Prehospital and Disaster Medicine

Special Report

Anglo-American vs. Franco-German Emergency Medical Services System

Wolfgang F. Dicka1 c1

a1 Clinic of Anesthesiology-University Hospital, Mainz, Germany

Abstract

It has been stated that the Franco-German Emergency Medical Services System (FGS) has considerable drawbacks compared to the Anglo-American Emergency Medical Services System (AAS):

1. The key differences between the AAS and the FGS are that in the AAS, the patients is brought to the doctor, while in the FGS, the doctor is brought to the patient.

2. In the FGS, patients with urgent conditions usually are evaluated and treated by general practitioners in their offices or at the patient`s home; initially, very few approach an emergency department.

3. Emergency patients with life-threatening trauma or disease are treated by emergency physicians at the scene and during transport. Paramedics often are first to arrive at the scene, and until the emergency physician arrives at the scene, are allowed to defibrillate, to intubate endotracheal-ly, and to administer life-saving drugs (epinephrine endotracheally, glucose intravenously, etc.).

4. Prehospital emergency physicians treat patients at the scene and during transport.

5. Emergency patients are guaranteed to be reached by an appropriate emergency vehicle and a respective crew within 10 minutes in 80% of the responses and within 15 minutes in 95% of cases.

6. The FGS deploys qualified emergency physicians assisted by qualified paramedics as prehospital intensive care providers; extended immediate care is standard. Total Prehospital Times (TPT) and scene times only are minimally longer than in the AAS.

7. Emergency Medicine is recognized as a supra-specialty to the base specialties. Specific training programs exist for emergency physicians, medical directors of emergency medical services systems (EMSS), and chief emergency physicians (CEP).

8. Resuscitation attempts are carried out not only by anesthesiologists, but also by internists, surgeons, pediatricians, etc. Emergency medicine encompasses cardiopulmonary resuscitation (CPR) and shock cases, and patients with an acute myocardial infarction, stroke, poly-trauma, status asthmaticus, etc. Emergency patients are admitted directly to emergency departments of the hospitals, which, depending upon the size of the hospital.

9. The incidence of life-threatening trauma victims has decreased to <10% in the FGS. Of a total of 830,000 deaths/year, fatal trauma cases ranked the lowest at 4%.

10. Survival figures on cardiac arrest (asystole, ventricular fibrillation/ventricular tachycardia (VF/VT), pulseless electrical activity (PEA), etc.) reported in the German EMSS correspond to those in Europe and the United States.

11. Paramedic training is characterized by a two-year program followed by a theoretical and a practical examination.

12. Paramedics and emergency physicians-in-training are supervised at the scene and during transport. Quality assurance (Q/A) constitutes an integral and legally compulsory part of the EMSS.

13. In the majority of cases, the emergency patients are evaluated and treated by the respective specialties without delays caused by patient transfer to other hospitals.

14. The FGS does not require a greater number of ambulances and/or personnel than does the AAS.

15. The German healthcare system creates less expenses/ capita than the does the U.S. system at a similar level of quality of care.

16. Emergency procedures are carried out by anesthesiologists, emergency physicians, surgeons, internists, and other specialists.

(Received March 06 2001)

(Accepted June 03 2003)

(Revised June 20 2003)

Correspondence:

c1 Clinic of Anesthesiology-University Hospital, Langenbeckstr. 1 D 55131, Mainz, Germany, E-mail: dick@anaesthesie.klinik.uni-mainz.de

Dick WF: Anglo-American vs. Franco-German emergency medical services system. Prehosp Disast Med 2003; 18(1):29–37.