Background: The Kids save lives statement recommends annual Basic Life Support (BLS) training for school children but the implementation is challenging. Trainings should be easy to realise and every BLS training should be as effective as possible to prepare learners for lifesaving actions. Preparedness implies skills and positive beliefs in the own capability (high self-efficacy). Methods: This randomized controlled cluster study investigates, if self-regulated learning promotes self-efficacy and long-term retention of practical BLS skills. Students in the age of 12 years participated in a practical training in BLS and a scenario testing of skills. In the control group the practical training was instructor-led. In the intervention group the students self-regulated their learning processes and feedback was provided by the peer-group. The primary outcome self-efficacy for helping in cardiac arrest after the training and 9 months later was analysed using a multilevel mixed model. Means and pass-rates for BLS skills were secondary outcomes. Results: Contrary to the assumptions, this study could not measure a higher self-efficacy for helping in cardiac arrest of the students participating in the intervention (n = 307 students) compared to the control group (n = 293 students) after training and at the follow-up (mean difference: 0.11 points, 95% CI: − 0.26 to 0.04, P = 0.135). The odds to pass all items of the BLS exam was not significantly different between the groups (OR 1.11, 95% CI: 0.81 to 1.52, p = 0.533). Self-regulated learning was associated with a higher performance of male students in the BLS exam (mean score: 7.35) compared to females of the intervention (female: 7.05) and compared to males of the control (7.06). Conclusion: This study could not resolve the question, if self-regulated learning in peer-groups improves self-efficacy for helping in cardiac arrest. Self-regulated learning is an effective alternative to instructor-led training in BLS skills training and may be feasible to realise for lay-persons. For male students self-regulated learning seems to be beneficial to support long-term retention of skills. Trial registration: ISRCTN17334920, retrospectively registered 07.03.2019.

Zusammenfassung: Der deutsche Rettungsdienst steht vor erheblichen Herausforderungen, die durch Fachkräftemangel, demografischen Wandel und sinkende Gesundheitskompetenz der Bevölkerung verschärft werden. Um die Versorgung zu verbessern, wird eine effizientere Nutzung der Ressourcen sowie eine stärkere Integration aller beteiligten Berufsgruppen gefordert. Notfälle, die keinen Arzt erfordern, überlasten häufig die Rettungssysteme, weshalb qualifizierte Notfallsanitäter mehr Verantwortung übernehmen sollten. Zudem spielt die Leitstelle eine zentrale Rolle bei der effizienten Steuerung der Notfallressourcen. Es wird eine Erweiterung der verfügbaren Einsatzmittel, einschließlich telemedizinischer Lösungen, vorgeschlagen. Erste-Hilfe-Apps könnten ebenfalls helfen, lebensrettende Maßnahmen früher einzuleiten. Die Weiterentwicklung des Berufsbilds des Notfallsanitäters, einschließlich der Möglichkeit zur Akademisierung, soll helfen, das Personal langfristig zu binden und die Qualität der Notfallversorgung zu erhöhen. Die Einführung eines Telenotarztsystems ergänzt die Präsenznotärzte, deren Einsätze auf komplexe und lebensbedrohliche Fälle konzentriert werden sollten. Notärzte müssen umfassend qualifiziert sein, um komplexe Situationen adäquat zu bewältigen. Insgesamt erfordert ein zukunftsfähiges Rettungssystem eine reibungslose Zusammenarbeit aller Beteiligten, klare Zuständigkeiten und fortlaufende Qualitätskontrollen. Darüber hinaus ist die Implementierung einer einheitlichen standardisierten digitalen Dokumentation entlang der Rettungskette eine wesentliche Voraussetzung für die effektive intersektorale Zusammenarbeit sowie für die Qualitätssicherung in der Notfallversorgung.

