Background The city of Freiburg has been among the most affected regions by the COVID-19 pandemic... more Background The city of Freiburg has been among the most affected regions by the COVID-19 pandemic in Germany. In out of hospital cardiac arrest (OHCA) care, all parts of the rescue system were exposed to profound infrastructural changes. We aimed to provide a comprehensive overview of these changes in the resuscitation landscape in the Freiburg region. Methods Utstein-style quantitative data on OHCA with CPR initiated, occurring in the first pandemic wave between February 27th, 2020 and April 30th, 2020 were compared to the same time periods between 2016 and 2019. Additionally, qualitative changes in the entire rescue system were analyzed and described. Results Incidence of OHCA with attempted CPR did not significantly increase during the pandemic period (11.1/100.000 inhabitants/63 days vs 10.4/100.000 inhabitants/63 days, p = 1.000). In witnessed cases, bystander-CPR decreased significantly from 57.7% (30/52) to 25% (4/16) (p = 0.043). A severe pre-existing condition (PEC) was doc...
International Journal of Environmental Research and Public Health
Background: Critical Care Providers (CCPs) experience situations that challenge their ethics and ... more Background: Critical Care Providers (CCPs) experience situations that challenge their ethics and professional standards and may entail moral distress (MD). Aim: To analyze MD perceived by CCPs in intensive care units (ICUs) or emergency departments (EDs) and further clarify whether CCPs who rely on spiritual resources differ in their perception of MD from those who do not utilize these resources. Methods: A cross-sectional anonymous survey was administered using a modified version of the German language version of the Moral Distress Scale (MDS) with 2 × 12 items to assess the frequency and the respective perceived burden of specific situations by applying a 5-point Likert scale. Explorative factor analysis was performed and the sub-constructs of the respective items regarding MD frequency and burden were identified. Job burden and professional satisfaction were measured using visual analogue scales (VAS) and a four-point Likert scale, respectively. The 15-item SpREUK questionnaire w...
Carbon monoxide (CO) can occur in numerous situations and ambient conditions, such as fire smoke,... more Carbon monoxide (CO) can occur in numerous situations and ambient conditions, such as fire smoke, indoor fireplaces, silos containing large quantities of wood pellets, engine exhaust fumes, and when using hookahs. Symptoms of CO poisoning are nonspecific and can range from dizziness, headache, and angina pectoris to unconsciousness and death. This guideline presents the current state of knowledge and national recommendations on the diagnosis and treatment of patients with CO poisoning. The diagnosis of CO poisoning is based on clinical symptoms and proven or probable exposure to CO. Negative carboxyhemoglobin (COHb) levels should not rule out CO poisoning if the history and symptoms are consistent with this phenomenon. Reduced oxygen-carrying capacity, impairment of the cellular respiratory chain, and immunomodulatory processes may result in myocardial and central nervous tissue damage even after a reduction in COHb. If CO poisoning is suspected, 100% oxygen breathing should be imme...
Background Randomized trials have shown that trans-nasal evaporative cooling initiated during CPR... more Background Randomized trials have shown that trans-nasal evaporative cooling initiated during CPR (i.e. intra-arrest) effectively lower core body temperature in out-of-hospital cardiac arrest patients. However, these trials may have been underpowered to detect significant differences in neurologic outcome, especially in patients with initial shockable rhythm. Methods We conducted a post hoc pooled analysis of individual data from two randomized trials including 851 patients who eventually received the allocated intervention and with available outcome (“as-treated” analysis). Primary outcome was survival with favourable neurological outcome at hospital discharge (Cerebral Performance Category [CPC] of 1–2) according to the initial rhythm (shockable vs. non-shockable). Secondary outcomes included complete neurological recovery (CPC 1) at hospital discharge. Results Among the 325 patients with initial shockable rhythms, favourable neurological outcome was observed in 54/158 (34.2%) pat...
