BACKGROUND

A growing number of reports have been published in Germany related to problems with the operational readiness of mobile emergency physician services, although no systematic analyses have yet been presented. However, such investigations form the prerequisite for the deployment of countermeasures.

METHODS

Rhineland-Palatinate (4,060,000 inhabitants, 7,753 mi(2)) is a typical territorial state in the southwest of Germany with extensive wooded areas covering 42% of the state and only few metropolitan areas. These basic conditions represent a challenge to the provision of state-wide emergency medical services (EMS). On behalf of the Ministry of the Interior a web-based platform for the collation, display and analysis of the operational readiness of all 68 ground-based physician-staffed emergency units within the state was developed. Of these units 61 are affiliated to hospitals and 7 units to medical practices and 89,000 emergency missions are carried out annually.

RESULTS

Within the study period (April 2009-March 2010) 56 of the 68 units (82.4%) reported 1 or more periods of unavailability of operational readiness. In total 2,613 periods of temporary unavailability were documented with a mean duration of 8.9 h. The mean unavailability of operational readiness was 3.9% for the whole state, 6.2% for the northern and 1.6% for the southern EMS districts. In 7 of the units (10.3%) the degree of unavailability exceeded 5% and in 8 units (11.7%) it exceeded 10%. Two thirds of all suspended services were the result of shortages of emergency physicians, with considerably higher deficits at bases affiliated with hospitals of lower levels of care or in rural regions.

CONCLUSIONS

This tool enables the large-scale collation and analysis of the operational readiness of physician-based ambulance services. Currently the state does not suffer from a general lack of emergency physicians. However, rural areas as well as bases affiliated with small hospitals show a considerable deficit in operational readiness caused by a shortage of staff. These deficits may be partially compensated by optimized planning and disposition within rescue coordination centers. Moreover, they call for corrective actions in the light of health care politics. In addition, analyses of other elements of EMS (i.e. rescue helicopters) should be undertaken.