[Alternative care concepts for low-acuity emergency medical service missions in the German ambulance service: Descriptive results of an online survey]

Abstract

Introduction: In Germany, the number of emergency missions has been rising for several years. At the same time, it can be observed that the amount of missions involving emergency physicians is decreasing, while the number of outpatient treatments without transport is increasing. To cope with this situation, different alternative care concepts have been developed as complementary resources throughout Germany. This study comprehensively compares these concepts, and it aims to highlight best-practice examples and stimulate a joint learning process.

Methods: As part of an online survey project leaders of various concepts were asked to take part in a standardized online survey. The survey comprised a total of 28 questions relating to various areas such as qualifications and training or resource equipment. The information was supplemented by documents, which were additionally submitted by the respondents.

Results: A total of seven concepts were examined. They all have in common that they are alerted by the dispatch centers to care mainly for low-code cases. Furthermore, the resources are staffed by trained paramedics, and patient transport is not possible. All resources are able to contact other medical facilities. Differences can be seen in the areas of funding, training, equipment, availability, and further areas of responsibility.

Discussion: The development of a large number of different care concepts in Germany has taken place in parallel with the development in other European countries, where different approaches have also been established for low-priority requests for assistance. In order to direct low-priority requests for assistance to a needs-based care unit in Germany as well, rescue dispatch centers should have a broader repertoire of care at their disposal. Implications for research arising from this lie in particular in evaluating the various concepts adequately, especially with regard to the quality of care, and thus ensuring needs-based and targeted care.

Conclusion: Widespread introduction of alternative care concepts might help relieve the burden on emergency medical care. This requires more research and evaluation as well as optimized data quality and standardization. In addition, it is desirable to enhance cooperation with the medical on-call service.

Keywords: Ambulante Versorgung; Cross-sectoral care; Low acuity; Low codes; Niedrigprioritäre Hilfeersuchen; Non-urgent care; Outpatient care; Prehospital emergency care; Prähospitale Notfallversorgung; Sektorübergreifende Versorgung.