Competence Lies With the Emergency Physician
Emergency medical care should be included in the standard management in the prehospital phase of stroke. It is a distinct advantage if the dispatchers can optimally assess the urgency by means of standardized “filtering questions” (triage) and can then dispatch accordingly. The authors’ recommendations in Table 1 do not reflect the Notarztindikationskatalog (the catalogue of indications for emergency medical management) for Bavaria. In my opinion, distinctions such as those listed in Table 1 are therefore obsolete, as they stipulate that the emergency physician should be alerted only if a patient is unconscious, and in all other cases the emergency ambulance team should decide on site about alerting the doctor. This would mean acting against the slogans “time is brain” and “competence is brain,” since all therapeutic measures listed in Table 3 constitute actions taken by physicians. Paramedics may just be able to meet the requirement for venous access in all patients with a suspected diagnosis of stroke (in accordance with the German Medical Association’s statement relating to the emergency competence of paramedics and delegating medical services in the emergency medical services). However, administration of urapidil, for example, would not be covered by the emergency competence. Competence in the prehospital phase lies with the emergency physician for all measures listed by the authors—and this is not intended to diminish the professionalism of our emergency services. Paramedics cannot take a structured medical history with subsequent differential diagnostic evaluation. Even experienced emergency physicians are not able to predict the course during transport, especially if the cause of the symptoms is an intracerebral hemorrhage. Potential peracute deterioration of the patient’s condition, including life threatening events, requires management by emergency physicians. And especially in rural areas, much valuable time would be lost if the emergency physician is called out afterwards.
Facharzt für Anästhesiologie/Notfallmedizin/Ärztliches Qualitätsmanagement
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Kessler C, Khaw AV, Nabavi DG, Glahn J, Grond M, Busse O: Standardized pre-hospital management of stroke. Dtsch Arztebl Int 2011; 108(36): 585–91. VOLLTEXT|