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Herr D, Bhatia S, Breuer F, Poloczek S, Pommerenke C, Dahmen J. Increasing emergency number utilisation is not driven by low-acuity calls: an observational study of 1.5 million emergency calls (2018-2021) from Berlin. BMC Med 2023; 21:184. [PMID: 37193989 DOI: 10.1186/s12916-023-02879-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/24/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND The Emergency Medical Service (EMS) in Germany is increasingly challenged by strongly rising demand. Speculations about a greater utilisation for minor cases have led to intensive media coverage, but empirical evidence is lacking. We investigated the development of low-acuity calls from 2018 to 2021 in the federal state of Berlin and its correlations with sociodemographic characteristics. METHODS We analysed over 1.5 million call documentations including medical dispatch codes, age, location and time using descriptive and inferential statistics and multivariate binary logistic regression. We defined a code list to classify low-acuity calls and merged the dataset with sociodemographic indicators and data on population density. RESULTS The number of emergency calls (phone number 112 in Germany) increased by 9.1% from 2018 to 2021; however, the proportion of low-acuity calls did not increase. The regression model shows higher odds of low-acuity for young to medium age groups (especially for age 0-9, OR 1.50 [95% CI 1.45-1.55]; age 10-19, OR 1.77 [95% CI 1.71-1.83]; age 20-29, OR 1.64 [95% CI 1.59-1.68] and age 30-39, OR 1.40 [95% CI 1.37-1.44]; p < 0.001, reference group 80-89) and for females (OR 1.12 [95% CI 1.1-1.13], p < 0.001). Odds were slightly higher for calls from a neighbourhood with lower social status (OR 1.01 per index unit increase [95% CI 1.0-1.01], p < 0.05) and at the weekend (OR 1.02 [95% CI 1.0-1.04, p < 0.05]). No significant association of the call volume with population density was detected. CONCLUSIONS This analysis provides valuable new insights into pre-hospital emergency care. Low-acuity calls were not the primary driver of increased EMS utilisation in Berlin. Younger age is the strongest predictor for low-acuity calls in the model. The association with female gender is significant, while socially deprived neighbourhoods play a minor role. No statistically significant differences in call volume between densely and less densely populated regions were detected. The results can inform the EMS in future resource planning.
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Affiliation(s)
- David Herr
- Faculty of Medicine, School of Public Health, Imperial College London, South Kensington Campus, London, SW7 2 AZ, UK.
| | - Sangeeta Bhatia
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Jameel Institute, Imperial College London, London, UK
| | - Florian Breuer
- Emergency Medical Services Director, Rhine-Berg District, Office for Fire Protection and Emergency Medical Service, Bergisch Gladbach, Germany
| | - Stefan Poloczek
- Office of the Medical Director, Emergency Medical Services, Berlin, Germany
| | | | - Janosch Dahmen
- Faculty of Health, Department of Medicine, Witten/Herdecke University, Witten, Germany
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Kraus P, Greiner F, Ebmeyer U, Brammen D. Umsetzung der standardisierten und strukturierten Notrufabfrage in deutschen Rettungsleitstellen im Jahr 2019. Notf Rett Med 2022. [DOI: 10.1007/s10049-022-01099-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Zwischen Notfall und Fehleinsatz – eine retrospektive Analyse der Einsätze eines Notarzteinsatzfahrzeugs in Frankfurt am Main von 2014 bis 2019. Notf Rett Med 2022. [DOI: 10.1007/s10049-022-01097-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Zusammenfassung
Hintergrund
Ein steigendes Einsatzaufkommen lässt sich sowohl im Rettungsdienst als auch im notärztlichen System in Deutschland verzeichnen. Oft werden dabei Fehleinsätze durch leicht erkrankte/verletzte Patienten als wachsende Problematik vermutet. Die vorliegende Untersuchung überprüft die Hypothese von steigenden Einsatzzahlen mit gleichzeitiger Zunahme von gegebenenfalls nichtindizierten Einsätzen.
