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Spoed bij nacht en ontij. Vraag en aanbod van Mobiele Medische Teams in het donker
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Series / Report no.
RIVM rapport 270144001
Open Access
Type
Report
Language
nl
Date
2008-05-30
Research Projects
Organizational Units
Journal Issue
Title
Spoed bij nacht en ontij. Vraag en aanbod van
Mobiele Medische Teams in het donker
Translated Title
Emergency Medical Services out of hours. Supply
and demand of Mobile Medical Teams during night-time in the
Netherlands
Published in
Abstract
In november 2006 is Traumacentrum Oost (TCO) van het
Radboud Ziekenhuis in Nijmegen voor een proefperiode gestart met
nachtvluchten van de traumahelikopter vanaf vliegbasis Volkel. In deze
periode is onderzocht of ook in het donker op een veilige manier een Mobiel
Medisch Team (MMT) met een helikopter naar de plaats van een ongeval kan
worden gebracht. Als dat het geval is, zou bij de realisatie van 24-uurs
traumazorg ook 's nachts gebruikgemaakt kunnen worden van helikopters.
Als onderdeel van dit proefproject heeft het RIVM in opdracht van TCO
onderzocht wat de vraag naar MMT's is in de nachtelijke uren. Hierbij is
specifiek gekeken naar de geografische spreiding van de vraag en de
benodigde tijd voor het MMT om op de plaats van het incident aan te komen.
Een MMT kan per helikopter of per auto worden vervoerd. Beide
vervoersmogelijkheden zijn in dit onderzoek onderzocht.
Voor de analyses zijn diverse modellen ontwikkeld. Met deze modellen kunnen
spreidingsscenario's van MMT's worden doorgerekend waarbij kan worden
berekend hoeveel mensen, gegeven een bepaalde spreiding van MMT-voertuigen
en helikopters, binnen een bepaalde normtijd kunnen worden bereikt.
Eerst is bekeken hoe groot de vraag naar MMT's was de afgelopen jaren en hoe
de geografische verdeling van deze vraag was. Vervolgens is een analyse
gemaakt van de mogelijke nachtelijke vraag naar MMT's als er ook 's nachts
een landsdekkende MMT-voorziening is. Tenslotte is bekeken hoe deze vraag
wordt bediend, gegeven een bepaalde spreiding en beschikbaarheid van MMT's.
In de afgelopen jaren is het aantal MMT-oproepen sterk gestegen; vergeleken
met 2004 waren er in 2005 25% meer oproepen. In 2006 steeg het aantal
inzetten met 30% ten opzichte van 2005 naar een totaal van bijna 4.700
oproepen. Deze groei hangt deels samen met een toename van het aantal
diensturen. Het aantal oproepen is echter sneller gestegen dan het aantal
diensturen.
Het aantal oproepen per meldkamerregio verschilt strek. Deze variatie heeft
een drietal mogelijke verklaringen. Ten eerste wordt er minder een beroep
op een MMT gedaan naarmate de afstand tot de MMT-stationeringsplaats groter
is. Ten tweede lijkt er sprake van aanbodgestuurde vraag; als een MMT
paraat of beschikbaar is, wordt er ook gebruik van gemaakt. Ten derde kan
een aantal typisch regionale verschillen in meldingen de oorzaak zijn van de
regionale variatie. Hierbij kan gedacht worden aan verschillen in het
toepassen van het inzetprotocol. Een eenduidig protocol voor het oproepen
van MMT's ontbreekt op de meldkamers. Verder kan gedacht worden aan
verschillen in kenmerken van de regio, verschillen in meldkamercultuur en
cultuur in de ambulancewereld en verschillen in bejegening, vaardigheden en
ervaring van personeel van zowel ambulancediensten als het MMT. Vanwege
deze regionale verschillen, lopen de schattingen van de nachtelijke vraag
uiteen van 90 tot ruim 2.600 oproepen per jaar in Nederland.
Het bereik van de helikopter is 's nachts minder groot dan overdag. In de
nacht ligt de gemiddelde snelheid ongeveer 25 km/u lager dan overdag. Het
aantal bereikte inwoners binnen 30 minuten (de dekkingsgraad) is daardoor,
afhankelijk van de stationeringsplaats van de helikopter, 30% tot 45% lager
ten opzichte van de dagsituatie. 's Nachts moet de helikopter 6 minuten
langer vliegen om dezelfde afstand te halen als overdag binnen 30 minuten.
Momenteel hebben vier traumacentra een paraat MMT. Deze centra hebben
tevens de beschikking hebben over een helikopter. Daarnaast worden vanuit
zes andere traumacentra beschikbaarheidsdiensten van MMT's met een voertuig
georganiseerd. Bovendien is er nog ondersteuning door een Belgische en twee
Duitse helikopters. Overdag wordt door dit netwerk 98,2% van de Nederlandse
bevolking bereikt. Zonder buitenlandse helikopters neemt dit percentage af
tot 94,2%. In de nachtsituatie loopt de dekking terug naar
78,3%.
