Evaluation of a Rural Emergency Medical Service Project in Germany: Protocol for a Multimethod and Multiperspective Longitudinal Analysis

Background 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. Objective 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. Methods 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. Results We started the project in 2017 and will complete enrollment in 2020. We finished the preanalysis phase in September 2018. Conclusions 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

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Making Emergency Care in Rural Areas Fit for Future: Protocol for multi-method and multi-perspective longitudinal analysis and control group study (Preprint)

10.2196/preprints.14358 ◽

2019 ◽

Author(s):

Camilla Metelmann ◽

Bibiana Metelmann ◽

Dorothea Kohnen ◽

Clara Prasser ◽

Rebekka Süss ◽

...

Keyword(s):

Health Care ◽

Emergency Care ◽

Rural Areas ◽

Statutory Health Insurance ◽

First Aid ◽

Medical Services ◽

Emergency Medical Care ◽

Free Interval ◽

Emergency Medical

BACKGROUND The German Emergency Medical Services is a two-tiered system with paramedic staffed ambulances as primary response supported by pre-hospital emergency doctors for life-threatening conditions. As in all European health care systems, German medical practitioners are in short supply whilst 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 essence [1], because with each minute passing, the chance of survival with good neurological outcome decreases. OBJECTIVE The project follows four main objectives: 1) Reducing the therapy-free interval through widespread reinforcement of resuscitation skills and motivating the public to provide help (called bystander-CPR), (2) fast, professional first aid in addition to rescue services through alarming trained first aiders via smartphone, (3) faster and higher availability of emergency physicians through introducing the tele-emergency physician (TEP) system, and (4) enhanced emergency care through improving the cooperation between statutory health insurance on-call medical services (German: Kassenärztlicher Bereitschaftsdienst) and emergency medical services. METHODS The implementation of the project is evaluated through a tripartite prospective and intervention study: (1) in medical evaluation, the influences of various project measures on quality of care are assessed using multiple methods. (2) The economic evaluation mainly focuses on the valuation of inputs and outcomes of the different measures while considering various relevant indicators. (3) As part of the scientific work and organizational evaluation important work- and occupational-related parameters but also network and regional indexes are assessed. RESULTS The project was started in 2017 and enrollment will be completed in 2020. The pre-analysis phase recently finished. CONCLUSIONS Overall, the implementation of the project entails the realignment of emergency medicine in rural areas and the enhancement of quality of medical emergency care in the long-term. It is expected to lead to a measurable increase in medical laypersons’ individual motivation to provide resuscitation, to strengthen resuscitation skills as well as much more frequently provided first aid through medical laypersons. Furthermore, the project is intended to decrease the therapy-free interval in cases of cardiac arrest by dispatching first aiders via smartphones. As demonstrated by previous projects in urban regions, the TEP system has already proven a higher availability and quality of emergency call-outs in regular health care. A closer interrelation of emergency practices of statutory health insurance physicians with the rescue service is expected to lead to a better coordination of rescue and on-call services. CLINICALTRIAL Ethikkomission (ethics comission) an der Universität Greifswald BB 111/17 http://www2.medizin.uni-greifswald.de/ethik/

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Quality of services of emergency medical care in terms of health care reform

Services in Russia and abroad ◽

10.12737/20187 ◽

2016 ◽

Vol 10 (4) ◽

pp. 102-111

Author(s):

Алексей Белобородов ◽

Aleksey Beloborodov ◽

Елена Данилина ◽

Elena Danilina ◽

Екатерина Яковлева ◽

...

Keyword(s):

Health Care ◽

Medical Care ◽

Performance Indicators ◽

Structural Model ◽

Medical Services ◽

Emergency Medical Care ◽

Emergency Medical ◽

And Performance ◽

Definition Of

The article deals with the question of quality assurance of emergency medical care. It is of vital importance in terms of reforming the system of healthcare in the Russian Federation, as the quality and availability of various types of medical services are priority indicators of reform. Quality ensuring of emergency medical care is the most important socially significant task of health care, which lies in maintaining the health of people in extreme conditions and in meeting the challenges of mortality reduction. This is resulted in increased attention to research in this area. Quality ensuring of emergency medical services actualizes the task of improving of its assessment methodology. The methodological problems of services quality assessment in the system of emergency medical care limiting applied research are the subject of the study. The structure of emergency medical care is specified, the separation of concepts of "medical service" and "medical care" of services of emergency medical care is accomplished, and the concept of "medical care" is defined in the article. Based on the results of market research of patients’ satisfaction with quality of medical care in emergency hospital of Krasnoyarsk a structural model of services of emergency medical care has been created. This model reflects the patients’ understanding that the quality of service of emergency medical care is an integrated category, combining the quality of the result of medical services and quality of care. Content analysis of the definition of basic concepts in the field of quality of health care has allowed to formulate the concept of "service quality of emergency medical care”. Its difference is that the definition includes goal-setting of quality of emergency medical care as ensuring the effective medical care, as well as performance indicators of emergency medical care are formulated. The proposed concept and performance indicators of emergency medical care stimulate new directions for research in this area.

