BACKGROUND AND OBJECTIVE Teleemergency doctors support ambulance cars at the emergency site by means of telemedicine. Currently, each district has its own teleemergency doctor office (decentralized solution). This paper analyses the advantages and disadvantages of a centralized solution where several teleemergency doctors work in parallel in one office to support the ambulances in more districts. METHODS The service of incoming calls from ambulances to the teleemergency doctor office can be modelled as a queuing system. Based on the data of the district of Vorpommern-Greifswald in the Northeast of Germany, we assume that arrivals and services are Markov chains. The model has parallel channels proportionate to the number of teleemergency doctors working simultaneously and the number of calls which one doctor can handle in parallel. We develop a cost function with variable, fixed and step-fixed costs. RESULTS For the district of Greifswald, the likelihood that an incoming call has to be put on hold because the teleemergency doctor is already fully occupied is negligible. Centralization of several districts with a higher number of ambulances in one teleemergency doctor office will increase the likelihood of overburdening and require more doctors working simultaneously. The cost of the teleemergency doctor office per ambulance serviced strongly declines with the number of districts cooperating. DISCUSSION The calculations indicate that centralization is feasible and cost-effective. Other advantages (e.g. improved quality, higher flexibility) and disadvantages (lack of knowledge of the location and infrastructure) of centralization are discussed. CONCLUSIONS We recommend centralization of telemedical emergency services. However, the number of districts cooperating in one teleemergency doctor office should not be too high and the distance between the ambulance station and the telemedical station should not be too large.

中文翻译：

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远程医疗紧急服务：中央还是分散协调？

背景和目的远程急诊医生通过远程医疗为急救现场的救护车提供支持。当前，每个地区都有自己的远程医疗医生办公室（分散式解决方案）。本文分析了集中解决方案的优缺点，在该解决方案中，几个远程急诊医生在一个办公室中并行工作以支持更多地区的救护车。方法可以将从救护车到远程急诊医生办公室的呼入服务建模为排队系统。根据德国东北部Vorpommern-Greifswald地区的数据，我们假设到达和服务是马尔可夫链。该模型具有并行通道，该通道与同时工作的远程急诊医生的数量以及一名医生可以并行处理的呼叫数量成正比。我们开发了具有可变，固定和固定成本的成本函数。结果对于格赖夫斯瓦尔德（Greifswald）地区，由于远程急诊医生已被完全占用，不得不暂停来电的可能性微乎其微。在一个远程急诊医生办公室集中多个具有较高救护车数量的地区，将增加负担过重的可能性，并需要更多的医生同时工作。随着合作区域数量的增加，每辆急救车的急诊医生办公室的成本大大下降。讨论计算表明，集中化是可行的且具有成本效益。讨论了集中化的其他优点（例如，改进的质量，更高的灵活性）和缺点（缺少位置和基础结构的知识）。结论我们建议集中远程医疗应急服务。但是，在一个远程急诊室中合作的区数不应太高，并且救护站和远程医疗站之间的距离不应太大。