[Prehospital treatment of the acute coronary syndrome in the emergency medical services in Bavaria].
OBJECTIVE
Regarding patients suffering from cardiovascular diseases, the most common reason for call-outs of German emergency physicians is in 37.2 % of cases, the acute coronary syndrome (ACS). Despite substantial improvements in diagnosis and therapy a reduction of mortality rate has not been documented.


METHODS
200,221 protocols of emergency physicians were analyzed regarding the prehospital treatment of ACS by German emergency physicians. It was a retrospective analysis from available protocols of the emergency medical services in Bavaria.


RESULTS
Within 15 minutes after the emergency call the physician reached 92.2 % of the patients. The time to treatment averaged 23.2 (+/- 3.3) minutes. In 37.5 % of the call-outs there was only a slight danger, while in 35.6 % an acute life-threatening event was the reason for hospitalization. Hypertension existed in 52 % of the patients. 25.5 % had a tachycardia, with ECG-changes increased with age and severity of the syndrome. In 93.9 % an emergency-ECG was recorded but only in 8.5 % a 12-channel-ECG. Most frequently (39.1 %) analgetics were administered. Vasodilatators followed in 29.1 %, sedatives in 19.5 %. Antiemetics (18.1 %) were associated with the use of opioids. Typical cardiovascular drugs, such as catecholamines (10.6 %), antihypertensives (10.8 %), antiarrhythmics (9.9 %) or diuretics (7.1 %) were given less frequently. In 68.6 % of the cases the condition improved after medical intervention, in 28.1 % it remained unchanged and in 3.3 % it deteriorated


CONCLUSIONS
Structural and logistic conditions for an early care in Bavaria are provided for prehospital treatment of patients with ACS. However, life support provided by paramedic personnel and medical therapy by the emergency physician still can be improved. The actual protocol of emergency physicians does not provide a complete view of the prehospital medical care.
Sefrin
P
P
Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg. sefrin_p@klinik.uni-wuerzburg.de
Lafontaine
B
B
D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D005858:Germany; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D008020:Life Support Care / Q000592:standards; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013610:Tachycardia / Q000453:epidemiology; D013997:Time Factors; D014665:Vasodilator Agents / Q000008:administration & dosage
D000700:Analgesics; D006993:Hypnotics and Sedatives; D014665:Vasodilator Agents
Die präklinische Versorgung des "akuten Koronarsyndroms" im Notarztdienst in Bayern.