Transcript The German Emergency Medical Services

Status of Emergency Medicine
Around the World
EMERGENCY MEDICINE
IN GERMANY
PROF.DR.W.F.DICK
OVERVIEW
• Descriptive information/statistics
– Country information
– EM-Specialty status
– EM system information
• Challenges/innovative strategies
• Summary
COUNTRY INFORMATION 1
• Federal Republic of Germany
• Inhabitants:83 Mio (2001): 231 / Sqkm
• Age: 0-14 y -12.6 Mio :15- 65y - 55.7 Mio:
> 65 y -14.0 Mio
• Climate:Moderate
• Finance:
Compulsory Insurance
• GNP/Capita:
24.650 €
COUNTRY INFORMATION 2
„Burden of diseases“
• Life expectancy (years) : 81 F - 75 M
• Major causes of mortality: 828.541 total
–
–
–
–
–
–
Cardiovascular
Malignancy
Endocrine diseases:
Respiratory diseases
Trauma/Intoxications etc.
Various others
30 %
10 %
3%
6%
4%
48 %
COUNTRY INFORMATION 3
Health Care System
• Health Care System :Nat./Reg./Pub./Priv.
• Insurance compulsory: Public/Private
• Hospitals(except milit.): 2.240
of different categories
University Hospitals:
40
* Hospital beds (2001):
550.000 (80%)
COUNTRY INFORMATION 4
MEDICAL EDUCATION
• Number of Medical Schools:
• Length of study:
• PG Training leading to
spezialisation
• Medical Specialty Board
certification
40
6 years
5-6 years
Final exam
CONTACT INTERVALS
• The German EMSS has to guarantee
a call-to-patient-contact-interval of:
- 10 minutes in 80 %
- 15 minutes in 90 %
of all cases
EM-SPECIALTY STATUS
• EM is recognized as a supraspecialty to...
not as a specialty of its own
• Recognizing bodies are regional medical
councils
• Officially recognized for 2-10 years
• Board certification process consists of a
training program and a final exam
EM-SUPRASPECIALTY STATUS 1
In addition to the curriculum of the base
specialty, trainees have to undergo:
• 30 months hospital practice in emergency
care, including 6 months ICU,ED and/or
anesthesia under supervision and
instruction of a state certified trainer........
EM-SUPRASPECIALTY STATUS 2
• 50 prehospital emergency operations(MLSU,
helicopter etc.)under the guidance of an
experienced EMPhy.
• A course program of 80 credit hours on general
and special aspects of emergency medicine
• Final examination at regional medical councils
EM-SUPRASPECIALTY STATUS 3
•
•
•
•
•
•
1.Flight physiology
2.Medical equipment
3.Transport media
4.Flight safety
5.Documentation/TQM
6.Case scenarios
2h
4h
4h
4h
2h
2h
EM-SUPRASPECIALTY STATUS 4
• Red Cross and comparable organisations
are concerned with prehospital EM
(anesthesiologists, internists, surgeons
pediatricians )
• In-hospital emergency care is provided by
different specialties
EM-SYSTEM INFORMATION 1
• Health Care is a responsibility of the
Federal Government
• EM is a resonsibility of State Governments
• EM is considered as part of the transport
system
• The EMS operates on local level
EM-SYSTEM INFORMATION 2
• Prehospital emergency care
Type of ambulances: Basic ( 2 EMTs)
Advanced(1 Param.
+1 EMT)
MLSU( EMPhys..+ 2 Param.)
- EMT :
6 months
- Paramedic : 2 years
- EMPhys. : s.above
EM-SYSTEM INFORMATION 3
DISPATCH MECHANISM
Bystander to dispatch center
public telephone or cellular phone
Dispatch center (paramedics + EMTs)
to ambulance or MLSU (paramedics)
via radio communication
EM-SYSTEM INFORMATION 4
FUNDING
Funding is provided by health care insurance
companies on a fee for service basis
• EMS-budget : < than 1 % of the total health care
budget ( 1.25 Bio. € of 325 Bio.€ / year)
• Expenses /operation
-Regular ambulance : 75 to 200 €
-MLSU :
400 €
-Helicopter :
40 €/Min
EM-SYSTEM INFORMATION
IN-HOSPITAL EMERGENCY CARE
• The scope of patient care provided depends
on the case and the hospital category :
–
–
–
–
Basic Care
Intermediate Care
Maximum Care
„Supramaximum Care“
EM-SYSTEM INFORMATION
IN-HOSPITAL EMERGENCY CARE 2
• Intermediate and some maximum care hospitals
provide emergency care in one central ED;
• other maximum and all supramaximum care
hospitals provide EM in 2-3 separate „receiving
areas“(surgical,internal,pediatric)
• Accordingly,the multispecialty approach is
common, but based upon close cooperation with
other hospital departments
CHALLENGES AND STRATEGIES
• TOP CHALLENGES
1.EM is part of the public transport system
2.There is no general emergency phone number
3.Bystander preparedness is limited
4.Paramedic training program is under revision
5.Status and number of EMS-Medical Directors
is insufficient
CHALLENGES AND STRATEGIES I
• TOP CHALLENGES
1.Legislation requires EMS to be a component
of the public transport system;
i.e.the system is underfinanced due to the
reimbursement system rather than by on scene
patient care
CHALLENGES AND STRATEGIES 1
• TOP CHALLENGES
2.There is no general public emergency phone
number
An emergency patient can either call 112 via
cellular phone or 110 (Police) 112(fire fighters),
19222 (EMS dispatch center)or 19292(office
based physicians)
CHALLENGES AND STRATEGIES I
• TOP CHALLENGES:
3.Bystander preparedness is limited
According to study figures,only between 10 and
30 % of bystanders are prepared or willing to carry
out first aid measures.
Ministeries and school administrations are rarely
helpful in improving the situation
CHALLENGES AND STRATEGIES I
• TOP CHALLENGES:
4. Paramedic training programs are under
revision:
The present 2- year training program is under
revision with respect to the status of
paramedics,their skills and capabilities
CHALLENGES AND STRATEGIES I
• TOP CHALLENGES
5.Installation of EMS-Medical Directors
is insufficient
Among the various EMS-organisations,regional
Red Cross branches entirely oppose the
installation of the position of a medical
EMS director responsible for all organisations
CHALLENGES AND STRATEGIES II
• Mechanisms by which strategies are developed
and implemented are:
- Discussion and development in GMC-councils,
critical care organisations etc.
- Presentation to the „Standing Conference of EM“
- Presentation to the political committees and
organisations
- Public hearings etc.
SUMMARY 1
• MAJOR POINTS
Country information
Specialty and supraspecialty status situation
System information
Dispatch mechanism information
Funding mechanism information
In-hospital emergency care situation
Challenges and strategies
SUMMARY 2
• CONCLUSIONS
+ All patients are financially covered(Insurances)
+ The system works fairly well ; however
- Structure and funding need to be improved
- Prehospital - and immediate in-hospital care
have to be integrated
- One common emergency number ist needed
- Status of Medical Directors has to be improved
THANK YOU
Any
QUESTIONS?