[Carbon monoxide poisoning by a heating system]. / Kohlenmonoxidvergiftungen durch Heizungsanlagen.

A case of accidental carbon monoxide poisoning in several occupants of two neighboring residential buildings in Hamburg-Harburg (Germany) caused by a defective gas central heating system is described. Because of leaks in one of the residential buildings and the directly adjacent wall of the neighboring house, the gas could spread and accumulated in both residential buildings, which resulted in a highly dangerous situation. Exposure to the toxic gas caused mild to severe intoxication in 15 persons. Three victims died still at the site of the accident. Measures to protect the occupants were taken only with a great delay. As symptoms were unspecific, it was not realized that the various alarms given by persons involved in the accident were related to the same cause. In order to take appropriate measures in time it is indispensible to recognize, assess and check potential risks, which can be done by using carbon monoxide warning devices and performing immediate COHb measurements with special pulse oximeters on site. Moreover, the COHb content in the blood should be routinely determined in all patients admitted to an emergency department with unspecific symptoms.

[Mass casualty incidents - current concepts and developments]. / Massenanfall von Verletzten†/†Erkrankten - Aktuelle Aspekte zur medizinischen Versorgung.

Medical concepts and strategies are permanently changing. Due to the emergency response in a mass casualty incident everyone who is involved has to work together with different organisations and public authorities, which are not part of the regular emergency medical service. Within the last 25 years throughout the whole country of Germany the role of a "chief emergency physician" has been implemented and in preparation for the FIFA World Cup 2006 mobile treatment units were set up. In 2007, special units of the "Medical Task Force" - funded by the german state - were introduced and have been established by now. They will be a permanent part of regional plannings for mass casualty incidents. This article highlights current concepts and developments in different parts of Germany.

Paramedics experiences and expectations concerning advance directives: a prospective, questionnaire-based, bi-centre study.

BACKGROUND: Advance directives and palliative crisis cards are means by which palliative care patients can exert their autonomy in end-of-life decisions. AIM: To examine paramedics' attitudes towards advance directives and end-of-life care. DESIGN: Questionnaire-based investigation using a self-administered survey instrument. SETTING/PARTICIPANTS: Paramedics of two cities (Hamburg and Goettingen, Germany) were included. Participants were questioned as to (1) their attitudes about advance directives, (2) their clinical experiences in connection with end-of-life situations (e.g. resuscitation), (3) their suggestions in regard to advance directives, 'Do not attempt resuscitation' orders and palliative crisis cards. RESULTS: Questionnaires were returned by 728 paramedics (response rate: 81%). The majority of paramedics (71%) had dealt with advance directives and end-of-life decisions in emergency situations. Most participants (84%) found that cardiopulmonary resuscitation in end-of-life patients is not useful and 75% stated that they would withhold cardiopulmonary resuscitation in the case of legal possibility. Participants also mentioned that more extensive discussion of legal aspects concerning advance directives should be included in paramedic training curricula. They suggested that palliative crisis cards should be integrated into end-of-life care. CONCLUSIONS: Decision making in prehospital end-of-life care is a challenge for all paramedics. The present investigation demonstrates that a dialogue bridging emergency medical and palliative care issues is necessary. The paramedics indicated that improved guidelines on end-of-life decisions and the termination of cardiopulmonary resuscitation in palliative care patients may be essential. Participants do not feel adequately trained in end-of-life care and the content of advance directives. Other recent studies have also demonstrated that there is a need for training curricula in end-of-life care for paramedics.

[Obesity in prehospital emergency care]. / Adipositas im Rettungsdienst - Was ist zu beachten?

The prevalence of obesity has increased steadily in recent years. Obese people often suffer from diseases which acute decompensation requires a prompt prehospital therapy. The Emergency Medical Service will be confronted with difficulties in clinical diagnostic, therapy and especially with a delayed management of rescue and transport. It is most important to avoid prehospital depreciation in quality and time management. This article reviews the specific requirements of prehospital care of obese persons and discusses possible solutions to optimize the prehospital therapy.

[Medical coverage of a road bicycle race]. / Notfallversorgung einer Radsportveranstaltung. Planung, Management und Einsatzaufkommen.

Major sport events require adequate expertise and experience concerning medical coverage and support. Medical and ambulance services need to cover both participants and spectators. Likewise, residents at the venue need to be provided for. Concepts have to include the possibility of major incidents related to the event. Using the example of the Hamburg Cyclassics, a road bicycle race and major event for professional and amateur cyclists, this article describes the medical coverage, number of patients, types of injuries and emergencies. Objectives regarding the planning of future events and essential medical coverage are consequently discussed.