Medizinische Klinik - Intensivmedizin und Notfallmedizin, 2022
Das hier vorgestellte Dokument beschreibt die Anwendungsmöglichkeiten des Kontrastmittelultrascha... more Das hier vorgestellte Dokument beschreibt die Anwendungsmöglichkeiten des Kontrastmittelultraschalls („contrast enhanced ultrasound“, CEUS) bei notfallmäßig indizierten Untersuchungen. Leitlinien zur Kontrastmittelsonographie in der klinischen Akut- und Notfallmedizin sowie Intensivmedizin wurden bisher nicht veröffentlicht. Auf die evidenzbasierten Empfehlungen und Leitlinien der European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) und World Federation for Ultrasound in Medicine and Biology (WFUMB) wird verwiesen. Die hier vorgestellten Empfehlungen beschreiben die Anwendungsmöglichkeiten und Protokolle von CEUS in der Akutmedizin.
Checklists can improve adherence to standardized procedures and minimize human error. We aimed to... more Checklists can improve adherence to standardized procedures and minimize human error. We aimed to test if implementation of a checklist was feasible and effective in enhancing patient care in an emergency department handling internal medicine cases. We developed four critical event checklists and confronted volunteer teams with a series of four simulated emergency scenarios. In two scenarios, the teams were provided access to the crisis checklists in a randomized cross-over design. Simulated patient outcome plus statement of the underlying diagnosis defined the primary endpoint and adherence to key processes such as time to commence CPR represented the secondary endpoints. A questionnaire was used to capture participants’ perception of clinical relevance and manageability of the checklists. Six teams of four volunteers completed a total of 24 crisis sequences. The primary endpoint was reached in 8 out of 12 sequences with and in 2 out of 12 sequences without a checklist (Odds ratio,...
Zusammenfassung Hintergrund Das neue, pandemische Coronavirus SARS-CoV-2 und die damit einhergehe... more Zusammenfassung Hintergrund Das neue, pandemische Coronavirus SARS-CoV-2 und die damit einhergehende Erkrankung COVID-19 (Coronavirus Disease 2019) stellt die medizinischen Versorgungssysteme vor große Herausforderungen. Die vorliegende Arbeit fasst die Strategie, Organisation und Maßnahmen der COVID-Taskforce des Universitätsklinikums Freiburg zusammen und berichtet über Erfahrungen und Behandlungsergebnisse von der Versorgung der ersten 115 COVID-19-Patienten. Methoden Retrospektive, narrative Prozessbeschreibung und -analyse des Zeitraums Ende Januar bis Anfang April 2020, durchgeführt unter Mitwirken der beteiligten Departments, Kliniken und Institute des Universitätsklinikums Freiburg. Ergänzend erfolgte eine retrospektive Beobachtungsstudie mit deskriptiver statistischer Auswertung der epidemiologischen und klinischen Daten aller bis 31. März 2020 hospitalisierten COVID-19-Patienten. Ergebnisse Durch eine interdisziplinär zusammengesetzte Taskforce Coronavirus wurden Maßnahmen...
Medizinische Klinik - Intensivmedizin und Notfallmedizin, 2021
Zusammenfassung Hintergrund In Deutschland gibt es bisher keine Gesundheitsberichterstattung zu s... more Zusammenfassung Hintergrund In Deutschland gibt es bisher keine Gesundheitsberichterstattung zu sektorenübergreifenden Versorgungsverläufen im Kontext einer Notaufnahmeversorgung. Das Projekt INDEED (Inanspruchnahme und sektorenübergreifende Versorgungsmuster von Patienten in Notfallversorgungsstrukturen in Deutschland) erhebt Routinedaten aus 16 Notaufnahmen, die mit ambulanten Abrechnungsdaten der Jahre 2014 bis 2017 personenbezogen zusammengeführt werden. Ziel der Arbeit Die methodischen Herausforderungen der Planung der internen Zusammenführung von klinischen und administrativen Routinedaten aus Notaufnahmen in Deutschland bis zur finalen Datenextraktion werden hier gemeinsam mit Lösungsansätzen dargestellt. Methodik Die Auswahl der Notaufnahmedaten erfolgte in einem iterativen Prozess unter Berücksichtigung der Forschungsfragen, medizinischen Relevanz und angenommenen Datenverfügbarkeit. Nach einer Vorbereitungsphase zur Klärung der Rahmenbedingungen (u. a. Datenschutz, Ethik),...