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Zufriedenheit mit der Gesundheitsversorgung: Gibt es strukturelle Unterschiede?

Zeitschrift für Wirtschaftspolitik ◽

10.1515/zfwp-2018-0017 ◽

2018 ◽

Vol 67 (3) ◽

pp. 288-307

Author(s):

Katharina Lima de Miranda ◽

Daniel Prosi ◽

Ulrich Schmidt ◽

Hanna Wecker

Keyword(s):

Health Care ◽

Rural Areas ◽

Statutory Health Insurance ◽

Waiting Times ◽

Private Insurance ◽

Public And Private ◽

Structural Differences ◽

Urban And Rural Areas ◽

Care Costs

Abstract This study examines structural differences in the subjective quality of health care in Germany using a newspaper survey. We find that there are significant differences between urban and rural areas as well as between public and private insurance. In rural areas, the provision of general practitioners, specialists and hospitals are considered as worse than in cities. In particular, public insured individuals asses the provision of specialized doctors and hospitals as lower than private insured and criticize long waiting times for appointments and lacking coverage of health care costs by the statutory health insurance.

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Abstract 230: Opioid-Related Cardiac Arrest Incidence and Epidemiology in Maine

Circulation ◽

10.1161/circ.140.suppl_2.230 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Teresa MAY ◽

David Gagnon ◽

David B Seder ◽

Bailey West ◽

Patricia Lerwick ◽

...

Keyword(s):

Cardiac Arrest ◽

Emergency Medical Services ◽

Rural Areas ◽

The United States ◽

Medical Services ◽

Opioid Overdose ◽

Shockable Rhythm ◽

Emergency Medical ◽

Bystander Cpr ◽

Urban And Rural Areas

Introduction: The frequency of opioid-related cardiac arrest (ORCA) is increasing across several geographic regions in the United States. Understanding how Maine’s urban and rural areas are affected by ORCA is necessary to improving prevention and treatment of this public health threat. Hypothesis: Patient demographics, clinical features, rurality and survival to emergency department (ED) admission vary significantly between ORCA and non-ORCA. Methods: We evaluated the National Emergency Medical Services Information System data from 2016-2017 for all emergency 911 responses in which emergency medical services (EMS) reported non-traumatic out of hospital cardiac arrest (OOHCA). We defined ORCA as EMS suspected opioid overdose as the primary etiology, or an overdose without established etiology and naloxone administered during cardiopulmonary resuscitation (CPR). Rurality was assigned using Rural-Urban Commuting Area Codes (RUCA). Demographics and arrest-specific factors were compared between ORCA and non-ORCA, followed by logistic regression to evaluate how ORCA was associated with survival to ED admission. Results: There were 3131 EMS responses for OOHCA during the study period. One hundred sixty-eight (5%) patients met the definition of ORCA. These patients were younger (35 ± 9 years vs 62 ± 17 years, p<0.001), less likely to have the reported diagnosis or treatment for chronic medical conditions (p<0.001-0.02), an initial shockable rhythm (12% vs 28%, p<0.001), occur in a public place (13% vs 23%, p=0.02), or be witnessed (38% vs 60%, p<0.001), but more likely to receive bystander CPR (27% vs 16%, p<0.001) and report illicit drug use (19% vs 2%, p<0.001). ORCA was more likely to occur in metropolitan or large rural areas compared to small rural or isolated rural areas (75% vs 25%, p<0.001). After adjusting for age, gender, initial shockable rhythm, witnessed arrest, bystander CPR, and rurality, patients with ORCA had an increased odds of surviving to ED admission (OR 1.83 [CI 1.11-2.95]). Conclusions: Patients in Maine with ORCA are distinctly different from patients with non-ORCA, are more likely to survive to ED admission and are seen more commonly in metropolitan and large rural areas.

