In their excellent article, Messelken and coauthors presented a valuable and relevant analysis of the physician-staffed emergency medical care system in Baden-Württemberg (1). In contrast to small analyses that usually focus on a particular point in time, their study is unique in that it provides data for a lengthy period of time for almost the entire state. I wish to congratulate the authors on this achievement, because such analyses by emergency physicians have become indispensable and are of utmost importance.
In addition to descriptive quality characteristics, the study showed one aspect in particular in an exemplary manner:
Legal regulations concerning the response time are unequivocally laid out in Baden-Württemberg’s law on emergency services (RDG-BW §3 para. 2) (2), but they have not been adhered to for years and, what’s more important, they are consistently being ignored (response times should not be more than 10 minutes, a maximum of 15 minutes”). The assumed target rate is 95% (3), but this is achieved in less than 92.05% (1). This structural quality problem has been proved to exist since at least 2005 (1).
The number of participating sites in the state-wide NADOK evaluation is similarly shocking: only 106 of 130 sites are currently participating. Why is it being tolerated that some 20% of sites where physician-staffed emergency medical care is available are not participating in a mandatory evaluation?
Physicians as emergency medical directors (Ärztliche Leiter Rettungsdienst, ÄLRD) are firmly established in other German states, but this instance was not introduced in Baden-Württemberg even when the RDG-BW was revised. Comprehensive quality analyses are therefore currently available for Baden-Württemberg to an unsatisfactory degree only. By establishing physicians as emergency medical directors in Baden-Württemberg, the above mentioned structural problems may be qualified and neutrally analyzed on the one hand, and on the other hand they may be dealt with and a solution could be found.
References
- 1.Messelken M, Kehrberger E, Dirks B, Fischer M. The quality of emergency medical care in Baden-Württemberg (Germany): Four years in focus. Dtsch Arztebl Int. 2010;107(30):523–530. doi: 10.3238/arztebl.2010.0523. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Gesetz über den Rettungsdienst (Rettungsdienstgesetz - RDG) von Baden-Württemberg in der Fassung vom 08. Februar 2010. GBl. 2010. 285 pp. [Google Scholar]
- 3.Hinkelbein J, Gröschel J, Krieter H. Definition von Zeitpunkten und Zeitabschnitten zur Beschreibung der Struktur- und Prozessqualität im organisatorischen Rettungsablauf. Notarzt. 2004;20(4):125–132. [Google Scholar]