Background Typical lung ultrasound (LUS) findings in patients with a COVID-19 infection were repo... more Background Typical lung ultrasound (LUS) findings in patients with a COVID-19 infection were reported early on. During the global SARS-CoV-2 pandemic, LUS was propagated as a useful instrument in triage and monitoring. We evaluated LUS as a rapid diagnostic triage tool for the management of patients with suspected COVID-19 in the emergency department (ED). Methods The study retrospectively enrolled patients with suspected COVID-19, who were admitted from 1st April to 25th of April 2020 to the ED of a tertiary care center in Germany. During clinical work-up, patients underwent LUS and polymerase chain reaction (PCR) testing for SARS-CoV-2. The recorded ultrasound findings were analyzed and judged regarding typical signs of viral pneumonia, blinded for clinical information of the patients. The results were compared with PCR test and chest computed tomography (CT). Results 2236 patients were treated in the ED during the study period. 203 were tested for SARS-CoV-2 using PCR, 135 (66.5%...
Background: Smartphone Alerting Systems (SAS) potentially reduce the resuscitation-free interval.... more Background: Smartphone Alerting Systems (SAS) potentially reduce the resuscitation-free interval. Many of these systems invite lay persons, who a have been trained in Basic Life Support (BLS). The Freiburg alert system Region of Lifesavers (Region der Lebensretter, RDL) only registers first responders with a professional background (i.e. paramedics, nurses, physicians, medical students) and volunteers with at least 48 units training in emergency medicine. Here we describe the evolution of the RDL system during the pandemic.Methods: Due to a lack of personal protective equipment (PPE), the alert system had been stopped at the beginning of the COVID 19 pandemic on March 16th, 2020.The board of the charity organization operating RDL decided to design a concept for a safe restart. Following the raise of 34,000 Euros of private funds, 1,000 backpacks were equipped with FFP-2 mask, gloves, protective gown, safety glasses, mouth-nose protection, airway filter and ventilation bag/mask. Furt...
Background The pressures exerted by the pandemic of COVID-19 pose an unprecedented demand on heal... more Background The pressures exerted by the pandemic of COVID-19 pose an unprecedented demand on health care services. Hospitals become rapidly overwhelmed when patients requiring life-saving support outpace available capacities. We here describe methods used by a university hospital to forecast caseloads and time to peak incidence. Methods We developed a set of models to forecast incidence among the hospital catchment population and describe the COVID-19 patient hospital care-path. The first forecast utilized data from antecedent allopatric epidemics and parameterized the care path model according to expert opinion (static model). Once sufficient local data were available, trends for the time dependent effective reproduction number were fitted and the care-path was parameterized using hazards for real patient admission, referrals, and discharge (dynamic model). Results The static model, deployed before the epidemic, exaggerated the bed occupancy (general wards 116 forecasted vs 66 obse...
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, Jan 8, 2018
Delirium is frequent in elderly patients presenting in the emergency department (ED). Despite the... more Delirium is frequent in elderly patients presenting in the emergency department (ED). Despite the severe prognosis, the majority of delirium cases remain undetected by emergency physicians (EPs). At the time of our study there was no valid delirium screening tool available for EDs in German-speaking regions. We aimed to evaluate the brief Confusion Assessment Method (bCAM) for a German ED during the daily work routine. We implemented the bCAM into practice in a German interdisciplinary high-volume ED and evaluated the bCAM's validity in a convenience sample of medical patients aged ≥ 70 years. The bCAM, which assesses four core features of delirium, was performed by EPs during their daily work routine and compared to a criterion standard based on the criteria for delirium as described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Compared to the criterion standard, delirium was found to be present in 46 (16.0%) of the 288 nonsurgical patients enrol...
