Ambulance Germany 2021

Background: Ambulance accidents are an unfortunate indirect result of ambulance emergency calls, which create hazardous environments for personnel, patients, and bystanders. However, in European German-speaking countries, factors contributing to ambulance accidents have not been optimally researched and analyzed.

Objective: The objective of this study was to extract, analyze, and compare data from online newspaper articles on ambulance accidents for Austria, Germany, and Switzerland. We hope to highlight future strategies to offset the deficit in research data and official registers for prevention of ambulance and emergency vehicle accidents.

Ambulance Germany

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Methods: Ambulance accident data were collected from Austrian, German, and Swiss free web-based daily newspapers, as listed in Wikipedia, for the period between January 2014 and January 2019. All included newspapers were searched for articles reporting ambulance accidents using German terms representing "ambulance" and "ambulance accident." Characteristics of the accidents were compiled and analyzed. Only ground ambulance accidents were covered.

Results: In Germany, a total of 597 ambulance accidents were recorded, corresponding to 0.719 (95% CI 0.663-0.779) per 100,000 inhabitants; 453 of these accidents left 1170 people injured, corresponding to 1.409 (95% CI 1.330-1.492) per 100,000 inhabitants, and 28 of these accidents caused 31 fatalities, corresponding to 0.037 (95% CI 0.025-0.053) per 100,000 inhabitants. In Austria, a total of 62 ambulance accidents were recorded, corresponding to 0.698 (95% CI 0.535-0.894) per 100,000 inhabitants; 47 of these accidents left 115 people injured, corresponding to 1.294 (95% CI 1.068-1.553) per 100,000 inhabitants, and 6 of these accidents caused 7 fatalities, corresponding to 0.079 (95% CI 0.032-0.162) per 100,000 inhabitants. In Switzerland, a total of 25 ambulance accidents were recorded, corresponding to 0.293 (95% CI 0.189-0.432) per 100,000 inhabitants; 11 of these accidents left 18 people injured, corresponding to 0.211(95% CI 0.113-0.308) per 100,000 inhabitants. There were no fatalities. In each of the three countries, the majority of the accidents involved another car (77%-81%). In Germany and Switzerland, most accidents occurred at an intersection. In Germany, Austria, and Switzerland, 38.7%, 26%, and 4%, respectively, of ambulance accidents occurred at intersections for which the ambulance had a red light (P

Conclusions: This study draws attention to much needed auxiliary sources of data that may allow for creation of a contemporary registry of all ambulance accidents in Austria, Germany, and Switzerland. To improve risk management and set European standards, it should be mandatory to collect standardized goal-directed and representative information using various sources (including the wide range presented by the press and social media), which should then be made available for audit, analysis, and research.

Emergency Medical Service (German: "Rettungsdienst", lit. "Rescue Service") in Germany is a service of public pre-hospital emergency healthcare, including ambulance service, provided by individual German cities and counties. It is primarily financed by the German public health insurance system.

The development of ambulance services in Germany started in the late 19th century. Typically volunteer aid organizations, some private companies in larger cities and so called rescue corps provided ambulance services mostly with very little training or medical background. After World War II, prehospital care in Germany was in its infancy; in most predominately rural areas the German Red Cross provided an ambulance service. In West Germany the fire departments provided 24/7 service as a professional service in some cities and urban centres or towns. With the increase in individual motorized traffic at the beginning of the 1950s, road accidents also increased, leading to greater numbers of both injuries and fatalities. This encouraged the formation of several other emergency services, for example the Johanniter-Unfall-Hilfe e.V., a subsidiary of the German Order of St. John. Still, the EMS role was primarily done on a voluntary basis by individuals with only minimal training in emergency health care, using simple transport vehicles with almost no medical equipment. However, more and more it became evident, that not only transport saves live of patients, but treating them on-scene.

In the late 1960s and early 1970s, advanced demands lead to the establishment of helicopter ambulance services, dispatch centers, radio communication and general better organization of EMS as well as scientific approaches to provide better emergency care. The first emergency medical technicians were trained by some fire departments, organizations, and even universities. In 1977 the first nationwide educational standard for non-physician emergency medical providers was introduced, the Rettungssanitter.