Material und Methoden
Es erfolgte eine retrospektive Analyse der notärztlichen Einsätze des an der Universitätsklinik Frankfurt am Main stationierten Notarzteinsatzfahrzeugs von 2014 bis 2019. Die Analyse berücksichtigt zudem Faktoren wie die notärztliche Tätigkeit, Behandlungspriorität, Alarmierungsart und das Patientenalter.
Ergebnisse
Im beobachteten Zeitraum lässt sich ein Anstieg der notärztlichen Einsatzzahlen um mehr als 20 % erkennen. Der größte Anstieg zeigt sich bei Einsätzen, bei denen keine notärztliche Tätigkeit (+80 %) notwendig war. Einsätze der niedrigsten Behandlungspriorität (+61 %) sowie der höchsten Behandlungspriorität (+61 %) nahmen ebenfalls signifikant zu.
Diskussion
Die vorliegenden Zahlen stützen die Hypothese, dass bei signifikant gesteigertem Einsatzaufkommen mehr Einsätze durch den Notarzt bewältigt werden müssen, bei denen er rückblickend nicht notwendig gewesen wäre. Trotzdem gibt es auch mehr Patienten, die einen sofortigen Arztkontakt benötigen. Die hieraus resultierende erhöhte Einsatzfrequenz kann zu einer erhöhten Belastung sowie erschwerten zeitgerechten Disposition der notärztlichen Ressource führen.
Graphic abstract
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Breuer F, Brettschneider P, Poloczek S, Pommerenke C, Wolff J, Dahmen J. [Quo vadis joint emergency dispatch system?]. Notf Rett Med 2022:1-10. [PMID: 36090676 PMCID: PMC9449959 DOI: 10.1007/s10049-022-01073-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 11/30/2022]
Abstract
The call volume in emergency medical service (EMS) dispatch centers has seen a drastic increase for many years now, especially looking at urban regions of Germany. In this context, the control mechanisms of the EMS dispatch center can be utilized to break new ground regarding the handling of emergency calls and dispatch practice in order to manage incoming calls as efficiently as possible. This article clearly explains standardized protocol-based emergency medical call taking, internal structuring of control centers and pathways, also during the COVID-19 pandemic, using the Berlin EMS dispatch center as an example. The terms structured and standardized protocol-based emergency medical call taking should be differentiated, whereby the standardized call taking process is more binding and based on international standards with high reliability. Quality management measures ensure that the protocol is applied in accordance with the regulations. Improved collaboration and automated transfer of data between EMS dispatch centers and the control centers for non-life-threatening physician on-call services enable low-priority calls to be forwarded on a regular basis. Interprofessional teams in EMS can improve the care of specific patient groups in a targeted manner and avoid transport to emergency departments. Standardized protocol-based and software-based emergency call taking currently represents best practice according to medical science, supporting a nationwide implementation. Furthermore, an intensive collaboration between EMS control centers and control centers for non-life-threatening physician on-call services is recommended as well as the introduction of specialized EMS resources and app-based alerting of first responders.
