Comparison of dispatching after motor vehicle accidents – Effects of the TPS-eCall system on dispatching time

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A shorter duration of prehospital care correlates with a positive change in outcome in numerous studies. Dispatching by the public safety answering points has hardly been discussed to date. Thanks to improved vehicle safety, additional accident data is now available to the emergency call centers. Methods: We investigated the effects of third-party system emergency calls (TPS-eCalls), which have become mandatory in new passenger cars in the EU in 2018, on dispatching in the emergency medical services (EMS). For this purpose, we linked the data of a public-safety answering point (PSAP) and an EMS. All emergency service deployments from 01/01/2023 to 31/12/2023 were evaluated. N=1546 rescue missions were dispatched after motor vehicle accidents (MVA), 111 after TPS-eCall-alerts, 1435 after conventional alerts. Results: Dispatching in the PSAP currently took longer after a TPS eCall alerts than conventional alerts (01:39±01:40min vs. 02:41±02:01min, p ≤ 0.001). The differences were only significant in the case of accidents involving ≤ 2 passengers. Conclusions: TPS-eCall data will be available increasingly. The future expansion data availability offers the opportunity to include objective accident data (airbag deployment, number of occupants, change of velocity) in the dispatching process. Adequate technical connection can improve dispatching and shorten preclinical treatment, especially for complex events with more than 2 passengers. emergency Call eCall AACN TraumaRegister DGU® public-safety answering Figures Figure 1 Figure 2 1. Introduction 1.1 Medical treatment The term “golden hour of shock” was first introduced by R Adams Cowley in 1975 [ 1 ]. Over the past 50 years, the concept of the golden hour of shock has been established as one of the central tenets of emergency trauma medicine. The idea of treating the right patient with the right equipment in the appropriate trauma center has formed the basis of organized trauma treatment and certification processes throughout the world. Less known is the military concept of preclinical emergency medicine, in which the on-scene time of emergency medical services for seriously injured patients should be shorter than “10 platinum minutes” [ 2 ]. Both concepts and numerous studies support the idea of shortening prehospital time to improve outcomes [ 3 – 10 ]. Time delays due to rural accident locations and longer distances to specialized hospitals may be two explanations for worse outcomes after MVA [ 11 ]. While preclinical and especially clinical treatments are discussed in the current literature, dispatching by public safety answering points (PSAP) is rarely considered. However, dispatching marks the beginning of the dogmatically trained “golden hour of shock” and the “10 platinum minutes” and shall be discussed as the first possibility to reduce prehospital time. 1.2 eCall-Data European Regulation 2015/758 regulates that new cars must be equipped with an automatic emergency call notification system. Emergency call systems (eCall systems) have been mandatory for new passenger cars and light commercial vehicles in Germany since 04/01/2018. The general requirements are shown in Table 1 (Table 1 ). Table 1 General requirements for operating an eCall system GPS receiver for determining the position of the vehicle GSM antenna for sending the emergency call Control unit for reporting the location Crash sensor for detecting the type of accident Hands-free system Separate emergency power supply Button for manually triggering the emergency call Indicator light In Germany, the automotive industry can choose between two different systems to contact a PSAP. Accident data can be transmitted via emergency call number 112 (112-eCall) or so-called third-party service eCalls (TPS-eCalls) to provide vehicle occupants with early assistance in medical emergencies. The main difference is that 112 eCalls establish a direct connection between the vehicle occupants and the emergency call center. TPS-eCalls, on the other hand, are routed through a service center. In both systems, eCalls can be triggered manually or automatically. Both systems contain a minimum set of data (MSD). The MSD includes among other data about the exact place and time of an accident. The contents of the MSD are shown in Table 2 (Table 2 ). Table 2 Parameters of the Minimal Set of Data (= MSD) ECall activation Automatic or manual activation Test-Call Test use or real use Plausible position information Yes/ no Vehicle type Type of vehicle VIN Vehicle identification number Drive type Petrol, diesel, hybrid, electric drive Time information Time of activation Position Latitude Location at the time of activation (Latitude) Position Longitude Location at the time of activation (Longitude) Direction of travel Last direction of travel Due to increasing safety demands in the European New Car Assessment Program (Euro NCAP), further data availability is expected in extended sets of data (ESDs). Possible extensions include objective information on the number of passengers, airbag deployments and velocity changes. Furthermore, an expansion to other vehicle systems (e.g., trucks and motorcycles) is planned. 1.3 Benefit for PSAP, EMS and patients The development of standardized, evidence-based protocols for dispatching in PSAPs and for the effective use of telemetry data from MVA has long been discussed. ECall systems and their implementation in the rescue chain represent a way of forwarding objective accident data automatically from the vehicle manufacturer to the emergency medical service (EMS) personnel within seconds. In 2018, the year in which eCall systems became mandatory in new cars in Germany, 40 people per million inhabitants died from MVA. While the number of fatalities has not steadily declined recently, the mandatory installation of eCall systems is expected to increase the number of eCalls and thus also provide an opportunity to optimize treatment in individual cases. An increasing number of eCalls may lead to an acceleration of the flow of information after MVA and potentially lead to faster treatment of life-threatening injuries. The transmission of objective crash data can also enable an evaluation of specific accident mechanisms, which can lead to individualization of treatment in emergency services and hospitals. 1.4 Aim The aim of our study was to evaluate the dispatching time of the PSAP after the MVA in the city of Essen, Germany, in 2023 (01/01/2023 to 12/31/2023). We examined the effects of dispatching rescue resources with and without TPS-eCall alerts on the operational process in the EMS. An individual risk assessment after MVA was made possible by linking to an extended TPS-eCall dataset. The current work focused on an evaluation of the handling of TPS-eCall accident datasets by the PSAP in the German public emergency service. In contrast to many other emergency services, a relatively high proportion of German EMS units are manned with emergency physicians (EPs). 