Telemedical emergency services: central or decentral coordination?

Area of Science:

• Emergency Medicine
• Health Services Research
• Telemedicine

Background:

• Current teleemergency doctor support is decentralized, with each district operating independently.
• This study evaluates the shift from decentralized to centralized teleemergency doctor services.

Purpose of the Study:

• To analyze the advantages and disadvantages of a centralized teleemergency doctor model.
• To assess the feasibility and cost-effectiveness of centralizing telemedical emergency services across multiple districts.

Main Methods:

• Queuing system modeling of ambulance calls to teleemergency doctor offices.
• Utilized Markov chain assumptions for call arrivals and service times.
• Developed a cost function incorporating variable, fixed, and step-fixed costs.

Main Results:

• Centralization significantly reduces the cost per ambulance serviced as more districts cooperate.
• The risk of teleemergency doctors being overburdened increases with centralization, necessitating more simultaneous doctors.
• For Greifswald, call hold times are currently negligible.

Conclusions:

• Centralization of telemedical emergency services is recommended for feasibility and cost-effectiveness.
• Optimal centralization involves a moderate number of cooperating districts and proximity between ambulance and telemedical stations.
• Potential benefits include improved quality and flexibility, while challenges involve localized knowledge gaps.