Metelmann Camilla, Metelmann Bibiana, Kohnen Dorothea, Prasser Clara, Süss Rebekka, Kuntosch Julia, Scheer Dirk, Laslo Timm, Fischer Lutz, Hasebrook Joachim, Flessa Steffen, Hahnenkamp Klaus, Brinkrolf Peter
Clinic for Anaesthesiology, University Medicine Greifswald, Greifswald, Germany.
zeb.business school, Steinbeis University Berlin, Münster, Germany.
JMIR Res Protoc. 2020 Feb 14;9(2):e14358. doi: 10.2196/14358.
German emergency medical services are a 2-tiered system with paramedic-staffed ambulances as the primary response, supported by prehospital emergency doctors for life-threatening conditions. As in all European health care systems, German medical practitioners are in short supply, whereas the demand for timely emergency medical care is constantly growing. In rural areas, this has led to critical delays in the provision of emergency medical care. In particular, in cases of cardiac arrest, time is of the essence because, with each passing minute, the chance of survival with good neurological outcome decreases.
The project has 4 main objectives: (1) reduce the therapy-free interval through widespread reinforcement of resuscitation skills and motivating the public to provide help (ie, bystander cardiopulmonary resuscitation), (2) provide faster professional first aid in addition to rescue services through alerting trained first aiders by mobile phone, (3) make more emergency physicians available more quickly through introducing the tele-emergency physician system, and (4) enhance emergency care through improving the cooperation between statutory health insurance on-call medical services (German: Kassenärztlicher Bereitschaftsdienst) and emergency medical services.
We will evaluate project implementation in a tripartite prospective and intervention study. First, in medical evaluation, we will assess the influences of various project measures on quality of care using multiple methods. Second, the economic evaluation will mainly focus on the valuation of inputs and outcomes of the different measures while considering various relevant indicators. Third, as part of the work and organizational analysis, we will assess important work- and occupational-related parameters, as well as network and regional indexes.
We started the project in 2017 and will complete enrollment in 2020. We finished the preanalysis phase in September 2018.
Overall, implementation of the project will entail realigning emergency medicine in rural areas and enhancing the quality of medical emergency care in the long term. We expect the project to lead to a measurable increase in medical laypersons' individual motivation to provide resuscitation, to strengthen resuscitation skills, and to result in medical laypersons providing first aid much more frequently. Furthermore, we intend the project to decrease the therapy-free interval in cases of cardiac arrest by dispatching first aiders via mobile phones. Previous projects in urban regions have shown that the tele-emergency physician system can provide a higher availability and quality of emergency call-outs in regular health care. We expect a closer interrelation of emergency practices of statutory health insurance physicians with the rescue service to lead to better coordination of rescue and on-call services.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/14358.
德国的紧急医疗服务是一个两级系统，配备护理人员的救护车作为主要响应力量，对于危及生命的情况由院前急救医生提供支持。与所有欧洲医疗保健系统一样，德国的执业医生短缺，而对及时紧急医疗护理的需求却在不断增长。在农村地区，这导致了紧急医疗护理的严重延迟。特别是在心脏骤停的情况下，时间至关重要，因为每过一分钟，获得良好神经功能预后存活的机会就会降低。
该项目有4个主要目标：（1）通过广泛强化复苏技能并激励公众提供帮助（即旁观者心肺复苏）来缩短无治疗间隔时间；（2）通过手机提醒经过培训的急救人员，除救援服务外提供更快的专业急救；（3）通过引入远程急救医生系统更快地提供更多急救医生；（4）通过改善法定医疗保险随叫随到医疗服务（德语：Kassenärztlicher Bereitschaftsdienst）与紧急医疗服务之间的合作来加强紧急护理。
我们将在一项三方前瞻性干预研究中评估项目实施情况。首先，在医学评估中，我们将使用多种方法评估各种项目措施对护理质量的影响。其次，经济评估将主要关注不同措施的投入和结果的估值，同时考虑各种相关指标。第三，作为工作和组织分析的一部分，我们将评估重要的工作和职业相关参数以及网络和区域指标。
我们于2017年启动该项目，并将于202年完成招募。我们在2018年9月完成了预分析阶段。
总体而言，该项目的实施将需要调整农村地区的急诊医学，并从长远来看提高紧急医疗护理的质量。我们预计该项目将导致非专业医疗人员提供复苏的个人积极性显著提高，增强复苏技能，并使非专业医疗人员更频繁地提供急救。此外，我们希望该项目通过手机调度急救人员来缩短心脏骤停情况下的无治疗间隔时间。城市地区以前的项目表明，远程急救医生系统可以在常规医疗保健中提供更高的紧急出诊可用性和质量。我们预计法定医疗保险医生的急救实践与救援服务之间更紧密的相互关系将导致救援和随叫随到服务的更好协调。
国际注册报告识别码（IRRID）：DERR1-10.2196/14358。