2. Materials and methods We analyzed collected monocentric call logs from one PSAP and one EMS control center in a prospective observational study. One of the authors (BB) works in the medical management of the EMS of the City of Essen, Germany, in a prospective observational study of routine data. In the context of professional supervision, an overall assessment of the treatment data from the EMS had to be made. The study was reviewed and approved by the Ethics Committee of the Medical Faculty of the University of Duisburg-Essen (20-9161-BO). The data sets for the study come from two data sources, the call logs of the emergency call center and statistical, anonymous parts from the EMS logs. Medical diagnoses or personal details are not available in these parts. Consent was therefore not required. All protocols were linked in a multistage process. All emergency service deployments after the MVA from 01/01/2023 to 31/12/2023 were evaluated. In the call logs, alerts were filtered on the basis of keywords that indicated an MVA. In addition to the callout keywords, a caller number evaluation (TPS-eCall service center vs. other callers) was provided and linked to the EMS database. All operations that contained no reference to MVA in the operational keywords were subsequently excluded. The emergency calls received by the PSAP in Essen, Germany, via 112-eCalls could not be distinguished from non-eCall alerts. This occurred because 112-eCalls cannot be recognized by their phone number. TPS-eCalls, on the other hand, can be identified on the basis of the defined number of callers of the service center. Thus, the TPS-eCalls were compared to a mixed group of non-eCalls and 112-eCalls. Our data, which were based on data collected from a German PSAP, distinguished between rescue resources with and without an emergency physician (EP). The option of alerting an EP in addition to an ambulance made dispatching more difficult for the PSAP. The availability of several EPs in the Essen EMS offered the PSAP the opportunity to access the resource at a low threshold. Compared with international emergency services with fewer available EPs, the probability of overtriage shifted. To enable international comparability, only the arrival of the first vehicle, corresponding to the dispatching of an ambulance in the system without EPs, was considered when calculating the data. However, we later considered specifically for Germany whether an EP’s qualification was subsequently dispatched or whether an EP who was present had an effect on follow-up dispatching. We also analyzed differences depending on the number of people injured in the accidents. We assumed a higher disposition complexity (DC) with a larger number of patients. This may have applied to missions with severely injured persons who were required to be transported to a hospital in particular. In the evaluation of accident events, we categorized accidents on the basis of the number of patients. In this initial assessment, we defined the categories as follows: none or one patient (disposition complexity 1 (DC1), 2 patients (DC2), and ≥ 3 or more patients (DC3)). 3. Results 3.1. Primary dispatching From 01/01–12/31/2023, the PSAP of the Essen Fire Department dispatched 1546 operations triggered by MVAs. In 1435 cases, a conventional alarm was raised following information from parties involved in the accident. In 111 cases, a TPS-eCall Service Center contacted the PSAP by telephone. A total of 2409 rescue vehicles were involved in 1546 deployments. The duration of dispatch from call receipt in the PSAP to alerting the EMS unit was 01:44 ± 01:43 minutes for the entire collective. Dispatching was significantly shorter for interventions that were not initiated by TPS-eCall service centers (01:39 ± 01:40 vs. 02:41 ± 02:01 min, p ≤ 0.001) (Fig. 1 ). The involvement of EPs did not differ between the categories, with 18% EP involvement in TPS-eCall dispositions and 22% non-eCall dispositions. 3.2 Follow-up dispatching: Follow-up dispatching (FUD) was interpreted as an undertriage of the PSAP-dispatcher. A comparison of the TPS-eCall and non-eCall categories revealed differences in the number of additional EMS units ordered (Table 3 ). There were significantly more additional requests for further emergency resources after TPS-eCall alerts (9% vs. 23.4%, p ≤ 0.001). Table 3 Numbers of follow-up dispatched (FUD) EMS units Follow-up dispatched EMS units 0 1 AMB 1 EP ≥ EMS unit TPS-eCall (n = 111 operations) 85 (76.6%) 12 (10.8%) 4 3.6%) 10 (9%) non-TPS-eCall (n = 1435 operations) 1310 (91.3%) 59 (4.1%) 41 (2.9%) 25 (1.7%) Total (n = 1546 operations) 1395 71 45 35 (90.2%) (4.6%) (2.9%) (2.3%) 3.2.1 Follow-up dispatching depending on the qualifications of the EMS: In 1212 cases (n = 1125 (92.8%) non-eCall vs. n = 87 (7.2%), TPS-eCall) there was no primary alerting of an EP. The subsequent alerting of an EP was necessary in 4 cases (3.6%) (TPS-eCall) and 41 cases (2.9%) (non-eCall) (Table 4 ). In the event of a primary alert of an EP, emergency resources were subsequently alerted in 334 cases (310 (92.8%) non-eCall vs. 24 (7.2%) TPS-eCall). After the primary alerts of an EP, there were no significant differences in the subsequent alerts. After the primary alerts of an EP, there were no significant differences in the subsequent alerts. Table 4 Follow-up dispatches with or without on-scene EP Follow-up dispatched EMS unit without on-scene EP 0 1 AMB 1 EP ≥ EMS unit TPS-eCall (n = 87 operations) 64 (73.6%) 10 (11.5%) 4 (4.6%) 9 (10.3%) non-TPS-eCall (n = 1125 operations) 1031 (91.6%) 36 (3.2%) 40 (3.6%) 18 (1.6%) Total (n = 1212 operations) 1095 46 44 27 (90.3%) (3.8%) (3.6%) (2.2%) Follow-up dispatched EMS unit with on-scene EP 0 1 AMB 1 EP ≥ EMS unit TPS-eCall (n = 24 operations) 21 (87.5%) 2 (8.3%) 0 (0%) 1 (4.2%) non-TPS-eCall (n = 310operations) 279 (90%) 23 (7.4%) 1 (0.3%) 7 (2.3%) Total (n = 334 operations) 300 25 1 8 3.3 Dispatching complexity: The duration of the dispatching process was significantly longer for the TPS-eCall interventions for DC1 and DC2 (Fig. 2 ). When differentiating by dispatching complexity, DC1 (TPS-eCall n = 19: 02:38 ± 01:44, non-eCall n = 1278: 01:37 ± 01:41, p < 0.001) and DC2 (TPS-eCall n = 73: 02:46 ± 02:16, non-eCall n = 105: 01:49 ± 01:26, p < 0.05) were significant. The differences in DC3 were not significant. There were no differences when the categories of eCall-associated accidents were compared. Non-eCall-associated accidents were significantly different in all comparisons (DC1 vs. DC2: p < 0.05, DC2 vs. DC3 p < 0.05, DC1 vs. DC3 p < 0.001). 4. Discussion The common belief is that brief but precise EMS treatment with a short total prehospital time benefits patients with urgent treatment indications, as shown in 2 meta-analyses from 2015 and 2020 [ 12 , 13 ]. Even if the concepts of the EMS and hospitals are increasingly considered in conjunction, the EMS is rarely the central focus of scientific considerations [ 13 ]. Documentation in registers generally begins when the EMS is alerted. In the few studies in which the activation time was discussed, no change in outcome was found as a result of the activation time, neither for severe thoracic injuries nor for polytraumatized persons [ 14 , 15 ]. However, the more frequently discussed preclinical overall treatment duration had an impact. Emergency call times, dispatching intervals and standardization in the dispatching process can rarely be discussed in the context of accident-specific patient outcomes due to a lack of data linkages. Nevertheless, dispatchers throughout Europe initiate cost-intensive operations, mostly due to accident mechanisms, and decide on the necessity of EP treatment [ 16 ]. However, it should be noted that the assessment of the ideal treatment location (hospital selection) by the PSAP differs between the dispatching and the EMS during treatment [ 17 , 18 ]. Both the PSAP and EMS can adjust their decisions on treatment urgency and destination hospitals with more objective accident data. To illustrate the potential impact of better decisions, reference is given to the high number of potentially avoidable preclinical deaths [ 19 ]. Kleber et al. described a 15% proportion of (potentially) preventable, because treatable, causes in an analysis of trauma-related deaths in an urban EMS, which is comparable to the EMS in Essen, Germany. In a 2020 meta-analysis, Bedard et al. substantiated the effects of prehospital time on the outcomes of trauma patients [ 13 ]. Unfortunately, the evaluation of prehospital treatment was based on in-hospital deaths with an observation period of 30 days, while prehospital deaths were excluded. In the current TR-DGU® annual report from 2024, two time points with an increased rate of death were identified in patients: within the first 48 hours after trauma and around the 7th day