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Professional and scientific expertise in demand: Doctors at Leipzig University Hospital played a key role in the new version of the emergency doctor indication catalog

Updated basis for action for dispatchers in rescue control centers: Prof. André Gries and Prof. Christian Kleber are part of a national working group of the German Medical Association / Thousands of Saxon emergency service operations have been evaluated

The German Medical Association has had the so-called emergency doctor indication catalog, or NAIK for short, revised and republished. The NAIK forms the basis for the decision in rescue control centers and emergency service centers as to whether an emergency doctor needs to be dispatched to the scene or not.

Important impulses for the new version came from the Leipzig University Hospital (UKL): two UKL experts, Prof. André Gries and Prof. Christian Kleber, were represented in the national working group “Update NAIK” of the German Medical Association (BÄK).

The emergency doctor indication catalog was first published in 2001 and adapted in 2013. “Since then, new scientific findings and guidelines have been published, the non-medical emergency services personnel now have significantly higher qualifications, having now completed three years of training as emergency paramedics, and the options for telemedical support of operations have also been further developed. From the perspective of the German Medical Association, this, but also the ever-increasing number of emergency doctor visits that are often not medically necessary, made it necessary to rewrite the catalog,” explains Prof. André Gries, Medical Director of the Central Emergency Department (ZNA) at the UKL.

In 2019, the BÄK formed the working group from selected experts, which, in addition to Gries, also included Prof. Christian Kleber, head of the trauma surgery department and head of the national trauma center at the clinic and polyclinic for orthopedics, trauma surgery and plastic surgery at the UKL. The entire process took three years. Last but not least, the corona pandemic caused difficulties, as many of the working group members were actively involved in combating the pandemic.

Saxon cooperation in the analysis of accident data

“To answer the question of when an emergency doctor is needed and when not, there has so far been little scientific knowledge available for the German emergency services system,” says Prof. Gries.

And so the representatives of Saxony came to play a special role in this committee: In order to obtain new data, Prof. Kleber analyzed it on behalf of the German Medical Association together with Dr. Michael Hetz and Prof. Klaus-Dieter Schaser from the University Center for Orthopedics, Trauma Surgery and Plastic Surgery at the University Hospital “Carl Gustav Carus” Dresden and the Dresden Traffic Accident Research (VUFO) compiled current data from traffic accidents and accident scenarios with serious injuries using the GIDAS database to create scenarios to be able to reliably predict who will need an emergency doctor. GIDAS is the German study for in-depth traffic accident data collection and stands for “German In-Depth Accident Study”.

The constellations derived from this were published in the specialist journal “Accident Surgery”, were then incorporated into the new catalog and can now be queried by control center dispatchers.

Prof. Gries' working group, together with Yacin Keller from the Fire Department of the Dresden Fire Department and Anne Schrimpf from the Institute of General Medicine at the University of Leipzig, worked on the statistical evaluation of over 75.000 emergency service operations in the Saxon capital. The basis for their assessment was the international “Emergency ABCDE” scheme and the technical competence required to carry out the operations. From this, so-called patient conditions were identified that required emergency medical attention. ABCDE stands for life-threatening situations of the respiratory tract or breathing itself (A, B), the circulatory system (C), neurological functions (D) and for special conditions or operational situations (E).

“By evaluating thousands of missions, we were able to find criteria for sending emergency doctors, which were incorporated into the new catalog,” reports Prof. Gries.

New perspective: For example, if a stroke is suspected, emergency medical attention is not always necessary

The head of the central emergency department at the UKL gives two examples that make the practical benefit clear: In the new NAIK, for example, the very unspecific condition “no normal breathing” has been eliminated. This parameter has been removed in the now adopted and published version of the NAIK, as the term is difficult to define and can only be assessed to a limited extent by laypeople.

“Or let’s take the suspected stroke as an example,” explains Prof. Gries. “According to the old catalog, an emergency doctor was required due to the typical symptoms such as paralysis on one side or speech disorders,” he explains.

The new version, with its view of the ABCDE levels, now states that in the case of stroke symptoms (exclusively D/neurological status, no ABC problems and therefore no threat to life), no emergency doctor is required. “In these cases, it is much more important for those affected to be taken to hospital as quickly as possible by the emergency services - after the necessary care on site,” emphasizes Gries.

At the end of the process, both UKL experts were also part of the only five-member editorial group that brought together all the research results, viewed them and developed the now published version. The two Saxon studies represented an essential basis for the decision-making process for the new NAIK.

Source: Press release at Leipzig University Hospital from December 28.12.2023, XNUMX

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