While not formally affiliated with the EMS system, the general practitioner (GP) frequently interacts with that system. In Germany, it is still commonplace for physicians to make house calls for those patients who are not able to visit a medical practice. Additionally, most cities and counties run a service called rztlicher Hausbesuchsdienst (Physician Home Call Service), which provides a GP to make housecalls for all people in the specific area. The physician will not only respond to patients from their own practice, but will also visit and treat patients all over the area. The GP service is delivered and maintained by an organisation known as the Kassenrztliche Vereinigung (Union of Health Fund Approved Physicians) and is usually only used for minor illnesses (i.e. fever, common cold), where a hospital stay is not necessary but the intervention of a physician may be advisable. The availability of this service provides a better treatment option to those patients who, in other EMS systems, might generate low-acuity ambulance calls or emergency department visits. Occasionally, the visiting GP will contact the EMS dispatcher and order a Krankentransport, should it be determined following medical assessment, that the patient could be cared for in a safer and better manner in a hospital.

Emergency physicians are dispatched along with a paramedic ambulance according to several standard dispatch criteria (indication catalogue, "Notarzt-Indikationskatalog"), including myocardial infarction, dyspnoea, potential severe trauma, unconsciousness, life-threatening intoxication and needed pain management.[8] Non-physician ambulance crews may request assistance from a Notarzt via dispatch as well.

Depending on the state in which they work, those in the Rettungshelfer role are usually the drivers of non-emergency patient transports, with a Rettungssanitter acting as crew chief for the vehicle. In most German states, for emergency ambulance service, those in the Rettungssanitter role are often the drivers of emergency ambulances and act as an assistant to the Rettungsassistent and Notfallsanitter.

Other vehicles that are also employed include neonatal units for special pediatric care and transport, intensive care transport units (ITW) for transporting ICU-patients from hospital to hospital with an emergency physician on board, ambulances for obese patients, special infectious transport units and disaster response supply vehicles. Some larger cities (i.e. Hamburg, Berlin) still operate Notarztwgen (NAW), a RTW supplemented by an ermergency physician and additional material, although this system has become rather outdated, due to its lack of flexibility.

Germany has a well-developed air ambulance network, consisting of primary EMS helicopters, interhospital transport and dual use helicopters. Most of them are operated by Germany's largest automobile club ADAC, the non-profit "Deutsche Rettungsflugwacht e.V." (DRF) and the German Ministry of the Interior. Germany is completely covered by EMS helicopters, however most of them operate only during daytime.

In addition, ADAC and DRF operate a fleet of fixed wing air ambulances, including jets, primarily to provide foreign repatriation service to their club members. Other companies (often health insurances) provide foreign repatriation services for their customers as well, mostly with rented aircraft and medical staff.

To illustrate, a call is received in the dispatch center about a possibly unconscious person. The dispatcher will immediately identify the call location, and will then ask further questions, in order to assess precipitating symptoms, specific location, and any special circumstances (no house number, a neighbor is calling, etc.). While this interview is occurring, the dispatcher will enter the command Bewutlosigkeit (unconsciousness) into the dispatch computer, resulting in an automatic suggestion to dispatch of a Rettungswagen (emergency ambulance) and a Notarzteinsatzfahrzeug (Doctor's Car). Upon entering the address of the patient, the computer will look for the emergency vehicles closest to this address. Now the dispatcher can send the whole package over the air and those two vehicles are alarmed, similar to Computer-assisted dispatch (CAD) in the United States. After sending the alarm, the dispatcher may remain on the line with the caller, providing telephone advice or assistance until the EMS resources arrive on the scene.

In this model, the emergency ambulance (RTW) and Doctor's car (NEF) are not necessarily co-located. In most emergencies, only the ambulance is deployed for providing patient care and transport. However, when the situation on scene is of a more severe nature, the ambulance crew can radio in for support by a physician and the NEF will be deployed. There are some medical situations where the NEF will be deployed automatically; those are usually pediatric emergencies, patients who are unconscious, emergencies including neurological or cardiovascular conditions, mass-casualty incidents, and situations where the need for analgesics and anesthetics is foreseeable.The advantage of this system is the fact that the physician is available for other emergencies, while the ambulance crew can handle minor cases on their own. e24fc04721