after the accident [ 20 ]. Unfortunately, prehospital deaths were not included in the TR-DGU® analyses, as well. The questions of whether the higher mortality is due to prehospital or clinical treatment strategies and whether dispatching and the resulting prehospital time reduction have an impact on mortality remain unanswered. Our results reveal significant differences in the disposition process, with shorter activation times for non-TPS eCall activations. A shorter time may improve outcomes for potentially treatable causes of death. Due to the relatively low number of TPS-eCall cases, no patient with high ISS or an immediate need for treatment due to airway obstruction, tension pneumothorax or critical hemorrhage was identified. Lovely et al. described in 2018, again excluding prehospital deaths and admission time, that on-scene time and transport time are less relevant to outcome than the injury severity score (ISS) in MVA [ 21 ]. Even if ISS is the main determinant of outcome, early treatment may have a positive effect. This interpretation is also supported by Brown et al., who described a prolongation of hospitalization by a factor of 1.16 for each additional minute on-scene [ 22 ]. Although Brown et al. did not refer to the deployment time, a worsening of the findings at high ISS without adequate treatment seems to have a conclusive correlation regardless of the extension of the deployment time or the on-scene time. We also found significant differences between TPS-eCall and conventionally dispatched operations with a lower or middle dispatching complexity (DC1 or DC2). In the case of complex MVA (DC3), the dispatching times for TPS-eCall alerts and conventional alerts no longer differ. While the dispatching time for conventional alarms increased with the number of passengers, the dispatching time for TPS-eCalls was constant. In the detailed analysis, it should be noted that for all the results, conventional alarms are raised via emergency number 112. TPS-eCall alerts do not reach the emergency number 112 but instead address a nonprioritized telephone number in the PSAP. Due to purely telephone-based data transmission, it may be necessary to convert geodata into postal addresses when coordinating the location of an emergency. These technical disadvantages are possibly the reason for the significant differences in dispatching times. An identical connection to the emergency number 112 could lead to an improvement in alerts from TPS-eCall service centers. Unfortunately, the evaluation of time differences is only possible after telephone contact with the PSAP. TPS eCall data could be supplemented with the exact time of the accident event if the service centers were connected via a data interface with the PSAP. In the case of accidents without eCall data, the time of the accident will remain unknown, so this limitation persists in the comparison. Compared with conventional alerting without eCall data, a relative shortening of the dispatching process after TPS-eCalls via data interfaces is highly probable. The explanation for the higher FUD rate, interpreted as a prior undertriage of the PSAP, may be caused by several factors. The reasons could be that the dispatchers in the PSAP are not yet trained in handling the available information or that dispatchers at the service centers are less in line with the guidelines when assessing accident incidents than the EMS personnel on site are. Next, low case numbers can make interpretation more difficult for operations with higher dispatching complexity. However, with low case numbers but an identical percentage ratio of TPS-eCall alerts to conventional alerts, the number of FUD appears to be greater, particularly when no EP is alerted. During the study period, the S3 guidelines for the treatment of polytrauma/seriously injured patients were updated. It is therefore also possible that the EMS personnel still followed the previous guidelines, which provided a more generous indication for the activation of a trauma team and thus also an EP indication, while the EPs were already familiar with the new guidelines. 5. Limitations The current study is subject to several limitations. On the one hand, the number of ecall alerts and the number of complex dispositions are relatively low in the local study approach. The duration from the accident event to contact the PSAP is not traceable for either the TPS-eCall or the conventional alerting, so that only the disposition at the PSAP can be evaluated. Unfortunately, TPS eCalls do not reach the PSAP via the prioritized emergency number, so there may be a time delay compared with conventional alarms. The technical connection and transmission of TPS-eCall events as data records can lead to a significant acceleration of the dispatching process, especially compared with alerts by persons who have been injured, but this cannot yet be verified. As eCall systems become more widespread, the relevance of accident reporting systems increases. At present, the proportion of 112-eCalls cannot be identified, meaning that conventional alerts also contain 112-eCalls. Due to the lack of data availability, the current study did not follow up on hospital treatment. By including hospital treatment, an improved evaluation of the outcome may be possible. 6. Conclusions From the authors' point of view, objective, sensor-measured TPS-eCall data can be of higher quality than accident information from vehicle occupants. In the future, standardized dispatching must be established and evaluated for conventional alerts and, because of data availability, even more for TPS-eCall-alerts. Dispatchers must be trained to process and interpret TPS-eCall data. A basic prerequisite for the adequate use of eCall data is the establishment of a data interface between the PSAP and the TPS-eCall service center. To understand aspects of prehospital time and its impact on outcomes, an understanding of dispatching, dispatching complexity and the use of objective prehospital data is desirable. The evaluation of objective accident mechanisms can provide an additional step in analyses of registry data. Abbreviations The following abbreviations are used in this manuscript: DC Dispatching complexity eCall Emergency call EMS Emergency medical service EP Emergency physician FUD Follow-up dispatching ISS Injury severity score PSAP Public-safety answering point TPS-eCall Third-Party-Service-emergency call TR-DGU® TraumaRegister of the German Trauma Society Declarations Funding: This research received no external funding. Conflicts of Interest: The authors declare no conflicts of interest. Institutional Review Board Statement: The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Ethics Committee of the of the Medical Faculty of the University of Duisburg-Essen (20-9161-BO) Informed Consent Statement: Not applicable Consent for publication: Not applicable Data Availability Statement: The datasets presented in this article are not readily available because of privacy. Requests to access the datasets should be directed to BB. References Cowley RA. A total emergency medical system for the State of Maryland. Md State Med J. 1975;24:37–45. Battlefield advanced trauma life support (BATLS). J R Army Med Corps. 2000;146:215–27. 10.1136/jramc-146-03-12 . Sampalis JS, Lavoie A, Williams JI, Mulder DS, Kalina M. Impact of on-site care, prehospital time, and level of in-hospital care on survival in severely injured patients. J Trauma. 1993;34:252–61. 10.1097/00005373-199302000-00014 . 