Preoxygenation is a crucial manoeuvre for patients’ safety, particularly for morbidly obese patients due to their reduced pulmonary reserve and increased risk for difficult airway situations. The oxygen reserve index (ORI™) was recently introduced as a new parameter of multiple wavelength pulse oximetry and has been advocated to allow assessment of hyperoxia [quantified by the resulting arterial oxygen partial pressure (PaO₂)]. This study investigates if ORI can be used to evaluate the impact of two different preoxygenation manoeuvres on the grade of hyperoxia. Two preoxygenation manoeuvres were sequentially evaluated in 41 morbidly obese patients: First, breathing 100% oxygen for 5 min via standard face mask. Second, after achieving a second baseline, 5 min of non-invasive ventilation (NIV) with 100% oxygen. The effect of preoxygenation on ORI compared to PaO₂ was evaluated and whether differences in the two preoxygenation manoeuvres can be monitored by ORI. Overall correlation of PaO₂ and ORI was significant (Spearman-Rho coefficient of correlation 0.818, p < 0.001). However, ORI could not differentiate between the two preoxygenation manoeuvres although the PaO₂ values for NIV preoxygenation were significantly higher compared to standard preoxygenation (median 505 mmHg (M1) vs. 550 mmHg (M3); p < 0.0001). In contrast, ORI values did not differ significantly (median 0.39 (M1) vs. 0.38 (M3); p = 0.758). Absolute values of ORI cannot be used to assess effectiveness of a preoxygenation procedure in bariatric patients, mainly because its range of discrimination is considerably lower than the high ranges of PaO₂ attained by adequate preoxygenation. Trial registration German Clinical Trials Register: DRKS00025023 (retrospectively registered on April 16th, 2021).

Background: This study aimed to determine whether prehospital qSOFA (quick sequential organ failure assessment) assessment was associated with a shortened ‘time to antibiotics’ and ‘time to intravenous fluid resuscitation’ compared with standard assessment. Methods: This retrospective study included patients who were referred to our Emergency Department between 2014 and 2018 by emergency medical services, in whom sepsis was diagnosed during hospitalization. Two multivariable regression models were fitted, with and without qSOFA parameters, for ‘time to antibiotics’ (primary endpoint) and ‘time to intravenous fluid resuscitation’. Results: In total, 702 patients were included. Multiple linear regression analysis showed that antibiotics and intravenous fluids were initiated earlier if infections were suspected and emergency medical services involved emergency physicians. A heart rate above 90/min was associated with a shortened time to antibiotics. If qSOFA parameters were added to the models, a respiratory rate ≥ 22/min and altered mentation were independent predictors for earlier antibiotics. A systolic blood pressure ≤ 100 mmHg and altered mentation were independent predictors for earlier fluids. When qSOFA parameters were added, the explained variability of the model increased by 24% and 38%, respectively (adjusted R² 0.106 versus 0.131 for antibiotics and 0.117 versus 0.162 for fluids). Conclusion: Prehospital assessment of qSOFA parameters was associated with a shortened time to a targeted sepsis therapy.

Algorithmen und Standards in Form von SOPs, Verfahrensanweisungen und Leitlinien sind in vielen klinischen Bereichen fest etabliert, so auch in der Notfallmedizin. Sie bieten viele Vorteile und können den Arbeitsfluss unterstützen. Sie dürfen jedoch die Anpassung an die Bedürfnisse des individuellen Patienten nicht behindern. In everyday emergency medicine, the use of algorithms and standards has already become firmly established in many places. When determining treatment procedures, the establishment of standards competes with the individualization of treatment for the specific needs of the patient. If everyone on the team has the same algorithm in mind, this can promote communication and collaboration in the sense of a shared mindset, but it can also encourage fixation errors within the team. Even though algorithms have been shown in studies to be effective in processing specific action steps, simply changing the steps in an algorithm can produce a different result. Thus, they must be developed and tested with care. Cognitive aids can support the daily work routine, but must not replace learning and training, nor the clinical view. Article published online: 08 June 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany