HintergrundDie Kliniklandschaft in Deutschland ver & auml;ndert sich kontinuierlich. Da Transportziele des Rettungsdiensts h & auml;ufig Krankenh & auml;user sind, haben diese Strukturver & auml;nderungen auch Auswirkungen auf die rettungsdienstliche Versorgung. FragestellungVor dem Hintergrund einer geplanten Spezialisierung und Konzentration von Standorten und Fachabteilungen muss die schnelle Erreichbarkeit geeigneter Kliniken bei Notf & auml;llen gew & auml;hrleistet bleiben. So k & ouml;nnen angemessene Pr & auml;hospitalzeiten eingehalten werden, die eine zeitnahe weiterf & uuml;hrende Therapie erm & ouml;glichen. Spezielle Planungstools k & ouml;nnen dabei helfen, die Versorgungssituation zu beurteilen. Material und MethodenEs wurde ein interaktives Planungstool entwickelt, das die aktuelle Erreichbarkeit des n & auml;chsten geeigneten Krankenhauses f & uuml;r verschiedene Tracerdiagnosen kartographisch visualisiert und die Simulation struktureller Ver & auml;nderungen erlaubt. Als Datengrundlage flie ss en die Rettungsdienststruktur, die Krankenhausstruktur und die planerischen Fahrzeiten im Stra ss ennetz ein. ErgebnisseDie in der Benutzeroberfl & auml;che generierten Karten erm & ouml;glichen r & auml;umliche Einsichten in die pr & auml;klinische Versorgung. Es werden regionale Unterschiede sichtbar. Auch stellt sich die Versorgung bei h & auml;ufigen Tracerdiagnosen als weitgehend fl & auml;chendeckend dar, w & auml;hrend sich f & uuml;r seltenere Notf & auml;lle tendenziell l & auml;ngere Pr & auml;hospitalzeiten ergeben, besonders in peripheren Regionen. SchlussfolgerungenInteraktive Karten k & ouml;nnen bestehende Versorgungsl & uuml;cken aufdecken und Auswirkungen von Strukturver & auml;nderungen simulieren. Sie liefern damit einen wichtigen Beitrag zur Planung der Notfallversorgung.

Die Kliniklandschaft in Deutschland verändert sich kontinuierlich. Da Transportziele des Rettungsdiensts häufig Krankenhäuser sind, haben diese Strukturveränderungen auch Auswirkungen auf die rettungsdienstliche Versorgung. Vor dem Hintergrund einer geplanten Spezialisierung und Konzentration von Standorten und Fachabteilungen muss die schnelle Erreichbarkeit geeigneter Kliniken bei Notfällen gewährleistet bleiben. So können angemessene Prähospitalzeiten eingehalten werden, die eine zeitnahe weiterführende Therapie ermöglichen. Spezielle Planungstools können dabei helfen, die Versorgungssituation zu beurteilen. Es wurde ein interaktives Planungstool entwickelt, das die aktuelle Erreichbarkeit des nächsten geeigneten Krankenhauses für verschiedene Tracerdiagnosen kartographisch visualisiert und die Simulation struktureller Veränderungen erlaubt. Als Datengrundlage fließen die Rettungsdienststruktur, die Krankenhausstruktur und die planerischen Fahrzeiten im Straßennetz ein. Die in der Benutzeroberfläche generierten Karten ermöglichen räumliche Einsichten in die präklinische Versorgung. Es werden regionale Unterschiede sichtbar. Auch stellt sich die Versorgung bei häufigen Tracerdiagnosen als weitgehend flächendeckend dar, während sich für seltenere Notfälle tendenziell längere Prähospitalzeiten ergeben, besonders in peripheren Regionen. Interaktive Karten können bestehende Versorgungslücken aufdecken und Auswirkungen von Strukturveränderungen simulieren. Sie liefern damit einen wichtigen Beitrag zur Planung der Notfallversorgung.

