Comparing emergency medical service and walk-in patients in German emergency departments: a prospective multicentre survey

Emergency department (ED) crowding is a major concern across Europe. This study compares EMS-transported and walk-in patients across EDs in different settlement types with regard to care-seeking behaviour, presenting complaints and awareness of alternative care pathways. We conducted a prospective, multicentre survey among patients in 20 EDs in Berlin and Bavaria (Mar–Oct 2024). A tablet-based questionnaire captured sociodemographics, presenting complaints, perceived urgency and health-care utilisation. EMS and self-referred patients (walk-ins) were compared using χ² and Mann–Whitney U-tests. Multivariable logistic models examined predictors of EMS use and attendance at predominantly urban versus intermediate EDs. Of 9,719 patients, 2,641 (27.2%) arrived by EMS. EMS patients were older and more likely to attend predominantly urban EDs. They had more often cardio-respiratory or neurological complaints, whereas pain predominated in walk-ins. Prior outpatient contact was less common among EMS patients (29.3%). In adjusted regional analyses, injury-related presentations were more common in predominantly urban EDs (20.5% vs. 26.3%; p = 0.003), while cardio-respiratory and abdominal complaints showed no differences. Awareness of national on-call service number (116117) was associated with higher odds of predominantly urban attendance. EMS patients differ from walk-ins in age, presentation and care-seeking. Differences between regions in case-mix and pre-hospital decision-making suggest that strategies to improve emergency care coordination may benefit from region-sensitive approaches. Whether integration of structured telephone advice (116117) and digital self-assessment tools with EMS dispatch can contribute to more appropriate resource allocation warrants prospective evaluation. DRKS00033986; DRKS00034961.