Short report 163 Should the general practitioner be prepared for the patient with decreased consciousness or coma? Jan Matthys a , Walter Buylaert b , Peter De Paepe b , Anke Thoen a , Jean-Pierre Matthijs c and An De Sutter a Background Data are scarce about the possible role for the general practitioner (GP) in patients with decreased consciousness (DC) or coma. We wanted to investigate how often a GP is confronted with DC or coma during out-of-hours service in an urban region and to compare the patients presented to primary care to those who were immediately treated by the emergency medical services (EMS). Method In a prospective observational study during 2 weekends in the city of Ghent, Belgium, which has 232 500 inhabitants, 724 patients were seeking emergency care, and DC or coma was the reason for encounter in 27 patients (3.8%). Eight patients initially seen by a GP had more heterogeneous diagnoses than the 19 patients immediately transferred to the emergency department without intervention by a GP. Results and conclusion This study shows that about one-third (N = 8) of emergencies involving patients with DC or coma were initially evaluated by a GP; five out of these eight patients were subsequently transported by the EMS. We conclude that telephone triage guidelines providing simultaneous alerts of the GP and the EMS for DC or coma patients, tailored training of GPs with skills maintenance, adequate equipment and close collaboration with the EMS are recommended for GP out-of-hours services. European Journal of Emergency Medicine 16:163–165  c 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins. European Journal of Emergency Medicine 2009, 16:163–165 Keywords: coma, epidemiology, general practice, guideline, loss of consciousness, triage Departments of a General Practice and Primary Health Care, b Emergency Medicine, Ghent University and c Ghent Association of General Practitioners, Ghent, Belgium Correspondence to Jan Matthys, MD, Department of General Practice and Primary Health Care, Ghent University, De Pintelaan 185, Ghent 9000, Belgium Tel: +32 9 332 33 12; fax: +32 9 332 49 67; e-mail: jan.matthys@ugent.be Received 2 June 2008 Accepted 4 October 2008 Introduction The role of the general practitioner (GP) in patients with decreased consciousness (DC) or coma is often limited to arranging a prompt transfer to the hospital by the emergency medical services (EMS). Their handling of these calls and the collaboration with the EMS in the field is, however, of utmost importance for the patient. In this study, we describe the incidence and causes of DC or coma in calls for primary care in an urban region and compare the patients presenting to primary care to those who were transferred to the EMS without intervention of a GP. Methods We carried out a prospective study from Saturday 1200 h to Sunday 1200 h during two consecutive weekends in January 2006 in Ghent, Belgium. During this time period, urgent medical help was accessible either through primary medical care service by dialling a unique nine-digit telephone number or through the unique number 100 of the EMS with transport by ambulance or mobile intensive care unit of the patient to one of the four emergency departments in the city of Ghent. Each of the services participated in the study. All patients presenting to the primary medical care service of GPs and to the EMS were included. At the GP call centre, when a telephone call for a possible life-threatening emergency arrived, the ambulance and mobile intensive care unit could immediately be solicited. All other calls were handled by one of the 36 GPs involved in the out-of-hours service. The individual patient characteristics, the reason for contact and a provisional diagnosis of all patients seen by the GPs were collected during a telephone call by a doctor in vocational training on the same day of the patient contact. Furthermore, the GPs provided a written report about the tentative diagnosis and hospital referral (Tables 1 and 2). Results are expressed as mean ± standard deviation (SPSS Inc., Chicago, Illinois, USA; version 12). Results During the study period, 724 patients sought medical care: 437 patients were seen at the emergency department and 287 patients were first evaluated by a GP. DC or coma was present in 19 (4.3%) patients presenting to the emergency department, and in eight 0969-9546  c 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI: 10.1097/MEJ.0b013e32831ceff2 Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.