Analysis of 67,975 emergency deployments in a major German city - criteria for more efficient dispatching of emergency physicians.

Abstract

Objectives: Efficient dispatching of physician-staffed vehicles in emergency medical services requires clear criteria to ensure timely allocation of resources, improve patient outcomes, and minimize response time under high-pressure conditions. The aim of this study was to identify criteria ensuring that emergency physicians are safely managed and efficiently deployed.

Methods: Rescue service deployments in the city of Dresden, Germany (01/01/2021-12/31/2021), were analyzed retrospectively. The rescue mission indications determined by the telecommunicator, along with the presence of vital sign abnormalities at site - such as airway, breathing, circulation, and disability - based on the ABCDE approach from the Advanced Life Support and Advanced Trauma Life Support algorithms, were analyzed. Specific emergency medical procedures carried out in the particular mission were assigned to the respective competence level (CL): CL1: invasive measures reserved for physicians; CL2: invasive measures that paramedics are trained to use independently in emergency situations; CL3: standard measures; CL4: counseling only; and CL5: no measures.

Results: In all, 67,975 missions were analyzed. Missions were most frequently dispatched for internal indications, such as cardiovascular and pulmonary emergencies (28.4%), and traumatological indications (20.4%). Despite the physician being dispatched in 36.5% of cases, invasive measures (CL1/CL2) were only used in 13.9% of missions. Internal indications (11.8%) and resuscitation (19.6%) frequently required CL1 measures. CL2 measures were more frequently applied than CL1 measures for allergic (44.2% vs. 1.9%), neurological (12.5% vs. 3.4%), and psychological (6.1% vs. 0.7%) indications. In most interventions (62.2%), only the standard competencies (CL3) were used as the highest level of competence. For most mission indications, the probability of invasive measures (CL1/CL2) increased significantly in the presence of at least one vital sign abnormality.

Conclusions: The results show opportunities for optimizing emergency physician dispatch. The presence of a vital sign abnormality should be given greater consideration in the future. Query algorithms for detecting cases with a high probability of requiring CL1/CL2 measures could support efficient dispatching. Furthermore, emergencies requiring CL2 but rarely CL1 measures could be handled independently by emergency paramedics, particularly if they have access to the support of a tele-emergency physician for situations where CL1 measures become necessary.