ARE EMERGENCY PHYSICIANS PREHOSPITAL DIAG NOSES RELIABLE

Methods and aim of the study: The on-scene performance during all miss ions of the emergency physician-operated rescue helicopter and mobile intensive care unit based at a large-city hospital over a period of 1 year was retrospectively analysed; 2,254 hospital discharge reports we re available (92% of the patients treated by the emergency physicians [n = 2,493]). The following parameters were investigated: reliability of the primary diagnosis established by the emergency physician (by co mparison with the discharge diagnoses); initial on-scene therapeutic m easures; means of transportation (with or without accompanying emergen cy physician); and level of care of the target hospital. Results. The most common reasons for a mission were cardiopulmonary diseases (55%), neurological disorders (18%), and traumatic events (7%). The diagnose s, therapeutic measures, and mode of transportation were correct in 2, 033 (90%) patients with a discharge report, Severe errors of assessmen t by the emergency physician were identified in 73 patients (3%): life -threatening conditions were not recognised and/or grossly incorrect t herapeutic measures were taken and/or the chosen means of transportati on was unsuitable, Relative errors in assessment occurred in 4% (n = 8 3): the most crucial diagnosis was not made, but the patient was escor ted by the emergency physician (without therapeutic errors) to a suita ble hospital. In 3% (n = 65) of the cases, the patient's condition was overestimated by the emergency physician as suggested by the obviousl y exaggerated on-scene therapy. Underestimations of the severity were most common in patients with cardiopulmonary diseases and increased in frequency and severity with increasing age and the presence of a conc omitant neurologic deficit. Underestimations of a severe condition in younger patients were extremely rare; overestimations of the severity and consequent overtreatment were particularly common in traumatised p atients independent of age. Conclusions. In the context of quality man agement measures, a careful evaluation of on-scene diagnoses, therapeu tic measures, and decisions made by the emergency physician is a suita ble procedure for identifying systematic errors. A high percentage of correct diagnoses and therapy at the emergency site can only be ensure d by clinically experienced physicians who constantly deal with patien ts with acutely life-threatening conditions.