Use of pre-hospital emergency medical services in urban and rural municipalities over a 10 year period: an observational study based on routinely collected dispatch data

Abstract

Background Pre-hospital emergency medical services (EMS) are an integral part of emergency medical care. EMS planning can be achieved by analyzing patterns of use. However, long-term time trends of EMS use have rarely been studied. The objective of this retrospective study was to investigate utilization patterns over a ten year period, and to compare utilization trends between urban and rural municipalities and between events with and without prehospital emergency physician (PEP) dispatch. Methods Routine data collected by 26 dispatch centers in the federal state of Bavaria, Germany, from 2007 to 2016 was analyzed. Emergency locations were classified into five levels of rurality. Negative binomial mixed effects regression models were fitted to predict emergency rates and to investigate differences in rates and utilization trends. Graphical representation methods were used to compare distribution of transport rates and distribution across daytime and weekday. Results Twelve million two hundred thousand one hundred fifty-five dispatches assigned to 7,725,636 single emergencies were included. The mean number of emergencies per year and 1000 population (emergency rate) was 42.8 (±16.0) in rural municipalities and 80.7 (±9.3) in large cities. Compared to rural municipalities, cities had higher emergency rates without (IRR = 3.0, CI 2.2–4.0) and with pre-hospital physicians (IRR = 1.5, CI 1.2–2.0). Between 2007 and 2016, the absolute number of emergencies increased by 49.1%. Estimated annual percent change of emergency rates without physician activation ranged from 5.7% (CI 4.3–7.1) in cities to 7.8% (CI 7.6–7.9) in rural areas. Changes in emergency rates with physician attendance were lower, with estimated increases between 1.3 and 2.4%. The average proportion of patients transported to a hospital was lower in cities and remained unchanged. There were no considerable differences or changes in the distribution across daytime and weekdays. Conclusion Differences between cities and other areas suggest that the planning of EMS should be targeted to regional characteristics. A substantial increase in emergency rates was observed across all areas of Bavaria, but did not impact transport rates or temporal distributions. Further research is needed to better understand the urgency of emergency events and reasons behind increasing EMS utilization.

Accuracy of prehospital point‐of‐care lactate in early in‐hospital mortality

“…7,14,21,22 F I G U R E 1 Flow chart showing analysis population. 1 On-site resolution: either the ALS physician has been able to stabilize the patient on the scene and his/her condition was no longer serious or once the patient has been evaluated it was found that he/she does not needed any type of manoeuvre or be transferred to the ED. 2 Risk on scene: situations with weapons on the scene, aggressive patients, traffic accidents with risk of fire or explosion, etc In order to study pLA triggers or cut-off points we used already described thresholds.…”

“…Emergency medical services (EMS) deal on the scene and en route with complex patients suffering from acute pathologies usually presenting several comorbidities. 1 Such scenarios are faced by the EMS workers with very limited diagnostic information which hampers their clinical decisions. 2 There is today a growing interest in detecting bed-side situations which require rapid clinical responses.…”

Differences between cases admitted to hospital and discharged from the emergency department after emergency medical services transport

“…Demand for EMS in Germany is rising, with an increase of 105% since 2001 1. An increase in EMS activation in both, urban and rural regions of Bavaria was observed over the past 10 years 2. Rising use of EMS and emergency departments (ED) contributes to ED crowding and scarcity of hospital admission capacities.…”

Which health-related reasons lead to prehospital emergency care and how does subjective emergency status connect to subsequent care?

“…Similarly, a "transport" itself and especially "transports to hospitals" seem to be inadequate objective indicators: Germany's rate of EMS transports per case is higher than in other European countries [26,27] and the U.S. [28]. Analysis of Bavarian dispatch data hint that about 20% of the patients are not transported to a hospital [29]. Schmiedel and Behrendt [2] estimated for Germany that 9% without and 6% of all prehospital emergency care cases with physicians are cases without transports, procedures or being cancelled prior to arrival.…”