Professional and scientific expertise in demand: doctors from Leipzig University Hospital play a key role in the new version of the emergency physician indication catalogue

The German Medical Association has revised and republished the so-called Emergency Doctor Indication Catalogue (NAIK). The NAIK forms the basis for the decision in rescue control centres and emergency service centres as to whether an emergency doctor needs to be dispatched or not.

The Leipzig University Hospital (UKL) provided important impetus for the new version: Prof André Gries and Prof Christian Kleber, two UKL experts, were represented on the national working group "Updating the NACC" of the German Medical Association (BÄK).

The emergency physician indication catalogue was first published in 2001 and adapted in 2013. "Since then, new scientific findings and guidelines have been published, non-physician rescue service personnel now have a significantly higher level of qualification with three years of training for emergency paramedics, and the possibilities of telemedical support for emergency services have also been further developed. This, but also the ever-increasing number of emergency doctors who are often not medically necessary, made the revision of the catalogue necessary from the point of view of the German Medical Association," explains Prof. André Gries, Medical Director of the Central Emergency Department (ZNA) at the UKL.

In 2019, the BÄK then formed the working group from selected experts, which included Gries and Prof. Christian Kleber, Head of Trauma Surgery and Head of the Transregional Trauma Centre at the UKL's Clinic and Polyclinic for Orthopaedics, Trauma Surgery and Plastic Surgery. The entire process took three years. However, the coronavirus pandemic was not the least of the difficulties, as many of the working group members were actively involved in the fight against the pandemic.

Sächsische Kooperation bei Analyse von Unfalldaten

"To answer the question of when an emergency doctor is needed and when not, there has been little scientific evidence available for the German rescue service system to date," says Prof Gries.

And this is how the representatives from Saxony came to play a special role in this committee: in order to obtain new data, Prof. Kleber analysed the data on behalf of the German Medical Association together with Dr Michael Hetz and Prof. Klaus-Dieter Schaser from the University of Freiburg. Klaus-Dieter Schaser from the University Centre for Orthopaedics, Trauma Surgery and Plastic Surgery at the Carl Gustav Carus University Hospital in Dresden and the Dresden Traffic Accident Research Unit (VUFO) analysed current data on traffic accidents and accident scenarios with serious injuries using the GIDAS database in order to be able to reliably predict scenarios that require an emergency doctor. GIDAS is the German study for in-depth traffic accident data collection and stands for "German In-Depth Accident Study".

The constellations derived from this were published in the specialist journal "Unfallchirurgie", were then incorporated into the new catalogue and can now be queried by control centre dispatchers.

The working group led by Prof Gries, together with Yacin Keller from the Dresden Fire Department and Anne Schrimpf from the Institute of General Medicine at the University of Leipzig, worked on the statistical evaluation of over 75,000 rescue service calls in the Saxon state capital. Their evaluation was based on the international "Emergency ABCDE" scheme and the professional expertise required to handle the missions. From this, it was possible to crystallise so-called patient conditions for which an emergency medical intervention is required. ABCDE stands for life-threatening situations involving the airways or breathing itself (A, B), circulation (C), neurological functions (D) and special conditions or emergency situations (E).

"By evaluating thousands of missions, we were able to find criteria for the deployment of emergency physicians that have been incorporated into the new catalogue," reports Prof. Gries.

New view: For example, emergency doctor intervention is now not always necessary in the event of a suspected stroke

The Head of the Central Emergency Department at the UKL cites two examples that illustrate the practical benefits: In the new NAIK, for example, the very unspecific condition "no normal breathing" has been omitted. This parameter has now been removed from the approved and published version of the NAIK, as the term is difficult to define and can only be assessed to a limited extent by laypersons.

"Or let's take a suspected stroke as an example," explains Prof. Gries, "typical symptoms such as hemiplegia or speech disorders would have required emergency medical intervention according to the old catalogue," he explains.

The new version, with its focus on the ABCDE levels, now states that no emergency doctor is required for stroke symptoms (exclusively D/neurological status, no ABC problems and therefore no vital danger). "In these cases, it is much more important for the ambulance service to deliver the patient to hospital as quickly as possible after providing the necessary care on site," emphasises Gries.

At the end of the process, both UKL experts were also members of the five-person editorial group, which summarised and sifted through all the research results and produced the version that has now been published. The two Saxon studies formed an essential basis for the decision on the new NAIK.

Source: Press release Leipzig University Hospital from 28 December 2023