Rescue service deployment data as an indicator of heat morbidity in Frankfurt / Main, Germany (2014-2022) - Trend association with various heat exposure indicators and considerations for outreach.

Many publications dealt with the monitoring of heat-related mortality. Fewer analyses referred to indicators of heat-related morbidity. The aim of this work was to describe the heat-related morbidity using rescue service data from the city of Frankfurt/Main, Germany for the time period 2014-2022, with regard to the questions: 1) How do rescue service deployments develop over the years? Is there a trend identifiable towards a decrease in deployments over the years, e.g. as an effect of either (physiological) adaptation of the population or of the measures for prevention of heat-related morbidity? 2) Which heat parameters (days with a heat warning, heat days, heat weeks, heat waves) are most strongly associated with heat-related morbidity in terms of rescue service deployments and might therefore be additionally used as an easily communicable and understandable heat-warning indicator? Rescue service data were provided by the interdisciplinary medical supply compass system "IVENA" and adjusted for population development including age development. The effect of various indicators for heat exposure, such as days with a heat warning from the German meteorological service based on the scientific concept of "perceived heat", heat days, heat wave days and heat week days on different endpoints for heat morbidity (deployments in total as well as for heat associated diagnoses) was calculated using both difference-based (difference ± 95% CI) and ratio-based (ratio ± 95% CI) effect estimators. Rescue services deployments in summer months increased overall from 2014 to 2022 in all age groups over the years (2698 to 3517/100.000 population). However, there was a significant decrease in 2020, which could be explained by the special situation of the COVID-19 pandemic, probably caused by the absence of tourists and commuters from the city. In addition, no data are available on the actual implementation of the measures by the population. Therefore, an effect of the measures taken to prevent heat-associated morbidity in Frankfurt am Main could not be directly demonstrated, and our first question cannot be answered on the basis of these data. Almost all heat definitions used for exposure (day with a heat warning, heat day, heat wave day, heat week day) showed significant effects on heat-associated diagnoses in every year. When analysing the effect on all deployments, the effect was in part strongly dependent on individual years: Heat wave days and heat week days even showed negative effects in some years. The definition heat day led to a significant increase in rescue service deployments in all single years between 2014 and 2022 (ratio 2014-2022 1.09 (95CI 1.07-1.11); with a range of 1.05 (95CI 1.01-1.09) in 2020 and 1.14 (95CI 1.08-1.21) in 2014), this was not the case for days with a heat warning (ratio 2014-2022 1.04 (95CI1.02-1.05); with a range of 1.01 (95CI 0.97-1.05) in 2017 and 1.16 (95CI 1.10-1.23). Thus being not inferior to the heat warning day, the "heat day" defined as ≥32 °C maximum temperature, easily obtainable from the weather forecast, can be recommended for the activities of the public health authorities (warning, surveillance etc.) regarding heat health action planning.

Emergency airway management in trauma patients using laryngeal tube suction.

BACKGROUND: Endotracheal intubation (ETI) is considered to be the "gold standard" of prehospital airway management of trauma patients. However, ETI requires substantial technical skills and ongoing experience. Because failed prehospital ETI is common and associated with a higher mortality, reliable airway devices are needed to be used by rescuers who are less experienced in ETI. OBJECTIVE: To prospectively evaluate the feasibility of the use of laryngeal tubes by paramedics and emergency physicians for out-of-hospital airway management in trauma patients. METHODS: During a 40-month period, data for all cases of prehospital use of the laryngeal tube suction disposable (LTS-D) within a large metropolitan area were recorded by a standardized questionnaire. We determined indications for laryngeal tube use, placement success, number of placement attempts, placement time, and personal level of experience. All patients admitted to our institution also underwent in-hospital follow-up. RESULTS: Fifty-six of 57 prehospital intubations attempts with the LTS-D were successfully performed by paramedics (n = 19) or emergency physicians (n = 37) within one (n = 50) or two (n = 6) placement attempts. The device was used as initial airway (n = 27) or rescue device after failed ETI (n = 30). The placement time was ≤ 45 seconds (n = 42), 46-90 seconds (n = 13), and >90 seconds (n = 1). The majority of users (n = 44) were relative novices with no more than 10 previous laryngeal tube placements on actual patients. Of 33 patients eligible for follow-up, one underwent urgent LTS-D removal and subsequent ETI upon hospital admission, six underwent ETI after primary survey, and 26 underwent both primary and secondary survey or even damage-control surgery with the LTS-D. CONCLUSION: The LTS-D represents a promising alternative to ETI in the hands of both paramedics and emergency physicians. It can be used as an initial tool to secure the airway until ETI is prepared, as a definitive airway by rescuers less experienced in ETI, or as a rescue device when ETI has failed.