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Cite Share Download PDF Status: Published Journal Publication published 23 Sep, 2025 Read the published version in BMC Emergency Medicine → Version 1 posted Editorial decision: Revision requested 12 Aug, 2025 Reviews received at journal 09 Aug, 2025 Reviewers agreed at journal 18 Jul, 2025 Reviews received at journal 07 Jul, 2025 Reviewers agreed at journal 22 Jun, 2025 Reviews received at journal 12 May, 2025 Reviewers agreed at journal 10 May, 2025 Reviewers agreed at journal 07 May, 2025 Reviewers invited by journal 07 May, 2025 Editor assigned by journal 07 May, 2025 Editor invited by journal 05 May, 2025 Submission checks completed at journal 01 May, 2025 First submitted to journal 01 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6378481","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":454650010,"identity":"7ad91d87-8e49-4bcf-b899-245acbd901cc","order_by":0,"name":"Bastian Brune","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIiWNgGAWjYBACAxCRAGMwVEBpIGBswK2FsQGh5QyxWuDWMbYRocWc/fjzBw9q7jCYS58xe/Bx3mFjBvb2xx8+7mCQ7cehxbInx7Ah4dgzBsu+HHPDmdsOmzHwnDGTnHmGwXgmDmsMDuQA/cJ2mMHgDI+ZNO+2wzb2N3LYmHnbGBI3HMCh5fzzhw0J/6Ba/s45bMMg//zx579ALftxabmRYNiQ2AbVwtgAdJgEg4E0I8gWXH6Z8cZwRmLfYR7LHrYyyZ5j6cYMPDlmkr1tEsYzcNhizp/+4OOPb4flzHmYt0n8qLE2bGA//vjDzzYb2X4c3ocBHnQBCfzqR8EoGAWjYBTgBQBBgVyLE/CxxAAAAABJRU5ErkJggg==","orcid":"","institution":"Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University Duisburg Essen","correspondingAuthor":true,"prefix":"","firstName":"Bastian","middleName":"","lastName":"Brune","suffix":""},{"id":454650011,"identity":"009ea685-7aff-48db-a425-04fa73ca9b8f","order_by":1,"name":"Fabian Haut","email":"","orcid":"","institution":"Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University Duisburg Essen","correspondingAuthor":false,"prefix":"","firstName":"Fabian","middleName":"","lastName":"Haut","suffix":""},{"id":454650013,"identity":"b98b10b5-c2e7-42c6-8b66-4a0e871beecc","order_by":2,"name":"Maximilian Wolf","email":"","orcid":"","institution":"Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University Duisburg Essen","correspondingAuthor":false,"prefix":"","firstName":"Maximilian","middleName":"","lastName":"Wolf","suffix":""},{"id":454650014,"identity":"7853a967-f1d6-4a78-97f4-f3321e43372c","order_by":3,"name":"André Nohl","email":"","orcid":"","institution":"Emergency Department, BG-Klinikum Duisburg","correspondingAuthor":false,"prefix":"","firstName":"André","middleName":"","lastName":"Nohl","suffix":""},{"id":454650015,"identity":"759ee5ea-91e4-4a37-bfd2-0825c75cb781","order_by":4,"name":"Frank Herbstreit","email":"","orcid":"","institution":"Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg- Essen","correspondingAuthor":false,"prefix":"","firstName":"Frank","middleName":"","lastName":"Herbstreit","suffix":""},{"id":454650016,"identity":"4cddf3c2-2bb6-4519-b54e-00f6a5f1d80c","order_by":5,"name":"Christian Waydhas","email":"","orcid":"","institution":"Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University Duisburg Essen","correspondingAuthor":false,"prefix":"","firstName":"Christian","middleName":"","lastName":"Waydhas","suffix":""},{"id":454650017,"identity":"83b99493-70e6-49c0-b5c0-cf866b5ce0b4","order_by":6,"name":"Marcel Dudda","email":"","orcid":"","institution":"Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University Duisburg Essen","correspondingAuthor":false,"prefix":"","firstName":"Marcel","middleName":"","lastName":"Dudda","suffix":""},{"id":454650019,"identity":"0fd3fa69-73a5-431a-80bf-e033c9a563c6","order_by":7,"name":"Lars Becker","email":"","orcid":"","institution":"Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University Duisburg Essen","correspondingAuthor":false,"prefix":"","firstName":"Lars","middleName":"","lastName":"Becker","suffix":""}],"badges":[],"createdAt":"2025-04-04 19:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6378481/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6378481/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12873-025-01361-2","type":"published","date":"2025-09-23T15:58:17+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82620070,"identity":"c7657cde-fd3d-412a-a9aa-f8ed1939a1b2","added_by":"auto","created_at":"2025-05-13 12:12:17","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":10225,"visible":true,"origin":"","legend":"\u003cp\u003eAverage dispatching time ± standard deviation in minutes non-TPS-eCall vs. TPS-eCall.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6378481/v1/f5efb723c5c4eb9153ef2677.png"},{"id":82620072,"identity":"d1909fb8-6c93-4716-b649-b0f08ac8f82f","added_by":"auto","created_at":"2025-05-13 12:12:17","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":18512,"visible":true,"origin":"","legend":"\u003cp\u003eAverage dispatching time ± standard deviation in minutes non-TPS-eCall vs. TPS-eCall depending on dispatching complexity\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6378481/v1/20a2c089c3abd05d6ab94c1b.png"},{"id":92430912,"identity":"b7be2d0d-03ce-441e-b1b3-44ad95af0b66","added_by":"auto","created_at":"2025-09-29 16:08:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":768426,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6378481/v1/c520f040-0b64-4f96-80bb-4ea1aafaa53d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of dispatching after motor vehicle accidents – Effects of the TPS-eCall system on dispatching time","fulltext":[{"header":"1. Introduction","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Medical treatment\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe term \u0026ldquo;golden hour of shock\u0026rdquo; was first introduced by R Adams Cowley in 1975 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Over the past 50 years, the concept of the golden hour of shock has been established as one of the central tenets of emergency trauma medicine. The idea of treating the right patient with the right equipment in the appropriate trauma center has formed the basis of organized trauma treatment and certification processes throughout the world. Less known is the military concept of preclinical emergency medicine, in which the on-scene time of emergency medical services for seriously injured patients should be shorter than \u0026ldquo;10 platinum minutes\u0026rdquo; [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Both concepts and numerous studies support the idea of shortening prehospital time to improve outcomes [\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8 CR9\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Time delays due to rural accident locations and longer distances to specialized hospitals may be two explanations for worse outcomes after MVA [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile preclinical and especially clinical treatments are discussed in the current literature, dispatching by public safety answering points (PSAP) is rarely considered. However, dispatching marks the beginning of the dogmatically trained \u0026ldquo;golden hour of shock\u0026rdquo; and the \u0026ldquo;10 platinum minutes\u0026rdquo; and shall be discussed as the first possibility to reduce prehospital time.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2 eCall-Data\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eEuropean Regulation 2015/758 regulates that new cars must be equipped with an automatic emergency call notification system. Emergency call systems (eCall systems) have been mandatory for new passenger cars and light commercial vehicles in Germany since 04/01/2018. The general requirements are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral requirements for operating an eCall system\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGPS receiver for determining the position of the vehicle\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGSM antenna for sending the emergency call\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl unit for reporting the location\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCrash sensor for detecting the type of accident\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHands-free system\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeparate emergency power supply\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eButton for manually triggering the emergency call\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndicator light\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn