Assessing the Need and Demand for a Community Emergency Paramedic Strategy in the Ambulance Rescue System of Hamburg,...

Background: Demand for Hamburg's ambulance rescue system (ARS) in Germany, which is managed by the fire service, increased by more than 10% between 2019 and 2021. This increase was mainly driven by a more than 20% increase in non-critical ambulance rescues, while critical rescues decreased over the same period. Factors contributing to this trend include demographic changes, longer waiting times in primary care and declining quality in out-of-hospital care. To address this issue, the introduction of community emergency paramedics (CEPs)-who provide treatment and advice to patients at home before ambulance services are called-has been proposed as a potential solution to alleviate pressure on the ARS. Methods: In this study, 17 ARS stations in Hamburg, categorized into three operational areas (East, South, West), were analyzed using comprehensive statistical methods such as hypothesis testing, correlation analysis, regression modeling and clustering. Data from 2019 and 2021 were examined to assess the feasibility of integrating CEPs into the existing system. Results: Key findings identified specific stations with high potential for CEP support and optimal mission times (based on time of day, day of week and calendar week) to improve operational efficiency. The impact of regulatory measures introduced during the COVID-19 pandemic was also evident in the 2021 data. Conclusions: Finally, four policy scenarios-taking into account different synergy effects among the 17 stations-are presented, providing projections of the managerial and economic benefits for Hamburg policymakers. These policy implications aim to support the development of a robust CEP strategy to improve the overall efficiency and sustainability of the ARS.