[Flawed initial treatment of dog bite injury]. / Fehlerhafte Erstversorgung einer Hundebissverletzung.

A 73-year-old male patient suffered multiple dog bites to the left hand and lower arm. The initial treatment in hospital consisted of conservative treatment with wound closure strips and bandages. For further treatment the patient was referred to the general practitioner who found a discharge of pus below the wound closure strips 2 days later. On the 3rd day the patient was admitted to a different hospital where surgical treatment with débridement, placement of vacuum bandages and subsequent flap plasty was conducted on admission. An examination 1 year later revealed stabbing pain over the carpometacarpal joint radiating into the thumb, hypoesthesia of the back of the hand, numbness of the thumb on the ulnar side, reduced range of movement in the wrist and thumb and suspected development of a neuroma. In the subsequent arbitration procedure, the patient criticized the initial treatment and claimed that the bite wounds were not cleansed and were then closed with wound closure strips without antibiotic treatment. This was assumed to have caused extensive infection, which required surgical treatment and caused lasting complaints. The arbitration board report determined an insufficient initial clinical assessment and a faulty wound care resulting in, among other things, reduced range of movement of all fingers of the left hand.

[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.