Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[Emergency physician expertise in the emergency medical services of tomorrow: requirements in the context of an evolving emergency care system].","authors":"Janika Briegel, Dominik Leistner, Sylvia Schaber","doi":"10.1007/s00063-026-01487-6","DOIUrl":"https://doi.org/10.1007/s00063-026-01487-6","url":null,"abstract":"<p><p>The prehospital emergency care system in Germany is undergoing profound structural change, driven by demographic shifts, increasing emergency service responses and the expanding competencies of paramedics as the most highly qualified non-physician Emergency Medical Services (EMS) professionals. Within standardized pre-delegation frameworks, they perform clearly defined physician-prescribed interventions and, in emergency situations, independently carry out medical procedures in accordance with Section 2a of the German Federal Act on the Profession of Emergency Paramedics (Notfallsanitätergesetz), allowing a substantial proportion of emergency situations to be managed autonomously by paramedics and enabling physician resources to be increasingly focused on critically ill patients. In this context, the competency profile of prehospital emergency physicians is shifting towards highly specialized skills required in rare, life-threatening high-acuity, low-occurrence (HALO) situations, in which complex invasive procedures, nuanced clinical decision-making and structured team leadership are essential. As reliable maintenance of these skills cannot be ensured solely within the EMS setting due to low case numbers, the growing discrepancy between dynamically expanding paramedic competencies and largely static qualification requirements for emergency physicians underscores the need for a structured, mandatory and more specialized framework for prehospital emergency physician training and continuing education.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Patient navigation to cooperation practices : Experiences from pilot projects on redirecting emergency department patients].","authors":"Sarah Oslislo, J Hagelskamp, D von Stillfried","doi":"10.1007/s00063-026-01491-w","DOIUrl":"https://doi.org/10.1007/s00063-026-01491-w","url":null,"abstract":"<p><strong>Background: </strong>Germany's Emergency Care Reform Act envisions integrated emergency centers (INZ) in which a central initial assessment assigns patients to the emergency department, an affiliated out of hours practice or contractually linked cooperation practices (CP). Pilot projects were carried out to examine under which conditions referrals to CP can succeed.</p><p><strong>Material and methods: </strong>Lessons-learned synthesis based on final reports and publications from seven projects conducted by the Central Research Institute for Ambulatory Health Care (Zi) in cooperation with hospitals and regional associations of statutory health insurance physicians. The content was extracted in a standardized manner along predefined process categories, documented in an extraction matrix and synthesized (framework-based synthesis).</p><p><strong>Results: </strong>The synthesis shows that patient navigation to CP depends less on the assessment instrument than on the process transitions between stakeholders. Key prerequisites include defined roles at first contact, time-based disposition pathways, transparent CP capacity profiles, confirmed acceptance and standardized feedback. A lack of appropriately matched acute care capacity proved to be a recurring barrier. Within the feasibility studies, no evidence of patient safety concerns was identified.</p><p><strong>Discussion: </strong>Off-campus navigation (referral to practices outside the hospital site) to CP poses requirements beyond those of the on-campus models (care provided at the hospital site) studied in the international literature. What matters is not individual instruments but the reliability of the entire process chain, from patient information through disposition to feedback. Without consistent reimbursement, procedural commitment is at risk in routine operations.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Emergency physician interventions in the care of patients with acute coronary syndrome : Comparative, retrospective, observational study].","authors":"Thomas Hofmann, Lena Himmelreich, Roland Kirschenlohr, Toni Fredrich, Patrick Andreas Eder, Frank Flake, Katrin Bagdahn, Jan Orendt, Melanie Reuter-Oppermann, Rolf Lefering","doi":"10.1007/s00063-025-01306-4","DOIUrl":"10.1007/s00063-025-01306-4","url":null,"abstract":"<p><strong>Background: </strong>The prehospital emergency care of patients with acute coronary syndrome (ACS) is highly relevant as such interventions have required an above-average involvement of emergency physicians to date. The aim of this study was to investigate the incidence of physicians' interventions in the context of ACS care and to identify predictors that indicate the need for such interventions at the time of the emergency call.</p><p><strong>Methods: </strong>A retrospective observational study was conducted based on 10,833 emergency department protocols from three regions in Germany. Protocols with (suspected) diagnoses such as STEMI, NSTEMI, unclear chest pain, or cardiogenic shock were included. After extensive data cleaning and coding of interventions, a descriptive analysis was performed to determine the incidence of physicians' measures and a logistic regression to determine predictors for physicians' interventions.