| Popis: |
Background The number of operations by the German emergency medical service almost doubled between 1994 and 2016. The associated expenses increased by 380 % in a similar period. Operations with treatment on-site, which retrospectively proved to be misallocated (OFF-Missions), have a substantial proportion of the assignment of the emergency medical service (EMS). Besides OFF-Missions, operations with patient transport play a dominant role (named as ON-Missions). The aim of this study is to work out the medical and economic relevance of both operation types.Methods This analysis examined N=819,780 missions of the EMS and patient transport service (PTS) in the catchment area of the emergency medical control center (EMCC) Bad Kreuznach over the period from 01/01/2007 to 12/31/2016 in terms of triage and disposition, urban-rural distribution, duration of operations and economic relevance (pResults 53.4 % of ON-Missions are triaged with the indication non-life-threatening patient transport; however, 63.7 % are processed by the devices of the EMS. Within the OFF-Mission cohort, 78.2 % and 85.8 % are triaged or dispatched for the EMS. 74 % of all ON-Missions are located in urban areas, 26 % in rural areas; 81.3 % of rural operations are performed by the EMS. 66 % of OFF-Missions are in cities. 93.2 % of the remaining 34 % of operations in rural locations are also performed by the EMS. The odds for both ON- and OFF-Missions in rural areas are significantly higher than for PTS (ORON 3.6, 95 % CI 3.21-3.30; OROFF 3.18, 95 % CI 3.04-3.32). OFF-Missions last 47.2 minutes (SD 42.3; CI 46.9-47.4), while ON-Missions are processed after 79.7 minutes on average (SD 47.6; CI 79.6-79.9). ON-Missions generated a turnover of more than € 114 million, while OFF-Missions made a loss of almost € 13 million.Conclusions This study particularly highlights the increasing utilization of emergency devices; especially in OFF-Missions, the resources of the EMS have a higher number of operations than PTS. OFF-Missions cause immensely high costs due to misallocations from an economic point of view. Appropriate patient management appears necessary from both medical and economic perspective, which requires multiple solution approaches. |