In November 2006, Traumacentrum Oost (TCO) of the Radboud University Hospital in Nijmegen started an experiment to increase out-of-hours availability of helicopter emergency medical services (HEMS) from Volkel air base near Eindhoven. While these emergency medical services were already available between 7 AM and 7 PM, the aim of this trial was to investigate whether helicopter emergency flights could be carried out safely during hours of darkness. Services are carried out by the TCO's Mobile Medical Team (MMT), after a triage process via the ambulance care dispatch centre. The trial was also set up to provide concrete data that were then incorporated in a scenario study. Through this study, a range of options as regards geographical coverage were considered in order to understand how supply of (helicopter) emergency medical services might meet the demand for it during night-time. These scenarios take into account that the MMT is not necessarily dependent on helicopter transport: they can also use specialised vehicles. The safety of emergency flights was not investigated as this is done by TCO itself in collaboration with ANWB Medical Air Assistance. Various models were developed to underpin the scenario analysis. Scenarios varied for the geographical spread and location of emergency vehicles and helicopters. For each scenario, population coverage was calculated as the number of people that could be reached within a time span of 30 minutes maximum. This study mapped volume and geographical spread of the actual uptake of MMT services over the three years prior to the start of the trial in November 2006. In conjunction with the data collected over the trial period, these data were taken as a starting point to calculate the potential demand for a helicopter emergency service would it have been available. The study then tried to identify how this demand could be met, given various scenarios as regards geographical coverage and availability of MMT's. Results indicate the actual requests for MMT services have increased considerably over the last few years: compared to 2004, 25% more requests were received in 2005. Over 2006, the number of requests again increased by 30% to a total of 4,700. This increase is only partly due to the increase in staff availability and working hours. The absolute number of requests made by the dispatch centres differs considerably across regions. There may be three possible explanations for this. Firstly, geographical distance between MMT location and regional dispatch centre location seems to impact on the likelihood of requests being made: the greater the distance, the less likely personnel is to make this call. Furthermore, demand seems to be influenced by supply: if an MMT unit is available this triggers the demand for it. Finally, organisational and cultural regional differences may play a role, such as protocol implementation in the dispatch centre; staff experience, attitudes and skills of both emergency ambulance and MMT personnel; and communication aspects. These regional differences are reflected in the actual demand for MMT services during the night-time: the study found these to range between 90 and 2,600 requests made over the period of one year. Flight data show night-time geographical coverage of helicopter services to be reduced when compared to day time coverage, as the average speed of a helicopter is 25 km/hr below daytime speed. Consequently, the number of people that can be reached within 30 minutes is 30-45 % below the potential reach during day time. From a different perspective: in order to achieve the same geographical coverage during night-time, helicopters would have to stay in the air for an additional 6 minutes. Based on the number of trauma centres that are available in the Netherlands, results show night-time availability of emergency services could potentially cover 78.3% of the population, against 98.2% during the day time.
In November 2006, Traumacentrum Oost (TCO) of the Radboud University Hospital in Nijmegen started an experiment to increase out-of-hours availability of helicopter emergency medical services (HEMS) from Volkel air base near Eindhoven. While these emergency medical services were already available between 7 AM and 7 PM, the aim of this trial was to investigate whether helicopter emergency flights could be carried out safely during hours of darkness. Services are carried out by the TCO's Mobile Medical Team (MMT), after a triage process via the ambulance care dispatch centre. The trial was also set up to provide concrete data that were then incorporated in a scenario study. Through this study, a range of options as regards geographical coverage were considered in order to understand how supply of (helicopter) emergency medical services might meet the demand for it during night-time. These scenarios take into account that the MMT is not necessarily dependent on helicopter transport: they can also use specialised vehicles. The safety of emergency flights was not investigated as this is done by TCO itself in collaboration with ANWB Medical Air Assistance. Various models were developed to underpin the scenario analysis. Scenarios varied for the geographical spread and location of emergency vehicles and helicopters. For each scenario, population coverage was calculated as the number of people that could be reached within a time span of 30 minutes maximum. This study mapped volume and geographical spread of the actual uptake of MMT services over the three years prior to the start of the trial in November 2006. In conjunction with the data collected over the trial period, these data were taken as a starting point to calculate the potential demand for a helicopter emergency service would it have been available. The study then tried to identify how this demand could be met, given various scenarios as regards geographical coverage and availability of MMT's. Results indicate the actual requests for MMT services have increased considerably over the last few years: compared to 2004, 25% more requests were received in 2005. Over 2006, the number of requests again increased by 30% to a total of 4,700. This increase is only partly due to the increase in staff availability and working hours. The absolute number of requests made by the dispatch centres differs considerably across regions. There may be three possible explanations for this. Firstly, geographical distance between MMT location and regional dispatch centre location seems to impact on the likelihood of requests being made: the greater the distance, the less likely personnel is to make this call. Furthermore, demand seems to be influenced by supply: if an MMT unit is available this triggers the demand for it. Finally, organisational and cultural regional differences may play a role, such as protocol implementation in the dispatch centre; staff experience, attitudes and skills of both emergency ambulance and MMT personnel; and communication aspects. These regional differences are reflected in the actual demand for MMT services during the night-time: the study found these to range between 90 and 2,600 requests made over the period of one year. Flight data show night-time geographical coverage of helicopter services to be reduced when compared to day time coverage, as the average speed of a helicopter is 25 km/hr below daytime speed. Consequently, the number of people that can be reached within 30 minutes is 30-45 % below the potential reach during day time. From a different perspective: in order to achieve the same geographical coverage during night-time, helicopters would have to stay in the air for an additional 6 minutes. Based on the number of trauma centres that are available in the Netherlands, results show night-time availability of emergency services could potentially cover 78.3% of the population, against 98.2% during the day time.
Description
Publisher
Sponsors
UMC St.Radboud
Nijmegen
Nijmegen