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Roessler M, Schulte C, Bobeth C, Wende D, Karagiannidis C. Hospital admissions following emergency medical services in Germany: analysis of 2 million hospital cases in 2022. Med Klin Intensivmed Notfmed 2024:10.1007/s00063-024-01148-6. [PMID: 38652145 DOI: 10.1007/s00063-024-01148-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/19/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND The use of emergency medical services (EMS) in Germany has increased substantially over the last few decades. While current reform efforts aim to increase effectiveness and efficiency of the German hospital and EMS systems, there is lack of data on characteristics of hospital cases using EMS. OBJECTIVES To analyze and compare the characteristics of cases hospitalized with and without the use of EMS. MATERIALS AND METHODS The BARMER health insurance data on more than 2 million hospital cases admitted in 2022 were analyzed. The distributions of age, clinical complexity (measured by patient clinical complexity levels, PCCL), main diagnoses, costs for EMS and hospital treatment, and multiple severity indicators were described. The overall severity of hospital cases was classified as "low or moderate" or "high" based on a combined severity indicator. All analyses were stratified by use of EMS and EMS type. RESULTS A total of 28% of all included hospital cases used EMS. Relative to hospital cases without use of EMS, hospital cases with use of EMS were older (physician-staffed ambulance: 75 years, interquartile range [IQR] 59-84, double-crewed ambulance: 78 years, IQR 64-85) and had a higher clinical complexity. The severity of more than 30% of the cases using EMS (except for patient transport service ambulance) was classified as "low or moderate". The distributions of main diagnoses differed by severity and use of EMS. CONCLUSIONS The high proportion of cases with low or moderate severity using EMS may indicate a substantial potential to avoid the use of EMS in the context of hospital admissions in Germany. Further investigation is required to explore whether the proportion of cases using EMS could be reduced by optimizing preclinical service.
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Affiliation(s)
- Martin Roessler
- BARMER Institute for Health Care System Research, Axel-Springer-Str. 44, 10969, Berlin, Germany.
| | - Claudia Schulte
- BARMER Institute for Health Care System Research, Axel-Springer-Str. 44, 10969, Berlin, Germany
| | - Christoph Bobeth
- BARMER Institute for Health Care System Research, Axel-Springer-Str. 44, 10969, Berlin, Germany
| | - Danny Wende
- BARMER Institute for Health Care System Research, Axel-Springer-Str. 44, 10969, Berlin, Germany
| | - Christian Karagiannidis
- ARDS and ECMO Centre Cologne-Merheim, Cologne, Germany.
- University Witten/Herdecke, Witten, Germany.
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Nau LM, Laux G, Altiner A, Szecsenyi J, Leutgeb R. The Use of Medical Services for Low-Acuity Emergency Cases in Germany: Protocol for a Multicenter Observational Pilot Study. JMIR Res Protoc 2024; 13:e54002. [PMID: 38598281 PMCID: PMC11043931 DOI: 10.2196/54002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND The increasing number of requests for help for acutely ill patients and their management is a major problem in the health systems of many countries, but especially in Germany. Rescue coordination centers and ambulances in Germany are increasingly overloaded. As a result, rides as a part of rescue operations have been increasing in length for years, yet a relevant proportion of these operations represent low-acuity calls (LACs). The basic objective of this pilot study is the quantitative analysis of the potential misuse of requests to the rescue control center. Indications for alternative treatment options and how to handle these treatment options in nonacute, non-life-threatening health conditions, such as minor injuries or minor infectious diseases, will be assessed. The identification of these LACs is vital in order to prevent health care resources in emergency medical care becoming inadequate. OBJECTIVE The overarching goal of this study is to determine the percentage of unnecessary rescue missions on site and subsequently to obtain an impression of the paramedics' assessment of alternative treatment options or alternative methods of rescue transportation. METHODS This will be an exploratory, noninterventional, cross-sectional study with a quantitative approach. The study is multicentric, with 21 ambulances in 12 different locations. The data for this study were collected via a questionnaire, newly developed for this study, for rescue personnel. Additionally, secondary data from the responsible control center will be linked and processed in an initial descriptive analysis. This descriptive analysis will form the basis for a subsequent variance analysis. RESULTS Data collection started as projected on September 18, 2023, and was ongoing until end of November 2023. We expect the documentation of several thousand rescue operations. We expect the following study results: (1) many unnecessary rescue operations, (2) immediate on-site assessment of correct care and treatment, and (3) patients' reasons for calling a rescue coordination center. CONCLUSIONS To our knowledge, this is the first observational study in which acute rescue operations are recorded on site. The focus of this study is on the trained paramedics' assessment of whether rescue operations are necessary or not. Additionally, alternative treatments, such as out-of-hours care service or primary care service, are shown for each individual case. The study also intends to cover the question of which factors are relevant and statistically significantly connected to the misuse of ambulances. TRIAL REGISTRATION German Register for Clinical Studies (Deutsches Register für Klinische Studien) DRKS00032510; https://drks.de/search/en/trial/DRKS00032510. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54002.
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Affiliation(s)
- Lara Maria Nau
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Gunter Laux
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Attila Altiner
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Rüdiger Leutgeb
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
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Schröder H, Beckers SK, Borgs C, Sommer A, Rossaint R, Grüßer L, Felzen M. Long-term effects of a prehospital telemedicine system on structural and process quality indicators of an emergency medical service. Sci Rep 2024; 14:310. [PMID: 38172217 PMCID: PMC10764932 DOI: 10.1038/s41598-023-50924-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024] Open
Abstract
The benefits of a telemedical support system for prehospital emergency medical services include high-level emergency medical support at the push of a button: delegation of drug administration, diagnostic assistance, initiation of therapeutic measures, or choice of hospital destination. At various European EMS sites telemedical routine systems are shortly before implementation. The aim of this study was to investigate the long-term effects of implementing a tele-EMS system on the structural and procedural quality indicators and therefore performance of an entire EMS system. This retrospective study included all EMS missions in Aachen city between 2015 and 2021. Regarding structural indicators of the EMS system, we investigated the overall number of emergency missions with tele-EMS and onsite EMS physicians. Furthermore, we analyzed the distribution of tracer diagnosis and process quality with respect to the time spans on the scene, time until teleconsultation, duration of teleconsultation, prehospital engagement time, and number of simultaneous teleconsultations. During the 7-year study period, 229,384 EMS missions were completed. From 2015 to 2021, the total number of EMS missions increased by 8.5%. A tele-EMS physician was consulted on 23,172 (10.1%) missions. The proportion of telemedicine missions increased from 8.6% in 2015 to 12.9% in 2021. Teleconsultations for missions with tracer diagnoses decreased during from 43.7% to 30.7%, and the proportion of non-tracer diagnoses increased from 56.3% to 69.3%. The call duration for teleconsultation decreased from 12.07 min in 2015 to 9.42 min in 2021. For every fourth mission, one or more simultaneous teleconsultations were conducted by the tele-EMS physician on duty. The implementation and routine use of a tele-EMS system increased the availability of onsite EMS physicians and enabled immediate onsite support for paramedics. Parallel teleconsultations, reduction in call duration, and increase in ambulatory onsite treatments over the years demonstrate the increasing experience of paramedics and tele-EMS physicians with the system in place. A prehospital tele-EMS system is important for mitigating the current challenges in the prehospital emergency care sector.
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Affiliation(s)
- Hanna Schröder
- Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
- Aachen Institute for Rescue Management and Public Safety, City of Aachen and University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - Stefan K Beckers
- Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Aachen Institute for Rescue Management and Public Safety, City of Aachen and University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Medical Direction of Aachen Fire Department, Stolberger Strasse 155, 52068, Aachen, Germany
| | - Christina Borgs
- Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Aachen Institute for Rescue Management and Public Safety, City of Aachen and University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Anja Sommer
- Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Aachen Institute for Rescue Management and Public Safety, City of Aachen and University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Linda Grüßer
- Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Marc Felzen
- Department of Anesthesiology, Medical Faculty RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Aachen Institute for Rescue Management and Public Safety, City of Aachen and University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Medical Direction of Aachen Fire Department, Stolberger Strasse 155, 52068, Aachen, Germany
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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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Breuer F, Beckers SK, Dahmen J, Gnirke A, Pommerenke C, Poloczek S. [Pre-emptive emergency service-Preventive missions and promotion of health literacy at the intersections with emergency medical services]. DIE ANAESTHESIOLOGIE 2023; 72:358-368. [PMID: 36912990 PMCID: PMC10010211 DOI: 10.1007/s00101-023-01272-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/14/2023]
Abstract
In the Emergency Medical Service Acts of the Federal States, the statements in these Acts have so far essentially been limited to the implementation of measures to maintain the health of emergency patients and to transport them to a suitable hospital. Preventive fire protection, on the other hand, is regulated in the Fire Brigade Acts or by statutory ordinances. Increasing numbers of emergency service missions and a lack of facilities for alternative care justify the need for a preventive emergency service. This includes all measures that take place before an event occurs in order to prevent emergencies from occurring. As a result, the risk of an emergency event leading to the emergency call 112 should be reduced or delayed. The preventive rescue service should also help to improve the outcome of medical care for patients. Furthermore, it should be made possible to provide those seeking help with a suitable form of care at an early stage.
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Affiliation(s)
- Florian Breuer
- Einsatzvorbereitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland.
- Ärztliche Leitung Rettungsdienst, Rheinisch-Bergischer Kreis, Amt für Feuerschutz und Rettungswesen, Am Rübezahlwald 7, 51469, Bergisch Gladbach, Deutschland.
| | - Stefan K Beckers
- Ärztliche Leitung Rettungsdienst Stadt Aachen, Fachbereich Feuerwehr und Rettungsdienst Stadt Aachen, Aachen, Deutschland
| | - Janosch Dahmen
- Einsatzvorbereitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
- Fakultät für Gesundheit, Department Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland
| | - Andre Gnirke
- Ärztliche Leitung Rettungsdienst, Rettungsdienst-Kooperation in Schleswig-Holstein, Pinneberg, Deutschland
| | | | - Stefan Poloczek
- Einsatzvorbereitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Berlin, Deutschland
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Borgstedt L, Schaller SJ, Goudkamp D, Fuest K, Ulm B, Jungwirth B, Blobner M, Schmid S. Successful treatment of out-of-hospital cardiac arrest is still based on quick activation of the chain of survival. Front Public Health 2023; 11:1126503. [PMID: 37113172 PMCID: PMC10126244 DOI: 10.3389/fpubh.2023.1126503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/22/2023] [Indexed: 04/29/2023] Open
Abstract
Background and goal of study Cardiopulmonary resuscitation (CPR) in prehospital care is a major reason for emergency medical service (EMS) dispatches. CPR outcome depends on various factors, such as bystander CPR and initial heart rhythm. Our aim was to investigate whether short-term outcomes such as the return of spontaneous circulation (ROSC) and hospital admission with spontaneous circulation differ depending on the location of the out-of-hospital cardiac arrest (OHCA). In addition, we assessed further aspects of CPR performance. Materials and methods In this monocentric retrospective study, protocols of a prehospital physician-staffed EMS located in Munich, Germany, were evaluated using the Mann-Whitney U-test, chi-square test, and a multifactor logistic regression model. Results and discussion Of the 12,073 cases between 1 January 2014 and 31 December 2017, 723 EMS responses with OHCA were analyzed. In 393 of these cases, CPR was performed. The incidence of ROSC did not differ between public and non-public spaces (p = 0.4), but patients with OHCA in public spaces were more often admitted to the hospital with spontaneous circulation (p = 0.011). Shockable initial rhythm was not different between locations (p = 0.2), but defibrillation was performed significantly more often in public places (p < 0.001). Multivariate analyses showed that hospital admission with spontaneous circulation was more likely in patients with shockable initial heart rhythm (p < 0.001) and if CPR was started by an emergency physician (p = 0.006). Conclusion The location of OHCA did not seem to affect the incidence of ROSC, although patients in public spaces had a higher chance to be admitted to the hospital with spontaneous circulation. Shockable initial heart rhythm, defibrillation, and the start of resuscitative efforts by an emergency physician were associated with higher chances of hospital admission with spontaneous circulation. Bystander CPR and bystander use of automated external defibrillators were low overall, emphasizing the importance of bystander education and training in order to enhance the chain of survival.
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Affiliation(s)
- Laura Borgstedt
- Department of Anesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefan J. Schaller
- Department of Anesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Daniel Goudkamp
- Department of Anesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kristina Fuest
- Department of Anesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Ulm
- Department of Anesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bettina Jungwirth
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Ulm, Ulm, Germany
| | - Manfred Blobner
- Department of Anesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Ulm, Ulm, Germany
| | - Sebastian Schmid
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Ulm, Ulm, Germany
- *Correspondence: Sebastian Schmid,
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Hauch H, El Mohaui N, Vaillant V, Sander M, Kriwy P, Rohde M, Wolff J, Berthold D, Schneck E. Prehospital emergency medicine for children receiving palliative home care in Germany-a cross-sectional, exploratory study of EMS providers. Front Pediatr 2023; 11:1104655. [PMID: 36865689 PMCID: PMC9971952 DOI: 10.3389/fped.2023.1104655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/24/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND The prevalence of children with life-limiting conditions is rising, and since the amendment of the social insurance code in Germany, palliative home care teams have treated an increasing number of children. These teams provide 24/7 readiness, yet some parents still call the general emergency medical service (EMS) for various reasons. EMS is exposed to complex medical problems in rare diseases. Questions arose about the experiences of EMS and whether they felt prepared for emergencies involving children treated by a palliative care team. METHODS This study used a mixed methods approach to focus on the interface between palliative care and EMS. First, open interviews were conducted, and a questionnaire was developed based on the results. The variables included demographic items and individual experiences with patients. Second, a case report of a child with respiratory insufficiency was presented to assess the spontaneous treatment intentions of EMS providers. Finally, the need, relevant topics, and duration of specific training in palliative care for EMS providers were evaluated. RESULTS In total, 1,005 EMS providers responded to the questionnaire. The average age was 34.5 years (±10.94SD), 74.6% were male. The average work experience was 11.8 years (±9.7), 21.4% were medical doctors. Experience with a call of a life-threatening emergency involving a child was reported by 61.5% and severe psychological distress during such a call was reported by 60.4%. The equivalent distress frequency for adult patient calls was 38.3%. (p < 0.001). After review of the case report, the EMS respondents suggested invasive treatment options and rapid transport to the hospital. Most (93.7%) respondents welcomed the consideration of special training in pediatric palliative care. This training should include basic information about palliative care, an analysis of cases involving palliatively treated children, an ethical perspective, practical recommendations, and available (24/7) local contact for further guidance and support. CONCLUSION Emergencies in pediatric palliatively treated patients were more common than expected. EMS providers perceived the situations as stressful, and there is a need for specific training with practical aspects.
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Affiliation(s)
- Holger Hauch
- Palliative Care Team for Children, University Children's Hospital, Giessen, Hesse, Germany.,University Children's Hospital Giessen, Department of Pediatric Oncology, Giessen, Hesse, Germany
| | - Naual El Mohaui
- Palliative Care Team for Children, University Children's Hospital, Giessen, Hesse, Germany
| | - Vera Vaillant
- Palliative Care Team for Children, University Children's Hospital, Giessen, Hesse, Germany
| | - Michael Sander
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital, Giessen, Hesse, Germany
| | - Peter Kriwy
- Institute of Sociology, University of Technology, Chemnitz, Saxony, Germany
| | - Marius Rohde
- University Children's Hospital Giessen, Department of Pediatric Oncology, Giessen, Hesse, Germany
| | - Johannes Wolff
- Department of Oncology, Cleveland Clinic, Pediatric Oncology, Cleveland, OH, United States
| | - Daniel Berthold
- University Hospital Giessen, Palliative Care Team for Adults, Giessen, Hesse, Germany
| | - Emmanuel Schneck
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital, Giessen, Hesse, Germany
