Browsing by Author "Panzer, W."

From 1985-1989 a community project on bystander CPR was carried out, including about 20.000 citizens; most of them were male, more than 60% younger than 30 years old. Evaluation of knowledge and skills among former participants in a realistic setting showed that six months after the course 66,7% performed according to AHA standards, after 12 and 24 months 23,5 % and 21,1%. Using a more practical method of interpreting the data with emergency medicine based criteria it could be found that after 6 months 90% of the test persons were able to improve the chances of survival in a real emergency, after 12 and 24 months each time 70%. The CPR data bank which has been established with the start of the project actually includes 1.825 cases. 70% of the patients on whom resuscitation has been attempted were male, mean age was 62 years. 60% of the emergencies occurred in the patients' home, 84% were witnessed, and 74% of cardiac origin. In 28% bystanders initiated resuscitation prior to the arrival of the EMS. Out of all 1.825 CPR attempts 35,8% were primarily successful, that means patients could be admitted to hospital with a spontaneous circulation. Following bystander CPR 42,4% of patients had VF in the first ECG compared with 29,1% in the non-bystander group. Corresponding to this out of the bystander group 43,6% of patients could be admitted to hospital with a spontaneous circulation, out of the non-bystander group only 32,7%. The positive effects of bystander CPR continued during the clinical course: 31,8% out of this group could be discharged without neurologic damage compared with 7,2% out of the non-bystander group. As far as long-term survival is concerned five years after discharge 53% of patients in whom bystanders had initiated resuscitation were alive and 31 % out of the non-bystander group. As an attempt to increase the rate of bystander initiated CPR and thus to bridge the interval without therapy a project on telephone CPR has started just recently.

Monolayers of human lymphocytes, attached to a 2-mum Mylar film, were irradiated with 60 kV X rays in the presence and absence of a 150-mum gold film backing the Mylar film. With the gold film present, the absorbed dose imparted to the cells was increased by a factor of 45.4 due to the release of photoelectrons from the gold film. The frequencies of dicentric chromosomes and centric rings as well as of excess acentric fragments were increased in agreement with this dose enhancement, and in addition an RBE of about 1.7 compared to the frequencies observed in the absence of the gold film was found. These radiation effects, which contribute to risk consideration in radiology, are interpreted in terms of the increased dose-mean restricted LET of the photoelectrons back-scattered from the metal and slowed down in the Mylar film before they enter the cell layer. (C) 2001 by Radiation Research Society.

The low-energy secondary electrons emerging from the entrance surface of an X-irradiated gold foil increase the dose to cells in contact with or at micrometer distances from this surface (Radiat. Res. 150, 92-100, 1998). We examined the effect of the spectrum of these low-energy electrons on the RBE for cytogenetic effects and showed that this RBE was increased. A monolayer of surface-attached human T lymphocytes was exposed to 60 kV X rays in the absence or presence of a gold foil positioned immediately behind the cell layer or separated from it by a Mylar foil 0.9 or 2 mum thick. The enhancement of dose in the cell nuclei caused by the photoelectrons and Auger electrons emerging from the entrance surface of the gold foil was measured by TSEE dosimetry. Dose enhancement factors of 55.7, 46.6 and 37.5 were obtained with 0, 0.9 and 2 mum of Mylar inserted between the gold surface and the cell layer. This large enhancement results from the photoelectric effect in the gold foil, as shown by the accompanying Monte Carlo calculations of the secondary electron spectra at the gold surface. Auger electrons from the gold foil generally were not able to penetrate into the cell nuclei except for that fraction of the cells that had a very thin (< 0.7 mum) layer of cytoplasm and membranes between gold surface and cell nucleus. The dose-yield curves for dicentric chromosomes plus centric rings and for acentric fragments obtained after exposures without or with the gold foil were linear-quadratic. The coefficient alpha, the slope of the linear yield component, was increased in the presence of the gold foil and showed RBE values ranging from 1.7 to 2.2 compared to exposures in absence of the gold foil. The ratio of the yield of interstitial deletions and dicentrics (H ratio) was significantly increased from about 0.17 in the absence of the gold foil to about 0.22 in the presence of the gold foil. The increases in the RBE and the H ratio are interpreted in microdosimetric terms: The preferred occurrence of electron track ends in the vicinity of the gold surface causes an increase in the dose-mean restricted linear energy transfer in cell nuclei exposed to the photoelectrons and Auger electrons. (C) 2002 by Radiation Research Society.

