Medical competence in emergency medical system -: Do we need to reorganize?

The services of the emergency medical system are mainly medical. The transport of emergency patients plays only a minor role. Although the expenses incurred by the public health insurers for the emergency medical system account for just above 3% of the total, these resources can be used more efficiently by future reorganisation. The constant rise in the number of emergency medical missions is easily explained. On the one hand, because of changes in social conditions the emergency physician is called to many acute cases, although there is no classical indication for such a call. On the other hand these patients are not treated adequately by anyone else, particularly because general practitioners and their emergency service do not fulfil their remit sufficiently. Therefore substantial changes concerning this part of emergency service are inevitable. All appeals for medical help must be answered by integrated medical dispatching centres, where specially qualified staff are on duty. In addition to a higher qualification of emergency physicians, supervision of all medical fields in emergency services must be established with a "Medical Supervisor for Emergency Services". Up to now there is a complete lack of medical supervision and quality management. Not every patient in the care of the emergency service needs admission to a hospital. In these cases, a better network with other branches (general practitioners) can help to reduce costs. This can only be achieved with an increased use of computer systems and the help of telemedicine. To support the evolution of emergency medicine, major clinics should establish centres of competence which are responsible for in further education as well as emergency research. After all, these centers of competence will face new challenges in emergency medicine e.g. relocation of intensive care patients.