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Dax F, Trentzsch H, Lazarovici M, Hegenberg K, Kneißl K, Hoffmann F, Prückner S. Unterschiede zwischen Rettungsdiensteinsätzen mit und ohne Patiententransport. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:996-1006. [PMID: 36112195 PMCID: PMC9522751 DOI: 10.1007/s00103-022-03590-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/31/2022] [Indexed: 11/24/2022]
Abstract
Hintergrund Die Inanspruchnahme des Rettungsdienstes in Bayern steigt seit Jahren an. Wir haben die Hypothese aufgestellt, dass Notfalleinsätze ohne Patiententransport (RoT) häufig Ausdruck einer unzureichenden Alarmierungsplanung sind. Das Ziel der Studie war es, für solche Einsätze die Unterschiede zwischen den Integrierten Leitstellen (ILS) in Bezug auf die Merkmale Transportquoten und Spannweiten nach Einsatzgrund sowie Uhrzeiten und Wochentage zu beschreiben. Methode Retrospektive Querschnittstudie der Daten aller 26 ILS des Freistaats Bayern im Jahr 2018. Transportquoten für wesentliche Einsatzgründe bei Notfalleinsätzen ohne Notarztbeteiligung wurden in Abhängigkeit von Leitstellenbereich, Tageszeit und Wochentag vergleichend analysiert. Einsätze wurden kategorisiert als RoT oder TP (Rettungswageneinsatz mit Transport). Ergebnisse Von 510.145 Einsätzen waren 147.621 (28,9 %) RoT und 362.524 (71,1 %) TP. Für alle untersuchten Einsatzgründe zeigten sich deutliche regionale Unterschiede in der Transportquote. Die höchste Spannweite unter den ILS ergab sich für die Einsatzgründe „Brandmeldeanlage“ (16,8 Prozentpunkte), „Hausnotruf aktiver Alarm“ (16,1) sowie „Herz/Kreislauf“ (14,6). In den Morgenstunden sinkt das Einsatzaufkommen bei steigenden TP. Die wenigsten RoT fanden zwischen 8 und 10 Uhr statt. Die Analyse der Wochentage ergab kleine Unterschiede in der Häufigkeit von RoT an Montagen sowie an Wochenenden ohne planerische Relevanz. Schlussfolgerung Wir haben deutliche Unterschiede in den Spannweiten festgestellt. Dies könnte auf örtlich unterschiedliche Alarmierungsplanungsvorgaben oder Dispositionsentscheidungen der ILS hindeuten. Die Leitstellen weisen hier wahrscheinlich ein erhebliches Potenzial zur Steuerung und Verbesserung der Ressourcenallokation auf. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-022-03590-3) enthalten.
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Affiliation(s)
- Florian Dax
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336, München, Deutschland
- Landesgeschäftsstelle, Bayerisches Rotes Kreuz (BRK), München, Deutschland
| | - Heiko Trentzsch
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336, München, Deutschland
| | - Marc Lazarovici
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336, München, Deutschland
| | - Kathrin Hegenberg
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336, München, Deutschland
| | - Katharina Kneißl
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336, München, Deutschland
| | - Florian Hoffmann
- Dr. von Haunersches Kinderspital, Kinderklinik und Kinderpoliklinik, Klinikum der Universität München, LMU München, München, Deutschland
| | - Stephan Prückner
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstr. 53, 80336, München, Deutschland.
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Liu W, Lu DJ, Li XW, Zhang YL, Shi MH, Wang XD. Epidemiological Analysis of Patients with Pre-Hospital First Aid in Keyouqian Banner, Hinggan League, Inner Mongolia. Risk Manag Healthc Policy 2022; 15:1651-1658. [PMID: 36092547 PMCID: PMC9450980 DOI: 10.2147/rmhp.s347841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 08/07/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To summarize the characteristics of patients calling the 120 emergency number for pre-hospital first aid in Keyouqian Banner, Hinggan League. Methods The clinical data of adult patients with pre-hospital first aid from 2016 to 2018 were retrospectively analyzed. Results There were 2711 cases with pre-hospital first aid. Males significantly outnumbered females. Young and middle-aged patients comprised 81.5%. Patients were mainly Han and Mongolians. Most injuries and illnesses occurred at home and on the road. The time to arrival of medical services was 30.34 ± 28.29 minutes. The proportion of pre-hospital first aid for trauma was the highest, followed by diseases concerning the cardiovascular and neurological systems. The proportion of patients with improved medical conditions after onsite first aid was 43.3%, the proportion with unchanged conditions was 51.7%, and the total mortality rate was 3.9%. Conclusion The disease spectrum, ethnic distribution, age at onset, and pre-hospital first aid capabilities for outpatients were analyzed. These results may facilitate the establishment of a pre-hospital first aid system for the local prevention and control of acute and critical illnesses, increase the success rate of the region's pre-hospital first aid services, and improve the prognosis.
