Incidence of invasive medical procedures in emergency medical services. Considerations regarding emergency paramedics

The 'Notfallsanitater' is a new paramedic-based profession to be introduced into the German emergency medical service. This article discusses the invasive medical procedures to be performed by the 'Notfallsanitater' considering the indications and incidence of these procedures. The incidence of invasive procedures within the district of Gottingen over a time period of 12 months was evaluated analyzing all medical databases used for electronic record keeping of medical emergencies, e.g. EPen, DIVIDOK-Online for the year 2013. A total of 23,118 emergencies where evaluated. In 28 % (n = 6400) of the cases 1 of 32 emergency physicians was called in. The incidence of invasive procedures, considering only the emergency physician-based emergencies, ranged from 76 % (n = 4053) for establishing an i.v. access line to 0.06 % for staunching severe hemorrhage. In 5.8 % (n = 309) of cases the airway was invasively secured and 3,1 % (n = 166) of the patients received non-invasive ventilation. An intraosseous cannulation or a needle thoracostomy was performed each in 0.3 % (n = 16) of cases. In 0.15 % (n = 8) treatment with an external pacemaker was started. In over 90 % of the cases the first ambulance arrived on the scene in less than 10 min. Emergency physicians, if called, arrived at the scene in less than 15 min in over 90 % of the cases. The procedures differ substantially with respect to the incidence, invasiveness and the potential to treat life-threatening conditions. Learning and retention of skills can be assumed only for some invasive procedures. Thus, the catalogue of procedures should be carefully reviewed in order to adapt it to current developments in emergency medicine.