Krösbacher Armin, Kaiser Herbert, Holleis Stefan, Schinnerl Adolf, Neumayr Agnes, Baubin Michael
Universitätsklinik für Anästhesie und Intensivmedizin Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
Leitstelle Tirol GmbH, Innsbruck, Österreich.
Anaesthesist. 2021 Aug;70(8):655-661. doi: 10.1007/s00101-021-00915-w. Epub 2021 Feb 10.
During the peak of the COVID-19 pandemic in spring 2020, the entire emergency rescue system was confronted with major challenges. Starting on 15 March, all tourists were asked to leave the State of Tyrol, Austria. The main goal of the efforts was to ensure the usual quality of emergency medical care while reducing the physical contact during emergency interventions on site.
The Austrian Emergency Medical Service is physician-based, meaning that in addition to an ambulance team, an emergency physician (EP) is dispatched to every potential life-threatening emergency call. In Tyrol and starting on 17 March 2020, 413 types of emergency call dispatches, which were addressed with an ambulance crew as well as an EP crew before COVID-19, were now dispatched only with an ambulance crew. This procedure of dispatching differently as well as the general development of emergency calls during this period were analyzed from 15 March to 15 May 2020 and compared to the data from the same time period from 2017 to 2019.
Despite the reduction of the population of around 30% because of absent tourists and foreign students staying in Tyrol, emergency calls with the operational keyword "difficulty in breathing/shortness of breath" rose by 18.7% (1533 vs. 1291), while calls due to traffic incidents decreased by 26.4% (2937 vs. 2161). Emergency calls with the dispatch of teams with an EP were reduced by 38.5% (1511 vs. 2456.3), whereby the NACA scores III and IV were the ones with the significant reduction of 40% each. For the reduced dispatchs, the additional dispatch of an EP team by the ambulance team amounted to 14.5%; however, for the keywords "unconscious/fainting" and "convulsions/seizures" the additional dispatch was significantly higher with over 40% each.
There was an overall reduction of emergency calls. Considering, that the reduced dispatches would have led to an EP team dispatch the overall emergency doctor dispatches would have been higher than in the years before. Our study was not able to find the reasons for this increase. Only considering the additional dispatching of EPs, was this reduction in dispatching EP teams highly accurate, except for the symptoms of "unconscious/fainting" and "convulsions/seizures"; however, the actual diagnoses that the hospitals or GPs made could not be collected for this study. Therefore, it cannot be said for sure that there was equality in the quality of emergency medical care.
It was possible to achieve the primary goal of reducing the physical contact with patients; however, before keeping these reductions of the dispatching order regarding. EPs for the routine operation, adaptions in these reductions as well as deeper evaluations under consideration of the data from hospitals and GPs would be necessary. Also, different options to reduce physical contact should be evaluated, e.g. building an EMT-led scout team to evaluate the patient's status while the EP team is waiting outside.
在2020年春季新冠疫情高峰期，整个紧急救援系统面临重大挑战。从3月15日起，所有游客被要求离开奥地利蒂罗尔州。这些举措的主要目标是在确保紧急医疗护理质量如常的同时，减少现场紧急干预期间的身体接触。
奥地利紧急医疗服务以医生为基础，这意味着除了救护车团队外，还会向每一个潜在的危及生命的紧急呼叫派遣一名急诊医生（EP）。在蒂罗尔州，从2020年3月17日起，413种在新冠疫情之前由救护车团队和急诊医生团队共同应对的紧急呼叫派遣，现在仅由救护车团队处理。对2020年3月15日至5月15日期间这种不同的派遣程序以及该期间紧急呼叫的总体发展情况进行了分析，并与2017年至2019年同一时期的数据进行了比较。
尽管由于游客不在以及外国学生离开蒂罗尔州，当地人口减少了约30%，但操作关键词为“呼吸困难/呼吸急促”的紧急呼叫增加了18.7%（从1291次增至1533次），而交通事故导致的呼叫减少了26.4%（从2937次降至2161次）。派遣有急诊医生团队的紧急呼叫减少了38.5%（从2456.3次降至1511次），其中美国急诊医师协会（NACA）评分III和IV的呼叫减少幅度显著，各减少了40%。对于减少的派遣，救护车团队额外派遣急诊医生团队的比例为14.5%；然而，对于关键词“昏迷/昏厥”和“抽搐/癫痫发作”，额外派遣比例显著更高，均超过40%。
紧急呼叫总体减少。考虑到减少的派遣次数若由急诊医生团队来处理，那么总体急诊医生派遣次数会比前几年更高。我们的研究未能找到这种增加的原因。仅考虑急诊医生的额外派遣情况，除了“昏迷/昏厥”和“抽搐/癫痫发作”症状外，急诊医生团队派遣次数的减少是非常准确的；然而，本研究无法收集医院或全科医生做出的实际诊断。因此，不能确定紧急医疗护理质量是否平等。
有可能实现减少与患者身体接触的首要目标；然而，在将这些关于急诊医生的派遣减少措施用于常规操作之前，有必要根据医院和全科医生的数据对这些减少措施进行调整并进行更深入的评估。此外，应评估不同的减少身体接触的方案，例如组建一支由急救医疗技术员（EMT）带领的侦察小组，在急诊医生团队在外面等待时评估患者状况。