Background The city of Freiburg has been among the most affected regions by the COVID-19 pandemic... more Background The city of Freiburg has been among the most affected regions by the COVID-19 pandemic in Germany. In out of hospital cardiac arrest (OHCA) care, all parts of the rescue system were exposed to profound infrastructural changes. We aimed to provide a comprehensive overview of these changes in the resuscitation landscape in the Freiburg region. Methods Utstein-style quantitative data on OHCA with CPR initiated, occurring in the first pandemic wave between February 27th, 2020 and April 30th, 2020 were compared to the same time periods between 2016 and 2019. Additionally, qualitative changes in the entire rescue system were analyzed and described. Results Incidence of OHCA with attempted CPR did not significantly increase during the pandemic period (11.1/100.000 inhabitants/63 days vs 10.4/100.000 inhabitants/63 days, p = 1.000). In witnessed cases, bystander-CPR decreased significantly from 57.7% (30/52) to 25% (4/16) (p = 0.043). A severe pre-existing condition (PEC) was doc...
International Journal of Environmental Research and Public Health
Background: Critical Care Providers (CCPs) experience situations that challenge their ethics and ... more Background: Critical Care Providers (CCPs) experience situations that challenge their ethics and professional standards and may entail moral distress (MD). Aim: To analyze MD perceived by CCPs in intensive care units (ICUs) or emergency departments (EDs) and further clarify whether CCPs who rely on spiritual resources differ in their perception of MD from those who do not utilize these resources. Methods: A cross-sectional anonymous survey was administered using a modified version of the German language version of the Moral Distress Scale (MDS) with 2 × 12 items to assess the frequency and the respective perceived burden of specific situations by applying a 5-point Likert scale. Explorative factor analysis was performed and the sub-constructs of the respective items regarding MD frequency and burden were identified. Job burden and professional satisfaction were measured using visual analogue scales (VAS) and a four-point Likert scale, respectively. The 15-item SpREUK questionnaire w...
Carbon monoxide (CO) can occur in numerous situations and ambient conditions, such as fire smoke,... more Carbon monoxide (CO) can occur in numerous situations and ambient conditions, such as fire smoke, indoor fireplaces, silos containing large quantities of wood pellets, engine exhaust fumes, and when using hookahs. Symptoms of CO poisoning are nonspecific and can range from dizziness, headache, and angina pectoris to unconsciousness and death. This guideline presents the current state of knowledge and national recommendations on the diagnosis and treatment of patients with CO poisoning. The diagnosis of CO poisoning is based on clinical symptoms and proven or probable exposure to CO. Negative carboxyhemoglobin (COHb) levels should not rule out CO poisoning if the history and symptoms are consistent with this phenomenon. Reduced oxygen-carrying capacity, impairment of the cellular respiratory chain, and immunomodulatory processes may result in myocardial and central nervous tissue damage even after a reduction in COHb. If CO poisoning is suspected, 100% oxygen breathing should be imme...
Background Randomized trials have shown that trans-nasal evaporative cooling initiated during CPR... more Background Randomized trials have shown that trans-nasal evaporative cooling initiated during CPR (i.e. intra-arrest) effectively lower core body temperature in out-of-hospital cardiac arrest patients. However, these trials may have been underpowered to detect significant differences in neurologic outcome, especially in patients with initial shockable rhythm. Methods We conducted a post hoc pooled analysis of individual data from two randomized trials including 851 patients who eventually received the allocated intervention and with available outcome (“as-treated” analysis). Primary outcome was survival with favourable neurological outcome at hospital discharge (Cerebral Performance Category [CPC] of 1–2) according to the initial rhythm (shockable vs. non-shockable). Secondary outcomes included complete neurological recovery (CPC 1) at hospital discharge. Results Among the 325 patients with initial shockable rhythms, favourable neurological outcome was observed in 54/158 (34.2%) pat...