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Affiliation(s)
- Wei Liu
- Department of Emergency, Aerospace Center Hospital, Beijing, 100049, People’s Republic of China
| | - Di-Jun Lu
- Department of Emergency, Aerospace Center Hospital, Beijing, 100049, People’s Republic of China
| | - Xiao-Wen Li
- Department of Emergency, Aerospace Center Hospital, Beijing, 100049, People’s Republic of China
| | - Yu-Liang Zhang
- Department of Emergency, Keyouqianqi People’s Hospital, Inner Mongolia, 137400, People’s Republic of China
| | - Ming-Hua Shi
- Department of Emergency, Keyouqianqi People’s Hospital, Inner Mongolia, 137400, People’s Republic of China
| | - Xu-Dong Wang
- Department of Emergency, Aerospace Center Hospital, Beijing, 100049, People’s Republic of China,Correspondence: Xu-Dong Wang, Department of Emergency, Aerospace Center Hospital, No. 15 of Yuquan Street, Haidian District, Beijing, 100049, People’s Republic of China, Tel +86 10 59971968, Fax +86 10 59971199, Email
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Wibring K, Lingman M, Herlitz J, Bång A. The potential of new prediction models for emergency medical dispatch prioritisation of patients with chest pain: a cohort study. Scand J Trauma Resusc Emerg Med 2022; 30:34. [PMID: 35527302 PMCID: PMC9080130 DOI: 10.1186/s13049-022-01021-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/25/2022] [Indexed: 08/30/2023] Open
Abstract
Abstract
Objectives
To develop emergency medical dispatch (EMD) centre prediction models with high sensitivity and satisfying specificity to identify high-priority patients and patients suitable for non-emergency care respectively, when assessing patients with chest pain.
Methods
Observational cohort study of 2917 unselected patients with chest pain who contacted an EMD centre in Sweden due to chest pain during 2018. Multivariate logistic regression was applied to develop models predicting low-risk or high-risk condition, that is, occurrence of time-sensitive diagnosis on hospital discharge.
Results
Prediction models were developed for the identification of patients suitable for high- and low-priority dispatch, using 11 and 10 variables respectively. The area under the receiver-operating characteristic curve (AUROC) for the high-risk prediction model was 0.79 and for the low-risk model it was 0.74. When applying the high-risk prediction model, 56% of the EMS missions were given highest priority, compared with 65% with the current standard. When applying the low-risk model, 7% were given the lowest priority compared to 1% for the current standard. The new prediction models outperformed today’s dispatch priority accuracy in terms of sensitivity as well as positive and negative predictive value in both high- and low-risk prediction. The low-risk model predicted almost six times as many patients as having low-risk conditions compared with today’s standard. This was done without increasing the number of high-risk patients wrongly assessed as low-risk.
Conclusions
By introducing prediction models, based on logistic regression analyses, using variables obtained by standard EMD-questions on age, sex, medical history and symptomology, EMD prioritisation can be improved compared with using current criteria index-based ones. This will allow a more efficient emergency medical services resource allocation.
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The Feasibility of Using Machine Learning to Classify Calls to South African Emergency Dispatch Centres According to Prehospital Diagnosis, by Utilising Caller Descriptions of the Incident. Healthcare (Basel) 2021; 9:healthcare9091107. [PMID: 34574881 PMCID: PMC8472370 DOI: 10.3390/healthcare9091107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 11/24/2022] Open
Abstract
This paper presents the application of machine learning for classifying time-critical conditions namely sepsis, myocardial infarction and cardiac arrest, based off transcriptions of emergency calls from emergency services dispatch centers in South Africa. In this study we present results from the application of four multi-class classification algorithms: Support Vector Machine (SVM), Logistic Regression, Random Forest and K-Nearest Neighbor (kNN). The application of machine learning for classifying time-critical diseases may allow for earlier identification, adequate telephonic triage, and quicker response times of the appropriate cadre of emergency care personnel. The data set consisted of an original data set of 93 examples which was further expanded through the use of data augmentation. Two feature extraction techniques were investigated namely; TF-IDF and handcrafted features. The results were further improved using hyper-parameter tuning and feature selection. In our work, within the limitations of a limited data set, classification results yielded an accuracy of up to 100% when training with 10-fold cross validation, and 95% accuracy when predicted on unseen data. The results are encouraging and show that automated diagnosis based on emergency dispatch centre transcriptions is feasible. When implemented in real time, this can have multiple utilities, e.g. enabling the call-takers to take the right action with the right priority.
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