Engel P, Wilp T, Lukas R P, Harding U, Weber T P, Van Aken H, Bohn A
Arbeitsgruppe Forschung in der Notfallmedizin (AGFiN), Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Münster, Deutschland.
Anaesthesist. 2011 Oct;60(10):929-36. doi: 10.1007/s00101-011-1932-x. Epub 2011 Sep 2.
Demographic development and changes in healthcare utilization have led to a rising number of calls for emergency services. In Germany life-threatening situations are responded by physician-staffed ambulances in a 2-tier system whereas paramedic-staffed ambulances are dispatched in non-life-threatening emergencies. A nationwide protocol guides dispatchers in triage decisions. In the years 1999 to 2009 a continuous rise in the number of calls for a physician-staffed ambulance in Münster was recorded. The degree of healthcare utilization according to socioeconomic status and age structure was retrospectively examined.
For the year 2006 all emergency calls in the City of Münster responded to by physician-staffed ambulances were analyzed. Each call was assigned to 1 of the 45 urban districts. The local incidence of emergency calls (calls/100 residents/year) was determined and compared to the socioeconomic status which was defined as the percentage of welfare and unemployment benefit recipients per district. Patient condition was assessed by the Munich National Advisory Committee for Aeronautics (M-NACA) score. This scoring system allows calls to be allocated to either life-threatening conditions or non-life-threatening conditions by objective vital parameters. The age structure of the emergency callers was also examined.
Urban districts with a low socioeconomic status showed a higher incidence of emergency calls requiring physician-staffed ambulance responses than districts with a high socioeconomic status. Measured by the M-NACA scoring system, the fraction of life-threatening emergencies among all calls proved to be equal to districts with a high socioeconomic status. A correlation between elderly patients and increasing numbers of life-threatening emergencies was found.
A low socioeconomic status of an urban district will result in more ambulance responses. However, the proportion of life-threatening emergencies is equal to districts with a high socioeconomic status. Thus, the greater need for physician-staffed ambulance responses matches clinical needs and legitimates current resource use in a 2-tier ambulance system. Indications for the abuse of physician-staffed ambulances were not found. Considering an aging population the number of emergency calls will rise in the future.
人口结构的发展以及医疗保健利用情况的变化导致紧急服务呼叫数量不断增加。在德国，威胁生命的情况由配备医生的救护车通过两级系统做出响应，而在非威胁生命的紧急情况下则派遣配备护理人员的救护车。一项全国性协议指导调度员进行分诊决策。1999年至2009年期间，明斯特配备医生的救护车呼叫数量持续上升。对根据社会经济地位和年龄结构划分的医疗保健利用程度进行了回顾性研究。
对2006年明斯特市所有由配备医生的救护车响应的紧急呼叫进行了分析。每个呼叫被分配到45个市区中的1个。确定了紧急呼叫的当地发生率（呼叫数/100居民/年），并与社会经济地位进行了比较，社会经济地位定义为每个区领取福利和失业救济金的百分比。患者状况通过慕尼黑国家航空咨询委员会（M-NACA）评分进行评估。该评分系统允许根据客观生命参数将呼叫分配到威胁生命的情况或非威胁生命的情况。还研究了紧急呼叫者的年龄结构。
社会经济地位较低的市区比社会经济地位较高的市区需要配备医生的救护车响应的紧急呼叫发生率更高。通过M-NACA评分系统衡量，所有呼叫中威胁生命的紧急情况比例与社会经济地位较高的市区相同。发现老年患者与威胁生命的紧急情况数量增加之间存在相关性。
市区的低社会经济地位将导致更多的救护车响应。然而，威胁生命的紧急情况比例与社会经济地位较高的市区相同。因此，对配备医生的救护车响应的更大需求符合临床需求，并使两级救护车系统中当前的资源使用合法化。未发现滥用配备医生的救护车的迹象。考虑到人口老龄化，未来紧急呼叫数量将会增加。
