This research project aims to develop needs-based care services for low-priority requests for assistance in rescue control centres via the 112 number.
To this end, the data collected using structured and (internationally) standardised query and decision support software and the secondary data recorded in the dispatch system for low-priority requests for assistance received via the emergency number 112 in the Oldenburger Land (GOL) large-scale control centre will be analysed. Based on these results, case studies will be defined and discussed in focus group interviews with the aim of evaluating the actual need for care options for low-priority requests for assistance and identifying use cases with possible care paths.

The project is funded by the Central Institute of Statutory Health Insurance Physicians.

High-quality healthcare, close to the person seeking help, even if a doctor is not on site, that is the goal of the project "Smart Emergency - rescue services newly networked! 5G telemedicine networking". To this end, the potential of 5G for innovative medical care for patients in rural areas is to be tapped and the players in the healthcare system are to be more closely networked. In this way, challenges such as a high workload for nursing staff, a low density of doctors, a shortage of specialists and an increasing volume of emergency care can be addressed.

A 5G telemedicine case, which combines medical devices as basic elements and innovative applications such as augmented reality glasses, will be tested under ideal 5G conditions as part of this project where scarce resources are particularly valuable - in a retirement and nursing home and a hospital in the district of Cloppenburg, in order to test both non-acute teleconsultation hours and emergency care as areas of application.

To create the necessary 5G infrastructure, campus networks are being installed to ensure real-time vital data transmission, stable high-quality telemedical video connections and the functionality of medical devices. The long-term goal is to be able to transfer the tested applications to mobile use cases, such as the emergency services, on a large scale as the 5G mobile communications infrastructure expands.

The project, which is being funded by the Federal Ministry of Digital and Transport for three years, will be scientifically monitored and evaluated by the Oldenburg Research Network for Emergency and Intensive Care Medicine at the University of Oldenburg from December 2021. The applicant is the district of Cloppenburg, other partners are Ernst & Young GmbH Wirtschaftsprüfungsgesellschaft, St. Pius-Stift Cloppenburg, St. Josefs-Hospital Cloppenburg, Cloppenburg gGmbH, Klinikum Oldenburg AöR and ZTM Bad Kissingen GmbH

For a number of years now, the number of call-outs to the emergency services has been rising steadily. This is not due to an increase in life-threatening emergencies. Rather, the number of call-outs has increased where on-site care would be sufficient. Due to a lack of alternatives, the rescue coordination centres have not been able to adequately support patients in their unclear but non-life-threatening situation. Against this background, the health insurance-funded project "Community emergency paramedic" project was jointly developed by several partners - the Oldenburg professional fire brigade, the German Red Cross Cloppenburg, Malteser Hilfsdienst Oldenburg and Vechta and the Ammerland rescue service - and went live on 2 January 2019.

A total of 25 "community emergency paramedics" with additional training are on duty. In the event of an unclear request for assistance below the emergency threshold, the rescue coordination centre deploys the community emergency paramedic as a medical specialist on site and thus obtains a clear picture.
The aim is to avoid having to send an ambulance originally intended for emergency rescue directly to low-threshold operations. On site, the community paramedic provides direct assistance and, if necessary, draws on the network of outpatient care by seeking contact with the relevant authorities or the family doctor.
The community paramedic can also access telemedical support from the Oldenburg Clinical Centre if required to provide support in the emergency situation.

The project is being scientifically monitored and evaluated by the Oldenburg Research Network for Emergency and Intensive Care Medicine, Maastricht University and Oldenburg Hospital.

The care of patients in emergency situations is one of the most important tasks in the healthcare sector. In recent years, the number of patients in emergency departments and ambulance services has risen steadily, while the number of emergencies handled by on-call doctors has continued to fall. Expenditure on rescue services has risen enormously during this period: In 2005, a total of 2.6 million euros was spent on rescue services while in 2015 it was already 4.6 million euros. However, this is not due to an increase in life-threatening emergencies. Rather, more patients are using the ambulance service or emergency departments even though they could actually be treated locally. In four municipalities in the Oldenburg region, "community emergency paramedics" are helping to relieve the pressure on ambulance services and emergency centres. They assess the patient's emergency situation and treat them on site if necessary. If possible, the community paramedics also decide on further treatment. Community paramedics are deployed when a life-threatening injury or illness has already been ruled out by the control centre, but without personal contact with the patient it is not possible to decide whether they should be referred to another care facility.

The aim of the research project is to show the changes in the utilisation of ambulance services and emergency departments as a result of the deployment of community paramedics. In addition, the further care of patients will be mapped and, at the same time, data on safety and quality of care will be collected and evaluated. It is planned to evaluate control centre, ambulance service and emergency admission register data. In addition, patient and general practitioner surveys will be conducted. In this way, the researchers involved want to obtain a data basis to steer the project and, if necessary, expand it to other districts. The project will be funded for two and a half years with a total of around 1.1 million euros, with the project starting on 1 July 2020.

Consortium partners

Maastricht University; Otto von Guericke University Magdeburg; Rheinisch-Westfälische Technische Hochschule Aachen

Further information

• Information sheet for patients
• Information sheet GP
• Data protection concept
• Draft vote

In the ‘NurBeat’ study onneurological respiratory care, detailed key figures relating to the structures of neurological respiratory care – specifically bed capacity, equipment, staffing and qualifications, as well as treatment methods and approaches, and the characteristics of the patients treated there. The data collected is intended to contribute to an understanding of the existing facilities, to the establishment of necessary structural criteria, and to the improvement of patient care.