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Affiliation(s)
- Florian Breuer
- Berliner Feuerwehr Einsatzvorbereitung Rettungsdienst, Berlin, Deutschland
- Ärztliche Leitung Rettungsdienst Rheinisch-Bergischer Kreis, Amt für Feuerschutz und Rettungswesen, Am Rübezahlwald 7, 51469 Bergisch Gladbach, Deutschland
| | | | - Stefan Poloczek
- Berliner Feuerwehr Einsatzvorbereitung Rettungsdienst, Berlin, Deutschland
- Ärztliche Leitung Rettungsdienst Berliner Feuerwehr, Berlin, Deutschland
| | | | - Justus Wolff
- Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| | - Janosch Dahmen
- Berliner Feuerwehr Einsatzvorbereitung Rettungsdienst, Berlin, Deutschland
- Ärztliche Leitung Rettungsdienst Berliner Feuerwehr, Berlin, Deutschland
- Universität Witten/Herdecke, Fakultät für Gesundheit, Department Humanmedizin, Witten/Herdecke, Deutschland
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Wingen S, Rott N, Schittko N, Hackstein A, Kreimeier U, Bartholme B, Böttiger BW. State of Implementation of Telephone Cardiopulmonary Resuscitation by Rescue Coordination Centers in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:55-56. [PMID: 35410670 DOI: 10.3238/arztebl.m2022.0087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 09/22/2021] [Accepted: 12/08/2021] [Indexed: 11/27/2022]
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Breuer F, Brettschneider P, Pommerenke C, Poloczek S, Dahmen J. Notrufe und gemeldete Hauptbeschwerden während der COVID-19-Pandemie in der Leitstelle der Berliner Feuerwehr. DER NOTARZT 2021. [DOI: 10.1055/a-1403-3347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Zusammenfassung
Einleitung Die Notrufabfrage in Berlin erfolgt unter Anwendung des Priority Dispatch Systems. Ein spezielles Notrufabfrageprotokoll wird in der Leitstelle der Berliner Feuerwehr seit dem 28.02.2020 genutzt.
Methodik Es werden das Notrufaufkommen und Notrufverhalten zu Beginn der COVID-19-Pandemie sowie die Entwicklung und die Auslastung von Notverlegungen anhand von Daten aus dem Einsatzleitsystem dargestellt.
Ergebnisse Im betrachteten Zeitraum vom 21.02.2020 bis zum 30.04.2020 waren Anruf- und Einsatzzahlen kontinuierlich auf einem hohen Niveau. Ab dem 18.03.2020 (Lockdown) sind diese gesunken. Unter den in der standardisierten Notrufabfrage angewendeten Hauptbeschwerdeprotokollen wurde vermehrt das Protokoll „Pandemie/Epidemie/Ausbruch“ angewendet.
Schlussfolgerung Die andauernde Pandemie stellt sowohl die Rettungsleitstellen als auch die operativen Einsatzkräfte vor besondere Herausforderungen. Rettungsleitstellen haben als primäre ständig erreichbare Stelle eine zentrale Bedeutung, eine standardisierte Notrufabfrage bietet erweiterte Möglichkeiten, auf eine Pandemielage zu reagieren.
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Affiliation(s)
- Florian Breuer
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
- Berliner Feuerwehr, Berlin, Deutschland
| | | | | | - Stefan Poloczek
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
- Berliner Feuerwehr, Berlin, Deutschland
| | - Janosch Dahmen
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
- Berliner Feuerwehr, Berlin, Deutschland
- Fakultät für Gesundheit, Universität Witten Herdecke, Witten, Deutschland
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[COVID-19 Stress test for ensuring emergency healthcare: strategy and response of emergency medical services in Berlin]. Anaesthesist 2021; 70:420-431. [PMID: 33245381 PMCID: PMC7692437 DOI: 10.1007/s00101-020-00890-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hintergrund Die COVID-19-Pandemie stellt die Notfallversorgung in Deutschland vor eine beispiellose Belastungsprobe. Neben der klinischen Notfallversorgung in den Notaufnahmen der Krankenhäuser kommt der präklinischen Notfallrettung die entscheidende Sicherstellungsaufgabe notfallmedizinischer Gesundheitsversorgung zu. Die Berliner Feuerwehr zeigt in dem vorliegenden Beitrag für die Notfallrettung im Land Berlin neue Wege auf, dieser gewachsenen Verantwortung in der prähospitalen Patientenversorgung gerecht zu werden. Methode Es erfolgte eine systematische Darstellung der Herausforderungen und konzeptionellen Antworten der präklinischen Notfallmedizin auf die COVID-19-Pandemie am Beispiel der Notfallrettung im Land Berlin. Ergebnisse Die Berliner Feuerwehr koordiniert in einer zentralen Leitstelle für das Land Berlin alle Hilfeersuchen des Notrufs 112. Je 24 h gehen im Mittel 2565 Notrufe ein, aus denen 1271 Einsätze generiert werden. Im Rahmen der Pandemie kam es zu einer deutlichen Zunahme an Einsätzen zu Patienten mit akuten respiratorischen Erkrankungen (ARE). So erfolgten 11 % der Einsätze zu Patienten mit dem Verdacht einer COVID-19-Erkrankung. Die Notrufdauer verlängerte sich bei ergänzender Abfrage des „Pandemie-Protokolls“ im Schnitt um 1:36 min, die Einsatzdauer bei Einsätzen mit Alarmstichwort-Zusatz „akute respiratorische Erkrankung [ARE.]