Implementation of a Nurse-Based or Hybrid system of Emergency Medical Service provision
Introduction
The idea set out here aims to better simulate Ambulance service provision in countries where a system exists that does not quite fit the more widespread Anglo-American system of Emergency Medical Service provision, nor the Franco-German system of Emergency Medical Service provision. In stead it focus on systems which are seen in countries such as The Netherlands, Spain and Australia (among other countries), where ‚Emergency Physicians‘ do not exist or are only deployed in very rare scenario’s, however where Ambulance service provision is not focussed on rapid-transportation to a hospital either. Often the system here considered is described as a ‚Nurse-based‘ system of Emergency Merdical Service provision, or as a ‚Hybrid‘ system of Emergency Merdical Service provision.
The ‚Traditional Systems‘ (broadly summarized)
Broadly speaking the Franco-German system and Anglo-American system distinguish themselves in that the first focussed on ‚bringing the doctor to the patient‘, while the latter focussed on ‚bringing the patient to the doctor‘.
In the Franco-German system that broadly means that to complex/severe medical emergencies an emergency physician is dispatched for very advanced medical treatment of a patient on scene.
In the Anglo-American system that broadly means that in (complex/severe) medical emergencies the ambulance on scene focussed on brief/rapid stabilization on scene followed as soon as possible by transport to a hospital, or scoop-and-run during which stabilization occurs ‚on ride‘ to the hospital. The most advanced medical treatment of a patient does not start ‚on scene‘ like in the Franco-German system, but starts when the patient reaches the hospital.
The Nurse-Based / Hybrid System (broadly summarized)
In the Nurse-Based / Hybrid System, to complex/severe medical emergencies often more than 1 ambulance gets dispatched to optimize care, rather than sending an emergency physician. In most of these systems (such as in The Netherlands and Australia), doctors are still available via helicopter-deployment, but are relatively rare and only get send to the most serious cases, for example mass casualties, very serious trauma or (suspected) resuscitations of children or adults below certain ages. As in impression: in The Netherlands there are only 4 helicopter-Emergency Physicians available at any time during a day on a population of ~18 million people.
In most cases if the dispatcher receives a call for a (potentially) complex case or (severely) unstable patient, the dispatcher will immediately dispatch two ambulance crews. If the initial call does not indicate a complex case or (severely) unstable patient clearly, but the first ambulance on scene establishes such complexity or severity, the ambulance will often request an additional crew from dispatch for more advanced treatment.
These systems often do adopt the approach of bringing ‚advanced care‘ to the scene, except do so by sending two crews (two paramedics/nurses) rather than sending an emergency physician. Once the patient gets transported, often the ambulances drive to the hospital together, with one transporting the patient with a driver in the front, and (at least) two paramedics/nurses in the back.
The actual suggestion for implementation
Zweck: This suggestion establishes a better representation of countries that adopt a Nurse-Based/Hybrid system of Emergency Medical Service provision.
Vorteile: With the countries currently implemented it opens doors for more realistic simulation of control centres in The Netherlands, and as far as my knowledge reaches, the Spanish system as well. Additionally countries such as Norway are moving towards a more hybrid system (coming from a more traditional Franco-German system) more and more. In the future, with implementation of more countries, it could open doors for for example users wanting to represent EMS systems in Australia and others.
Mögliche Umsetzung:
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Instead of the current option to set the ‚switch‘ for „Disable physician-based EMS (no doctors)“ in the ‚General‘ settings tab of a control centre to either ‚on‘ or ‚off‘, it should show three options:
a. Franco-German system: Emergency Physicians enabled and required as per currently implemented settings.
b. Anglo-American system: Emergency Physicians disabled and not required as per currently implemented settings.
c. Nurse-Based / Hybrid system: see below.
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Whenever in the ‚code‘ of a call a doctor is required („doc+“), in stead of asking for an emergency physician in the ‚physician-enabled system‘, and instead of not asking for anything in the ‚psysician-disabled system‘, calls with this characteristic will require any two medical units on scene. Units that would count are: KTW, RTW, NAW, NEF, RTH, ITH, ITW. This keeps the system flexible for users regardless of which units they use to represent their country’s units in their control centre. Any combination of two of those units present on scene would fulfil the ‚doc+‘ requirement.
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It is still up to the dispatcher to judge the initial call and determine how many units he/she will dispatch. However if the first unit is on scene and estables it is a ‚doc+‘ call, the unit will request an additional unit on scene. The dispatcher will, like with the ‚physician-enabled system‘ have the option to ‚decline‘ and say no additional units are available. In that case the system should deal with it the same way it would in the ‚physician-enabled system‘ when a doctor is unavailable.
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Once a complex/severely unstable patient gets transported, both dispatched units will be required to ‚travel along‘ until the patient reaches the hospital (like the NEF unit travelling with the RTW unit). In reality this is because one ambulance carries the patient, two nurses/paramedics and a driver, while the second only carries a driver which will ‚reconvene‘ with its only paramedic/nurse once the patient has been admitted to the ER.
Beispiele und Szenarien: No new scenario’s need to be established. It builds upon the current system already implemented and only uses the ‚doc+‘ tag on a call to activate the requirement for an additional unit.
Visualisierungen: N/a
Closing notes
Hopefully the community and developers will see the added value of this suggestion for a realistic representation of the Ambulance systems in existence in quite a few countries around the world. I do of course realize implementation of this system will require resources and time, but I wanted to put it forward anyway.
I look forward to any feedback from members of the community and development team. I’d happily provide more details where the current suggestion would not provide the necessary details suficiently.