</p><p><strong>Results: </strong>Interventions requiring the presence of an emergency physician were performed in 2.5% of cases. Significant predictors for physicians' interventions were undocumented (odds ratio [OR] 2.7), reduced (OR 7.77) or absent consciousness (OR 24.5), undocumented breathing (OR 5.13), dyspnea (OR 2.1), cyanosis (OR 4.48), apnea (OR 8.82) or cold sweats (OR 3.2).</p><p><strong>Conclusion: </strong>The incidence of physicians' interventions in ACS patients is low. The results suggest that not all ACS cases require physicians on scene. However, patients with reduced consciousness, cyanosis or respiratory arrest should continue to be treated primarily by emergency physicians. Prospective studies could further improve prehospital care.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"465-472"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Predictability of patient disposition from emergency medical services triage categories: exploratory analysis of routine data].","authors":"Torben Brod, Uta Hillebrand, Christoph Schröder, Andreas Flemming, Nils Schneider, Tanja Schleef","doi":"10.1007/s00063-025-01300-w","DOIUrl":"10.1007/s00063-025-01300-w","url":null,"abstract":"<p><strong>Background: </strong>Efficient and patient-centered emergency care requires early control of patient flow. It is unclear whether this is already possible in the prehospital phase by emergency medical services (EMS) and whether this can contribute to relieving pressure on emergency departments (EDs).</p><p><strong>Objectives: </strong>To examine the correlation between prehospital triage categories by EMS personnel and patient admission/discharge after treatment in the ED, and to assess the use of hospital resources for patients who remained outpatients.</p><p><strong>Methods: </strong>Retrospective analysis of routine preclinical and clinical data from all patients presenting to the ED of a university hospital by EMS over a 2-week period. Analyses were performed descriptively and using the Mann-Whitney U test and the χ² test. Positive and negative predictive values were also calculated.</p><p><strong>Results: </strong>During the observation period, 570 EMS patients were seen in the ED, of whom 307 (53.9%) remained as outpatients. For 309 (54.2%) of the patients, the triage category assigned by the EMS corresponded to the type of subsequent care (outpatient/inpatient); in 249 cases (43.7%) the need for inpatient care was overestimated. In addition, 262 patients (85.3%) received at least one diagnostic or therapeutic resource prior to discharge, the most common being X‑rays (118/38.4%).</p><p><strong>Conclusion: </strong>In only about half of the cases was the EMS personnel's prognosis consistent with the subsequent decision to admit or discharge the patient from the ED. Patients who remained as outpatients tended to require further diagnostic and therapeutic resources. Therefore, direct transfer of EMS patients to alternative care structures seems risky in the current environment.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"454-464"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Action algorithm: management of long lie trauma in clinical acute and emergency medicine].","authors":"Guido Michels, Maximilian Sobek, Jenny Kubitza, Christoph Hüser, Christoph Adler","doi":"10.1007/s00063-026-01463-0","DOIUrl":"10.1007/s00063-026-01463-0","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"514-515"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Daylight therapy in intensive care units: a review].","authors":"Sarah Lohmeier, Lars Krüger, Thomas Mannebach","doi":"10.1007/s00063-026-01423-8","DOIUrl":"10.1007/s00063-026-01423-8","url":null,"abstract":"<p><strong>Background: </strong>As a neuropsychiatric syndrome, delirium worsens the prognosis of critically ill patients in the intensive care unit (ICU). Risk factors such as sleep deprivation increase the incidence of delirium. Targeted light exposure influences the circadian rhythm, and daylight interventions can help to restore the natural daily rhythm. To date, a review of daylight therapy for German-speaking countries is lacking.</p><p><strong>Objective: </strong>This work aims to provide an overview of the currently available evidence on the use of daylight therapy in critically ill patients on the ICU, with a medical focus on cardiology or thoracic and cardiovascular surgery. The potential effects of daylight therapy on delirium and sleep are discussed.</p><p><strong>Materials and methods: </strong>A systematic literature search was conducted in the databases CareLit (hpsmedia, Hungen, Germany), Cochrane Library (The Cochrane Collaboration, London, U.K.), Livivo (German National Library of Medicine - Information Centre for Life Science, Cologne, Germany), and Medline via PubMed (U.S. National Library of Medicine, Bethesda, MD, USA). German- and English-language literature involving ICU patients at least 18 years of age in the context of light therapy was included. A critical appraisal was performed using the assessment tools developed by Behrens and Langer.