“ im Mittel um 17 min. Schlussfolgerung Die andauernde Pandemie macht deutlich, dass Aufgaben und Verantwortung der öffentlichen Träger der Notfallrettung über die unmittelbare, medizinische Gefahrenabwehr für Leib und Leben hinausgehen. Neben einer Lotsen- und Triage-Funktion in der integrierten Leitstelle der Berliner Feuerwehr (112) konnte durch umfassende Maßnahmen der Lageüberwachung, Lagedarstellung und Lagebewältigung trotz Ausfall alternativer, ambulanter Versorgungsangebote u. a. im Bereich der Haus- und Facharztpraxen die Notfall- resp. Gesundheitsversorgung sichergestellt werden. Zusatzmaterial online Die Online-Version dieses Beitrags (10.1007/s00101-020-00890-8) enthält weiteres Online-Zusatzmaterial. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“. ![]()
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Chappuis VN, Deham H, Cottet P, Gartner BA, Sarasin FP, Niquille M, Suppan L, Larribau R. Emergency physician's dispatch by a paramedic-staffed emergency medical communication centre: sensitivity, specificity and search for a reference standard. Scand J Trauma Resusc Emerg Med 2021; 29:31. [PMID: 33563301 PMCID: PMC7871575 DOI: 10.1186/s13049-021-00844-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/29/2021] [Indexed: 12/14/2022] Open
Abstract
Background Some emergency medical systems (EMS) use a dispatch centre where nurses or paramedics assess emergency calls and dispatch ambulances. Paramedics may also provide the first tier of care “in the field”, with the second tier being an Emergency Physician (EP). In these systems, the appropriateness of the decision to dispatch an EP to the first line at the same time as the ambulance has not often been measured. The main objective of this study was to compare dispatching an EP as part of the first line emergency service with the severity of the patient’s condition. The secondary objective was to highlight the need for a recognized reference standard to compare performance analyses across EMS. Methods This prospective observational study included all emergency calls received in Geneva’s dispatch centre between January 1st, 2016 and June 30th, 2019. Emergency medical dispatchers (EMD) assigned a level of risk to patients at the time of the initial call. Only the highest level of risk led to the dispatch of an EP. The severity of the patient’s condition observed in the field was measured using the National Advisory Committee for Aeronautics (NACA) scale. Two reference standards were proposed by dichotomizing the NACA scale. The first compared NACA≥4 with other conditions and the second compared NACA≥5 with other conditions. The level of risk identified during the initial call was then compared to the dichotomized NACA scales. Results 97′861 assessments were included. Overall prevalence of sending an EP as first line was 13.11, 95% CI [12.90–13.32], and second line was 2.94, 95% CI [2.84–3.05]. Including NACA≥4, prevalence was 21.41, 95% CI [21.15–21.67], sensitivity was 36.2, 95% CI [35.5–36.9] and specificity 93.2 95% CI [93–93.4]. The Area Under the Receiver-Operating Characteristics curve (AUROC) of 0.7507, 95% CI [0.74734–0.75397] was acceptable. Looking NACA≥5, prevalence was 3.09, 95% CI [2.98–3.20], sensitivity was 64.4, 95% CI [62.7–66.1] and specificity 88.5, 95% CI [88.3–88.7]. We found an excellent AUROC of 0.8229, 95% CI [0.81623–0.82950]. Conclusion The assessment by Geneva’s EMD has good specificity but low sensitivity for sending EPs. The dichotomy between immediate life-threatening and other emergencies could be a valid reference standard for future studies to measure the EP’s dispatching performance. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00844-y.
