Which health-related reasons lead to prehospital emergency care and how does subjective emergency status connect to subsequent care?

Abstract

Objectives/Background In many countries, the use of emergency medical services (EMS) increases steadily each year. At the same time, the percentage of life-threatening complaints decreases. To redesign the system, an assessment and consideration of the patients’ perspectives is helpful. Methods We conducted a paper-based survey of German EMS patients who had at least one case of prehospital emergency care in 2016. Four health insurance companies sent out the questionnaire to 1312 insured persons. We linked the self-reported data of 254 respondents to corresponding claims data provided by their health insurance companies. The analysis focuses a.) how strongly patients tend to call EMS for themselves and others given different health-related scenarios, b.) self-perceived health complaints in their own index case of prehospital emergency care and c.) subjective emergency status in combination with so-called “objective” characteristics of subsequent EMS and inpatient care. We report principal diagnoses of (1) respondents, (2) 57,240 EMS users who are not part of the survey and (3) all 20,063,689 inpatients in German hospitals. Diagnoses for group 1 and 2 only cover the inpatient stay that started on the day of the last EMS use in 2016. Results According to the survey, the threshold to call an ambulance is lower for someone else than for oneself. In 89% of all cases during their own EMS use, a third party called the ambulance. The most common, self-reported complaints were pain (38%), problems with heart and circulation (32%), and loss of consciousness (17%). The majority of respondents indicated that their EMS use was due to an emergency (89%). We could detect no or only weak associations between patients’ subjective urgency and different items for objective care. Conclusion Dispatchers can possibly optimize or reduce the disposition of EMS staff and vehicles if they spoke directly to the patients more often. Nonetheless, there is need for further research on how strongly the patients’ perceived urgency may affect the disposition, rapidness of the service and transport targets.

Apart from the Medical Complaints, Why do Patients Use Emergency Medical Services? Results of a Patient Survey

“…It remains contradictory that 89 % of all respondents confirmed an emergency as a reason while 26 % worried to become an emergency soon. The percentage (84 %) of people answering that someone else's call was reason for the EMS use seems plausible in combination with the high amount of third party calling in their index case (89 %) reported in a previous paper [33]. As it is very likely that not every patient had relevant impairments and only 17 % reported unconsciousness, one may assume that the patients' wish had at least some impact on third party calling.…”

“…Nonetheless, they overrepresented southern federal states and patients with statutory health insurance, lacking those with private insurance (which equal about 11 % of all persons insured in Germany [39]). According to results published in a previous paper [33], there is a high plausibility that the vast majority of the respondents were able to recall their EMS use, even though it took place two years ago: For example, self-reported complaints versus diagnosed ICD codes (during inpatient care accompanying the EMS use) correspond well. Patients also reported that their EMS use was a rare event (median/modus: 2 EMS uses per life).…”

Improving prevention and early detection of sepsis among patient groups at risk: Introducing a model for a multimodal information campaign—The SepWiss study protocol

“…Reaching risk-groups by addressing them or their relatives directly: Previous findings demonstrate that the most likely person to call an ambulance for someone else in case of a perceived emergency is a family member [ 21 ]. Additionally, a high proportion of patients receiving long-term care have an increased sepsis risk because of older age or underlying diseases, and the majority of long-term care is provided at home by relatives, not in nursing homes [ 22 ].…”

Der Einfluss von Frequent Usern auf das Rettungsfachpersonal: Ergebnisse einer Umfrage

“…Einen Teil der steigenden Einsatzzahlen machen Einsätze aus, welche ursprünglich keine oder eine geringe rettungsdienstliche Relevanz haben. Die Ursachen hierfür sind multifaktoriell und wissenschaftlich noch nicht in Gänze erforscht [18,25]…”