Background

In the field of neurological respiratory medicine, the healthcare landscape in Germany has undergone a significant expansion and specialisation over the past decade. Three specialist areas can be distinguished within neurological respiratory medicine:

• ventilation in acute neuro-intensive care
• weaning and early neurological and neurosurgical rehabilitation involving ventilation, which may include the treatment of patients with spinal cord injury
• ventilation for neuromuscular patients with progressive ventilatory insufficiency

The exact bed capacities in neurological respiratory medicine are just as unknown as the structural characteristics in terms of bed capacity, equipment, staffing, qualifications, treatment methods and approaches.

As a pilot study, the ‘NurBeat’ project team and the other authors developed an online survey comprising 48 questions on the type and size of the facilities, structural criteria, and equipment and staffing levels; this was supported by the German Society of Neurology (DGN), the German Interdisciplinary Society for Out-of-Hospital Ventilation (DIGAB) and the German Society for Neurorehabilitation (DGNR) (Groß et al. 2019). Sixty-three facilities took part in the online survey, operating a total of 687 neurological ventilation beds. In most organisational units, comprehensive structures were in place in the areas of equipment, staffing and qualifications, as well as treatment methods and concepts; however, with the exception of neurophysiological electrophysiology, no single equipment-based method was consistently available. The care of neurologically ill patients on non-hospital ventilators showed room for improvement in the area of diagnostic equipment. Furthermore, most organisational units did not have the capacity to provide long-term outpatient or inpatient care for such patients. Thus, two fundamental requirements have already been demonstrated: reaching a consensus on the structural characteristics required for the treatment of neurological ventilated patients—who are often complex and seriously ill—and improving the care of patients on non-hospital ventilation within the field of neurology.

However, the following issues were identified in the pilot study: 1. The collected data could not be linked, and 2. There was insufficient specificity regarding the exact type of facility. In particular, this meant that it was not possible to characterise the individual care models (acute care hospital, specialist hospital/rehabilitation clinic) more precisely.

In NurBeat, these issues are resolved by designing the study as a point-in-time survey involving the collection of patient data, as well as by specifying questions regarding the type of facility – in line with the ICU-CardioMan study (Funcke et al. 2016). The study is conducted under the auspices of the German Society for Neurorehabilitation (DGNR) and is supported by the German Interdisciplinary Society for Out-of-Hospital Ventilation (DIGAB). We expect to obtain a precise characterisation of the structures of neurological respiratory care in Germany. This, in turn, could provide significant support in the future for the development of structural criteria and future certification schemes. Specific structural criteria would be particularly helpful in two areas to ensure the quality of care:

• Centres that provide ventilator weaning and early neurological and neurosurgical rehabilitation
• Centres that provide initial assessment and long-term care for patients on out-of-hospital ventilation

We would be grateful for your support of our study through your participation. On this page, we will keep you updated on the progress of the project.

Dr Martin Groß Prof. Dr Marcus Pohl Dr Oliver Summ Annette Weigel Prof. Dr Rainer Röhrig

The study is supported by the Oldenburg Research Network for Emergency and Intensive Care Medicine. Further information can be found at: uol.de/nurbeat

Use of mechanical insufflation-exsufflation [MI-E] for ineffective cough in diseases of the
peripheral or central nervous system

Patients in neurological intensive care units, specialised weaning wards and rehabilitation units often suffer from a cough disorder. This can be caused by a reflex disorder or muscle weakness. Coughing disorders can lead to life-threatening secretions, atelectasis and pneumonia. A mechanical cough assistant (mechanical insufflation-exsufflation; MI-E) can be used to improve coughing ability, prevent atelectasis and mobilise secretions from the bronchi. MI-E is already established as a standard treatment for patients with neuromuscular diseases.

The aim of the study is to demonstrate the effectiveness of MI-E interventions in ventilated neurological patients by means of a monocentric, randomised, controlled intervention study. The study was conducted at the Evangelical Hospital Oldenburg.

Your personal data is processed as part of the study programmes organised by the Oldenburg Research Network for Emergency and Intensive Care Medicine (OFNI). The following information is provided in accordance with Article 13 of the GDPR regarding the processing of your data.

1. Name and contact details of the data controller

   University of Oldenburg, a body governed by public law, legally represented by the President, Ammerländer Heerstraße 114–118, 26129 Oldenburg.

2. Contact details of the Data Protection Officer

   The Data Protection Officer, Ammerländer Heerstraße 114–118, 26129 Oldenburg, telephone: 0441 798 4196, email: .

3. Purposes and legal bases of processing

   1. Purposes of processing
   2. Legal bases for processing

   Your data is processed for the purpose of conducting and organising study events (workshops, interviews).

   Your data is processed on the basis of your consent in accordance with Article 6(1)(a) of the GDPR. You may withdraw your consent at any time; to do so, simply send an email to the OFNI. You are not obliged to provide your personal data.

4. Recipients of personal data

   The recipients of your personal data are the staff of the OFNI at the University of Oldenburg. Your personal data will be treated confidentially in accordance with the GDPR. We do not intend to disclose your personal data to third parties or to third countries without your consent.

5. Retention period for personal data

   Your personal data will be deleted upon completion of the relevant course, as soon as it is no longer required, unless you give separate consent for your personal data to be retained for a longer period.

6. Data subjects’ rights

   You have the following rights:

   Right of access (Art. 15 GDPR), right to rectification (Art. 16 GDPR),

   Right to erasure (Art. 17 GDPR), right to restriction of processing (Art. 18 GDPR), right to data portability (Art. 20 GDPR), right to object (Art. 21 GDPR)

   You also have the right to lodge a complaint with the State Data Protection Commissioner for Lower Saxony.

7. Right to withdraw consent

   You may withdraw your consent at any time with effect for the future. This does not affect the lawfulness of the data processing carried out on the basis of your consent up until the time of withdrawal.