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Affiliation(s)
- Victor Nathan Chappuis
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Hélène Deham
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Philippe Cottet
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Birgit Andrea Gartner
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - François Pierre Sarasin
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Marc Niquille
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Robert Larribau
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland. .,Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Chemin du Petit-Bel-Air 2, CH 1226, Geneva, Thônex, Switzerland.
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Larribau R, Chappuis VN, Cottet P, Regard S, Deham H, Guiche F, Sarasin FP, Niquille M. Symptom-Based Dispatching in an Emergency Medical Communication Centre: Sensitivity, Specificity, and the Area under the ROC Curve. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218254. [PMID: 33182228 PMCID: PMC7664854 DOI: 10.3390/ijerph17218254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/01/2020] [Accepted: 11/06/2020] [Indexed: 06/11/2023]
Abstract
Measuring the performance of emergency medical dispatch tools used in paramedic-staffed emergency medical communication centres (EMCCs) is rarely performed. The objectives of our study were, therefore, to measure the performance and accuracy of Geneva's dispatch system based on symptom assessment, in particular, the performance of ambulance dispatching with lights and sirens (L&S) and to measure the effect of adding specific protocols for each symptom. Methods: We performed a prospective observational study including all emergency calls received at Geneva's EMCC (Switzerland) from 1 January 2014 to 1 July 2019. The risk levels selected during the emergency calls were compared to a reference standard, based on the National Advisory Committee for Aeronautics (NACA) scale, dichotomized to severe patient condition (NACA ≥ 4) or stable patient condition (NACA < 4) in the field. The symptom-based dispatch performance was assessed using a receiver operating characteristic (ROC) curve. Contingency tables and a Fagan nomogram were used to measure the performance of the dispatch with or without L&S. Measurements were carried out by symptom, and a group of symptoms with specific protocols was compared to a group without specific protocols. Results: We found an acceptable area under the ROC curve of 0.7474, 95%CI (0.7448-0.7503) for the 148,979 assessments included in the study. Where the severity prevalence was 21%, 95%CI (20.8-21.2). The sensitivity of the L&S dispatch was 87.5%, 95%CI (87.1-87.8); and the specificity was 47.3%, 95%CI (47.0-47.6). When symptom-specific assessment protocols were used, the accuracy of the assessments was slightly improved. Conclusions: Performance measurement of Geneva's symptom-based dispatch system using standard diagnostic test performance measurement tools was possible. The performance was found to be comparable to other emergency medical dispatch systems using the same reference standard. However, the implementation of specific assessment protocols for each symptom may improve the accuracy of symptom-based dispatch systems.
