Un artículo encontrado ayer por casualidad. ¿Estamos los médicos de emergencias del modelo europeo mejor preparados que los paramédicos norteamericanos? Sin ganas de polemizar pero con ánimo crítico ¿resistimos la comparación? MacDonald, Damian., Breckwoldt, Jan., Nix, Eric. and Cone, David. "Comparison of German Pre-Hospital Physician Practice to Paramedic Protocols" Paper presented at the annual meeting of the National Association of EMS Physicians, Registry Resort, Naples, FL, <Not Available>. 2008-02-24 <http://www.allacademic.com/meta/p64913_index.html> APA citation: MacDonald, D. , Breckwoldt, J. , Nix, E. and Cone, D. "Comparison of German Pre-Hospital Physician Practice to Paramedic Protocols" Paper presented at the annual meeting of the National Association of EMS Physicians, Registry Resort, Naples, FL <Not Available>. 2008-02-24 from http://www.allacademic.com/meta/p64913_index.html Publication Type: Abstract Abstract: Pre-hospital care in Europe and America is rendered using two different models. In American systems, patient care protocols and standing orders guide non-physician pre-hospital providers. In Germany, physicians directly perform interventions. The objective of this study was to determine whether the interventions performed by German EMS physicians are available to paramedics in a typical U.S. city using indirect medical oversight. Methods: Consecutive patient care reports from EMS physicians in a district of Berlin between January and March 2005 were abstracted into a database, including demographics, presenting complaint, interventions, and diagnosis. Inclusion criteria were all dispatches that resulted in patient contact and a diagnosis. Interventions for the most common diagnoses were compared to paramedic protocols in a U.S. city of 125,000 people. Descriptive statistics were used. Results: 1105 run forms (97% of dispatches) were analyzed; 584 met inclusion criteria. The most common diagnoses were angina pectoris (13%), field pronouncement (12%), myocardial infarction (10%), asthma/COPD (9%), arrhythmia (6%), hypoglycemic coma (6%), seizure (6%), pulmonary edema (5%), and trauma (5%). For angina pectoris (n=77), 402/455 interventions provided (88%) are available in the standing orders of the comparison U.S. city. Interventions not available include heparin (57% use in Berlin) and metoclopramide (12%). For MI/ROMI (n=4, 221/296 interventions (75%) are covered; not covered are heparin (85%), metoprolol (19%), thrombolysis (13%) and metoclopramide (40%). For asthma/COPD (n=51), 104/241 interventions (43%) are included in the paramedic protocols; not included are steroids (86%), intravenous beta-agonists (41%), and theophylline (76%). For arrhythmia 110/123 interventions (89%) were contained; exceptions were metoprolol (27%), vasopressin (9%), and heparin(9%). All interventions for hypoglycemic coma (81/81, 100%) are found in the U.S. protocols, as are 136/150 (91%) for pulmonary edema patients. In traumatic injuries, 117/144 (81%) of interventions are covered; exceptions are sedation (37%, allowed in the U.S. only with direct medical oversight), colloids (31%), and rapid sequence intubation (9%). Conclusion: Interventions commonly performed by German EMS physicians are available to paramedics through standing orders in a typical U.S. comparison city. Exceptions were found in management of asthma; use of antiemetics; pre-hospital heparinization, thrombolysis, and beta-blockade in suspected MI; and rapid sequence intubation.La traducción en breve.