Correspondence (letter to the editor): Far From Reality

The conclusions reached by the authors may reflect the zeitgeist, but they do not reflect reality. It has become fashionable to evaluate one's own work as a part of quality assessment. In my opinion, however, the study data need to be interpreted differently. Only 80% of patients received a venous access and those a mean of 1.4 drugs. This is particulary astonishing since more than 50% of patients were reported to have had a NACA score of IV to VII. It defies me how such minimal treatment would have achieved such an enormous improvement in clinical symptoms (Delta-MEES) during the short treatment period allocated by the emergency physician to these severely ill patients. I have worked as an emergency physician for more than 10 years and cannot confirm these numbers from my own experience. In an estimated 80% of all pre-hospital emergencies it is found on arrival that an emergency physician would not have been required because no threat to life existed and no immediate medication was necessary. A real clinical improvement is not possible in such a setting. I don't believe in quality assurance and the conclusions drawn from it when they are based on subjective impressions and have not been further reviewed. For serious quality assessment, objective data are required. In case of pre-hospital emergency services there should be a follow up of the cases, for example reviewing their files of their following hospital stays. Otherwise not even the initially suspected diagnosis can be confirmed. This approach is indeed very laborious but the methods used so far are rather pointless.