Prevalence of prehospital pain and pain assessment difference between patients and paramedics: a prospective cross-sectional observational study.

Adequate analgesia is one of the most important interventions in emergency medicine. However, studies suggest that many patients are undertreated for pain. There can be many reasons why patients assess their pain differently to the paramedics. This study aimed to assess the differences in pain ratings between patients and paramedics and factors influencing them in prehospital emergencies. This prospective cross-sectional observational study included patients treated and transported by paramedics or paramedics and emergency physicians of the German Red Cross in Reutlingen, Germany. This study included 6,365 patients. The prevalence of pain was 49.7%. Among patients with a self-reported numerical rating scale (NRS) > 0, the mean patient pain rating was NRS 4.2 ± 2.7, while the mean paramedic pain rating was NRS 3.6 ± 2.4 (p < 0.001). Approximately 11.8% (n = 751) of patients reported subjectively unbearable pain. Patients reported a mean NRS of 7.7 ± 1.8 for unbearable pain, but a mean NRS of 3.3 ± 2.0 for bearable pain (p < 0.001). The difference in pain ratings between patients and paramedics increased with pain severity. Univariate analysis showed that there were no gender differences, but the difference in pain rating was influenced by patient age (p < 0.001) and paramedic age (p = 0.042). The differences in pain ratings were particularly pronounced for abdominal diseases (p < 0.001) and trauma (p < 0.001). There is a difference in pain ratings between patients and paramedics, which increases with pain severity and appears to be associated with the patient's age and the paramedic's age. To determine the desire and need for analgesics, the question about unbearable pain is a good addition to the NRS.

Techno-economic analysis of underground hydrogen storage in Europe.

Hydrogen storage is crucial to developing secure renewable energy systems to meet the European Union's 2050 carbon neutrality objectives. However, a knowledge gap exists concerning the site-specific performance and economic viability of utilizing underground gas storage (UGS) sites for hydrogen storage in Europe. We compile information on European UGS sites to assess potential hydrogen storage capacity and evaluate the associated current and future costs. The total hydrogen storage potential in Europe is 349 TWh of working gas energy (WGE), with site-specific capital costs ranging from $10 million to $1 billion. Porous media and salt caverns, boasting a minimum storage capacity of 0.5 TWh WGE, exhibit levelized costs of $1.5 and $0.8 per kilogram of hydrogen, respectively. It is estimated that future levelized costs associated with hydrogen storage can potentially decrease to as low as $0.4 per kilogram after three experience cycles. Leveraging these techno-economic considerations, we identify suitable storage sites.

Patient-reported side effects and satisfaction of pre-hospital analgesia with low-dose esketamine: a cross-sectional study.

BACKGROUND: Analgesia is a core intervention in emergency medicine. Pain is subjective, so patient-reported experience with pain and analgesia is essential for healthcare professionals. The aim of this study was to evaluate patient-reported side effects and satisfaction associated with pre-hospital analgesia with low-dose esketamine. METHODS: This is an observational cross-sectional study conducted as part of quality assurance measures of the German Red Cross Emergency Medical Service, Reutlingen, Germany. The survey was administered to all patients who received prehospital esketamine analgesia from paramedics. Addresses were obtained from medical records and mailed 10 days after the event. Patient feedback was anonymous and could not be linked to operational documentation. RESULTS: A total of 201 patients were contacted, and 119 responses were received via the online questionnaire and postal mail (response rate 59%). The mean age of the patients was 68±13 years, with 64.7% (n=77) being female. The main diagnosis reported was fractures of the extremities in 69.7%. Patients reported initial median pain intensity on a Numeric Rating Scale (NRS) of 10 [8-10]. Pain was unbearable for 96.3% of patients. After administration of analgesia, 95.3% were satisfied or very satisfied. Patients reported no side effects in 78.5%, minor side effects in 10.0%, significant but well tolerable side effects in 11.3%, borderline tolerable side effects in 0.2%, and no unbearable side effects. Borderline tolerable nausea was reported in 2% of patients along with dreams in 0.8%. No nightmares were reported. Further analysis showed that patients older than 80 years reported significantly more side effects (p < 0.001) and were thus less satisfied with the analgesia. CONCLUSIONS: Both patient perception and analgesia with few side effects were important for both safety and satisfaction. In the present study, low-dose esketamine analgesia was associated with low side effects and high patient satisfaction.

Geochemical Integrity of Wellbore Cements during Geological Hydrogen Storage.

