Notfallmedizin in Deutschland als Systemleistung : Innovation, Regulation und die Rolle von (Nach-)Steuerung für eine funktionierende Notfallversorgung
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Abstract
The present cumulative dissertation is based on five publications which, from a medical
perspective, illuminate three complementary dimensions of the emergency care system. Against
the background of increasing demand, limited human resources, and fragmented federal
responsibilities, emergency care in Germany is analysed as an interconnected system, addressing
the following central research question:
Which medical system prerequisites, exemplarily along the chain of survival in Germany,
shape guideline-adherent, time-critical emergency care; how can they be empirically
operationalized and compared as measurable structural, process, and governance
indicators; and what implications arise for evidence-based emergency care system
development?
The five studies deliberately cover different, yet complementary system levels. First, innovations
with immediate clinical relevance are examined: a community first responder system in which lay
responders are alerted via a smartphone app to out-of-hospital resuscitations. The analyses show
that a low-threshold first responder alerting system can mobilise many volunteers within a short
period of time, initiates or supports resuscitation measures in a relevant proportion of
deployments before professional help arrives, and is only rarely perceived as highly
psychologically distressing. At the structural level, regulatory and infrastructural framework
conditions are then considered: a nationwide mapping of all emergency care hospitals and their
helicopter emergency medical services (HEMS) landing infrastructure demonstrates that only
around 70% of emergency hospitals provide a landing option, with predominantly outdated
infrastructure and notable gaps particularly at specialized urban centres. Complementing this, a
nationwide cross-sectional survey of key emergency medical services structural parameters
reveals substantial heterogeneity, even in basic metrics, contemporary medical quality indicators,
and dispatch-centre processes. At the governance and process level, the dissertation addresses
steering and feedback mechanisms at the system’s point of entry. The analysis of standardized
medical call-taking and dispatch in the Berlin Fire Brigade dispatch centre shows that several
thousand requests for assistance are triaged and prioritized in a standardized manner each day,
and that a substantial proportion are transferred seamlessly into ambulatory urgent care
pathways.
Taken together, the five studies provide a consistent overall picture of the emergency care system
from different angles: structures shape processes, and these processes, in turn, create the broad
preconditions for patient-centred outcomes. The findings highlight that CFR systems can effectively complement the chain of survival, that HEMS landing infrastructure remains incomplete
and unevenly distributed, that German EMS is characterized by heterogeneous structures and
non-comparable metrics, and that dispatch centres, through standardized call-taking, can assume
a pivotal role in cross-sector triage and resource allocation.
From this synthesis, the dissertation derives concrete fields for action. Firstly, nationwide
implementation of standardized call-taking and dispatch systems as the basis for evidenceinformed
deployment decisions, with broader roll-out of CFR systems. Secondly, establishment of
a national EMS registry with a mandatory core dataset capturing structural, process, and selected
quality indicators. Thirdly, development of a national HEMS infrastructure strategy with defined
minimum standards and priority expansion areas.
At a more fundamental level, the dissertation demonstrates that the contribution of medical
expertise must not end at the boundary between bedside practice and the system level. Physicians
bear a dual responsibility: for direct patient care and for the co-design of clinical framework
conditions extending to system structures and processes. Excellence in emergency care, therefore,
does not arise solely from individual clinical competence, but from medically grounded and
systematically designed prerequisites. The present work makes these prerequisites visible and
renders them usable as a foundation for future clinical, scientific, and health policy decisionmaking.
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Issued: 2026-04-28
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Is based on: 10.1186/s13049-025-01418-yIs based on: 10.1007/s10049-024-01429-9Is based on: 10.1007/s10049-024-01408-0Is based on: 10.1186/s13049-023-01152-3Is based on: 10.1007/s10049-022-01073-1
Faculty
FB20:Medizin
Language
de
Keywords
NotfallmedizinNotfallversorgungSystemLeitstelleCommunity First ResponderHEMSLandeplatzRettungshubschrauberInfrastrukturNotfallkliniken
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Wolff, Justus Felix: Notfallmedizin in Deutschland als Systemleistung : Innovation, Regulation und die Rolle von (Nach-)Steuerung für eine funktionierende Notfallversorgung. : 2026-04-28. DOI: https://doi.org/10.17192/openumr/674.
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Except where otherwised noted, this item's license is described as Attribution-NonCommercial 4.0 International