Prehospital management of medical emergencies treated by family doctors, the general practitioners' acute response service and by certified emergency physicians - A prospective study.

Introduction: In Germany emergency patients are currently treated both by certified emergency physicians as well as by family doctors and general practitioners. Methods: 1.) We evaluated the cooperation between the regional rescue service centres of the general practitioners' acute response service and the EMS system in Baden-Wurttemberg, a German "Land" (province), with about 10 million inhabitants. 2.) We analysed the management of patients who had been initially treated by the general practitioners' acute response service or by family doctors and had then to be further stabilised by the emergency physicians of our mobile intensive care unit (MICU). Results: 1.) joint rescue service centres of the two organisations exist in only 12 of a total of 37 areas. Although lacking adequate emergency equipment, practitioners often treat vitally compromised patients without the assistance of the EMS system. 2.) 97 out of 105 jobs were further analysed (acute response service: n=45; family doctors: n=52). Suspected myocardial infarction (n=32) and acute heart failure (n=15) were the most common emergencies. Emergency management before the emergency physician arrived often did not meet common standards (lack of ECG monitoring, oxygen treatment, venous access, pain relief). Until the emergency physician arrived 40% of the patients had been left alone by their doctor. Moreover, medical documentation had to be classified as insufficient in 70%. Conclusions: Prehospital treatment of medical emergencies is impeded by the lack of cooperation between the involved organisations. Family doctors and general practitioners should not treat emergencies without the help of the local MICU. Solutions of these problems are presented.