Every day, hundreds of time-critical and care-intensive emergencies occur in Germany. However, despite all routine, efficient medical care along the entire chain of emergency services is never totally free of problems in reality. Even though Germany has nationwide emergency services with relatively short response times, valuable minutes often pass at the site of the emergency until a target hospital is found for the patient that is medically suitable, easy to reach, and, in particular, willing to accept the patient. Especially in vast emergency service center areas with a multitude of target hospitals, there is currently often a veritable “phone marathon”, frequently resulting in more than 10 to 15 minutes of time being lost.
Such practice is no longer state of the art and often also means an excessive workload for the dispatchers. Let’s look at a typical scenario to illustrate this issue. A 9-year old boy is hit by a car on his way to school. Due to massive pain and shock symptoms, the emergency physician is alerted immediately. He tells the dispatch office to find a “place for a hemodynamically instable child with blunt abdominal trauma and spinal trauma“. To do so, the dispatcher must successively check a total of five hospitals. At the first hospital, the shock room is already occupied; at the second hospital, his request is denied with a reference to the capacity for intensive care patients; the third hospital checks and says that it can currently treat only the abdominal injury, but not the spinal injury; the fourth hospital reports that children cannot be treated in general. After a total of 25 minutes on the phone, a major regional hospital 80 km away agrees to accept the child. This was the only hospital where direct information could be obtained, whereas in the other four hospitals, the request had to be relayed internally, sometimes more than once. Due to the distance, a rescue helicopter is called to transport the child to the hospital. In the end, the time difference between accident and arrival at the hospital is 90 minutes.
Despite the fact that the child could be saved, this case impressively demonstrates the problems and delays resulting from a method for checking on treatment capacities that is no longer state of the art. Innovative technological solutions can make the necessary information available not only much faster, but also with less effort by the extremely busy dispatchers as well as the hospitals being queried. On behalf of the state of Rhineland-Palatinate, Fraunhofer IESE has therefore developed a web-based information system – the so-called ZLB – which shows the current readiness of a hospital to accept patients to the dispatchers in real time. The State Emergency Service Act and the State Hospital Act stipulate that hospitals shall report their acceptance and care capacities to the (integrated) emergency service centers. This information can now be entered directly into the ZLB by the hospital or the respective dispatch center.
Depending on the site of the emergency, the dispatcher can check all available capacities statewide, which are then displayed as a table, resp. on a map, with all necessary information. The focus is not only on the issue of available regular and intensive care beds, resp. special infrastructure, but also on the emergency care capacities that are available. This includes, for example, for polytrauma patients the features shock room, CT capacity, and surgical capacity, and for patients with a fresh stroke an immediately available CT and the option of fibrinolysis.
As part of quality management, all status changes are recorded and can be analyzed in terms of various aspects. The extension of the system for use during catastrophic events is planned for 2013.