Medizinische Klinik - Intensivmedizin und Notfallmedizin, 2022
Das hier vorgestellte Dokument beschreibt die Anwendungsmöglichkeiten des Kontrastmittelultrascha... more Das hier vorgestellte Dokument beschreibt die Anwendungsmöglichkeiten des Kontrastmittelultraschalls („contrast enhanced ultrasound“, CEUS) bei notfallmäßig indizierten Untersuchungen. Leitlinien zur Kontrastmittelsonographie in der klinischen Akut- und Notfallmedizin sowie Intensivmedizin wurden bisher nicht veröffentlicht. Auf die evidenzbasierten Empfehlungen und Leitlinien der European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) und World Federation for Ultrasound in Medicine and Biology (WFUMB) wird verwiesen. Die hier vorgestellten Empfehlungen beschreiben die Anwendungsmöglichkeiten und Protokolle von CEUS in der Akutmedizin.
Checklists can improve adherence to standardized procedures and minimize human error. We aimed to... more Checklists can improve adherence to standardized procedures and minimize human error. We aimed to test if implementation of a checklist was feasible and effective in enhancing patient care in an emergency department handling internal medicine cases. We developed four critical event checklists and confronted volunteer teams with a series of four simulated emergency scenarios. In two scenarios, the teams were provided access to the crisis checklists in a randomized cross-over design. Simulated patient outcome plus statement of the underlying diagnosis defined the primary endpoint and adherence to key processes such as time to commence CPR represented the secondary endpoints. A questionnaire was used to capture participants’ perception of clinical relevance and manageability of the checklists. Six teams of four volunteers completed a total of 24 crisis sequences. The primary endpoint was reached in 8 out of 12 sequences with and in 2 out of 12 sequences without a checklist (Odds ratio,...
Zusammenfassung Hintergrund Das neue, pandemische Coronavirus SARS-CoV-2 und die damit einhergehe... more Zusammenfassung Hintergrund Das neue, pandemische Coronavirus SARS-CoV-2 und die damit einhergehende Erkrankung COVID-19 (Coronavirus Disease 2019) stellt die medizinischen Versorgungssysteme vor große Herausforderungen. Die vorliegende Arbeit fasst die Strategie, Organisation und Maßnahmen der COVID-Taskforce des Universitätsklinikums Freiburg zusammen und berichtet über Erfahrungen und Behandlungsergebnisse von der Versorgung der ersten 115 COVID-19-Patienten. Methoden Retrospektive, narrative Prozessbeschreibung und -analyse des Zeitraums Ende Januar bis Anfang April 2020, durchgeführt unter Mitwirken der beteiligten Departments, Kliniken und Institute des Universitätsklinikums Freiburg. Ergänzend erfolgte eine retrospektive Beobachtungsstudie mit deskriptiver statistischer Auswertung der epidemiologischen und klinischen Daten aller bis 31. März 2020 hospitalisierten COVID-19-Patienten. Ergebnisse Durch eine interdisziplinär zusammengesetzte Taskforce Coronavirus wurden Maßnahmen...
Medizinische Klinik - Intensivmedizin und Notfallmedizin, 2021
Zusammenfassung Hintergrund In Deutschland gibt es bisher keine Gesundheitsberichterstattung zu s... more Zusammenfassung Hintergrund In Deutschland gibt es bisher keine Gesundheitsberichterstattung zu sektorenübergreifenden Versorgungsverläufen im Kontext einer Notaufnahmeversorgung. Das Projekt INDEED (Inanspruchnahme und sektorenübergreifende Versorgungsmuster von Patienten in Notfallversorgungsstrukturen in Deutschland) erhebt Routinedaten aus 16 Notaufnahmen, die mit ambulanten Abrechnungsdaten der Jahre 2014 bis 2017 personenbezogen zusammengeführt werden. Ziel der Arbeit Die methodischen Herausforderungen der Planung der internen Zusammenführung von klinischen und administrativen Routinedaten aus Notaufnahmen in Deutschland bis zur finalen Datenextraktion werden hier gemeinsam mit Lösungsansätzen dargestellt. Methodik Die Auswahl der Notaufnahmedaten erfolgte in einem iterativen Prozess unter Berücksichtigung der Forschungsfragen, medizinischen Relevanz und angenommenen Datenverfügbarkeit. Nach einer Vorbereitungsphase zur Klärung der Rahmenbedingungen (u. a. Datenschutz, Ethik),...
