EXPERIENCES WITH AN AMBULANCE FOR ENVIRONMENTAL MEDICINE AT THE UNIVERSITY-OF-HEIDELBERG GERMANY

Outpatient departments and advice centres for environmental medicine w ere established in the late eighties in Germany. Most of these institu tions focus on patient-care, whereas scientific questions have only be en dealt with randomely. Thus the evaluation of applied methods and pr ocedures is not satisfactory at present. Patients suffering from ''env ironmental-medical'' disorders usually complain about chronic or recur ring illnesses. Up to now the complex etiology has not been understood . Generally environmental agents in a literal sense do not seem to be of great importance. It is merely impossible to verify the extent to w hich such exposures influences a multifactorial etiology. Acute health disorders or a disorder that can definitely be related to a specific cause occur very rarely in our field. Thus a serious methological dile mma results for the clinical aspect of environmental medicine. Neverth eless an increasing number of patients associate their complaints to e nvironmental influences such as harmful substances and physical enviro nmental influences, e.g. electromagnetic fields. Mass media and some p hysicians support this idea. Scientifically unsound methods of treatme nt are often applied in ''Environmental practices'', ''Environmental c linics'', ''Mobile Environmental Outstations''. The results of diagnos tic examinations are interpreted in a dubious fashion and questionable therapeutic advice is given. An extension of the environmental medica l field is nor only taking place in the private (commercial) sector; b ut public institutions, especially public health centres, are particip ating in the unreflected extension of the outpatient section for envir onmental medicine. As a consequence we decided to establish a research -orientated ''Environmental Outpatient Department'' as part of the Hyg iene Institute of the Heidelberg University in 1993. The aim was an ev ulation of the concept of outpatient stations and if required its furt her development. The main aspects of the Heidelberg outpatient station -concept will be shown as well as the first case related research resu lts which have reinforced our critical attitude towards clinical envir onmental medicine. In less than a tenth of the presented cases environ mental agents could be proved partly responsible for the mentioned com plaints. In a third of all cases a connection between the suspected en vironmentally harmful substances or others and the apparent health dis orders could neither be proved nor totally denied. There was, however, little evidence for a causal connection. In two-thirds of the cases p hysical-chemical environmental pollution could not be proved responsib le for the complaints. More than half of the patients suffered from mo re or less obvious psychosomatic problems.