key: cord-0772843-6dpi7vbl
authors: Krösbacher, Armin; Kaiser, Herbert; Holleis, Stefan; Schinnerl, Adolf; Neumayr, Agnes; Baubin, Michael
title: Evaluierung der Maßnahmen zur Reduktion von Notarzteinsätzen in Tirol während der COVID-19-Pandemie
date: 2021-02-10
journal: Anaesthesist
DOI: 10.1007/s00101-021-00915-w
sha: f33f848b41957d3f012a8f8e1aee7e73a39c6f34
doc_id: 772843
cord_uid: 6dpi7vbl

BACKGROUND: During the peak of the COVID-19 pandemic in spring 2020, the entire emergency rescue system was confronted with major challenges. Starting on 15 March, all tourists were asked to leave the State of Tyrol, Austria. The main goal of the efforts was to ensure the usual quality of emergency medical care while reducing the physical contact during emergency interventions on site. METHODS: The Austrian Emergency Medical Service is physician-based, meaning that in addition to an ambulance team, an emergency physician (EP) is dispatched to every potential life-threatening emergency call. In Tyrol and starting on 17 March 2020, 413 types of emergency call dispatches, which were addressed with an ambulance crew as well as an EP crew before COVID-19, were now dispatched only with an ambulance crew. This procedure of dispatching differently as well as the general development of emergency calls during this period were analyzed from 15 March to 15 May 2020 and compared to the data from the same time period from 2017 to 2019. RESULTS: Despite the reduction of the population of around 30% because of absent tourists and foreign students staying in Tyrol, emergency calls with the operational keyword “difficulty in breathing/shortness of breath” rose by 18.7% (1533 vs. 1291), while calls due to traffic incidents decreased by 26.4% (2937 vs. 2161). Emergency calls with the dispatch of teams with an EP were reduced by 38.5% (1511 vs. 2456.3), whereby the NACA scores III and IV were the ones with the significant reduction of 40% each. For the reduced dispatchs, the additional dispatch of an EP team by the ambulance team amounted to 14.5%; however, for the keywords “unconscious/fainting” and “convulsions/seizures” the additional dispatch was significantly higher with over 40% each. DISCUSSION: There was an overall reduction of emergency calls. Considering, that the reduced dispatches would have led to an EP team dispatch the overall emergency doctor dispatches would have been higher than in the years before. Our study was not able to find the reasons for this increase. Only considering the additional dispatching of EPs, was this reduction in dispatching EP teams highly accurate, except for the symptoms of “unconscious/fainting” and “convulsions/seizures”; however, the actual diagnoses that the hospitals or GPs made could not be collected for this study. Therefore, it cannot be said for sure that there was equality in the quality of emergency medical care. CONCLUSION: It was possible to achieve the primary goal of reducing the physical contact with patients; however, before keeping these reductions of the dispatching order regarding. EPs for the routine operation, adaptions in these reductions as well as deeper evaluations under consideration of the data from hospitals and GPs would be necessary. Also, different options to reduce physical contact should be evaluated, e.g. building an EMT-led scout team to evaluate the patient’s status while the EP team is waiting outside.

Zur optimalen Verwendung der bodengebundenen notärztlichen Einsatzmittel und zur Sicherstellung der kontinuierlichen notärztlichen Versorgung der Bevölkerung, auch im Hinblick auf evtl. COVID-19-Erkrankungen des Personals, wurde durch den Ärztlichen Leiter Rettungsdienst des Landes Tirol (ÄLRD) die Ausrückordnung für Notarztrettungsmittel reduziert. Die initiale Mitalarmierung von Notarztmittel wurde auf jene Fälle beschränkt, in denen aus den Einsatzdaten der vorherigen Jahre eine hohe Wahrscheinlichkeit für tatsächlich notarztpflichtige Patienten besteht. Wie aus den Daten 2019 hervorgeht, ist die Anzahl der Notarztstornierungen in Tirol mit im Schnitt 8,8 % relativ hoch; in sehr einsatzstarken Regionen wie Innsbruck-Stadt beträgt die Rate 21,9 % ( [4] ; . Tab. 1).

Insgesamt wurden 413 vormals notarztpflichtige Abfrageergebnisse definiert, welche nun primär ohne Notarzt alarmiert wurden. Diese Einsätze werden gemäß dem Abfragesystem der Leitstelle Tirol durch Einführung des neuen Einsatzcodes "B0" als B0-Einsätze bezeichnet.

Die COVID-19-Hochphase in Tirol erstreckte sich vom 15. 03 

Anaesthesist https://doi.org/10.1007/s00101-021-00915-w © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2021 

Notarztnachforderung · Notarztdienst · Rettungswesen · Notarztindikationen · Notarztreduktion Evaluation of measures to reduce the number of emergency physician missions in Tyrol during the COVID-19 pandemic Abstract Background. During the peak of the COVID-19 pandemic in spring 2020, the entire emergency rescue system was confronted with major challenges. Starting on 15 March, all tourists were asked to leave the State of Tyrol, Austria. The main goal of the efforts was to ensure the usual quality of emergency medical care while reducing the physical contact during emergency interventions on site.

Service is physician-based, meaning that in addition to an ambulance team, an emergency physician (EP) is dispatched to every potential life-threatening emergency call. In Tyrol and starting on 17 March 2020, 413 types of emergency call dispatches, which were addressed with an ambulance crew as well as an EP crew before COVID-19, were now dispatched only with an ambulance crew. This procedure of dispatching differently as well as the general development of emergency calls during this period were analyzed from 15 March to 15 May 2020 and compared to the data from the same time period from 2017 to 2019.