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THE QUALITY OF MEDICAL CARE IN MEDICAL ORGANIZATIONS OF MOSCOW PUBLIC HEALTH CARE SYSTEM IN APPRAISALS OF PATIENTS AND PHYSICIANS

Социология медицины ◽

10.18821/1728-2810-2017-16-2-100-106 ◽

2017 ◽

Vol 16 (2) ◽

pp. 100-106 ◽

Cited By ~ 1

Author(s):

I. Ya Tadjiev ◽

A. V Belostotsky ◽

S. S Budarin

Keyword(s):

Health Care ◽

Medical Care ◽

Medical Personnel ◽

Public Health Care ◽

Fee For Service ◽

Emergency Medical Care ◽

Emergency Medical ◽

Quality Of Medical Care ◽

High Level

The article presents the analysis of results of complex medical sociological survey of effectiveness and efficiency of medical care as main criteria of its quality and accessibility. The survey comprised 1,737 patients of various social groups of population of Moscow and 203 physicians of polyclinics. At self-rating of health, 13.2% of respondents determined it as unsatisfactory, 45.1% as satisfactory and 31.3% as good. In all population groups, the most called-for proved to be polyclinic institutions. The high level of satisfaction of patients with quality of emergency medical care was established in all groups. The quality of medical care in polyclinics and hospitals was assessed significantly lower. The most negatively assessed criteria turned out transition to fee-for-service forms of medical support and time limits of waiting for all modes of medical care, except emergency medical care and district therapist. The evaluation by physicians of their own activity and present problems is characterized by their unanimity in need of increasing of salary (100%) and increasing of typical sectoral standards of time of reception of a patient (96.5%), decreasing of intensity of work of medical personal (92.3%) and reduction of some forms of record cards with the purpose of releasing of time and attention of physician for a patient (88.4%). The disrespectful attitude of patients to medical personnel was mentioned by 77.3% of physicians which is a new phenomenon testifying loss of confidence in patient-physician relationship. The quality of implemented work was assessed equally and rather high by both young and experienced physicians. The positive and negative aspects of reorganization of health care were analyzed. Two alternatives of problems were established to focus plans of development of system of Moscow health care to support accessible and qualitative medical care of population.

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The emergency medical system

10.1093/med/9780199687039.003.0007 ◽

2015 ◽

Cited By ~ 1

Author(s):

Marc Sabbe ◽

K Bronselaer ◽

O Hoogmartens

Keyword(s):

Medical Care ◽

Emergency Medical Services ◽

Medical Services ◽

Emergency Medical Care ◽

Hospital Emergency ◽

High Quality Research ◽

Emergency Medical ◽

System P ◽

Quality Of Medical Care

The mission of the emergency medical services is to promote and support a system that provides timely, professional, and state-of-the art emergency medical care, including ambulance services, to anyone who is victim of a sudden injury or illness, at any time or location and at any phase of the emergency incident. These phases include lay people’s prevention and preparedness, occurrence of the problem, its detection, alarming of trained responders, help provided by bystanders and trained pre-hospital providers, transport to the appropriate hospital, and, if necessary, admission or transfer to a more appropriate hospital. In order to meet the goal outlined, emergency medical services must work closely with local and state officials—fire and rescue departments, other ambulance providers, hospitals, and other agencies—to foster a smooth functioning network. The term emergency medical services evolved to reflect a change from a simple system of ambulances, providing only transportation, to a system in which actual medical care is given at the scene and during transport. Medical supervision and/or participation of emergency medicine physicians in the emergency medical services systems contribute to the quality of medical care. This emergency medical services network must be capable of responding instantly and reliably around the clock, with well-trained, well-equipped personnel linked, as needed, through a strong communication system. Research plays an important role in conserving resources and improving the delivery of health care. This chapter gives an overview of the different aspects of emergency medical services and calls for high-quality research in pre-hospital emergency care in a true partnership between cardiologists and emergency physicians.