Germany, the automotive industry can choose between two different systems to contact a PSAP. Accident data can be transmitted via emergency call number 112 (112-eCall) or so-called third-party service eCalls (TPS-eCalls) to provide vehicle occupants with early assistance in medical emergencies. The main difference is that 112 eCalls establish a direct connection between the vehicle occupants and the emergency call center. TPS-eCalls, on the other hand, are routed through a service center. In both systems, eCalls can be triggered manually or automatically. Both systems contain a minimum set of data (MSD). The MSD includes among other data about the exact place and time of an accident. The contents of the MSD are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParameters of the Minimal Set of Data (=\u0026thinsp;MSD)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eECall activation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAutomatic or manual activation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTest-Call\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTest use or real use\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlausible position information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes/ no\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVehicle type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eType of vehicle\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVIN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVehicle identification number\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrive type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePetrol, diesel, hybrid, electric drive\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime of activation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosition Latitude\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLocation at the time of activation (Latitude)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosition Longitude\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLocation at the time of activation (Longitude)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirection of travel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLast direction of travel\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eDue to increasing safety demands in the European New Car Assessment Program (Euro NCAP), further data availability is expected in extended sets of data (ESDs). Possible extensions include objective information on the number of passengers, airbag deployments and velocity changes. Furthermore, an expansion to other vehicle systems (e.g., trucks and motorcycles) is planned.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.3 Benefit for PSAP, EMS and patients\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe development of standardized, evidence-based protocols for dispatching in PSAPs and for the effective use of telemetry data from MVA has long been discussed. ECall systems and their implementation in the rescue chain represent a way of forwarding objective accident data automatically from the vehicle manufacturer to the emergency medical service (EMS) personnel within seconds.\u003c/p\u003e \u003cp\u003eIn 2018, the year in which eCall systems became mandatory in new cars in Germany, 40 people per million inhabitants died from MVA. While the number of fatalities has not steadily declined recently, the mandatory installation of eCall systems is expected to increase the number of eCalls and thus also provide an opportunity to optimize treatment in individual cases. An increasing number of eCalls may lead to an acceleration of the flow of information after MVA and potentially lead to faster treatment of life-threatening injuries. The transmission of objective crash data can also enable an evaluation of specific accident mechanisms, which can lead to individualization of treatment in emergency services and hospitals.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e1.4 Aim\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe aim of our study was to evaluate the dispatching time of the PSAP after the MVA in the city of Essen, Germany, in 2023 (01/01/2023 to 12/31/2023). We examined the effects of dispatching rescue resources with and without TPS-eCall alerts on the operational process in the EMS. An individual risk assessment after MVA was made possible by linking to an extended TPS-eCall dataset. The current work focused on an evaluation of the handling of TPS-eCall accident datasets by the PSAP in the German public emergency service. In contrast to many other emergency services, a relatively high proportion of German EMS units are manned with emergency physicians (EPs).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"2. Materials and methods","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eWe analyzed collected monocentric call logs from one PSAP and one EMS control center in a prospective observational study. One of the authors (BB) works in the medical management of the EMS of the City of Essen, Germany, in a prospective observational study of routine data. In the context of professional supervision, an overall assessment of the treatment data from the EMS had to be made. The study was reviewed and approved by the Ethics Committee of the Medical Faculty of the University of Duisburg-Essen (20-9161-BO).\u003c/p\u003e \u003cp\u003eThe data sets for the study come from two data sources, the call logs of the emergency call center and statistical, anonymous parts from the EMS logs. Medical diagnoses or personal details are not available in these parts. Consent was therefore not required.\u003c/p\u003e \u003cp\u003eAll protocols were linked in a multistage process. All emergency service deployments after the MVA from 01/01/2023 to 31/12/2023 were evaluated. In the call logs, alerts were filtered on the basis of keywords that indicated an MVA. In addition to the callout keywords, a caller number evaluation (TPS-eCall service center vs. other callers) was provided and linked to the EMS database. All operations that contained no reference to MVA in the operational keywords were subsequently excluded.\u003c/p\u003e \u003cp\u003eThe emergency calls received by the PSAP in Essen, Germany, via 112-eCalls could not be distinguished from non-eCall alerts. This occurred because 112-eCalls cannot be recognized by their phone number. TPS-eCalls, on the other hand, can be identified on the basis of the defined number of callers of the service center. Thus, the TPS-eCalls were compared to a mixed group of non-eCalls and 112-eCalls.\u003c/p\u003e \u003cp\u003eOur data, which were based on data collected from a German PSAP, distinguished between rescue resources with and without an emergency physician (EP). The option of alerting an EP in addition to an ambulance made dispatching more difficult for the PSAP. The availability of several EPs in the Essen EMS offered the PSAP the opportunity to access the resource at a low threshold. Compared with international emergency services with fewer available EPs, the probability of overtriage shifted. To enable international comparability, only the arrival of the first vehicle, corresponding to the dispatching of an ambulance in the system without EPs, was considered when calculating the data. However, we later considered specifically for Germany whether an EP\u0026rsquo;s qualification was subsequently dispatched or whether an EP who was present had an effect on follow-up dispatching.\u003c/p\u003e \u003cp\u003eWe also analyzed differences depending on the number of people injured in the accidents. We assumed a higher disposition complexity (DC) with a larger number of patients. This may have applied to missions with severely injured persons who were required to be transported to a hospital in particular. In the evaluation of accident events, we categorized accidents on the basis of the number of patients. In this initial assessment, we defined the categories as follows: none or one patient (disposition complexity 1 (DC1), 2 patients (DC2), and \u0026ge;\u0026thinsp;3 or more patients (DC3)).