Breuer F, Pommerenke C, Ziemen B, Stiepak J-K, Poloczek S, Dahmen J
Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Voltairestr. 2, 10179 Berlin, Deutschland.
Fakultät für Gesundheit, Department Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland.
Notf Rett Med. 2021;24(7):1033-1042. doi: 10.1007/s10049-020-00786-5. Epub 2020 Sep 28.
It has been shown throughout the COVID-19 pandemic that the condition of a number of patients deteriorates acutely when not monitored. This is set against an increased demand for emergency medical services and the resulting scarcity of resources, which makes it necessary to prioritise inpatient treatment or ensure that patients are provided with appropriate outpatient care. In this context, the Berlin Fire Department has introduced emergency paramedic investigators (NotSan-Erkunder) as an additional operating resource.
We assessed all operations from 28.03.2020 to 28.04.2020 during which Emergency Paramedic Investigators of the Berlin emergency services were deployed. A total of 341 operations were included from the 31 days. Alongside data from the dispatch system, all operational documentation was assessed.
In 57% of cases, mNACA II patients (outpatient treatment) were identified, in 42% of cases, mNACA III patients (inpatient treatment) were identified, and in 1% of cases, mNACA IV (imminent danger to life) patients were identified. In 51% of cases, the emergency services transported the patient to a hospital, and in 49%, alternative care measures were employed. These included referral to a local physician in 28% of cases. In 11% of cases, patients were referred to on-call services of the Association of Statutory Health Insurance Physicians (KV in German). In 4% of cases, the Berlin Fire Department emergency dispatch center deployed a physician of the KV (KV-ARE investigator).
The results show that additional operational resources serve an important function during a pandemic with regards to an initial assessment and pilot function. This can help relieve not only the emergency services but also the medical facilities responsible for providing further care. The standardised dispatch enquiry enables the linking with the appropriate codes from the low-priority operational spectrum and support by a Tele-emergency physician lends additional professional competency to the emergency paramedics.
在整个新冠疫情期间，有证据表明，许多患者在未得到监测时病情会急剧恶化。与此同时，紧急医疗服务的需求增加，导致资源短缺，这使得有必要对住院治疗进行优先排序，或确保为患者提供适当的门诊护理。在此背景下，柏林消防部门引入了急救护理调查员（NotSan-Erkunder）作为额外的运营资源。
我们评估了2020年3月28日至2020年4月28日期间柏林急救服务部门部署急救护理调查员的所有行动。在这31天里，共纳入了341次行动。除了调度系统的数据外，还评估了所有行动文件。
在57%的案例中，识别出mNACA II级患者（门诊治疗），在42%的案例中，识别出mNACA III级患者（住院治疗），在1%的案例中，识别出mNACA IV级（生命垂危）患者。在51%的案例中，急救服务部门将患者送往医院，在49%的案例中，采用了替代护理措施。其中28%的案例是转诊给当地医生。在11%的案例中，患者被转诊至法定医疗保险医师协会（德语为KV）的随叫随到服务。在4%的案例中，柏林消防部门应急调度中心部署了一名KV医师（KV-ARE调查员）。
结果表明，在疫情期间，额外的运营资源在初始评估和试点功能方面发挥着重要作用。这不仅有助于减轻急救服务部门的负担，也有助于减轻负责提供进一步护理的医疗设施的负担。标准化的调度查询能够与低优先级运营范围内的适当代码相链接，远程急救医生的支持为急救护理人员提供了额外的专业能力。
