Peter Biesenbach, emergency physician and researcher at University of Southern Denmark (Esbjerg Hospital, ~38 ED pods, 8k admissions/year), presents two innovations to manage elderly “silver tsunami” via prehosp/outpatient shifts: “buy a car” (Mobile Emergency Unit, MEU) and “buy a phone” (tele-EM).
MEU (2023 Mercedes EV, EM specialist + nurse, 8-18 daily/365): Activated by dispatch/GP/nursing homes for acute/critical illness at home. Assess/treat on-site (labs, US, ABx, fluids, thoracentesis); retain responsibility ≤4 days, avoiding admissions. Cohort (1,300 pts, median age 80, frail/nursing home/dementia-heavy): 83% home-managed (infections 50%, palliation 12%); risk factors for admission: home-dwelling, DNAR. Acute EOL subset (130 pts): 98% dignified home deaths (median 3 days). 90%+ satisfaction; ~€600k/year cost offset by savings (~€3k/avoided EOL admission).
Tele-EM (24/7 phone): Paramedics screen non-siren 911s, consult ED physician for treat-and-release plans (e.g., COPD steroids Rx). Cohort (633 pts): 99% home (8% 48h readmit, 20% 30d, 4% mortality); young/psych-heavy. Combined: ~7k remote pts/year (~1/3 medical load) vs. 42k ED visits.
Barriers: Antagonism (e.g., EMS), upfront costs—but ED-flex redeploys staff. Future: Cost-effectiveness research, extended hours, devices (tablet/pulse-ox), direct 112 diversion. Q&A: Allies (dispatch rotation), ED efficiency (easy cases diverted). Pitch to admins: Proven, safe, economical for crowding/frail care.