[Spectrum of patients in prehospital emergency services. What has changed over the last 20 years?].
BACKGROUND
In Germany the physician staffed emergency systems have announced an increase in rescue missions over the years. The aim of this study is to analyse the development of the spectrum of patients in an emergency system over the last 20 years in order to highlight the significant changes.


METHODS
In a retrospective study we analyzed the prehospital chart views from 2004, 1992 and 1984 with respect to patients' demography, type of rescue mission, degree of internal disease or injury (NACA), state of consciousness (GCS), as well as prehospital interventions performed by prehospital emergency physician.


RESULTS
In 2004 (3,825), the absolute number of missions was 2 and 4 times higher than 1992 (2,114) and 1984 (957), resp. In all of these investigated time periods non-trauma missions (74%; 2,812 vs. 66%; 1,390 vs. 51%; 485) were leading, followed by trauma missions (18%; 690 vs. 22%; 464 vs. 39%; 375), aborted missions (3%; 126 vs. 7%; 154 vs. 6%; 56), and dead on arrival (5%; 197 vs. 5%; 106 vs. 4%; 41). Although, the percentage of patients with NACA IV-VI (39% vs. 50%) or patients with GCS < or =8 (18% vs. 34%) was lower in 2004, the absolute number of patients in each category was higher than in 1984 (NACA IV-VI: 1,434 vs. 448, p<0.01; GCS: 672 vs. 303, p<0.01).


CONCLUSIONS
The results of this study demonstrate, that the percentage of trauma, severely ill/injured or unconscious patients is lower than in previous years. However, the higher absolute numbers of patients demonstrate that the emergency physician now encounters more critically ill/injured, unconscious and trauma patients. It does not seem necessary to question the qualifications for an emergency physician, which have previously been considered essential for the management of acute life-threatening situations.
Bernhard
M
M
Sektion Notfallmedizin, Klinik für Anaesthesiologie, Universitätsklinikum, Im Neuenheimer Feld 110, 69120 Heidelberg. Michael.Bernhard@med.uni-heidelberg.de
Hilger
T
T
Sikinger
M
M
Hainer
C
C
Haag
S
S
Streitberger
K
K
Martin
E
E
Gries
A
A
D003244:Consciousness Disorders / Q000453:epidemiology / Q000628:therapy; D004632:Emergency Medical Services / Q000266:history / Q000706:statistics & numerical data / Q000639:trends*; D005858:Germany / Q000453:epidemiology; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D018635:Rescue Work / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014947:Wounds and Injuries / Q000628:therapy