Der psychiatrische Notfall im Rettungsdienst : eine Herausforderung des Notarztes?

摘要

Psychiatric emergencies are always indicated as a frequency of 10% in the literature as the third-most frequent cause for the emergency surgeon employment. Investigations over possible regional thing in common or differences over frequency, value and therapy were so far only present in a case from the year 1995. Therefore the retrospective evaluation took place of 13.251 emergency surgeon reports from the year 2005 of a medium sized German city, a district town and a municipality within a district to compare value, frequency and therapy of psychiatric emergencies. It has come to a rise of the psychiatric emergency situations of approximately 2 per cent on approximately 12 per cent within the last ten years. In addition the frequency of the psychiatric emergencies differs between urban and rural regions. On the country the psychiatric emergency occurs only half as frequently as in the urban areas. If one regards the kinds of the psychiatric emergencies, then differences and also thing in common show up. All emergency service regions are dominated by intoxications by alcohol, drugs and medicines, whereby the patients with the alcohol-conditioned intoxication represent the principal part. This group of patients is in the rural ranges above average frequently represented (75% vs. 50%), where going the intoxication through drug use (Aachen 26%) and the intoxication by medicines (Aachen 14%) dominates in the urban regions. Also more frequent in the urban region is the proportion of psychiatric emergencies with psychiatric diagnoses in the strict sense: psychosis, depression and mania. They are about twice as frequently as in the rural areas. The diagnoses suicide and suicide trial behave exactly in reverse. They are to be clearly more frequently found on the country than within the urban range (Düren +11% opposite Aachen). One finds the diagnosis withdrawal of alcohol, drugs and medicines in the rural regions not at all. Hardly regional differences show the excitation condition and the social crisis. These diagnoses employ the emergency services in city and country equally. Likewise the frequency of the psychiatric emergency per inhabitant lies on the average in the three examined regions with approximately 29 employments per 1000 inhabitants. No substantial regional differences resulted in the far investigation of the time spent of the emergency doctor at the scene of the psychiatric emergency. It oscillated within all ranges around the average value of 25.7 minutes. In the comparison of this time with the period spent on other non-psychiatric emergencies it resulted that the psychiatric emergency binds the emergency surgeon less than other emergencies. If one examines the time staying on scene of the emergency surgeon after its technical disciplines, then no significant difference of the fields taken part in the emergency surgeon service results among themselves. During the investigation of the therapy of the psychiatric emergency in the individual emergency service regions it showed up that the treatment strategies within many regions are to be called only rudimentary and conditions of the today's emergency-medical standards is not. In regions in those the verbal basic crisis-intervention is not expressly forced of leading emergency surgeons, the basis crisis-intervention is only scarcely or not at all accomplished, although the investigations showed that this led to a significant reduction of the use of benzodiacepines. The psychiatric emergency patient profited thereby of a basis crisis intervention by the emergency surgeon like already 2002 demanded. This only succeeds naturally only, if the techniques are implemented in the curricula to the education of the emergency surgeons. A further point is nevertheless, then it seems, the uncritical and often not indicated use of the benzodiazepins. So often benzodiazepines are used, which do not become fair the respective situation of the psychiatric emergency and/or an evaluation of the patient later in the emergency admission by the psychiatrist no more to permit. This effected often in the absence of alternatives, is it in the bad training of the active emergency surgeons in the verbal basis crisis intervention, and in the limited selection of the medical concepts in the emergency service regions, which do not permit an employment of the substance classes on the respective psychiatric emergency. As conclusion it remains recording that the psychiatric emergency is in constant change of time and should be the subject of the current emergency-medical view, not least to get an important value in the emergency-medical training.