Analysis of 67,975 Emergency Deployments in a Major German City – Criteria for More Efficient Dispatching of Emergency Physicians

Efficient dispatching of physician-staffed vehicles in emergency medical services requires clear criteria to ensure timely allocation of resources, improve patient outcomes, and minimize response time under high-pressure conditions. The aim of this study was to identify criteria ensuring that emergency physicians are safely managed and efficiently deployed.
Rescue service deployments in the city of Dresden, Germany (01/01/2021–12/31/2021), were analyzed retrospectively. The rescue mission indications determined by the telecommunicator, along with the presence of vital sign abnormalities at site – such as airway, breathing, circulation, and disability – based on the ABCDE approach from the Advanced Life Support and Advanced Trauma Life Support algorithms, were analyzed. Specific emergency medical procedures carried out in the particular mission were assigned to the respective competence level (CL): CL1: invasive measures reserved for physicians; CL2: invasive measures that paramedics are trained to use independently in emergency situations; CL3: standard measures; CL4: counseling only; and CL5: no measures.
In all, 67,975 missions were analyzed. Missions were most frequently dispatched for internal indications, such as cardiovascular and pulmonary emergencies (28.4%), and traumatological indications (20.4%). Despite the physician being dispatched in 36.5% of cases, invasive measures (CL1/CL2) were only used in 13.9% of missions. Internal indications (11.8%) and resuscitation (19.6%) frequently required CL1 measures. CL2 measures were more frequently applied than CL1 measures for allergic (44.2% vs. 1.9%), neurological (12.5% vs. 3.4%), and psychological (6.1% vs. 0.7%) indications. In most interventions (62.2%), only the standard competencies (CL3) were used as the highest level of competence. For most mission indications, the probability of invasive measures (CL1/CL2) increased significantly in the presence of at least one vital sign abnormality.
The results show opportunities for optimizing emergency physician dispatch. The presence of a vital sign abnormality should be given greater consideration in the future. Query algorithms for detecting cases with a high probability of requiring CL1/CL2 measures could support efficient dispatching. Furthermore, emergencies requiring CL2 but rarely CL1 measures could be handled independently by emergency paramedics, particularly if they have access to the support of a tele-emergency physician for situations where CL1 measures become necessary.

急诊医疗服务（Emergency Medical Services）中配备医师的急救车辆高效调度，需依托明确的判定标准，方可在高压作业环境中保障资源及时配置、改善患者预后并缩短响应时长。本研究旨在明确可保障急诊医师安全调配与高效部署的判定标准。
本研究回顾性分析了德国德累斯顿市2021年1月1日至2021年12月31日期间的全部急救调度任务。研究分析了由急救调度员（Telecommunicator）确定的急救任务指征，以及现场基于高级生命支持（Advanced Life Support, ALS）与高级创伤生命支持（Advanced Trauma Life Support, ATLS）算法的ABCDE评估法（ABCDE Approach）所判定的生命体征异常情况，涵盖气道、呼吸、循环与意识障碍四大维度。本次研究将单次急救任务中实施的特定急诊医疗操作，划归至对应的能力层级（Competence Level, CL）：CL1为仅医师可实施的有创操作；CL2为急救员（Paramedics）经培训可在急救场景下独立开展的有创操作；CL3为常规操作；CL4为仅提供咨询服务；CL5为无需实施任何操作。
本研究共计分析67975例急救任务。其中，因内科指征调度的任务占比最高，包括心血管与肺部急症（28.4%），以及创伤类指征（20.4%）。尽管36.5%的任务调度了急诊医师，但仅13.9%的任务实施了有创操作（CL1/CL2）。内科指征场景（11.8%）与复苏操作（19.6%）下，CL1操作的使用频次较高。针对过敏（44.2% vs 1.9%）、神经科（12.5% vs 3.4%）与精神科（6.1% vs 0.7%）指征，CL2操作的应用频次显著高于CL1操作。在多数急救干预（62.2%）中，仅以常规能力层级（CL3）作为最高实施标准。针对绝大多数急救任务指征，当存在至少一项生命体征异常时，实施有创操作（CL1/CL2）的概率显著升高。
研究结果显示，急诊医师调度流程存在明确优化空间。未来应进一步重视生命体征异常这一关键参考指标。可开发用于识别高概率需实施CL1/CL2操作病例的查询算法，以辅助实现高效调度。此外，仅需CL2操作、极少需要CL1操作的急诊场景，可由急救员独立处置；若后续需实施CL1操作时，急救员可通过远程急诊医师（Tele-emergency Physician）获得支持。