Michael Bentele

Recent international developments have led to increased terrorist activity and intentional violence across Europe. Interagency collaboration has repeatedly been identified as a key challenge in previous scenarios. This study explores the perspectives of European pre-hospital medical providers and law enforcement officers on collaboration during violent incidents, aiming to identify barriers, best practices, and opportunities for improvement. Twelve modified focus group interviews (3–8 individuals per group) with embedded polls were conducted online. Deductive coding was performed for predefined topics, e.g., Command, Communication, Hot Zone Care, Provider Safety, and Interagency Understanding. Inductive coding was applied to additional content arising from the interview dynamics. 64 participants from 20 European countries were interviewed. 41% (26/64) were non-physician pre-hospital providers, 38% (24/64) worked as pre-hospital emergency physicians, and 22% (14/64) served in law enforcement, including special forces. 49% (30/61) of participants denied feeling adequately trained to collaborate with other responding services in a tactical scenario. Training methods were criticised for neglecting situational awareness and interpersonal competencies. Overall, joint training opportunities are reportedly rare, leading to misconceptions of the capabilities and priorities of interagency counterparts on scene. 64% (39/61) of participants reported police as the primary care provider for casualties in the hot zone, with many regional protocols extending this reliance into the warm zone and specifically onto special forces. However, the interviews indicated that police are unlikely to deliver such care without significant delay. Thus, casualty evacuation emerged as a key bottleneck and priority for further debate. This study revealed a significant paucity of joint education and training opportunities. Training concepts should place greater emphasis on behavioural competencies instead of rigid protocol compliance. Although promising response frameworks exist across Europe, various deployed strategies risk prolonging the therapeutic vacuum of casualties inside high-risk zones and impairing provider safety. Joint strategies and interprofessional exchange will be essential to decrease such systemic vulnerabilities.

Zusammenfassung: Hintergrund: Die Versorgungsqualität bei einem Massenanfall von Notfallpatienten wird entscheidend durch die schnelle Identifikation lebensbedrohlich erkrankter oder verletzter Patienten beeinflusst. Diese soll durch Nutzung von Vorsichtungsalgorithmen (VSA) erleichtert werden. Über die regionale Verteilung und den Bekanntheitsgrad dieser Instrumente in Deutschland liegen bisher keine Erkenntnisse vor. Ziel der Arbeit: Ziel der vorliegenden Studie war die Bestandsaufnahme der in Deutschland etablierten VSA und deren regionaler Verteilung anhand der Angaben von medizinischem und Rettungsdienst-Fachpersonal. Material und Methoden: Online-Umfrage im Zeitraum Mai bis September 2023 über soziale und private Netzwerke mittels Fragebogen zu soziodemografischen Daten und Kenntnissen zu verschiedenen VSA sowie deren praktischem Einsatz. Ergebnisse: Die Auswertung von n = 986 Fragebögen, mehrheitlich von Notfallsanitätern (44,6 %) und Ärzten mit Zusatzweiterbildung Notfallmedizin (19,5 %), ergab eine ausgeprägte Heterogenität lokal genutzter VSA. 71,2 % der Teilnehmenden kannten den im eigenen Einsatzbereich geltenden VSA. Innerhalb der letzten 12 Monate vor der Umfrage hatten 41,1 % eine Schulung zu VSA erhalten und 44,0 % diese gar nicht oder nur einmal im Realeinsatz angewendet. Diskussion: Der lokal gültige VSA war sieben von zehn Teilnehmenden bekannt. Dieser Anteil gilt im internationalen Vergleich als hoch. Hinsichtlich der regionalen Verteilung zeigt Deutschland ein heterogenes Bild. Die Etablierung eines (bundes-)einheitlichen Vorsichtungsalgorithmus entspricht internationalen Empfehlungen und ist aus Sicht der Studienteilnehmenden notwendig und gewünscht.

Background: Paediatric emergencies are challenging for healthcare workers, first aiders, and parents waiting for emergency medical services to arrive. With the expected rise of virtual assistants, people will likely seek help from such digital AI tools, especially in regions lacking emergency medical services. Large Language Models like ChatGPT proved effective in providing health-related information and are competent in medical exams but are questioned regarding patient safety. Currently, there is no information on ChatGPT’s performance in supporting parents in paediatric emergencies requiring help from emergency medical services. This study aimed to test 20 paediatric and two basic life support case vignettes for ChatGPT and GPT-4 performance and safety in children.Methods: We provided the cases three times each to two models, ChatGPT and GPT-4, and assessed the diagnostic accuracy, emergency call advice, and the validity of advice given to parents.Results: Both models recognized the emergency in the cases, except for septic shock and pulmonary embolism, and identified the correct diagnosis in 94%. However, ChatGPT/GPT-4 reliably advised to call emergency services only in 12 of 22 cases (54%), gave correct first aid instructions in 9 cases (45%) and incorrectly advised advanced life support techniques to parents in 3 of 22 cases (13.6%).Conclusion: Considering these results of the recent ChatGPT versions, the validity, reliability and thus safety of ChatGPT/GPT-4 as an emergency support tool is questionable. However, whether humans would perform better in the same situation is uncertain. Moreover, other studies have shown that human emergency call operators are also inaccurate, partly with worse performance than ChatGPT/GPT-4 in our study. However, one of the main limitations of the study is that we used prototypical cases, and the management may differ from urban to rural areas and between different countries, indicating the need for further evaluation of the context sensitivity and adaptability of the model. Nevertheless, ChatGPT and the new versions under development may be promising tools for assisting lay first responders, operators, and professionals in diagnosing a paediatric emergency.Trial registration: Not applicable.

Introduction: The experience of a second victim phenomenon after an event plays a significant role in health care providers’ well-being. Untreated; it may lead to severe harm to victims and their families; other patients; hospitals; and society due to impairment or even loss of highly specialised employees. In order to manage the phenomenon, lifelong learning is inevitable but depends on learning motivation to attend training. This motivation may be impaired by overconfidence effects (e.g., over-placement and overestimation) that may suggest no demand for education. The aim of this study was to examine the interdependency of learning motivation and overconfidence concerning second victim effects. Methods: We assessed 176 physicians about overconfidence and learning motivation combined with a knowledge test. The nationwide online study took place in early 2022 and addressed about 3000 German physicians of internal medicine. Statistics included analytical and qualitative methods. Results: Of 176 participants, 83 completed the assessment. Analysis showed the presence of two overconfidence effects and in-group biases (clinical tribalism). None of the effects correlated directly with learning motivation, but cluster analysis revealed three different learning types: highly motivated, competent, and confident “experts”, motivated and overconfident “recruitables”, and unmotivated and overconfident “unawares”. Qualitative analysis revealed four main themes: “environmental factors”, “emotionality”, “violence and death”, and “missing qualifications” contributing to the phenomenon. Discussion: We confirmed the presence of overconfidence in second victim management competencies in about 3% of all persons addressed. Further, we could detect the same three learning motivation patterns compared to preceding studies on learning motivation in other medical competencies like life support and infection control. These findings considering overconfidence effects may be helpful for safety managers, medical teachers, curriculum developers and supervisors to create preventive educational curricula on second victim recognition and management.