Increasing greenhouse gas emissions have put pressure on global economies to adopt strategies for climate-change mitigation. Large-scale geological hydrogen storage in salt caverns and porous rocks has the potential to achieve sustainable energy storage, contributing to the development of a low-carbon economy. During geological storage, hydrogen is injected and extracted through cemented and cased wells. In this context, well integrity and leakage risk must be assessed through in-depth investigations of the hydrogen-cement-rock physical and geochemical processes. There are significant scientific knowledge gaps pertaining to hydrogen-cement interactions, where chemical reactions among hydrogen, in situ reservoir fluids, and cement could degrade the well cement and put the integrity of the storage system at risk. Results from laboratory batch reaction experiments concerning the influence of hydrogen on cement samples under simulated reservoir conditions of North Sea fields, including temperature, pressure, and salinity, provided valuable insights into the integrity of cement for geological hydrogen storage. This work shows that, under the experimental conditions, hydrogen does not induce geochemical or structural alterations to the tested wellbore cements, a promising finding for secure hydrogen subsurface storage.

Efficacy and safety in ketamine-guided prehospital analgesia for abdominal pain.

Abdominal pain is a common reason for presentation in the emergency department and for calling emergency medical services. The complexity of abdominal pain also influences the analgesia strategy. However, there are almost no data on the use of ketamine for abdominal pain. This study aims to analyze the safety and efficacy of using ketamine as an analgesic for abdominal pain. In a retrospective analysis of prehospital patient data within the framework of quality assurance, all cases with ketamine administered by paramedics as analgesia for abdominal pain were analyzed in terms of pain reduction and patient safety and also compared with other analgesic drugs including fentanyl, morphine, and metamizole. From 01/01/2018 to 11/24/2021, 129 datasets were analyzed. The mean patient age was 50 ± 19 years (19-90 years), with 47.3% (n = 61) women. The application of fentanyl was documented as a monotherapy in 10.9% (n = 14), morphine in 2.3% (n = 3), metamizole in 34.1% (n = 44), and ketamine in 52.7% (n = 68) of cases. The pain relief of fentanyl, metamizole, and ketamine differed significantly from each other (p < 0.001), with fentanyl and ketamine being comparable. Looking at the quality assurance definition of successful analgesia (pain on handover NRS < 5 or pain reduction ≥ 2 points), successful analgesia was shown in 92.9% (n = 13) of cases for fentanyl, in 65.9% (n = 44) for metamizole, and 92.6% (n = 68) for ketamine (p < 0.001). Adverse events were not observed in patients treated with ketamine. Analgesia is an important goal in the treatment of patients with abdominal pain. With ketamine, analgesia comparable to fentanyl can be achieved. Ketamine appears to be a safe and effective option for the treatment of patients with abdominal pain in emergency medicine.Trial registration number DRKS00027343, date of registration: 09.12.2021, retrospectively registered.

Learning Success and Influencing Factors in Out-of-Hospital Placement of Intravenous Catheters.

INTRODUCTION: Placing peripheral intravenous catheters ("IV lines") is a standard procedure for health care professionals in acute and emergency medicine. The study aimed to determine the learning curve and success rates in applying IV lines during a three-year paramedic training and the factors influencing successful placement. METHODS: This was a prospective and noninterventional observational study to determine the influencing factors, learning outcomes, and performance in the placement of IV lines by trainees and experienced paramedics. Trial registration: German Clinical Trials Register, ID DRKS00024631. RESULTS: From February 1, 2016 through December 31, 2021, a total of 3,547 peripheral venous accesses attempts were performed: 76.5% (n = 2,712) by trainees and 23.5% (n = 835) by experienced practitioners. The trainee group had one-to-three years of training and the experienced group had 11 (SD = 11) years of work experience after training (one-to-35 years). The learning or success curve in the successful placement of peripheral venous accesses was 85.2% in the first year of training, 88.5% in the second year of training, and 92.5% in the third year (and the end of training). It was then 94.3% in the fourth year (first year of being experienced). Successful insertion of peripheral venous accesses in the experienced group was up to 97.0%. The first-attempt success rate was 90.4% across the entire trainee group versus 95.9% in the experienced group (P <.0001).Significant factors influencing successful placement of IV lines were puncture site (P = .022), catheter size (OR = 0.600; P = .002), and number of attempts (OR = 0.370; P <.001). The time of day (or night) was not influential. Work experience, patient age, or blood pressure were also not significant.

Geological Hydrogen Storage: Geochemical Reactivity of Hydrogen with Sandstone Reservoirs.

