ABSTRACT
Background Due to the changes in demographics and morbidity, the demand for emergency medical services (EMS) in Germany continues to rise, which requires further enhancement of acute care structures especially between the sectors of outpatient and inpatient care. Therefore, the concept of the community paramedic (in German "Gemeindenotfallsanitater" [G-NFS]) was introduced in 2019 in the region of Oldenburg, Germany, as part of a pilot project with scientific supervision. Methods In this mixed-methods study, online focus group interviews (participation of 56.7% of all G-NFS) were conducted with all four regional groups of G-NFS (city of Oldenburg and the districts of Vechta, Cloppenburg, and Ammerland). In addition, a short online survey (participation of 53.3% of all G-NFS) was carried out with the same interviewees. The interviews and the online survey focused on the personal experiences of the G-NFS before and during the corona pandemic. The interview findings were analyzed based on thematic coding and subsequent evaluation. Results In all, 17 G-NFS participated in the interviews, and 16 G-NFS took part in the survey. According to the G-NFS, the EMS system (so far based on non-urgent and urgent care ambulances) is complemented by the G-NFS with a useful and skilled resource, which offers the necessary relief for urgent care ambulances. The indispensable cross-sectional collaboration with other services works target-oriented and efficiently but differs depending on the local setting. The same applies to the collaboration with the responsible dispatch centers. In addition, the G-NFS was dispatched to triage patients during the corona pandemic peaks and eased the burden on the overall EMS system in the region. Conclusion The G-NFS who participated believe that the concept has thus far in the project phase proven to be very useful. Based on the present experiences and results, the concept can be further developed.
ABSTRACT
Background: In the Euregio-Meuse-Rhine (EMR), cross-border collaboration is essential for resource-saving and needs-based patient care within the emergency medical service (EMS) systems and interhospital transport (IHT). However, at the onset of the novel coronavirus SARS-COV-2 (COVID-19) pandemic, differing national measures highlighted the fragmentation within the European Union (EU) in its various approaches to combating the pandemic. To assess the consequences of the pandemic in the EMR border area, the aim of this study was to analyze the effects and "lessons learned" regarding cross-border collaboration in EMS and IHT. Method: A qualitative study with 22 semi-structured interviews was carried out. Experts from across the EMR area, including the City of Aachen, the City region of Aachen, the District of Heinsberg (Germany), South Limburg (The Netherlands), and the Province of Limburg, as well as Liège (Belgium), took part. The interviews were coded and analyzed according to changes in cross-border collaboration before and during the pandemic, as well as lessons learned and recommendations. Results: Each EU member country within the EMR area, addressed the pandemic individually with national measures. Cross-border collaboration between regional actors was hardly or not at all addressed at the national level during political decision- or policymaking. Previous direct communication at the personal level was replaced by national procedures, which made regular cross-border collaboration significantly more difficult. The cross-border transfer regulations of patients with COVID-19 proved to be complex and led, among other things, to patients being transported to hospitals far outside the border region. Collaboration continues to be seen as valuable and Euregional emergency services including hospitals work well together, albeit to different degrees. The information and data exchange should, however, be more transparent to use resources more efficiently. Conclusion: Effective Euregional collaboration of emergency services is imperative for public safety in a multi-border region with strong economic, cultural, and social cross-border links. Our findings indicate that existing (pre-pandemic) structures which included regular meetings of senior managerial staff in the region and a number of thematic working groups were helpful to deal with and to compensate for the disruptions during the crisis. Regional cross-border agreements that are currently based on mutual but more or less informal arrangements need to be formalized and better promoted and recognized also at the national and EU level to increase resilience. The continuous determination of synergies and good and best practices are further approaches to support cross-border collaboration especially in preparation for future crises.
Subject(s)
COVID-19 , Emergency Medical Services , COVID-19/epidemiology , European Union , Expert Testimony , Humans , SARS-CoV-2ABSTRACT
Background The SARS-CoV-2 coronavirus, discovered in the city of Wuhan in November 2019, is now the cause of a pandemic with far-reaching consequences. Nevertheless, a decrease in the total number of emergency missions is reported. Method As part of a cohort analysis, the number of missions of EMS-physicians und tele-EMS-physicians from March 2020 was compared with March 2018 and 2019 with regard to potentially life-threatening diagnoses. In addition, all operational documentation of the ambulance, emergency medical service (EMS-)physician und tele-EMS-physician from the city of Aachen from March 2020 was evaluated. Results In March 2020, there was a significant decrease in emergency missions compared to 2018 and 2019 (p < 0.001). Potentially life-threatening missions decreased as well, however the proportion of them increased significantly from 52.3% (n = 294) in 2018 to 63.3% (n = 253) (p < 0.001). 39.6% (n = 89) of the 225 patients with infectious symptoms and normal vital signs were transported to the hospital by the ambulance without the involvement of a physician. Conclusion Above all, the number of non-life-threatening operations has declined. Despite normal vital signs, many patients were transported to the hospital by an ambulance. An increased consultation of the tele-EMS-physician could avoid transports that are not indicated.