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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
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