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Emergency response of medical force during the international exercise of the rescue services of Russia, Norway, Finland and Sweden – Barents Rescue-2017

Medico-Biological and Socio-Psychological Problems of Safety in Emergency Situations ◽

10.25016/2541-7487-2018-0-3-57-64 ◽

2018 ◽

pp. 57-64

Author(s):

Yu. V. Gudz ◽

S. S. Aleksanin ◽

V. Yu. Rybnikov ◽

O. A. Bashinskii

Keyword(s):

Medical Care ◽

First Aid ◽

Expert Assessment ◽

Emergency Medical Care ◽

Hospital Records ◽

Medical Evacuation ◽

Emergency Situations ◽

Rescue Services ◽

Emergency Medical

Relevance. The probability of emergency situations in the Barents region determines the need of improvement of forces and means of rendering first and emergency medical care to victims. In September 2017 the large-scale international exercise of rescue services of Russia, Norway, Sweden, and Finland under the code name “Barents-Rescue 2017” was carried out in the Republic of Karelia. The exercise worked oved rendering first-aid and emergency medical care to victims of emergency situations.Intention. To summarize experience in preparation, rendering and result assessment of first-aid and emergency medical care to victims of emergency situations in the framework of the international exercises.Methods. Medical document analysis (hospital records, medical triage records, expert assessment records), statistical analysis of groups using Student’s t-test. The exercise involved 76 victims with injuries of various severity levels, among them 30 were of minor severity, 19 were of medium severity and 27 were of heavy severity. They received first-aid and emergency medical care by 42 rescuers and 67 health workers (doctors, paramedics, nurses) of rescue services of Russia, Norway, Sweden, and Finland. Results assessment was made on the basis of the developed hospital records, medical triage records and expert assessment records and also statistical analysis methods.Result and their analysis. The average expert assessment of a first-aid rendered by rescuers was sufficiently high and was equal to 4.6 ± 0.1 on a 5-score rating system, where 5 points means providing full assistance in accordance with the established standards of its provision. A qualitative medical triage was provided competently, the ordering of evacuation was right, life-threatening damages and injuries were properly defined. At the stage of medical evacuation all the victims were provided with full assistance, there were no divergence of diagnoses, some differences from final diagnose were permissible at the stage of medical evacuation and had no effect on victim’s condition. In addition, a part of the victims in the hospital had medical cards, where was information about the diagnoses and the measures taken. These medical documents were also analyzed in terms of the timeliness and quality of the provision of specialized medical care to injured people in the hospital.Conclusion. The results of expert assessment during the international exercise of rescue services of Barents Rescue 2017 showed that the quality of first-aid, medical triage and emergency medical care during the evacuation and also in the hospital is high enough, but there were some remarks too. Suggestions and comments were addressed to the Exercise organizing committee to improve the engagement during first-aid and medical care to victim of the emergency and they were included in the final report on the exercise.

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Hospital Referral Patterns: How Emergency Medical Care Is Accessed in a Disaster

Disaster Medicine and Public Health Preparedness ◽

10.1001/dmp.2010.30 ◽

2010 ◽

Vol 4 (3) ◽

pp. 226-231 ◽

Cited By ~ 10

Author(s):

Michael J. Reilly ◽

David Markenson

Keyword(s):

Health Care ◽

Medical Care ◽

Emergency Medical Services ◽

Medical Services ◽

Major Incident ◽

Emergency Medical Care ◽

Referral Patterns ◽

Disaster Victims ◽

Emergency Medical ◽

The Impact

ABSTRACTBackground:A prevalent assumption in hospital emergency preparedness planning is that patient arrival from a disaster scene will occur through a coordinated system of patient distribution based on the number of victims, capabilities of the receiving hospitals, and the nature and severity of illness or injury. In spite of the strength of the emergency medical services system, case reports in the literature and major incident after-action reports have shown that most patients who present at a health care facility after a disaster or other major emergency do not necessarily arrive via ambulance. If these reports of arrival of patients outside an organized emergency medical services system are accurate, then hospitals should be planning differently for the impact of an unorganized influx of patients on the health care system. Hospitals need to consider alternative patterns of patient referral, including the mass convergence of self-referred patients, when performing major incident planning.Methods:We conducted a retrospective review of published studies from the past 25 years to identify reports of patient care during disasters or major emergency incidents that described the patients' method of arrival at the hospital. Using a structured mechanism, we aggregated and analyzed the data.Results:Detailed data on 8303 patients from more than 25 years of literature were collected. Many reports suggest that only a fraction of the patients who are treated in emergency departments following disasters arrive via ambulance, particularly in the early postincident stages of an event. Our 25 years of aggregate data suggest that only 36% of disaster victims are transported to hospitals via ambulance, whereas 63% use alternate means to seek emergency medical care.Conclusions:Hospitals should evaluate their emergency plans to consider the implications of alternate referral patterns of patients during a disaster. Additional consideration should be given to mass triage, site security, and the potential need for decontamination after a major incident.(Disaster Med Public Health Preparedness. 2010;4:226-231)

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