Notfallmedizin (D) – System and skill utilisation in an Austrian prehospital physician response system

Goal of the Study:

The number of calls for prehospital physician response systems has risen over the years all over Europe. This cannot be explained by the population growth alone. The present study aims to assess whether such an increase can be seen in Austria as well and whether prehospital physician response systems are used with good efficacy and efficiency.

Methods:

Retrospective study using data from the routine documentation database (MEDEA, iLOGs, Klagenfurt) of the prehospital physician response system located at the Medical University of Graz. Calls documented in the digital system between January 1^st, 2010 and December 31^st, 2018 were included in this study.

Calls were categorised into three categories according to skills performed on scene: Category I = need of a critical interventions (endotracheal intubation, mechanical ventilation, shock treatment and stabilisation of circulation); category II = lower acuity interventions (analgesia, sedation, anticonvulsive therapy, venous access and infusion therapy); category III = no medical therapy necessary or no patient encountered.

Results and Discussion:

15,732 call were documented in the observation time frame. Of these, the physician response unit was cancelled on route or did not encounter a patient on scene in 3687 (23.4%) cases. Overall utilisation of the system increased almost constantly over the years; while 1442 calls were answered to in 2010, the number of calls per year rose to 2301 in 2018.

Application of advanced skills was relatively rare; application rates of skills were (in descending order): venous access (8858, 56.3%), 12-lead ECG (3867, 24.6%), mechanical ventilation (1509, 9.6%), endotracheal intubation (1227, 7.8%), cardio-pulmonary resuscitation (1028, 6.5%), catecholamine therapy (788, 5.0%), arterial access (710, 4.5%) and non-invasive ventilation (506, 3.2%).

The increase in system utilisation per year can attributed to an increase in calls of all types (category 1, 2 and 3). There was a trend towards an emphasised increase in calls for medical interventions that would not necessarily require a prehospital care physician (category 2); these made up 709 (49.2%) calls in 2010 and 1221 (53,1%) in 2018. Figure 1 gives details.

Conclusion:

Current utilisation of prehospital physician response systems in Austria is suboptimal.

Fig. 1

References:

[1] Prause G, Kainz J. Entwicklung des Notarztwesens in Österreich – Development of the Physician Staffed Prehospital mergency Medical Service in Austria. Notarzt. 2014;30:258 – 60

[2] Prause G. Notfallmedizin – quo vadis?! Der Anaesthesist. 2002;51:957 – 8