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Primary dispatching\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eFrom 01/01\u0026ndash;12/31/2023, the PSAP of the Essen Fire Department dispatched 1546 operations triggered by MVAs. In 1435 cases, a conventional alarm was raised following information from parties involved in the accident. In 111 cases, a TPS-eCall Service Center contacted the PSAP by telephone. A total of 2409 rescue vehicles were involved in 1546 deployments.\u003c/p\u003e \u003cp\u003eThe duration of dispatch from call receipt in the PSAP to alerting the EMS unit was 01:44\u0026thinsp;\u0026plusmn;\u0026thinsp;01:43 minutes for the entire collective. Dispatching was significantly shorter for interventions that were not initiated by TPS-eCall service centers (01:39\u0026thinsp;\u0026plusmn;\u0026thinsp;01:40 vs. 02:41\u0026thinsp;\u0026plusmn;\u0026thinsp;02:01 min, p\u0026thinsp;\u0026le;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The involvement of EPs did not differ between the categories, with 18% EP involvement in TPS-eCall dispositions and 22% non-eCall dispositions.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Follow-up dispatching:\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eFollow-up dispatching (FUD) was interpreted as an undertriage of the PSAP-dispatcher. A comparison of the TPS-eCall and non-eCall categories revealed differences in the number of additional EMS units ordered (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). There were significantly more additional requests for further emergency resources after TPS-eCall alerts (9% vs. 23.4%, p\u0026thinsp;\u0026le;\u0026thinsp;0.001).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNumbers of follow-up dispatched (FUD) EMS units\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eFollow-up dispatched EMS units\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 AMB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 EP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026ge; EMS unit\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTPS-eCall\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;111 operations)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003cp\u003e(76.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003cp\u003e(10.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003cp\u003e(9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enon-TPS-eCall\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1435 operations)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1310\u003c/p\u003e \u003cp\u003e(91.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003cp\u003e(4.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41\u003c/p\u003e \u003cp\u003e(2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003cp\u003e(1.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1546 operations)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1395\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(90.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(4.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 Follow-up dispatching depending on the qualifications of the EMS:\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eIn 1212 cases (n\u0026thinsp;=\u0026thinsp;1125 (92.8%) non-eCall vs. n\u0026thinsp;=\u0026thinsp;87 (7.2%), TPS-eCall) there was no primary alerting of an EP. The subsequent alerting of an EP was necessary in 4 cases (3.6%) (TPS-eCall) and 41 cases (2.9%) (non-eCall) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). In the event of a primary alert of an EP, emergency resources were subsequently alerted in 334 cases (310 (92.8%) non-eCall vs. 24 (7.2%) TPS-eCall). After the primary alerts of an EP, there were no significant differences in the subsequent alerts. After the primary alerts of an EP, there were no significant differences in the subsequent alerts.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFollow-up dispatches with or without on-scene EP\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eFollow-up dispatched EMS unit without on-scene EP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 AMB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 EP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026ge; EMS unit\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTPS-eCall\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;87 operations)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003cp\u003e(73.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003cp\u003e(11.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e(4.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003cp\u003e(10.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enon-TPS-eCall\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1125 operations)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1031\u003c/p\u003e \u003cp\u003e(91.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003cp\u003e(3.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003cp\u003e(3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18\u003c/p\u003e \u003cp\u003e(1.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1212 operations)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(90.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(2.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFollow-up dispatched EMS unit with on-scene EP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1 AMB\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1 EP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026ge; EMS unit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTPS-eCall\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;24 operations)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003cp\u003e(87.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e(0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(4.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enon-TPS-eCall\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;310operations)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e279\u003c/p\u003e \u003cp\u003e(90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003cp\u003e(7.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(0.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003cp\u003e(2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;334 operations)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Dispatching complexity:\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe duration of the dispatching process was significantly longer for the TPS-eCall interventions for DC1 and DC2 (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). When differentiating by dispatching complexity, DC1 (TPS-eCall n\u0026thinsp;=\u0026thinsp;19: 02:38\u0026thinsp;\u0026plusmn;\u0026thinsp;01:44, non-eCall n\u0026thinsp;=\u0026thinsp;1278: 01:37\u0026thinsp;\u0026plusmn;\u0026thinsp;01:41, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and DC2 (TPS-eCall n\u0026thinsp;=\u0026thinsp;73: 02:46\u0026thinsp;\u0026plusmn;\u0026thinsp;02:16, non-eCall n\u0026thinsp;=\u0026thinsp;105: 01:49\u0026thinsp;\u0026plusmn;\u0026thinsp;01:26, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were significant. The differences in DC3 were not significant. There were no differences when the categories of eCall-associated accidents were compared. Non-eCall-associated accidents were significantly different in all comparisons (DC1 vs. DC2: p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, DC2 vs. DC3 p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, DC1 vs. DC3 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe common belief is that brief but precise EMS treatment with a short total prehospital time benefits patients with urgent treatment indications, as shown in 2 meta-analyses from 2015 and 2020 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Even if the concepts of the EMS and hospitals are increasingly considered in conjunction, the EMS is rarely the central focus of scientific considerations [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Documentation in registers generally begins when the EMS is alerted. In the few studies in which the activation time was discussed, no change in outcome was found as a result of the activation time, neither for severe thoracic injuries nor for polytraumatized persons [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, the more frequently discussed preclinical overall treatment duration had an impact.