Background: The spread of the COVID-19 pandemic and the corresponding implementation of measures such as stay-at-home orders and curfews had a major impact on health systems, including emergency medical services. This study examined the effect of the pandemic on call volumes, duration of calls and unanswered calls to the emergency number 112. Method: For this retrospective, descriptive study, 986,650 calls to seven emergency dispatch centres in Bavaria between January 01, 2019 and May 31, 2021 were analysed. The absolute number of calls and calls per 100,000 inhabitants as well as the number of unanswered calls are reported. The Mann‒Whitney U test was used to compare mean call durations between 2019 and 2020/2021 during several periods. Results: Call volume declined during the pandemic, especially during periods with strict lockdown restrictions. The largest decline (−12.9 %) occurred during the first lockdown. The largest reduction in the number of emergency calls overall (−25.3 %) occurred on weekends during the second lockdown. Emergency call duration increased, with the largest increase (+13 s) occurring during the “light” lockdown. The number of unanswered calls remained at a similar level as before the pandemic. Conclusion: This study showed that the studied Bavarian dispatch centres experienced lower call volumes and longer call durations during the first two waves of the COVID-19 pandemic (up to May 2021). Longer call durations could be the result of additional questions to identify potentially infectious patients. The fact that the number of unanswered calls hardly changed may indicate that the dispatch centres were not overwhelmed during the study period.

Abstract Background Not all patients who call the ambulance service are subsequently transported to hospital. In 2018, a quarter of deployments of an emergency ambulance in Bavaria were not followed by patient transport. This study describes factors that influence patient transport rates. Method This is a retrospective cross-sectional study based on data from all Integrated Dispatch Centres of the Free State of Bavaria in 2018. Included were ambulance deployments without emergency physician involvement, which were subdivided into ambulance deployments without transport and ambulance deployments with transport. The proportion of transported patients were determined for the primary reasons for deployment and for the different community types. On-scene time was compared for calls with and without patient transport. Differences were tested for statistical significance using Chi2 tests and the odds ratio was calculated to determine differences between groups. Results Of 510,145 deployments, 147,621 (28.9%) could be classified as ambulance deployments without transport and 362,524 (71.1%) as ambulance deployments with transport.The lowest proportion of patients transported was found for activations where the fire brigade was involved (“fire alarm system” 0.6%, “fire with emergency medical services” 5.4%) and “personal emergency response system active alarm” (18.6%). The highest transport rates were observed for emergencies involving “childbirth/delivery” (96.9%) and “trauma” (83.2%). A lower proportion of patients is transported in large cities as compared to smaller cities or rural communities; in large cities, the odds ratio for emergencies without transport is 2.02 [95% confidence interval 1.98–2.06] referenced to rural communites. The median on-scene time for emergencies without transport was 20.8 min (n = 141,052) as compared to 16.5 min for emergencies with transport (n = 362,524). The shortest on-scene times for emergencies without transport were identified for activations related to “fire alarm system” (9.0 min) and “personal emergency response system active alarm” (10.6 min). Conclusion This study indicates that the proportion of patients transported depends on the reason for deployment and whether the emergency location is urban or rural. Particularly low transport rates are found if an ambulance was dispatched in connection with a fire department operation or a personal emergency medical alert button was activated. The on-scene-time of the rescue vehicle is increased for deployments without transport. The study could not provide a rationale for this and further research is needed. Trial registration This paper is part of the study “Rettungswageneinsatz ohne Transport” [“Ambulance deployment without transport”] (RoT), which was registered in the German Register of Clinical Studies under the number DRKS00017758.

Background and Importance: The COVID-19 pandemic affected the utilization of health care services and posed organizational challenges. While many previous studies focused on the misuse of pre-hospital EMS for low-urgency health problems, the pandemic has put more emphasis on the avoidance of medically necessary calls. Objective: To compare the utilization of pre-hospital emergency medical services before and after specific pandemic periods. Design, setting and participants: This was a retrospective, descriptive analysis of routine data from 26 dispatch centers in Bavaria, Germany. Outcomes measure and analysis: We investigated the number of emergencies per 100,000 population, as well as the relative change in the emergency rates and transport rates in 2020, compared to the two previous years. Boxplots showed the distributions across the Bavarian districts per calendar week. The mean rates and standard deviations as well as the relative changes were presented for the specific periods. A paired samples t-test was used to compare the rates. Main results: Compared to the average of the two previous years, the emergency rates in 2020 were lower in 35 out of 52 calendar weeks. The strongest reductions were observed during the first wave, where the average emergency rate declined by 12.9% (SD 6.8, p < 0.001). There was no statistically significant difference in the overall emergency rate during the summer holidays. Lower transport rates were observed throughout the year, especially during the first wave. Conclusions: Utilization of pre-hospital emergency medical services decreased in 2020, especially during the periods with strict measures. This could be due to the lower morbidity from the behavioral changes during the pandemic, but also to the avoidance of medical services for both less urgent and severe conditions. While a reduction in unnecessary care would be beneficial, patients must be encouraged to seek necessary urgent care, even during a pandemic.