</p><p><strong>Results: </strong>Fourteen full texts were included, most of which involved multiple nonpharmacological interventions. The studies varied in terms of light application mode, timing, and duration. No significant effects on the delirium incidence were found, but positive effects on sleep promotion and psychological outcomes were observed.</p><p><strong>Conclusion: </strong>There are few conclusive studies on daylight therapy in the ICU. Most involved multicomponent intervention strategies. The prevailing evidence suggests beneficial effects on sleep promotion and psychological outcomes, which could contribute to delirium prevention strategies. Further research is needed.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"499-505"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Action algorithm: management of electrical injury in acute and emergency medicine].","authors":"Guido Michels, Amr Sherif Hamza, Martin Möckel, Hans-Jörg Busch","doi":"10.1007/s00063-026-01449-y","DOIUrl":"10.1007/s00063-026-01449-y","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"512-513"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Sepsis 2026: diagnosis and treatment].","authors":"Matthias Kochanek, Jan-Hendrik Naendrup","doi":"10.1007/s00063-026-01484-9","DOIUrl":"10.1007/s00063-026-01484-9","url":null,"abstract":"<p><p>Sepsis and septic shock require a standardized, time-critical approach: screening of acutely ill high-risk patients, prompt assessment of infection and sepsis-associated organ dysfunction, rapid initiation of appropriate intravenous antimicrobials, and early hemodynamic stabilization. Key elements include obtaining blood cultures before antimicrobials, balanced crystalloids as first-line fluids, norepinephrine as the main vasopressor, and-if vasopressor requirements persist-adjunctive strategies such as vasopressin or hydrocortisone ± fludrocortisone depending on the clinical scenario. Prevention (infection prevention, antibiotic stewardship (ABS)/antimicrobial stewardship (AMS) programs) and structured follow-up aim to reduce long-term sequelae after sepsis.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"516-525"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Hantavirus infections: clinical relevance in intensive care and emergency medicine].","authors":"Priyanka Böttger, Henning Lemm, Samuel Sossalla, Christoph Lübbert","doi":"10.1007/s00063-026-01464-z","DOIUrl":"10.1007/s00063-026-01464-z","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"493-495"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Palliative care and dying in emergency medical services-Attitudes, perspectives and knowledge of emergency physicians].","authors":"Susanne Glass, Magdalena Bier, Celina Pötz, Lukas Jäger, Tobias Grübl, Pia von Blanckenburg, Christian Volberg","doi":"10.1007/s00063-025-01313-5","DOIUrl":"10.1007/s00063-025-01313-5","url":null,"abstract":"<p><strong>Background: </strong>Emergency physicians are confronted with the topic of death and dying almost daily in their work. Demographic changes and the accompanying increase in chronic and incurable diseases at the end of life as well as the frequently expressed wish to die at home, are leading to an increase in emergency situations with palliative patients. To date, there is insufficient data available on how emergency physicians deal with palliative patients.</p><p><strong>Method: </strong>Emergency physicians from two service providers participated in the survey 'Palliative Care and Dying in Emergency Medical Service'. The emergency physicians were asked to complete a paper-and-pencil survey covering several topics in the areas of palliative medicine and descriptions of conflicts in non-emergency medical situations. They were also asked about their personal attitudes towards dying and death, based on established psychometric standards. The survey was conducted anonymously.</p><p><strong>Results: </strong>The response rate was 40% (n = 67). Participants had an average age of 41 years, and 66% (n = 44) were male. The majority of emergency physicians surveyed were anaesthetists and had worked as emergency physicians for more than five years. Only six respondents (9%) had an additional training in palliative medicine. On average, more experienced doctors felt better prepared to deal with dying patients than those with less than five years' professional experience as emergency physicians. The survey showed that many emergency physicians experience a conflict between end-of-life care and saving lives when treating palliative patients. None of the respondents stated that palliative medicine had nothing to do with emergency medicine. The emergency physicians surveyed expressed uncertainty regarding the acute preclinical care of palliative patients.</p><p><strong>Conclusion: </strong>The expertise of emergency physicians in palliative medicine increases with the level of operational experience. Almost all respondents consider this topic to be very important and would like to see it integrated more strongly into training and continuing professional education. A lack of knowledge may result in palliative patients being offered less meaningful therapies, which could lead to hospitalisation. Demographic changes will increase the need for emergency physicians with expertise in palliative medicine. The discrepancy identified must be addressed.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"473-483"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}