Whether it's a heart attack or a serious road accident - many people owe their lives to the rapid deployment of emergency doctors and paramedics. However, not all emergencies to which emergency services are called are actually life-threatening. And in some cases, on-site care may even be sufficient. But it is precisely these cases that have apparently increased in recent years, and rescue services and emergency departments are overloaded.
Against this backdrop, the two-year pilot project "Community Emergency Paramedics" was launched, financed by the AOK Lower Saxony and the Association of Substitute Health Insurance Funds (VdEK) Lower Saxony. The idea: through special further education with practical work shadowing, the community emergency paramedics should be able to provide on-site assistance in cases that do not appear to be emergencies when the emergency services are called.
An interdisciplinary team from the University's Department of Health Services Research is providing scientific support for the project: the research team wants to find out whether and how community paramedics actually help to reduce the high workload of emergency departments and ambulance services.
Grateful for help
Since the beginning of the year, the "Oldenburg Research Network for Emergency and Intensive Care Medicine" has been analysing the deployments of community paramedics with the help of questionnaires. The questionnaires focus, for example, on how urgent the care was or whether additional rescue resources were required. The initial results indicate a positive effect of the new paramedics. "Most patients are grateful for the help they receive," reports Dr Insa Seeger, coordinator of the research network.
"Apparently, the patients cared for by the paramedics can often stay in their home environment and don't have to go to hospital," adds the expert. This is also shown by the evaluation of around 1,700 deployment protocols from the first half of the year: for around 60 per cent of patients, transport to hospital was not medically necessary. After taking a medical history and recording vital signs, counselling and measures such as help with self-medication were often sufficient to ensure initial treatment.
Seeger believes that this is an important initial result for everyone involved, which is encouraging. "Together with my team, we regularly present our analyses and results to the project partners. This allows them to react quickly to new findings and developments," emphasises Seeger. The Oldenburg professional fire brigade, the German Red Cross Cloppenburg, Malteser Hilfsdienste Oldenburg and Vechta, the Ammerland rescue service, the Oldenburger Land large-scale control centre and the Vechta control centre are all involved in the project with the community emergency paramedics.
Focus on care
Thanks to funding from the Innovation Committee of the Joint Federal Committee (GBA) - the highest decision-making body of the joint self-administration in the German healthcare system - the scientists can now expand their accompanying research. The partners from the universities of Oldenburg, Aachen, Maastricht and Magdeburg will receive 1.1 million euros from 2020 to investigate how the community paramedic project is proving itself in practice in their project "Utilisation, services and effects of the community paramedic (ILEG)".
In future, the researchers want to analyse control centre, rescue service and emergency admission register data in addition to the community paramedic protocols. Patient and GP surveys are also planned. "In this way, we want to show how the deployment of community paramedics has actually changed the utilisation of rescue services and emergency admissions," explains Seeger.
The focus will also be on the actual care provided to patients - from the initial report to the control centre through to any treatment that may take place in a further care facility. The experts also want to analyse in which cases the community paramedics are deployed and what specific services they provide.
Insight into the need for community paramedics
To this end, the care researchers will survey around a thousand patients in four municipalities in north-west Lower Saxony (city of Oldenburg, district of Ammerland, district of Vechta, district of Ammerland) from January 2020. In order to clarify how the patients' treatment actually continued after the paramedics were deployed, the researchers analysed data that was recorded in the emergency department or on discharge from hospital, for example.
Tracking further treatment in particular enables the researchers to assess whether the assessments made by control centre dispatchers and community paramedics were correct. And whether the targeted alerting of paramedics actually reduces the number of call-outs to the emergency services and thus relieves the burden on emergency care. The researchers hope that the results could not only provide information on the need for community paramedics, but also on special training requirements or whether and how the guidelines for control centre dispatchers need to be adapted.