The geological storage of hydrogen is necessary to enable the successful transition to a hydrogen economy and achieve net-zero emissions targets. Comprehensive investigations must be undertaken for each storage site to ensure their long-term suitability and functionality. As such, the systematic infrastructure and potential risks of large-scale hydrogen storage must be established. Herein, we conducted over 250 batch reaction experiments with different types of reservoir sandstones under conditions representative of the subsurface, reflecting expected time scales for geological hydrogen storage, to investigate potential reactions involving hydrogen. Each hydrogen experiment was paired with a hydrogen-free control under otherwise identical conditions to ensure that any observed reactions were due to the presence of hydrogen. The results conclusively reveal that there is no risk of hydrogen loss or reservoir integrity degradation due to abiotic geochemical reactions in sandstone reservoirs.

[Best practice-example of a paramedic competence system in the context of user and patient safety: the Reutlinger Weg]. / Best Practice ­ Beispiel für ein Notfallsanitäterkompetenzsystem im Rahmen der Anwender- und Patientensicherheit: der Reutlinger Weg.

The discussion about the competencies and responsibilities of paramedics has been going on for decades and is the subject of controversial legal debates and currently the focus of political attention due to the heterogeneous country-specific design. However, there are only a few published examples of a so-called competency system for the safe and effective use of prehospital emergency medicine interventions. The practical experience of a competence system is presented. Adequate education and training are crucial for development of competence. A physician-supported quality assurance system creates the opportunity to confirm the competencies of paramedics within the framework of competence checks, monitor the system by means of indicators, and detect weak points at an early stage. Safety culture must be exemplified. Standard operating procedures (SOPs) are the guideline for implementation. In a competence system, certified paramedics can be granted authorization and thus contribute to rapid and efficient patient care, while keeping emergency physicians available for indications requiring their competencies.

Thermodynamic and transport properties of hydrogen containing streams.

The use of hydrogen (H2) as a substitute for fossil fuel, which accounts for the majority of the world's energy, is environmentally the most benign option for the reduction of CO2 emissions. This will require gigawatt-scale storage systems and as such, H2 storage in porous rocks in the subsurface will be required. Accurate estimation of the thermodynamic and transport properties of H2 mixed with other gases found within the storage system is therefore essential for the efficient design for the processes involved in this system chain. In this study, we used the established and regarded GERG-2008 Equation of State (EoS) and SuperTRAPP model to predict the thermo-physical properties of H2 mixed with CH4, N2, CO2, and a typical natural gas from the North-Sea. The data covers a wide range of mole fraction of H2 (10-90 Mole%), pressures (0.01-100 MPa), and temperatures (200-500 K) with high accuracy and precision. Moreover, to increase ease of access to the data, a user-friendly software (H2Themobank) is developed and made publicly available.

Development of an Adapted Model for Decision-Making to Improve Reasoning and Risk Assessment in an Emergency Team: A Prospective Simulation Study.

: Background and Objectives: Medical staff is rarely trained in structured decision-making, relying instead on intuition without due consideration for the associated pros and cons. Materials and Methods: We adopted a model for decision-making to improve reasoning and risk assessment and carried out a prospective simulation study using paramedic students in a three-year training program. We conducted a training session in which participants were lectured on decision-making using the FAR-BEK model (German abbreviation for facts, alternatives, risks, competence, decision, control), physiological processes in decision-making under stress, as well as medico-legal aspects for the comprehension and justification of medical decisions. We analyzed pre- and post-training scenarios to elucidate the influence of training on decision-making. Results: Twenty paramedic students, with a mean age of 22.0 ± 1.7 years, took part in the study. The question of whether decision aids can be applied, initially affirmed by 40% of participants, rose to 71.4% (p = 0.011) following our training. Confidence in decision-making increased on a 7-point Likert scale from 4.5 to 4.8 points (p < 0.394). The reasoning behind the decisions rose from 5.3 to 5.6 points (p < 0.081). Indication, options, and risks rose significantly, from 5.4 to 6.1 points (p = 0.045). Overall, our simulation training significantly increased the points of decision support taken into account (57.8% vs. 88.9%, p < 0.001). Viewed individually, the largest increase of 180% was seen in risk assessment (33.3% vs. 93.3%, p < 0.002). The second largest increase of 150% was seen in the question of one's own permissions (26.7% vs. 66.7%, p < 0.066). Also, the control increased (40.0% vs. 86.7%, p < 0.021). Conclusions: With a brief training course, both the awareness and the implementation of a structured decision-making model in paramedic students can be significantly increased. Nevertheless, no definitive conclusions can be made with respect to the implementation of real patient care. The application of structured, standardized decision-making tools may need to be further consolidated in routine medical use.