[Changes in number of emergency medical service deployments in an urban area during the first COVID-19 pandemic-related contact restriction phase]. / Veränderungen der rettungsdienstlichen Einsatzzahlen in einer Metropolregion während der ersten COVID-19-Pandemie-bedingten Kontaktbeschränkungsphase.

Background: To contain the coronavirus disease (COVID-19) pandemic, public life was reduced through contact restriction measures (referred to as "lockdown" in the further course for reading simplicity), among other things to make health system resources available for the treatment of COVID-19 patients. In parallel, a decrease in emergency patients was observed in the public health system. Methods: For two 10-week periods before and during the lockdown, ambulance service deployment rates were analysed in 6 ambulance service areas for 6 tracer diagnoses. Random effects were minimised by comparing the results with the corresponding 2018 and 2019 time periods and a calculated expected value. Results: For emergency ambulance service calls, there was a reduction in call numbers (-16%) during the lockdown. A 20% reduction for the categories cardiac and cerebral ischaemia was found. In the urban area, the reduction in cardiac ischaemia was less pronounced at 14% than in the surrounding area at 23%. The deployment figures for intoxications decreased by 27% and for psychiatric emergencies by 16%. Conclusion: The public ambulance service was not overwhelmed by the COVID-19 pandemic; there was a decrease in depolyments during the lockdown. For the reduction in cerebral or cardiac ischaemias, the explanatory models for the influence of the lockdown are missing. Further studies on the utilisation behaviour of the ambulance service during a lockdown appear necessary in order to detect potentially fatal reductions in utilisation for the patient outcome and to be able to counteract them through education.

Trauma-team-activation in Germany: how do emergency service professionals use the activation due to trauma mechanism? Results from a nationwide survey.

BACKGROUND: Trauma team activation (TTA) requires significant human and financial resources. The implemented German guidelines reduced the mortality of severe injured patients significantly over the last decade. Up to now there is no two-tier trauma team activation protocol in Germany. A two-tier TTA [often activated due to trauma mechanism (TM)] is thought to be a reasonable way to maintain patient safety while increasing cost efficiency. METHODS: We created an online survey addressed at the Emergency Medical Service in Germany to conduct a cross-sectional study. Both physicians and rescue service professionals (RSPs) were included. A minimum of 1550 participants answered questions in 4 different categories concerning the aspects of limited-TTA (L-TTA). Case studies were presented to evaluate the usage of TTA due to TM in the daily routine. RESULTS: Eighty percent (n:1233) of the respondents wish for a possibility to activate a limited trauma team. Seventy-two percent (n: 1109) of the participants consider a L-TTA due to TM to be adequate. There were significant differences (p < 0.05) in the assessment and opinion on L-TTA among physicians and RSPs as well as different medical professions. The evaluated case studies showed diverse answers: depending on the profession, the same patient was ranked as severely injured by 54% and as minorly injured by 46% of the 1550 participants. CONCLUSIONS: Members of the German Emergency Medical Service call for a two-tier TTA-protocol. Up to now we cannot fully recommend an automatic reduction of the trauma team when activated due to TM in Germany with the guidelines implemented. The profession might affect the L-TTA-behavior. Criteria for a L-TTA in Germany have to be defined and evaluated. LEVEL OF EVIDENCE: IV, cross-sectional study.