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Feasibility and utility of telemedical support through a paramedic-led primary response service to aid emergency services in northwestern Germany.

Daniel Overheu, Simon T Schäfer, Bastian Rosner, Tobias Warnecke, Nils Jacobsen

BMC Health Services Research · 2025-12-01 · Implementation & quality improvement

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Abstract

BACKGROUND: In Germany, the regional Associations of Statutory Health Insurance are responsible for providing an out-of-hours on-call service for family medicine. With a shortage of resident doctors in rural areas, maintaining this service becomes more challenging. This raises the question whether the combination of a physician-run telemedical support with a primary response service led by paramedics is feasible, and in which way the telemedical support affects decision-making on scene. METHODS: We implemented Germany's first Standard Operating Procedure (SOP)-based on-call service for paramedics on site with telemedical backup. Between March and June 2018, differentiated SOPs and a special medical backpack were established. Participating paramedics and telemedicine doctors were trained in SOPs and the use of telemedical software. Descriptive statistics were used to analyse data collected during the study period from July 2018 until December 2021. RESULTS: Overall, 17% of all cases required telemedical support, primarily for diagnostic confirmation of musculoskeletal disorders, unclear symptom constellations, and diseases of the cardiac circulatory system. In 56% of all telemedicine-assisted cases paramedics on scene altered their originally planned course of action following telemedical support. CONCLUSION: This study demonstrates that telemedical assistance is a feasible alternative to the long-established doctor-run on-call system which is currently implemented throughout Germany. In the majority of cases, the telemedical input had a significant impact on the decision-making process of the responsible paramedic on scene. Limitations arise through limited information on some variables driving that decision-making process. Furthermore, the number of telemedical personnel required to facilitate the provision of telemedical assistance across an entire national healthcare system remains unclear. TRIAL REGISTRATION: German register for clinical trials DRKS00024037, registered March 18th 2022 (BfArM - Deutsches Register Klinischer Studien (DRKS).

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Tags

Medical direction & oversight · Paramedics & EMTs · Rural & remote · Telemedicine

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