Zusammenfassung 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.

Background: The COVID-19 pandemic affects utilisation of health care services and posed organizational challenges. To determine the effect on utilisation of pre-hospital emergency medical care, we investigate utilisation throughout the year of 2020. Methods: This retrospective, descriptive analysis of routine data from 26 dispatch centres in Bavaria, Germany investigates the number of emergencies per 100,000 population as well as relative change in emergency rates and transport rates in 2020, compared to the two previous years. Boxplots show distributions across Bavarian districts per calendar week. Mean rates and standard deviations as well as relative changes are presented for specific periods and a paired samples t-test is used to compares rates. Findings: Compared to the average of the two previous years, emergency rates in 2020 were lower in 35 out of 52 calendar weeks. Strongest reductions were observed during the first wave, where the average emergency rate declined by 12∙9% (SD 6∙8, p < 0∙001). There was no statistically significant difference in the overall emergency rate during summer holidays and lockdown "light". Lower transport rates were observed throughout the year, especially during the first wave. Interpretation: Utilisation of pre-hospital emergency medical services decreased in 2020, especially during periods with strict measures. This could be due to lower morbidity from behavioural changes during the pandemic, but also to avoidance of medical services for probably both, less urgent and severe conditions. While a reduction in unnecessary care would be beneficial, patients must be encouraged to seek necessary urgent care, even during a pandemic. Funding: None to declare.Declaration of Interest: None to declare. Ethical Approval: The study was approved by the ethics committee of the medical faculty of the University of Munich (Project-No 21-0641 KB).

OBJECTIVE:Rising emergency medical services (EMS) utilisation increases transport to hospital emergency departments (ED). However, some patients receive outpatient treatment (discharged) while others are hospitalised (admitted). The aims of this analysis were to compare admitted and discharged cases, to assess whether cases that were discharged from the ED could be identified using dispatch data and to compare dispatch keyword categories and hospital diagnoses. DESIGN:Retrospective observational study using linked secondary data. SETTING AND PARTICIPANTS:78 303 cases brought to 1 of 14 ED in the city of Munich, Germany, by EMS between 1 July 2013 and 30 June 2014. MAIN OUTCOME MEASURES:Characteristics of admitted and discharged cases were assessed. Logistic regression was used to estimate the association between discharge and age, sex, time of day, ambulance type and dispatch keyword category. Keyword categories were compared to hospital diagnoses. RESULTS:39.4% of cases were discharged. They were especially likely to be young (OR 10.53 (CI 9.31 to 11.92), comparing <15-year-olds to >70-year-olds) and to fall under the categories 'accidents/trauma' (OR 2.87 (CI 2.74 to 3.01)) or 'other emergencies (unspecified)' (OR 1.23 (CI 1.12 to 1.34) (compared with 'cardiovascular'). Most frequent diagnoses came from chapter 'injury and poisoning' (30.1%) of the 10th revision of the international statistical classification of disease and related health problems (ICD-10), yet these diagnoses were more frequent at discharge (42.7 vs 22.0%) whereas circulatory system disease was less frequent (2.6 vs 21.8%). Except for accidents/trauma and intoxication/poisoning many underlying diagnoses were observed for the same dispatch keyword. CONCLUSION:Young age and dispatch for accidents or trauma were the strongest predictors of discharge. Even within the same dispatch keyword category the distribution of diagnoses differed between admitted and discharged cases. Discharge from the ED does not indicate that urgent response was unnecessary. However, these cases could be suitable for allocation to hospitals with low inpatient bed capacities and are of particular interest for future studies regarding the urgency of their condition.

Pre-hospital emergency medical services (EMS) are an integral part of emergency medical care. EMS planning can be achieved by analyzing patterns of use. However, long-term time trends of EMS use have rarely been studied. The objective of this retrospective study was to investigate utilization patterns over a ten year period, and to compare utilization trends between urban and rural municipalities and between events with and without prehospital emergency physician (PEP) dispatch.