2011; 82: 285-293 doi:10.1016/j.resuscitation.2010.11.001
- 3 College of Paramedics. Paramedic Curriculum Guidance, 3rd edition revised. 2015. Im Internet: https://www.collegeofparamedics.co.uk/downloads/Paramedic_Curriculum_Guidance_2015.pdf Stand: 11.11.2017
- 4 Cornwall Air Ambulance. Introduction. 2006 Im Internet: http://www.cornwall-online.co.uk/air-ambulance/ Stand: 11.11.2017
- 5 Londonʼs Air Ambulance. From social responsibility to medical innovation (2006). Im Internet: https://londonsairambulance.co.uk/our-service/our-work/history Stand: 11.11.2017
- 6 Booth A, Steel A, Klein J. Anaesthesia and pre-hospital emergency medicine. Anaesthesia 2013; 68 (Suppl. 01) 40-48
- 7 National Confidential Enquiry into Patient Outcome and Death NCEPOD. Trauma – who cares?. 2008 Im Internet: http://www.ncepod.org.uk/2007report2/Downloads/SIP_summary.pdf Stand: 11.11.2017
- 8 Deakin CD, Clarke T, Nolan J. et al. A critical reassessment of ambulance service airway management in prehospital care: Joint Royal Colleges Ambulance Liaison Committee Airway Working Group, June 2008. Emerg Med J 2010; 27: 226-233 doi:10.1136/emj.2009.082115 Im Internet: http://www.jrcalc.org.uk/wp-content/uploads/2013/11/airway17.6.8.pdf Stand: 11.11.2017
- 9 Association of Anaesthetists of Great Britain and Ireland. AAGBI: Safety Guideline Prehospital Anaesthesia 2009. Im Internet: https://www.aagbi.org/sites/default/files/prehospital_glossy09.pdf Stand: 11.11.2017
- 10 Association of Air Ambulances. Framework for a high performing Air Ambulance Service. 2008 Im Internet: http://www.uk-hems.co.uk/A Framework for a high performance Air Ambulanc Service.pdf Stand: 11.11.2017
- 11 National Health Service NHS. Taking Healthcare to the patient. 2005 Im Internet: http://aace.org.uk/wp-content/uploads/2011/11/Taking-Healthcare-to-the-Patient-Transforming-NHS-Ambulance-Services.pdf Stand: 11.11.2017
- 12 College of Paramedics. Paramedics career framework. 2016 Im Internet: https://www.collegeofparamedics.co.uk/downloads/College_of_ParamedicsInteractiveCareer_Framework16.pdf Stand: 11.11.2017
- 13 The Human Medicines Regulations. 2012 Im Internet: http://www.legislation.gov.uk/uksi/2012/1916/pdfs/uksi_20121916_en.pdf Stand: 11.11.2017
- 14 College of Paramedics. Proposal to introduce Paramedic Independent Prescribing. 2015 Im Internet: https://www.collegeofparamedics.co.uk/news/proposal-to-introduce-paramedic-independent-prescribing Stand: 11.11.2017
- 15 Intercollegiate Board für Training in Pre-hospital Emergency Medicine. Sub-specialty training in pre-hospital emergency medicine – curriculum and assessment system, second edition. 2015 Im Internet: http://www.ibtphem.org.uk/media/1039/sub-specialty-training-in-phem-curriculum-assessment-system-edition-2-2015.pdf Stand: 11.11.2017
- 16 Maitra S, Christian MR, Aka SE. Subspecialisation in emergency medicine: An international perspective. Emerg Med Australas 2016; 28: 465-467
- 17 Gotz VN. A career in pre-hospital emergency medicine. 2013 Im Internet: http://careers.bmj.com/careers/advice/view-article.html?id=20011662 Stand: 11.11.2017
- 18 Morris S, OʼCarrol L. Surgeons in the sky: doctors help air ambulances reach new heights. 2016 Im Internet: https://www.theguardian.com/society/2016/jan/31/surgeons-in-the-sky-doctors-help-air-ambulances-reach-new-heights Stand: 11.11.2017
- 19 Littlewood N, Parker A, Hearns S. et al. The UK helicopter ambulance tasking study. Injury 2010; 41: 27-29
- 20 Association of Anaesthetists of Great Britain and Ireland. AAGBI: Safer pre-hospital anaesthesia 2017. Anaesthesia 2017; 72: 379-390 doi:10.1111/anae.13779/full
- 21 McQueen C, Apps R, Mason F. et al. ‘Interception’: a model for specialist prehospital care provision when helicopters are not available. Emerg Med J 2013; 30: 956-957 doi:10.1136/emermed-2013-202989
- 22 Wikipedia. East Anglian Air Ambulance (2017). Im Internet: https://en.wikipedia.org/wiki/East_Anglian_Air_Ambulance Stand: 11.11.2017
- 23 National Health Service, NHS. Critical care paramedics. Delivering enhanced pre-hospital trauma and resuscitation care: a cost-effective approach. 2011 Im Internet: https://repository.royalholloway.ac.uk/file/4e0abf6c-395b-3179-8a3a-deedf5de4dc8/8/2011_Jashapara_Evaluation_of_Critical_Care_Paramedics_Summary_NHS_Confederation.doc.pdf Stand: 11.11.2017