\u003c/p\u003e \u003cp\u003eEmergency call times, dispatching intervals and standardization in the dispatching process can rarely be discussed in the context of accident-specific patient outcomes due to a lack of data linkages. Nevertheless, dispatchers throughout Europe initiate cost-intensive operations, mostly due to accident mechanisms, and decide on the necessity of EP treatment [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, it should be noted that the assessment of the ideal treatment location (hospital selection) by the PSAP differs between the dispatching and the EMS during treatment [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Both the PSAP and EMS can adjust their decisions on treatment urgency and destination hospitals with more objective accident data.\u003c/p\u003e \u003cp\u003eTo illustrate the potential impact of better decisions, reference is given to the high number of potentially avoidable preclinical deaths [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Kleber et al. described a 15% proportion of (potentially) preventable, because treatable, causes in an analysis of trauma-related deaths in an urban EMS, which is comparable to the EMS in Essen, Germany.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn a 2020 meta-analysis, Bedard et al. substantiated the effects of prehospital time on the outcomes of trauma patients [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Unfortunately, the evaluation of prehospital treatment was based on in-hospital deaths with an observation period of 30 days, while prehospital deaths were excluded. In the current TR-DGU\u0026reg; annual report from 2024, two time points with an increased rate of death were identified in patients: within the first 48 hours after trauma and around the 7th day after the accident [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eUnfortunately, prehospital deaths were not included in the TR-DGU\u0026reg; analyses, as well. The questions of whether the higher mortality is due to prehospital or clinical treatment strategies and whether dispatching and the resulting prehospital time reduction have an impact on mortality remain unanswered.\u003c/p\u003e\u003cp\u003eOur results reveal significant differences in the disposition process, with shorter activation times for non-TPS eCall activations. A shorter time may improve outcomes for potentially treatable causes of death. Due to the relatively low number of TPS-eCall cases, no patient with high ISS or an immediate need for treatment due to airway obstruction, tension pneumothorax or critical hemorrhage was identified. Lovely et al. described in 2018, again excluding prehospital deaths and admission time, that on-scene time and transport time are less relevant to outcome than the injury severity score (ISS) in MVA [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Even if ISS is the main determinant of outcome, early treatment may have a positive effect. This interpretation is also supported by Brown et al., who described a prolongation of hospitalization by a factor of 1.16 for each additional minute on-scene [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Although Brown et al. did not refer to the deployment time, a worsening of the findings at high ISS without adequate treatment seems to have a conclusive correlation regardless of the extension of the deployment time or the on-scene time.\u003c/p\u003e\u003cp\u003eWe also found significant differences between TPS-eCall and conventionally dispatched operations with a lower or middle dispatching complexity (DC1 or DC2). In the case of complex MVA (DC3), the dispatching times for TPS-eCall alerts and conventional alerts no longer differ. While the dispatching time for conventional alarms increased with the number of passengers, the dispatching time for TPS-eCalls was constant.\u003c/p\u003e\u003cp\u003eIn the detailed analysis, it should be noted that for all the results, conventional alarms are raised via emergency number 112. TPS-eCall alerts do not reach the emergency number 112 but instead address a nonprioritized telephone number in the PSAP. Due to purely telephone-based data transmission, it may be necessary to convert geodata into postal addresses when coordinating the location of an emergency. These technical disadvantages are possibly the reason for the significant differences in dispatching times. An identical connection to the emergency number 112 could lead to an improvement in alerts from TPS-eCall service centers.\u003c/p\u003e\u003cp\u003eUnfortunately, the evaluation of time differences is only possible after telephone contact with the PSAP. TPS eCall data could be supplemented with the exact time of the accident event if the service centers were connected via a data interface with the PSAP. In the case of accidents without eCall data, the time of the accident will remain unknown, so this limitation persists in the comparison. Compared with conventional alerting without eCall data, a relative shortening of the dispatching process after TPS-eCalls via data interfaces is highly probable.\u003c/p\u003e\u003cp\u003eThe explanation for the higher FUD rate, interpreted as a prior undertriage of the PSAP, may be caused by several factors. The reasons could be that the dispatchers in the PSAP are not yet trained in handling the available information or that dispatchers at the service centers are less in line with the guidelines when assessing accident incidents than the EMS personnel on site are. Next, low case numbers can make interpretation more difficult for operations with higher dispatching complexity. However, with low case numbers but an identical percentage ratio of TPS-eCall alerts to conventional alerts, the number of FUD appears to be greater, particularly when no EP is alerted. During the study period, the S3 guidelines for the treatment of polytrauma/seriously injured patients were updated. It is therefore also possible that the EMS personnel still followed the previous guidelines, which provided a more generous indication for the activation of a trauma team and thus also an EP indication, while the EPs were already familiar with the new guidelines.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"5. Limitations","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe current study is subject to several limitations. On the one hand, the number of ecall alerts and the number of complex dispositions are relatively low in the local study approach. The duration from the accident event to contact the PSAP is not traceable for either the TPS-eCall or the conventional alerting, so that only the disposition at the PSAP can be evaluated. Unfortunately, TPS eCalls do not reach the PSAP via the prioritized emergency number, so there may be a time delay compared with conventional alarms.\u003c/p\u003e \u003cp\u003eThe technical connection and transmission of TPS-eCall events as data records can lead to a significant acceleration of the dispatching process, especially compared with alerts by persons who have been injured, but this cannot yet be verified. As eCall systems become more widespread, the relevance of accident reporting systems increases. At present, the proportion of 112-eCalls cannot be identified, meaning that conventional alerts also contain 112-eCalls. Due to the lack of data availability, the current study did not follow up on hospital treatment. By including hospital treatment, an improved evaluation of the outcome may be possible.