Additional Prehospital Problems

The Emergency Medical Care of Patients With Acute Myocardial Infarction—Results From the First Medical Contact Study in the Context of the Berlin Myocardial Infarction Registry by PD. Dr. med. Martin Stockburger et al. in issue 29–30/2016

The authors have provided a valuable article on the care of patients with myocardial infarction (1). There is no disputing that correct diagnosis leads to swifter intervention or that training is required in this area. However, for the most part the authors limit themselves to seeking mistakes by emergency physicians, which is not the only factor in prehospital care. I will take the liberty of indicating other problems in prehospital care for STEMI, as the impression given in the article—that a high percentage of emergency physicians on the scene make errors in their work—is inaccurate.

It continues to occur that initial efforts to treat acute coronary syndrome take the form of emergency treatment, calling for an emergency physician to be present. Naturally, allocation of treatment depends on a complex interplay of many factors, but in Germany, if one examines the additional requests for emergency physicians in rural areas in particular, it leads to long delays.

How do emergency hospital admissions/catheterization laboratories work on the ground? Telemetry and discussions between physicians can generally ensure swift intervention as early as during prehospital care. How is it that almost 50% of correctly diagnosed STEMI cases in Berlin are initially admitted via the emergency room? Would the incorrectly diagnosed STEMI cases actually have benefited from a correct diagnosis?

A new profession is currently being developed in Germany: the emergency paramedic. The intention is that, with the aid of algorithms, they will be able to take on some work now done by physicians. Thus in the future much will depend on the composition and routine of emergency paramedic teams on the scene. As Mencl et al. have shown, regular training for paramedics was never successful in improving STEMI diagnosis outcomes beyond a certain amount (2).

DOI: 10.3238/arztebl.2017.0072a

PD Dr. med. habil. Udo Meißner

Bamberg, Germany

References

1. Stockburger M, Maier B, Fröhlich G, et al.: The emergency medical care of patients with acute myocardial infarction—results from the First Medical Contact Study in the context of the Berlin Myocardial Infarction Registry. Dtsch Arztebl Int 2016; 113: 497–502

2. Mencl F, Wilber S, Frey J, et al.: Paramedic ability to recognize ST-segment elevation myocardial infarction on prehospital electrocardiograms. Prehosp Emerg Care 2013; 17: 203–10