[Best practice deployment of lead emergency physicians in Germany - A Delphi study: A structured consensus process...

Complex emergency operations in prehospital care, such as mass casualty incidents (MCI), place special demands on the deployment of the Leading Emergency Physician (LNA). Uniform national standards for LNA appointment are currently lacking. This study aimed to develop a consensus-based best practice model and to highlight the relevance of the new curriculum of the German Medical Association (BÄK) for LNA qualification.

In two Delphi rounds, 20 theses were evaluated to determine consensus (K = agreement), neutrality (0 = abstention), or dissent (D = disagreement). The topics included professional qualification as well as structural, material, and organizational resources. Participants were N = 56 medical directors of emergency medical services (ÄLRD) attending the BV-ÄLRD annual meeting in 2024.

Broad consensus was reached that LNA should hold a specialist qualification (K = 96%) and complete specific continuing education (K = 96%). Regular activity as an emergency physician (K = 93%) and participation in exercises (K = 93%) were considered essential. Structural requirements such as fixed duty rosters (K = 89%) and defined alerting criteria (K = 96%) achieved high levels of agreement. Standard leadership tools (K = 96%) and personal protective equipment (K = 100%) were also rated as essential. An advisory function outside MCI scenarios was a controversial debate topic (K = 44%, 0 = 22%, D = 34%).

The results provide consensus-based recommendations for a quality-assured LNA appointment with standardized qualification and organizational structures. Standardized measures improve service readiness and quality of LNA deployment and emphasize the importance of a national curriculum and structural requirements.