[Preclinic in the hospital. In-hospital emergency and rescue service in a large hospital].
OBJECTIVE
Many hospitals have a special resuscitation service that is responsible for life-threatening emergencies outside the hospitals intensive care unit, i.e. in the wards and in patient-treatment areas. In contrast, there is generally no emergency service caring for patients, visitors or personnel outside of these areas. In order to provide emergency medical help in the entire hospital area, in 1999 we instituted an additional in-hospital emergency service to cover the larger hospital area. This paper describes the structure of our in-hospital emergency service and our experience in the first 26 months after its establishment.


METHODS
We analysed the emergency protocols of all 147 episodes, that had occurred within the first 26 months. We classified them according to type of disease and/or injury by using the NACA score (range 1 to 7) to assess the severity of disease and/or injury.


RESULTS
45 episodes took place within one of the 17 hospital buildings. 92 requests for help came from the hospital service and treatment areas including walkways and passages, while 3 came from the immediate vicinity outside of the hospital. A total of 7 requests turned out to be pranks, and 31.3% responses proved to be unnecessary when the team arrived at the scene. Of the total of 125 treated cases, 30 had a NACA score between 4 and 6, denoting life-threatening injury and/or disease. 6 patients were found dead at the scene or died shortly after arrival of the team. 101 of the patients had to be admitted to the hospital's emergency room.


CONCLUSIONS
Since its establishment, knowledge of the existence of our in-hospital emergency service has steadily increased within the hospital community. As a consequence, number of events have likewise steadily increased. We believe that a total of 20.4% life-threatening events underscores the importance of the service in our large and extended hospital area. We also feel that our adherence to the training and personnel requirements demanded of public emergency services is necessary in order to insure the quality and efficacy of the service. This is also important because of current intentions to use our in-hospital service as a back-up and/or reserve for the community's public emergency services.
Byhahn
C
C
Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt. c.byhahn@em.uni-frankfurt.de
Meininger
D
D
Bueck
M
M
Kessler
P
P
Füllner
M
M
Lischke
V
V
D004630:Emergencies / Q000145:classification; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005858:Germany; D006760:Hospitalization; D006801:Humans; D014600:Utilization Review