- 24 College of Paramedics. College of Paramedics (British Paramedic Association) updated position paper following JRCALC recommendations on paramedic intubation. 2008 Im Internet: https://www.collegeofparamedics.co.uk/downloads/College_of_Paramedics_post_report_intubation_position_paper_V4.pdf Stand: 11.11.2017
- 25 Lockey DJ, Healey B, Crewdson K. et al. Advanced airway management is necessary in prehospital trauma patients. Br J Anaesth 2015; 114: 657-662
- 26 Association of Anaesthetists of Great Britain and Ireland (AAGBI). Safer pre-hospital anaesthesia 2017. Anaesthesia 2017; 72: 379-390
- 27 Trier H, Larsen CF. Den præhospitale service i Danmark. Nord Med 1993; 108: 84-87
- 28 Larsen CF, Jørgensen HRI, Nielsen JR. et al. Præhospital behandling. Ambulance-projektet Odense. En prospektiv undersøgelse. Ugeskr Læger 1990; 152: 1886-1891
- 29 Hansen TM, Juelsgaard P, Christensen EF. Forsøg med indsaettelse af laegeambulance i Arhus. En pilotundersøgelse. Ugeskr Laeger 1996; 158: 5438-5442
- 30 Mikkelsen S, Krüger AJ, Zwisler ST. et al. Outcome following physician supervised prehospital resuscitation: a retrospective study. BMJ Open 2015; 5: e006167 doi:10.1136/bmjopen-2014-006167
- 31 Kindberg K, Nielsen SL, Møller AM. Præhospitale lægebaserede behandlinger i Danmark. Ugeskr Laeger 2009; 171: 2553-2557
- 32 The Capital Region of Denmark. Physician staffed Critical Care Units. 2017 Im Internet: https://www.regionh.dk/english/Healthcare-Services/Emergency-Medical-Services/Copenhagen-Emergency-medical-services/Pages/Physician-response-vehicles.aspx Stand: 11.11.2017
- 33 rth.info – Faszination Luftrettung. . „Ab dem 1. Oktober fliegen Dänemarks RTH“. 2014 Im Internet: http://www.rth.info/news/news.php?id=1495 Stand: 11.11.2017
- 34 Hamilton A, Steinmetz J, Wissenberg M. et al. Association between prehospital physician involvement and survival after out-of-hospital cardiac arrest: A Danish nationwide observational study. Resuscitation 2016; 108: 95-101 doi:10.1016/j.resuscitation.2016.08.007
- 35 Mikkelsen S, Lossius HM, Binderup LG. et al. Termination of pre-hospital resuscitation by anaesthesiologists – causes and consequences. A retrospective study. Acta Anaesthesiol Scand 2017; 61: 250-258 doi:10.1111/aas.12838
- 36 Meisler R, Berlac PA. [Prehospital trauma triage before and after deployment of a physician-manned mobile emergency care unit in Nordsjaelland]. Ugeskr Laeger 2009; 171: 2548-2552
- 37 Justitsministeriet. Vejledning om uddannelse til ambulancebehandler og ambulancebehandler med særlig competence. 2011 Im Internet: https://www.retsinformation.dk/Forms/R0710.aspx?id=142853 Stand: 11.11.2017
- 38 Frischknecht Christensen E, Berlac PA, Nielsen H. et al. The Danish quality database for prehospital emergency medical services. Clin Epidemiol 2016; 8: 667-671
- 39 Academie voor Ambulancezorg. Ambulanceverpleegkundige. 2017 Im Internet: http://www.academievoorambulancezorg.nl/initieel/initiele-opleidingen/ambulanceverpleegkundige/ Stand: 11.11.2017
- 40 Ambulancezorg Nederland. Landelijk Protocol Ambulancezorg. 2016 Im Internet: https://www.ambulancezorg.nl/dl/files/20160801_LPA8_1_definitief_drukproef_wm_bv(2).pdf Stand: 11.11.2017
- 41 Ringburg AN. Helicopter Emergency Medical Services – Effects, Costs and Benefits [Dissertation]. Rotterdam: Erasmus Universiteit Rotterdam; 2009
- 42 Giannakopoulos GF, Lubbers WD, Christiaans HMT. et al. Cancellations of (helicopter transported) mobile medical team dispatches in the Netherlands. Langenbecks Arch Surg 2010; 395: 737-745
- 43 van Schuppen H, Bierens J. Understanding the prehospital physician controversy. Step 1: comparing competencies of ambulance nurses and prehospital physicians. Eur J Emerg Med 2011; 18: 322-327 doi:10.1097/MEJ.0b013e32834533f4
- 44 van Schuppen H, Bierens J. Understanding the prehospital physician controversy. Step 2: analysis of on-scene treatment by ambulance nurses and helicopter emergency medical service physicians. Eur J Emerg Med 2015; 22: 384-390 doi:10.1097/MEJ.0000000000000204
- 45 den Hartog D, Romeo J, Ringburg AN. et al. Survival benefit of physician-staffed Helicopter Emergency Medical Services (HEMS) assistance for severely injured patients. Injury 2015; 46: 1281-1286 doi:10.1016/j.injury.2015.04.013
- 46 Sefrin P. Geschichte der Notfallmedizin in Deutschland unter besonderer Berücksichtigung des Notarztdienstes. Anästhesiol Intensivmed Notfallmed Schmerzther 2003; 38: 623-629