Table 2 Advantages and disadvantages of centralization
From: Telemedical emergency services: central or decentral coordination?
Criteria | Sub-criteria | Advantage | Disadvantage |
|---|---|---|---|
Cost | Equipment and setup | Higher utilization leads to lower cost per service unit | |
Personnel | Higher utilization leads to lower cost per service unit | ||
Economies of scope and scale | Learning effects lead to lower cost per service unit | ||
Quality | Knowledge of location | Detailed knowledge of location, infrastructure and peculiarities is not possible | |
Safety | TEDs can support each other in complex situations | ||
Learning effects | Higher routine, sub-specialization of TEDs | ||
Existential risks | Collapse of central system means breakdown for all districts | ||
Management | Cohesion of the team | Decentralized system induces stronger trust between paramedics and TEDs as well as better knowledge of the strengths and weaknesses of the respective partner | |
Staffing | Lower number of TEDs required | Stress for TEDs | |
Further education | Economies of scale | ||
Flexibility | Higher flexibility for staffing (e.g. night, weekend, leave, unexpected sickness) | Inflexible reaction to changes of local circumstances | |
Structures | Laws and regulations | Different emergency laws between German states limit centralization | |
Patients | Trust of patients | Patients might trust a TED more knowing that they are located in a nearby city |