Der Anaesthesist
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In 2019 a total of 756 people died in Germany while registered on the waiting list for an organ transplantation. With 10.8 organ donors/million inhabitants in 2019, Germany belongs to the bottom group in the Eurotransplant foundation as well as worldwide. ⋯ Critical care physicians play an important role in the identification of potential doners and are also the main point of contact for relatives; however, multiple uncertainties exist regarding the process of organ donation not only in discussions in the media and society but also among physicians involved in intensive care medicine. Many assumptions and hypotheses, which have been associated with the low number of donors, lack scientific evidence and are discussed in this article.
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Emergency medical services work in the environment of high responsibility teams and have to act under unpredictable working conditions. Stress occurs and has potential of negative effects on tasks, teamwork, prioritization processes and cognitive control. Stress is not exclusively dictated by the situation-the individuals rate the situation of having the necessary skills that a particular situation demands. There are different occupational groups in the emergency medical services in Germany. Training, tasks and legal framework of these groups vary. ⋯ Different stressors are relevant for the individual professional groups in the German emergency medical service. The developed catalogue can be used in the future to evaluate the subjective stress load of emergency service professionals. There are stressors that are inherent in the working environment (e.g. pressure to act) and others that can be improved through training (teamwork). We recommend training of general resistance as well as training of specific items (e.g., technical, nontechnical skills). All professionals mentioned items with respect to organizational factors. The responsible persons can identify potential for improvement based on the legal and organizational items. The EMT basic requires further subdivision according to task areas due to its variable applicability.
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In 2016 the first German recommendation for the preclinical use of tourniquets was published. Currently little is known of the frequency of the use of tourniquets in the prehospital setting in Germany. This study evaluated how often a tourniquet is used in a civilian German Helicopter Emergency Medical Service (HEMS). ⋯ With a frequency of 1.3% the need for a prehospital tourniquet application is low in civilian trauma patients. Monotrauma with isolated extremity injuries represent about half of the patients treated with tourniquets. The other half is represented by multiple injuries or multiple trauma patients who require significantly more invasive measures, such as airway management and more complex on-scene interventions are needed. The available data do not allow any conclusions to be drawn about the location and the quality of the tourniquet application. Future documentation systems should incorporate data on the use of tourniquets, such as the location of use, indications (tactical use/massive bleeding), bleeding control achieved (yes/no) or second tourniquet necessary, conversion (yes/no) and any obvious complications.
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In 1989 the United Nations passed the "United Nations Convention on the Rights of the Child" (UNCRC) and, among others, demanded the highest attainable standard of health for children. Safe Anesthesia for Every Tot (SAFETOTS, www.safetots.org ), an association of internationally active pediatric anesthetists, has derived 10 rights, the 10 R's, which are of essential importance for the pediatric anesthetic practice. The first right (R1) postulates: "Children have the right to enjoy the highest possible standard of health. ⋯ The "pay for performance" must change to "pay for quality". In addition to broad basic pediatric care, all complex forms of pediatric treatment must be carried out in specialized pediatric centers, particularly for small and severely ill children. Significant improvement can be achieved at the local level by reorganization, bundling of pediatric surgical interventions within a clinical unit together with the concentration on a dedicated team.