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EED-Project - Results

The Kick-off-meeting in Bonn, Germany (November 1st – 2nd, 2003) provided an overview of different EMS system designs and partners made a detailed presentation of their respective EMS systems. As a main result, the EED project group was able to develop a common template for analysis and comparison of systems, termed “Patient Journey”. This template begins with the patient’s first contact with the EMS system (“Access”) and concludes with the recording of the patient’s outcome at the time of “Handover / Disposal”. The template identifies components that all participating EMS systems have in common and establishes the basis for all further project work.

The main task of the second workshop in Santillana del Mar, Spain (January 23rd – 24th, 2003) was to identify and compare the data that are continuously available from each EMS system. Two approaches were applied. First, typical patient pathways were presented based on the template “Patient Journey”. Second, specific pathways for cardiac arrest and chest pain were analysed in more detail as both represent acute medical emergencies for which time is an essential factor to minimise morbidity.

During the third workshop in Paris, France (April 3rd - 4th, 2003) a preliminary list of indicators and draft definitions were developed. This list of indicators is based on comparable data which can be provided by all participating EMS systems. In addition, indicators were suggested that are desirable, but for which a common data may not yet be available.

At the fourth workshop in Helsinki, Finland (June 26th – 27th, 2003), the preliminary list of indicators and operational definitions were revised based on the experience of the pilot data collection that the individual systems completed at the two previous workshops. Furthermore, the group added components for data collection, validation and analysis to the draft definition of each indicator. The group also addressed the comments provided by the co-ordinator of the ECHI project and incorporated his comments into the final revision.

The main subject at the fifth meeting in Galway, Ireland (October 2nd – 3rd, 2004) was the development of an accompanying document for each indicator. The document comprises for each indicator: nominal definition, operational definition, format description, a comprehensive description of data source, information on upscaling procedures, an evaluation of strengths & limitations as public health indicators and references.

In preparation for the final workshop in Kramsach, Austria (January 22 nd – 23 rd, 2004), all partners conducted a pilot data collection based on the documents developed during the fifth workshop. Results of this data collection were discussed and reviewed in detail. Based on the experiences of data collection, the definitions of the indicators were adjusted. At last, the project group gave final recommendations on the indicators and agreed on an outline for the project report.

As main outcome, five key indicators were identified as recommendation for integration into the ECHI database:

1. Unit hours (ELS + BLS + ALS) p. a. / 100 000 inhabitants
Indicator for availability of organised EMS resources

2. Response time (% within 480 sec) for highest priority p. a.
Indicator for reliable access to organised EMS care

3. Rate of highest priority responses p. a. / 100 000 inhabitants
Indicator for demand/workload of organised EMS

4. Rate of First Hour Quintet incidences p. a. / 100 000 inhabitants
Indicator for those critical conditions on which EMS can have a significant impact on the outcome (cardiac arrest, acute coronary syndrome, stroke, respiratory failure and severe trauma)

5. Rate of ALS interventions p. a. / 100 000 inhabitants
Indicator for level of care of the EMS (drug administration, assisted ventilation, intubation)