Background Typical lung ultrasound (LUS) findings in patients with a COVID-19 infection were repo... more Background Typical lung ultrasound (LUS) findings in patients with a COVID-19 infection were reported early on. During the global SARS-CoV-2 pandemic, LUS was propagated as a useful instrument in triage and monitoring. We evaluated LUS as a rapid diagnostic triage tool for the management of patients with suspected COVID-19 in the emergency department (ED). Methods The study retrospectively enrolled patients with suspected COVID-19, who were admitted from 1st April to 25th of April 2020 to the ED of a tertiary care center in Germany. During clinical work-up, patients underwent LUS and polymerase chain reaction (PCR) testing for SARS-CoV-2. The recorded ultrasound findings were analyzed and judged regarding typical signs of viral pneumonia, blinded for clinical information of the patients. The results were compared with PCR test and chest computed tomography (CT). Results 2236 patients were treated in the ED during the study period. 203 were tested for SARS-CoV-2 using PCR, 135 (66.5%...
Background: Smartphone Alerting Systems (SAS) potentially reduce the resuscitation-free interval.... more Background: Smartphone Alerting Systems (SAS) potentially reduce the resuscitation-free interval. Many of these systems invite lay persons, who a have been trained in Basic Life Support (BLS). The Freiburg alert system Region of Lifesavers (Region der Lebensretter, RDL) only registers first responders with a professional background (i.e. paramedics, nurses, physicians, medical students) and volunteers with at least 48 units training in emergency medicine. Here we describe the evolution of the RDL system during the pandemic.Methods: Due to a lack of personal protective equipment (PPE), the alert system had been stopped at the beginning of the COVID 19 pandemic on March 16th, 2020.The board of the charity organization operating RDL decided to design a concept for a safe restart. Following the raise of 34,000 Euros of private funds, 1,000 backpacks were equipped with FFP-2 mask, gloves, protective gown, safety glasses, mouth-nose protection, airway filter and ventilation bag/mask. Furt...
Background The pressures exerted by the pandemic of COVID-19 pose an unprecedented demand on heal... more Background The pressures exerted by the pandemic of COVID-19 pose an unprecedented demand on health care services. Hospitals become rapidly overwhelmed when patients requiring life-saving support outpace available capacities. We here describe methods used by a university hospital to forecast caseloads and time to peak incidence. Methods We developed a set of models to forecast incidence among the hospital catchment population and describe the COVID-19 patient hospital care-path. The first forecast utilized data from antecedent allopatric epidemics and parameterized the care path model according to expert opinion (static model). Once sufficient local data were available, trends for the time dependent effective reproduction number were fitted and the care-path was parameterized using hazards for real patient admission, referrals, and discharge (dynamic model). Results The static model, deployed before the epidemic, exaggerated the bed occupancy (general wards 116 forecasted vs 66 obse...
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, Jan 8, 2018
Delirium is frequent in elderly patients presenting in the emergency department (ED). Despite the... more Delirium is frequent in elderly patients presenting in the emergency department (ED). Despite the severe prognosis, the majority of delirium cases remain undetected by emergency physicians (EPs). At the time of our study there was no valid delirium screening tool available for EDs in German-speaking regions. We aimed to evaluate the brief Confusion Assessment Method (bCAM) for a German ED during the daily work routine. We implemented the bCAM into practice in a German interdisciplinary high-volume ED and evaluated the bCAM's validity in a convenience sample of medical patients aged ≥ 70 years. The bCAM, which assesses four core features of delirium, was performed by EPs during their daily work routine and compared to a criterion standard based on the criteria for delirium as described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Compared to the criterion standard, delirium was found to be present in 46 (16.0%) of the 288 nonsurgical patients enrol...
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Papers by Hans-Jörg Busch