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Bildstein G, Redelsteiner C, Imboden P. Leitstellendisposition und deren Qualitätsbewertung. Notf Rett Med 2020. [DOI: 10.1007/s10049-020-00737-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Baubin M, Häske D, Lechleuthner A, Luiz T. [Dispatch center focus issue-do you just sound the alarm or do you already advise?]. Notf Rett Med 2020; 23:487-489. [PMID: 33110389 PMCID: PMC7581949 DOI: 10.1007/s10049-020-00796-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- M Baubin
- Universitätsklinik für Anästhesie und Intensivmedizin, Tirol Kliniken/Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - D Häske
- Zentrum für öffentliches Gesundheitswesen und Versorgungsforschung Tübingen, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - A Lechleuthner
- Institut für Schutz und Rettung, Berufsfeuerwehr Köln, Köln, Deutschland
| | - T Luiz
- Digital Healthcare, Fraunhofer IESE , Fraunhofer-Platz 1, 67663 Kaiserslautern, Deutschland
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Comparing the diagnostic concordance of tele-EMS and on-site-EMS physicians in emergency medical services: a retrospective cohort study. Sci Rep 2020; 10:17982. [PMID: 33093557 PMCID: PMC7581718 DOI: 10.1038/s41598-020-75149-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 10/12/2020] [Indexed: 11/08/2022] Open
Abstract
In 2014, a telemedicine system was established in 24-h routine use in the emergency medical service (EMS) of the city of Aachen. This study tested whether the diagnostic concordance of the tele-EMS physician reaches the same diagnostic concordance as the on-site-EMS physician. The initial prehospital diagnoses were compared to the final hospital diagnoses. Data were recorded retrospectively from the physicians' protocols as well as from the hospital administration system and compared. Also, all diagnostic misconcordance were analysed and reviewed in terms of logical content by two experts. There were no significant differences between the groups in terms of demographic data, such as age and gender, as well as regarding the hospital length of stay and mortality. There was no significant difference between the diagnostic concordance of the systems, except the diagnosis "epileptic seizure". Instead, in these cases, "stroke" was the most frequently chosen diagnosis. The diagnostic misconcordance "stroke" is not associated with any risks to patients' safety. Reasons for diagnostic misconcordance could be the short contact time to the patient during the teleconsultation, the lack of personal examination of the patient by the tele-EMS physician, and reversible symptoms that can mask the correct diagnosis.
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Ecker H, Lindacher F, Dressen J, Wingen S, Hamacher S, Böttiger BW, Wetsch WA. Accuracy of automatic geolocalization of smartphone location during emergency calls - A pilot study. Resuscitation 2020; 146:5-12. [PMID: 31706968 DOI: 10.1016/j.resuscitation.2019.10.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/29/2019] [Accepted: 10/29/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Widespread use of smartphones allows automatic geolocalization (i.e., transmission of location data) in countless apps. Until now, this technology has not been routinely used in connection with an emergency call in which location data play a decisive role This study evaluated a new software automatically providing emergency medical service (EMS) dispatchers with a caller's geolocation. We hypothesized that this technology will provide higher accuracy, faster dispatching of EMS and a faster beginning of thoracic compressions in a cardiac arrest scenario. MATERIAL AND METHODS Approval from the local Ethics Committee was obtained. 108 simulated emergency calls reporting a patient in cardiac arrest were conducted at 54 metropolitan locations, which were chosen according to a realistic pattern. At each location, a conventional emergency call, with an oral description of the location, was given first; subsequently, another call using an app with automatic geolocation was placed. Accuracy of localization, time to location, time to EMS dispatch and time to first thoracic compression were compared between both groups. RESULTS The conventional emergency call was always successful (n = 54). Emergency call via app worked successfully in n = 46 cases (85.2%). Automatic geolocation was provided to EMS in all these n = 46 cases (100%). Deviation from estimated position to actual position was 1173.5 ± 4343.1 m for conventional and 65.6 ± 320.5 m for automatic geolocalization (p < 0.001). In addition, time to localization was significantly shorter using automatic geolocalization (34.7 vs. 71.7 s, p < 0.001). Time to first thoracic compression was significantly faster in the geolocalization group (83.0 vs. 122.6 s; p < 0.001). CONCLUSIONS This pilot study showed that automatic geolocalization leads to a significantly shorter duration of the emergency call, significantly shorter times until the beginning of thoracic compressions, and a higher precision in determining the location of an emergency.
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Affiliation(s)
- Hannes Ecker
- University of Cologne, Medical Faculty and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Falko Lindacher
- University of Cologne, Medical Faculty and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jan Dressen
- University of Cologne, Medical Faculty and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Sabine Wingen
- University of Cologne, Medical Faculty and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Stefanie Hamacher
- University of Cologne, Medical Faculty and University Hospital Cologne, Institute of Medical Statistics and Computational Biology, Kerpener Str. 62, 50937 Cologne, Germany
| | - Bernd W Böttiger
- University of Cologne, Medical Faculty and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Wolfgang A Wetsch
- University of Cologne, Medical Faculty and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937 Cologne, Germany.
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