Nau Lara Maria, Laux Gunter, Altiner Attila, Szecsenyi Joachim, Leutgeb Rüdiger
Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany.
JMIR Res Protoc. 2024 Apr 10;13:e54002. doi: 10.2196/54002.
The increasing number of requests for help for acutely ill patients and their management is a major problem in the health systems of many countries, but especially in Germany. Rescue coordination centers and ambulances in Germany are increasingly overloaded. As a result, rides as a part of rescue operations have been increasing in length for years, yet a relevant proportion of these operations represent low-acuity calls (LACs). The basic objective of this pilot study is the quantitative analysis of the potential misuse of requests to the rescue control center. Indications for alternative treatment options and how to handle these treatment options in nonacute, non-life-threatening health conditions, such as minor injuries or minor infectious diseases, will be assessed. The identification of these LACs is vital in order to prevent health care resources in emergency medical care becoming inadequate.
The overarching goal of this study is to determine the percentage of unnecessary rescue missions on site and subsequently to obtain an impression of the paramedics' assessment of alternative treatment options or alternative methods of rescue transportation.
This will be an exploratory, noninterventional, cross-sectional study with a quantitative approach. The study is multicentric, with 21 ambulances in 12 different locations. The data for this study were collected via a questionnaire, newly developed for this study, for rescue personnel. Additionally, secondary data from the responsible control center will be linked and processed in an initial descriptive analysis. This descriptive analysis will form the basis for a subsequent variance analysis.
Data collection started as projected on September 18, 2023, and was ongoing until end of November 2023. We expect the documentation of several thousand rescue operations. We expect the following study results: (1) many unnecessary rescue operations, (2) immediate on-site assessment of correct care and treatment, and (3) patients' reasons for calling a rescue coordination center.
To our knowledge, this is the first observational study in which acute rescue operations are recorded on site. The focus of this study is on the trained paramedics' assessment of whether rescue operations are necessary or not. Additionally, alternative treatments, such as out-of-hours care service or primary care service, are shown for each individual case. The study also intends to cover the question of which factors are relevant and statistically significantly connected to the misuse of ambulances.
German Register for Clinical Studies (Deutsches Register für Klinische Studien) DRKS00032510; https://drks.de/search/en/trial/DRKS00032510.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54002.
对急重症患者求助及救治需求的不断增加是许多国家卫生系统面临的重大问题，在德国尤为突出。德国的救援协调中心和救护车负担日益加重。因此，救援行动中的转运时间多年来一直在延长，然而这些行动中有相当一部分是低 acuity 呼叫（LAC）。本试点研究的基本目标是对救援控制中心接到的求助可能被滥用的情况进行定量分析。将评估在非急性、非危及生命的健康状况下，如轻伤或轻度传染病，替代治疗方案的指征以及如何处理这些治疗方案。识别这些 LAC 对于防止紧急医疗护理中的医疗资源不足至关重要。
本研究的总体目标是确定现场不必要救援任务的百分比，并随后了解护理人员对替代治疗方案或替代救援运输方法的评估情况。
这将是一项采用定量方法的探索性、非干预性横断面研究。该研究为多中心研究，涉及 12 个不同地点的 21 辆救护车。本研究的数据通过为救援人员新开发的问卷收集。此外，来自负责控制中心的二手数据将被关联并在初步描述性分析中进行处理。该描述性分析将为后续的方差分析奠定基础。
数据收集于 2023 年 9 月 18 日按计划开始，一直持续到 2023 年 11 月底。我们预计记录数千次救援行动。我们预计得到以下研究结果：（1）许多不必要的救援行动；（2）对正确护理和治疗的现场即时评估；（3）患者呼叫救援协调中心的原因。
据我们所知，这是第一项在现场记录急性救援行动的观察性研究。本研究的重点是训练有素的护理人员对救援行动是否必要的评估。此外，针对每个具体案例展示了替代治疗方法，如非工作时间护理服务或初级护理服务。该研究还打算探讨哪些因素与救护车的滥用相关且在统计学上有显著关联。
德国临床研究注册中心（Deutsches Register für Klinische Studien）DRKS00032510；https://drks.de/search/en/trial/DRKS00032510。
国际注册报告识别号（IRRID）：DERR1-10.2196/54002。
