[Appropriate allocation of resources for interhospital transfer in emergency medical service-is a physician in the dispatch center helpful?]

[Physician-assisted interhospital transfer-an analysis from Schleswig-Holstein]

BACKGROUND

The need for interhospital transport (IHT) of intensive care patients is increasing due to changes in the hospital environment. Interhospital transports are challenging and require careful operational planning of personnel and rescue vehicles.

OBJECTIVE

To investigate the need for IHT, an analysis was conducted in the service area of the emergency medical service central dispatch center (IRLS) in Schleswig-Holstein.

MATERIAL AND METHODS

Emergency physician-assisted IHT were analyzed in the period from 01.10.2021 to 30.09.2022.

RESULTS

Of a total of 158,823 documented IRLS missions, 2264 (1.4%) records could be identified and included as IHT: 1389 IHT (61.4%) were managed by specialized ambulances, 875 (38.6%) by primary care ambulances. Primary care ambulances were mainly used for time-critical transfers and outside the duty hours of the intensive care ambulances, 21.2 % were by air. Of all IHT, 43.1% were required to hospitals with a higher level of medical care.

CONCLUSION

Emergency physician-assisted IHT are a relevant part of the emergency service's operational spectrum and concern both primary care and specialized rescue vehicles. A relevant number of urgent IHT were recorded outside the duty hours of the intensive care ambulances. For emergency transports during nighttime, an expansion of air-based transfer capacities should be considered due to the time advantage. For less urgent IHT, an adjustment of the capacities of specialized ground-based vehicles in Schleswig-Holstein seems reasonable.

Long-term effects of a prehospital telemedicine system on structural and process quality indicators of an emergency medical service

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.

[Update tele-emergency medicine : Status quo and perspectives]

CURRENT STATUS OF EMERGENCY MEDICINE IN GERMANY

Increasing numbers of rescue missions in recent years have led to a growing staff shortage of paramedics as well as physicians in the emergency medical system (EMS) with an urgent need for optimized usage of resources. One option is the implementation of a tele-EMS physician system, which has been established in the EMS of the City of Aachen since 2014.

IMPLEMENTATION OF TELE-EMERGENCY MEDICINE

In addition to pilot projects, political decisions lead to the introduction of tele-emergency medicine. The expansion is currently progressing in various federal states, and a comprehensive introduction has been decided for North Rhine-Westphalia and Bavaria. The adaptation of the EMS physician catalog of indications is essential for the integration of a tele-EMS physician.

STATUS QUO OF TELE-EMERGENCY MEDICINE

The tele-EMS physician offers the possibility of a long-term and comprehensive EMS physician expertise in the EMS regardless of location and, therefore, to partially compensate for a lack of EMS physicians. Tele-EMS physicians can also support the dispatch center in an advisory capacity and, for example, clarify secondary transport. A uniform qualification curriculum for tele-EMS physicians was introduced by the North Rhine and Westphalia-Lippe Medical Associations.

OUTLOOK

In addition to consultations from emergency missions, tele-emergency medicine can also be used for innovative educational applications, for example, in the supervision of young physicians or recertification of EMS staff. A lack of ambulances could be compensated for by a community emergency paramedic, who could also be connected to the tele-EMS physician.

Strukturqualität im Berliner Notarztdienst: Funktionen, Qualifikationen und Kompetenzerhalt

Die Voraussetzungen zum Einsatz im Notarztdienst sind in Deutschland unterschiedlich geregelt, allein die Rahmenbedingungen zur Erlangung der Zusatzbezeichnung Notfallmedizin variieren in den Bundesländern. Diese stellt nur die Mindestvoraussetzung zur ärztlichen Teilnahme am Rettungsdienst dar und ist nach aktueller Literatur und Rechtsprechung, ebenso wie die alleinige Teilnahme am Notarzt- oder Klinikdienst zum Kompetenzerhalt, längst nicht mehr ausreichend. Im Rahmen der erneuten Ausschreibung des Notarztdiensts im Land Berlin im Jahr 2020 wurden die Voraussetzungen zur Teilnahme am Notarztdienst an den Stand der medizinischen Wissenschaft und aktuellen Rechtsprechung angepasst, die Definition von ärztlichen Kompetenzniveaus und deren strukturierter Erwerb inklusive festgelegter Einarbeitungs- und Einsatzzeiten entsprechend definiert sowie supervidierende Komponenten festgelegt. Bereits existierenden ärztlichen Führungsfunktionen wie dem Oberarzt vom Dienst (OAVD) kommt als operativer Vertreter der Ärztlichen Leitung Rettungsdienst in der Notfallrettung der Hauptstadt eine zentrale Rolle bei der Etablierung und Sicherung dieser gebotenen Anpassungsmaßnahmen zu.