Graded Emergency System in emergency medical services in Cologne A new approach to handle increasing numbers of EMS calls with a new resource and classification system

Objectives The most commonly used medical classification instrument in emergency medical services (EMS) in Germany is the National Advisory Committee for Aeronautics (NACA) system. However, no connection between medical severity classification and emergency response (e.g., general practitioner; ambulance; ill-transportation car, emergency physician) can be made using it. Thus, a new classification system was established and evaluated in Germany. Methods The new classification system contains seven categories (1-7) and takes into consideration medical urgency, the required time frame, and the location of the individual (public, home). After the mission, the EMS staff classify the patients into one of the seven categories. Results Between July 2018 and June 2019, a total of 106,492 missions were classified. The distribution of the categories remained astonishing stable over the months, i.e., about 15.2% were attributable to category 1 (a general practitioner was appropriate), about 30% to category 2 (an ambulance was sufficient), about 15% were acute cases needing clarification within 60 & x202f;min (category 3), about 30% required an ambulance (category 4), in 10.6% an emergency physician and ambulance were required (category 5), in 0.6% resuscitation was required (category 6), and in 1% the patient was already dead (category 7). Validation of the 106,492 cases in a hospital was not performed. Conclusion The category distribution using the new classification system remained stable over months. These findings form the basis for further research to improve the planning in the dispatch center, and this instrument will be used in Cologne to further monitor the patient mix and to plan the number and distribution of recent as well as new EMS resources.