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Das Konzept der Frühdefibrillation

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Die Notfalltherapie bei akutem Myokardinfarkt

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Abstract

The introduction of “early defibrillation” by emergency technicians (nonphysicians) in Germany led to a very emotional and controversial discussion, since the use of a defibrillator had previously been restricted to physicians. “Early defibrillation” by definition signifies immediate defibrillation by first-arriving nonphysician rescuers. The alternative term is EMT (emergency medical technician) defibrillation. The term early defibrillation is suggestive of very early defibrillation. Even if this is seldom achieved in real life, it points to the fact that this means the earliest possible defibrillation. “Early defibrillation” is closely related to the chain of survival concept. The clearly structured optimized chain of survival, a tiered emergency medical system, is a precondition for an effective early defibrillation program. In the tiered system of densely stationed, basically qualified rescue personnel, basic life support including defibrillation with semi-automatic defibrillators is started until the emergency physician (in other countries paramedics) arrives at the scene. Only a few hours of training are necessary to enable safe and effective use of semi-automatic defibrillators by basic rescue personnel. The use of semi-automatic defibrillators in early defibrillation programs is recommended by the American Heart Association and by the European Resuscitation Council. Even the use of these devices by minimally trained non-rescue personnel (e.g., policemen and other security personnel) is a second-step recommendation.

Zusammenfassung

Frühdefibrillation (early defibrillation) ist ein suggestiver Begriff für einen Vorgang im Rettungsablauf, bei dem das zuerst eintreffende (nichtärztliche) Rettungspersonal mit einer eingreifenden Maßnahme betraut wird, die nur selten eine wirklich frühe immerhin aber die frühstmögliche Defibrillation erlaubt, d.h. in Deutschland schon vor Eintreffen eines Notarztes. Ein alternativer Begriff ist die Bezeichnung Sanitäterdefibrillation (EMT-defibrillation). Kaum ein an- deres notfallmedizinisches Verfahren wurde in Deutschland so emotional und kontrovers diskutiert wie die Defibrillation durch nichtärztliches Personal bei einem Herz-Kreislaufstillstand im Rettungsdienst. Die Frühdefibrillation ist unmittelbar mit dem Konzept einer existierenden Rettungskette verbunden. Die Einführung eines Frühdefibrillationsprogramms ist demnach weder möglich noch sinnvoll, wenn klare Strukturen im Aufbau einer optimierten Rettungskette fehlen.Voraussetzung dafür, dass ein Frühdefibrillations-programm wirksam werden kann, ist ein gestaffeltes Rettungssystem. Dabei werden zuerst ortsnah stationierte, einfach qualifizierte Rettungskräfte eingesetzt bis höher qualifiziertes Rettungspersonal (z. B. ein Notarzt) beim Patienten eintrifft. Halbautomatische Defibrillatoren erlauben bei geringem Trainingsaufwand den sicheren Gebrauch durch einfach qualifiziertes Rettungspersonal. Sowohl von der American Heart Association als auch vom European Resuscitation Council wird die Defibrillation bei Kammerflimmern zum frühstmöglichen Zeitpunkt empfohlen, d.h. sobald ein Gerät zur Defibrillation verfügbar ist. Wenn möglich sollten Geräte sogar bereits vor Eintreffen des organisierten Rettungsdienstes für kundige Helfer verfügbar sein.

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Authors and Affiliations

  1. Stadt Leipzig Dezernat V, Ltd. Arzt für den Rettungsbereich Leipzig, Goerdelerring 7, D-04109, Leipzig, Deutschland

    Dr. med. W.-H. Storch

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  1. Dr. med. W.-H. Storch
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Editors and Affiliations

  1. Klinikum Benjamin Franklin, Medizinische Klinik II, Hindenburgdamm 30, D-12200, Berlin, Germany

    H.-R. Arntz

  2. Städtisches Krankenhaus Hildesheim Medizinische Klinik I, Akademisches Lehrkrankenhaus der Medizinischen Hochschule Hannover, Weinberg 1, D-31134, Hildesheim, Germany

    H.-P. Schuster

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Storch, WH. (2000). Das Konzept der Frühdefibrillation. In: Arntz, HR., Schuster, HP. (eds) Die Notfalltherapie bei akutem Myokardinfarkt. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-642-57713-0_7

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  • DOI: https://doi.org/10.1007/978-3-642-57713-0_7

  • Publisher Name: Steinkopff, Heidelberg

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