Initiation of risk management: incidence of failures in simulated Emergency Medical Service scenarios.

AIM: This study is a description of the rate of unsafe acts and communication events in simulations of Emergency Medical Service (EMS) mission-based scenarios as first response for risk management and patient safety. SUBJECTS AND METHODS: The study involved video-based observation of German paramedic teams (n=40) during simulated EMS missions. Teams were randomised to four types of scenarios: advanced life support (ALS), bronchial asthma (BA), pulmonary embolism (PE) and multiple trauma (MT). All predefined events were analysed. RESULTS: In a total of 40 scenarios, paramedics committed more than seven unsafe acts per scenario (7.4+/-3.8, mean+/-standard deviation, 95% confidence interval (CI): 6.6-8.3). In detail, there were unsafe acts for ALS (6.8+/-3.9, 95% CI: 5.2-8.5), in BA (8.1+/-3.9, 95% CI: 6.4-9.8), in PE (4.0+/-1.6, 95% CI: 3.0-5.0) and in MT (9.3+/-3.2, 95% CI: 7.8-10.7). Strategies of diagnosis and treatment were heterogeneous chronologically and methodically. Bad communication events were noted with a mean of 3.9+/-1.6 (95% CI: 3.1-4.6) within the scenarios. All the handovers (100%) between paramedics and emergency physician were incomplete, and 53.7+/-11.0% (95% CI: 48.5-58.8%) of information of realised actions and status of patient were missed in handover. CONCLUSION: A subset of German paramedics caused many unsafe acts and dangerous communication in simulations that may affect real-life work. We suggest paramedics should take part in a need-based education programme and communication training.

Out-of-hospital airway management by paramedics and emergency physicians using laryngeal tubes.

CONCEPT: Endotracheal intubation (ETI) is considered to be the gold standard of prehospital airway management. However, ETI requires substantial technical skills and ongoing experience. Because failed prehospital ETI is common and associated with a higher mortality, reliable airway devices are needed to be used by rescuers less experienced in ETI. We prospectively evaluated the feasibility of laryngeal tubes used by paramedics and emergency physicians for out-of-hospital airway management. MATERIAL AND METHODS: During a 24-month period, all cases of prehospital use of the laryngeal tube disposable (LT-D) and laryngeal tube suction disposable (LTS-D) within five operational areas of emergency medical services were recorded by a standardised questionnaire. We determined indications for laryngeal tube use, placement success, number of placement attempts, placement time and personal level of experience. RESULTS: Of 157 prehospital intubation attempts with the LT-D/LTS-D, 152 (96.8%) were successfully performed by paramedics (n=70) or emergency physicians (n=87). The device was used as initial airway (n=87) or rescue device after failed ETI (n=70). The placement time was < or =45s (n=120), 46-90s (n=20) and >90s (n=7). In five cases the time needed was not specified. The number of placement attempts was one (n=123), two (n=25), three (n=2) and more than three (n=2). The majority of users (61.1%) were relative novices with no more than five previous laryngeal tube placements. CONCLUSION: The LT-D/LTS-D represents a reliable tool for prehospital airway management in the hands of both paramedics and emergency physicians. It can be used as an initial tool to secure the airway until ETI is prepared, as a definitive airway by rescuers less experienced with ETI or as a rescue device when ETI has failed.