Offenbach rescue service: "Standing still is not an option"
08.10.2024 – An emergency call can save lives - but often every second counts. Dialing the emergency number 112 is the first step towards fast and targeted help. The Offenbach Rescue Service is an example of this vital rescue chain, in which every action and every decision can be of great importance, and takes stock with an insight into its work.
"It is important to take a look at the work of the rescue service so that citizens know what the safety situation is in an emergency in Offenbach and can develop a better feeling for the interrelationships of the rescue chain. The results are positive, above all due to the extraordinary commitment to quality and patient safety of each individual in the team. I am very pleased that we have been among the leaders in Hesse in terms of the statutory response time of ten minutes in recent years. The Offenbach Fire Department can be more than proud of this," emphasizes Lord Mayor Dr. Felix Schwenke.
The central control center of the Offenbach fire department is also responsible for the rescue service. A dispatcher, also known as an operations officer, receives the emergency call - the starting signal for the rescue chain. "Getting the rescue chain off to the right start is extremely important, because the health of the public is at stake and everything has to be right for the rest of the process. That's why the initial question "Where exactly is the emergency location?" is so fundamental at the beginning of a call, because if the call is interrupted for any reason, the dispatcher can send an ambulance and that gives us the confidence to act," explains Dr. Ingo Brune, Medical Director of the Offenbach Rescue Service. When calls are made from a cell phone, the central control center is able to locate the device in order to identify the exact location of the caller so that appropriate measures can also be initiated if the call is abandoned. The people of Offenbach can rely on this: In an emergency, fast and professional help is just a phone call away.
The team behind the rescue service
The emergency services are on call around the clock. A total of 74 municipal employees work in the Offenbach Fire Department's Rescue Service department, supported by the Workers' Samaritan Federation and the German Red Cross. The rescue service staff are specially trained for the emergency situations that frequently occur in the city of Offenbach and in large cities in general, such as cardiological and neurological cases or intoxications, i.e. alcohol, drugs and other poisonings, and are also prepared for all other emergencies.
The team consists of an emergency paramedic and a paramedic and can be supplemented by an emergency doctor and another emergency paramedic depending on the emergency. In addition, the emergency services of the professional fire department are also available around the clock. All firefighters have at least a state qualification as a paramedic. Emergency paramedics have undergone three years of in-depth professional training with many practical training components.
In addition to the classic rescue service, the paramedics of the professional fire department are deployed both in the fire department's emergency service and, with additional training as an operations officer, in the central control center as an operations officer. Their main tasks are to answer calls in the central control centre and to organize rescue operations.
Each member of the Offenbach fire department is deployed to the respective station for 24 hours. After 6 hours of active operational readiness, the firefighter switches to standby duty for the same duration. On-call duty is for scenarios when the number of simultaneous deployments can no longer be managed with the normal reserve and its first fall-back levels. "It is important to keep an eye on the operational capability of all emergency personnel, both in the short and long term, and not to overburden anyone unnecessarily. Because in the end, every single member of the team counts in order to guarantee success," says Dr. Michael Eiblmaier, Head of the Offenbach Fire Department.
Modern systems with proven effectiveness
The law stipulates this: Every rescue service area must have a central control center that is available around the clock. This is responsible for general assistance, fire protection, disaster control and rescue services. The Offenbach fire department currently works here with two dispatchers every day and three dispatchers during the day who answer emergency calls. At the same time, two additional central control center employees are on standby at the fire and rescue station for larger volumes of calls and can be activated around the clock. The employees took a total of 43,000 emergency calls in 2022, compared to around 46,000 calls in 2023.
The central control center has been working with the structured emergency call query (SNA) since 2019. "This structured procedure has quickly proven its worth in our work processes, as our employees regularly tell us. With this tool, we can ensure our professionalism and quality of work for the health of Offenbach's residents," emphasizes Brune. The SNA makes first aid better and faster. It helps the staff at the central control center to ask all important medical questions. This allows them to quickly decide which emergency services are needed. This reduces the risk of errors. In addition, the dispatchers can help the caller on the phone and reassure them until the emergency services arrive.
It is possible for the dispatchers to alert the necessary emergency services while the emergency call is still being made. "If there is a deviation from the usual procedure in a situation, we discuss it afterwards. This allows us to regularly review our existing workflows and systems and improve them if necessary," explains Brune. Last year, the rescue service received around 26,500 alerts. In 2022, there were even around 29,000.