Since 2007 interhospital transport of intensive care patients in Lower Saxony appertains to the performance requirements of emergency medical services. Against this background the Working Group for Evaluation of Intensive Care Transport (Arbeitsgemeinschaft Evaluation Intensivverlegung) was established. This group formulated standardized definitions for the requirements of intensive care transport vehicles and a federal statewide monitoring of intensive care transport was implemented to analyze if simultaneously on-call intensive care transport systems (intensive care helicopter and ground based mobile intensive care units) can be deployed need-based and efficiently. A prospective follow-up study and evaluation of intensive care transport in Lower Saxony between April 1(st) 2008 and July 31(st) 2010 was carried out. A total of 6,779 data records were evaluated in this study of which 4,941 (72.9%) missions were located in Lower Saxony, 2,928 (43.2%) missions were carried out by helicopters and 3,851 (56.8%) by ground based mobile intensive care units. The mean duration of a mission was 3 h 59min +/- 2 h 25 min, 4 h 39 min +/- 2 h 23 min by ground based mobile intensive care units and 2 h 21 in +/- 30 min by helicopter units. All systems proved to be feasible for intensive care transport. The degree of urgency was estimated correctly in 94.8% of the evaluated missions and 58.0% of the transfers could not be deployed. In 76.8% patients were transferred to hospitals with a higher level of medical care, 51.7% of patients were transferred for intensive care therapy and 40.4% for an operation/intervention. Of the patients 38.2% required mechanical ventilation and in 48.3% invasive monitoring was carried out. Interhospital transfer of intensive care patients can be carried out need-based with a limited number of intensive care transport vehicles if the missions are deployed effectively by standardized disposition in accordance with performance requirements.

Background. Out-of-hospital airway management confronts emergency medical teams with complex challenges. To date no specific data are available on the qualifications of emergency physicians (EPs) and the quality of emergency equipment in northern Germany. Materials and methods. This study surveyed individual EPs at regional emergency dispatch centres about their personal knowledge and skills, and the procedures and equipment used in out-of-hospital airway management. Results. A total of 606 EPs from 59 of the 66 (89.4%) regional emergency dispatch centres surveyed responded and 56.1% of the EPs questioned were anesthesiologists. The other EPs were qualified in either internal medicine (22.6%), surgery (12.4%), general medicine (5.6%) or other specialties (3.3%). All (100%) of the EPs trained in anesthesia and 35.2% of the other EPs reported that they had performed more than 100 in-hospital endotracheal intubations (ETI). 93% of all EPs rated out-of-hospital ETI as more difficult than in-hospital ETI. A total of 33.0% of anesthesia-trained EPs and 6.1% of the other EPs used muscle relaxants for ETI in more than 20% of the cases. Of the anesthesia-trained EPs 38.1% used expiratory CO2 monitoring to verify tube placement compared to 12.1% of the other EPs. A total of 97.8% of anesthesia-trained EPs reported having used an extra-glottic airway device more than 20 times compared to 11.1 % of the other EPs. For the emergency equipment 44.4% included an extraglottic airway device, 57.8% a cricothyrotomy set and 27.1% CO2 monitoring options. Conclusion. Neither the emergency equipment nor the physicians' knowledge and skills were sufficient to meet the special demands of out-of-hospital airway management, particularly among non-anesthesiologists.