Status of Emergency Medicine Around the World

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Status of Emergency Medicine Around the World

• EMERGENCY MEDICINE
• IN GERMANY
• PROF.DR.W.F.DICK

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OVERVIEW

• Descriptive information/statistics
• Country information
• EM-Specialty status
• EM system information
• Challenges/innovative strategies
• Summary

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(No Transcript)
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COUNTRY INFORMATION 1

• Federal Republic of Germany
• Inhabitants83 Mio (2001) 231 / Sqkm
• Age 0-14 y -12.6 Mio 15- 65y - 55.7 Mio
• gt 65 y -14.0 Mio
• ClimateModerate
• Finance Compulsory Insurance
• GNP/Capita 24.650

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COUNTRY INFORMATION 2Burden of diseases

• Life expectancy (years) 81 F - 75 M
• Major causes of mortality 828.541 total
• Cardiovascular 30
• Malignancy 10
• Endocrine diseases 3
• Respiratory diseases 6
• Trauma/Intoxications etc. 4
• Various others 48

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COUNTRY INFORMATION 3Health 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)

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COUNTRY INFORMATION 4MEDICAL EDUCATION

• Number of Medical Schools 40
• Length of study 6 years
• PG Training leading to
• spezialisation 5-6 years
• Medical Specialty Board Final exam
• certification

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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

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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

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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........

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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

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EM-SUPRASPECIALTY STATUS 3

• 1.Flight physiology 2 h
• 2.Medical equipment 4 h
• 3.Transport media 4 h
• 4.Flight safety 4 h
• 5.Documentation/TQM 2 h
• 6.Case scenarios 2 h

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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

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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

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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

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EM-SYSTEM INFORMATION 3DISPATCH MECHANISM

• Bystander to dispatch center
• public telephone or cellular phone
• Dispatch center (paramedics EMTs)
• to ambulance or MLSU (paramedics)
• via radio communication

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EM-SYSTEM INFORMATION 4FUNDING

• Funding is provided by health care insurance
  companies on a fee for service basis
• EMS-budget lt 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

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EM-SYSTEM INFORMATIONIN-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

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EM-SYSTEM INFORMATIONIN-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

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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

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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

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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)

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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

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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

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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

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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.

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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

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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

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T H A N K Y O U

• A n y Q U E S T I O N S ?