Despite the reduction of the population of around 30% because of absent tourists and foreign students staying in Tyrol, emergency calls with the operational keyword "difficulty in breathing/shortness of breath" rose by 18.7% (1533 vs. 1291), while calls due to traffic incidents decreased by 26.4% (2937 vs. 2161). Emergency calls with the dispatch of teams with an EP were reduced by 38.5% (1511 vs. 2456.3), whereby the NACA scores III and IV were the ones with the significant reduction of 40% each. For the reduced dispatchs, the additional dispatch of an EP team by the ambulance team amounted to 14.5%; however, for the keywords "unconscious/fainting" and "convulsions/seizures" the additional dispatch was significantly higher with over 40% each. Discussion. There was an overall reduction of emergency calls. Considering, that the reduced dispatches would have led to an EP team dispatch the overall emergency doctor dispatches would have been higher than in the years before. Our study was not able to find the reasons for this increase. Only considering the additional dispatching of EPs, was this reduction in dispatching EP teams highly accurate, except for the symptoms of "unconscious/fainting" and "convulsions/seizures"; however, the actual diagnoses that the hospitals or GPs made could not be collected for this study. Therefore, it cannot be said for sure that there was equality in the quality of emergency medical care. Conclusion. It was possible to achieve the primary goal of reducing the physical contact with patients; however, before keeping these reductions of the dispatching order regarding. EPs for the routine operation, adaptions in these reductions as well as deeper evaluations under consideration of the data from hospitals and GPs would be necessary. Also, different options to reduce physical contact should be evaluated, e.g. building an EMT-led scout team to evaluate the patient's status while the EP team is waiting outside.

Additional dispatch · EMS · Emergency doctor · Paramedic · Ambulance service Der Anaesthesist Betrachtet man die notärztlichen Beurteilungen dieser Nachforderungen anhand des NACA-Scores fällt eine im Vergleichzu dendirektenAlarmierungen geringere Rate an NACA-I-und NACA-II-Fällen als im Vergleichszeitraum (NACA I 1,4 % vs. 1,9 %, NACA II 7,8 % vs. 13,3 %) auf. Dies spricht für einen geringen Anteil an nichtnotarztpflichtigen Patientinnen und Patienten und damit eine hohe Genauigkeit dieser Nachforderungen. Gleichzeitig finden sich innerhalb der Notarztnachforderungen auch 3 NACA-VI-(Reanimation) und 2 NACA-VII-(verstorben) Einsätze. Diese 5 Reanimationen stellen mit 0,4 % der B0-Einsätze zwar nur einen sehr kleinen Teil des Gesamtaufkommens dar, sollten aufgrund der absoluten Lebensbedrohung dennoch beachtet werden. Alle 3 NACA-VI-Einsätze und einer der beiden NACA-VII-Einsätze fanden unter dem Einsatzstichwort "Bewusstlosigkeit" statt, welche ohnehin eine hohe Nachforderungsrate aufweist und damit generell kritisch hinterfragt werden sollte. Des Weiteren sollte bedacht werden, dass gerade bei Reanimationen aufgrund der hohen Trainingsfrequenz und der technischen Möglichkeiten eines RTW-Teams (Defibrillation, Atemwegssicherung mittels Larynxtubus, evtl. Medikamentengabe) die Zeit bis zum Eintreffen eines Notarztes hochqualitativ überbrückt werden kann.

Diese Studie unterliegt mehreren Limitationen. Der Vergleich sämtlicher Einsatzzahlen mit den Vorjahren ist nur eingeschränkt möglich, da nicht eindeutig erhoben werden kann, wie viele Menschen sich im Laufe der Krise wirklich in Tirol befunden haben. Die zu versorgende Bevölkerung ändert sich nicht nur mit dem Tourismus, auch die Studierenden v. a. in der Landeshauptstadt Innsbruck sowie die evtl. abgereisten Arbeitskräfte im Gastgewerbe und der Freizeitwirtschaft können einen Einfluss haben.

Des Weiteren unterliegen die der Studie zugrunde liegendenZahleneinerkleinen Schwankungsbreite durch gelegent-

Strategies to handle increased demand in the COVID-19 crisis: a Coronavirus EMS support track and a web-based self-triage system

Delayed access or provision of care in Italy resulting from fear of COVID-19

Effect of the Coronavirus disease 2019 (COVID-19) pandemic on the U.S. emergency medical services system: a preliminary report

liche Sondersituationen wie umgeleitete RTW oder Notarztmittel.Die größte Limitation der Studie liegt in der fehlenden Möglichkeit der Evaluierung des Berufungsgrundes. Da in der Studie mit ausschließlich anonymisierten Daten gearbeitet wurde, ist die Bestätigung der im Notrufgespräch erstellten Verdachtsdiagnose mit der im Krankenhaus real getroffenen Diagnose nicht möglich. Insbesondere kann mit dieser Studie gezeigt werden, dass die notärztliche Nachforderungsrate bei B0-Einsätzen in der Regel im normalen Durchschnitt liegt. Ob diese Patienten jedoch nicht dennoch von einer notärztlichen Versorgung profitiert hätten, lässt sich nicht beurteilen. Da sich diese Unklarheit aber auch auf die Vorjahresdaten bezieht, erscheint zumindest der quantitative Vergleich zu den Vorjahren legitim.