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

Abstract

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/