Emergency physician attended calls that could have been covered by advanced emergency medical technicians in Austria

BackgroundEmergency physician-staffed emergency medical services (EMS) in Austria frequently attend low priority calls, raising concerns about over-triage and future workforce sustainability.ObjectiveTo quantify the proportion of emergency physician-attended calls that could have been managed by advanced emergency medical technicians (AEMT), with or without telemedical physician support, and evaluate current AEMT practice and training needs.MethodsThis prospective, nationwide audit collected data from public physician-staffed EMS in Austria over a 24-h period. Emergency physicians documented call characteristics, NACA (National Advisory Committee for Aeronautics) severity scores, AEMT presence, actual and potential EMT or AEMT interventions, accuracy of severity assessment and their judgement regarding the necessity of on-scene physician involvement.ResultsOut of 149 physician-staffed EMS, 88 (59.1%) participated recording 313 calls and 273 emergency calls, 25 interhospital transfers and 15 telemedical emergency physician consultations were included. Emergency physicians assessed that 53.4% (95% confidence interval, CI 46.8-60.0%) of emergency calls and 48.0% (95% CI 28.4-67.6%) of interhospital transfers could have been managed by AEMTs. Approximately one third of these would have required telemedical physician support. The AEMTs arrived on the scene before emergency physicians in 75.1% of emergency calls and correctly assessed disease severity in 88.4% of cases and one or more additional interventions could have been set by AEMTs before emergency physician arrival in 48.0% of emergency calls. Most physicians supported expanding AEMT competencies and telemedical physician services.ConclusionThe results of this nationwide audit suggest that more than half of emergency calls and interhospital transfers attended by emergency physicians in Austria could have been managed by AEMTs with or without telemedical emergency physician support.