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"6. Conclusions","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eFrom the authors' point of view, objective, sensor-measured TPS-eCall data can be of higher quality than accident information from vehicle occupants. In the future, standardized dispatching must be established and evaluated for conventional alerts and, because of data availability, even more for TPS-eCall-alerts. Dispatchers must be trained to process and interpret TPS-eCall data.\u003c/p\u003e \u003cp\u003eA basic prerequisite for the adequate use of eCall data is the establishment of a data interface between the PSAP and the TPS-eCall service center. To understand aspects of prehospital time and its impact on outcomes, an understanding of dispatching, dispatching complexity and the use of objective prehospital data is desirable. The evaluation of objective accident mechanisms can provide an additional step in analyses of registry data.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eThe following abbreviations are used in this manuscript:\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"524\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eDC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 452px;\"\u003e\n \u003cp\u003eDispatching complexity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eeCall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 452px;\"\u003e\n \u003cp\u003eEmergency call\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eEMS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 452px;\"\u003e\n \u003cp\u003eEmergency medical service\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eEP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 452px;\"\u003e\n \u003cp\u003eEmergency physician\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eFUD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 452px;\"\u003e\n \u003cp\u003eFollow-up dispatching\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eISS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 452px;\"\u003e\n \u003cp\u003eInjury severity score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003ePSAP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 452px;\"\u003e\n \u003cp\u003ePublic-safety answering point\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eTPS-eCall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 452px;\"\u003e\n \u003cp\u003eThird-Party-Service-emergency call\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eTR-DGU\u0026reg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 452px;\"\u003e\n \u003cp\u003eTraumaRegister of the German Trauma Society\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research received no external funding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e The authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement:\u003c/strong\u003e The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Ethics Committee of the of the Medical Faculty of the University of Duisburg-Essen (20-9161-BO)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e The datasets presented in this article are not readily available because of privacy. 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Prehosp Emerg Care. 2019;23:527\u0026ndash;37. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/10903127.2018.1551451\u003c/span\u003e\u003cspan address=\"10.1080/10903127.2018.1551451\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"emergency Call, eCall, AACN, TraumaRegister DGU®, public-safety answering","lastPublishedDoi":"10.21203/rs.3.rs-6378481/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6378481/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cu\u003eBackground/Objectives:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eOver the past 50 years, the concept of the golden hour of shock was established as one of the central tenets of emergency trauma medicine. A shorter duration of prehospital care correlates with a positive change in outcome in numerous studies. Dispatching by the public safety answering points has hardly been discussed to date. Thanks to improved vehicle safety, additional accident data is now available to the emergency call centers.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eMethods:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eWe investigated the effects of third-party system emergency calls (TPS-eCalls), which have become mandatory in new passenger cars in the EU in 2018, on dispatching in the emergency medical services (EMS). For this purpose, we linked the data of a public-safety answering point (PSAP) and an EMS. All emergency service deployments from 01/01/2023 to 31/12/2023 were evaluated. N=1546 rescue missions were dispatched after motor vehicle accidents (MVA), 111 after TPS-eCall-alerts, 1435 after\u003c/p\u003e\n\u003cp\u003econventional alerts.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eResults:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eDispatching in the PSAP currently took longer after a TPS eCall alerts than conventional alerts (01:39±01:40min vs. 02:41±02:01min, p ≤ 0.001). The differences were only significant in the case of accidents involving ≤ 2 passengers.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConclusions:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eTPS-eCall data will be available increasingly. The future expansion data availability offers the opportunity to include objective accident data (airbag deployment, number of occupants, change of velocity) in the dispatching process. Adequate technical connection can improve dispatching and shorten preclinical treatment, especially for complex events with more than 2 passengers.\u003c/p\u003e","manuscriptTitle":"Comparison of dispatching after motor vehicle accidents – Effects of the TPS-eCall system on dispatching time","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-13 12:12:13","doi":"10.21203/rs.3.rs-6378481/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-12T06:30:52+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-09T14:04:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"267848063192664998005236781890881370379","date":"2025-07-18T14:11:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-07T12:56:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"278153011828111428781419508716927191196","date":"2025-06-23T03:44:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-12T18:51:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"144674630899414839903972071025877331055","date":"2025-05-10T10:26:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"320344982682308130503489607224582285515","date":"2025-05-07T12:10:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-07T10:37:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-07T10:34:35+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-05T07:13:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-01T21:16:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Emergency Medicine","date":"2025-05-01T21:14:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2e7a19bd-1147-413c-8ac2-2ce0af05e1d3","owner":[],"postedDate":"May 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-29T16:06:22+00:00","versionOfRecord":{"articleIdentity":"rs-6378481","link":"https://doi.org/10.1186/s12873-025-01361-2","journal":{"identity":"bmc-emergency-medicine","isVorOnly":false,"title":"BMC Emergency Medicine"},"publishedOn":"2025-09-23 15:58:17","publishedOnDateReadable":"September 23rd, 2025"},"versionCreatedAt":"2025-05-13 12:12:13","video":"","vorDoi":"10.1186/s12873-025-01361-2","vorDoiUrl":"https://doi.org/10.1186/s12873-025-01361-2","workflowStages":[]},"version":"v1","identity":"rs-6378481","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6378481","identity":"rs-6378481","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}