Cardiac arrest outside a hospital is the third most common cause of death in Germany and occurs at home in 65% of cases. In such a case, the emergency response officer is obliged to offer resuscitation instructions over the phone and provide the caller with telephone support until the emergency services arrive. The caller can be sure that the rescue service will arrive at the scene of the emergency within the legally prescribed time limit of ten minutes.
This time limit is stipulated in the Hessian Rescue Service Act (HDRG) and requires an ambulance to arrive at the kerbside within this period in 90 percent of all call-outs per year. In Offenbach, 92.91% (2023) of the statutory response time is more than met and is above the legal standard. The current figure up to and including July 2024 is in a similar range at 91.64%."
In addition, the central control center dispatches the nearest geo-referenced resources in accordance with the HRDG. According to data from the German Resuscitation Register, the arrival of the first vehicle at the scene in 2023 is even 77.8% within 8 minutes. The expected value in these statistics is 70 percent, meaning that the Offenbach Rescue Service is above this figure. The urban infrastructure with short distances favors this positive value.
In addition, the fire engines are also equipped with medical supplies so that they can also be sent to the scene with a rescue team. This so-called first responder system allows time to be used for initial treatment until an ambulance reaches the patient. This occurs when many ambulances are dispatched at the same time and the requested regional ambulances have a longer journey time. This system shortens the response time for emergency care and improves the chances of survival.
If further transport to a hospital is necessary after initial treatment at the scene, an available facility equipped to treat the type of illness will be contacted directly in consultation with the central control center. In the past, the central control center had to contact individual hospitals to check whether they had the capacity for the patient. Today, the whole thing works in real time using the so-called IVENA system, which was implemented in 2014 as one of several measures to optimize the rescue service.
Dispatchers can see online which hospitals have which care capacities available and direct the ambulance there. This applies to both their own and neighboring rescue service areas. Efficient hospital referral is supported by this tool and offers a patient fast and appropriate care. The Offenbach fire department also benefits from the good cooperation with the Sana Klinikum Offenbach, which is considered a maximum care provider. This facility is also known as a Cardiac Arrest Center, which is specially equipped for the acute treatment of patients in cardiac arrest. There is also close cooperation with the Ketteler Hospital through its cardiac catheterization laboratory.
Continuous quality assurance
In December 2023, the Offenbach fire department's rescue service was certified in accordance with EN 15224 for its high quality standards. "Patient safety was a major focus of the voluntary certification. There are not many facilities in Germany that have this special distinction. Our citizens therefore have clear proof of the quality that sets us apart. At the same time, however, we have to stay on the ball in order to maintain the standard for Offenbach in the future," explains Eiblmaier.
Regularly reflecting on, reviewing and, if necessary, adapting the so-called Alarm and Deployment Regulations (AAO) for the rescue service is fundamental for the Offenbach fire department. To this end, emergency calls, deployments and compliance with response times are continuously evaluated in order to be able to react quickly to changes based on the data. The AAO is generally adapted and updated on this basis every five years, or earlier if necessary. Abnormal deployments and complaints are analyzed and also integrated into the annual training courses for emergency paramedics, paramedics and dispatchers. "The rescue service must always be up to date. Regardless of whether laws change, new medical knowledge is gained or the available medication changes - standing still is not an option," says Brune.
In addition, the regular exchange between the Medical Director of the Rescue Service and the Head of the Central Control Center as well as the consideration of national studies improve the rescue service in Offenbach.
Future-oriented expansion of the rescue service
Compared to the last increase in rescue service personnel and the expansion of resources in 2019, the Offenbach Rescue Service has seen an increase in deployment figures and has therefore developed a clear strategy to further improve response times. "We quickly realized that we would have to gradually expand our operational capacities as the number of deployments increases, the population of Offenbach grows and society ages. To this end, we are already in talks with the political decision-makers. We will continue on this path in 2025 and have therefore set ourselves clear goals," explains Eiblmaier.
The plans include the use of new technologies, the expansion of rescue service equipment and the creation of an additional command post in the central control center. An intensive care ambulance has already been added to the fleet in 2021 to relieve the pressure on the primary rescue service in Offenbach. Technologically, the introduction of a first responder app is being considered, which alerts qualified first responders in the vicinity. In addition to the existing first responder system of the professional fire department, this can further improve the response time of the rescue service. "With this constant exchange and joint planning, we are staying on course and I think that's more than good," says Eiblmaier.
