International EMS Systems: the Nordic countries
Introduction
The Nordic countries encompass Scandinavia (Denmark, Norway, Sweden) together with Iceland and Finland. This region shares some common geographical, climatic and historical phenomena making it natural to give a united account of the Emergency Medical Service (EMS) system. The EMS system in this region has gone through major changes during the last few years and has common features, but also obvious diversities. The EMS system for some Nordic cities and counties has been described previously [1], [2], [3], [4], [5] but a mutual national description has not been given before. We give a collective update of the EMS system in the five Nordic countries.
Section snippets
Denmark
This description of Denmark does not include the Faroe Islands and Greenland, which, though part of the Kingdom of Denmark, are self-governing overseas administrative units.
Denmark has 5.4 million inhabitants (2003) (Table 1). 18.7% of the population are from 0 to 14 years old, and 15% of 65 years or more. Birth rate is 11.74 per 1000 population. Life expectancy is 79.7 years for females and 74.3 years for males. Population growth rate is 0.29% [6].
Denmark is a small (43,093 km2) and flat
Denmark
The national emergency phone number 112 is used for access to all emergency services including EMS, rescue, fire and police. Denmark has nine dispatch centres (Table 4). The dispatch is operated by the police outside the capital and by the EMS in Copenhagen. Personnel at the dispatch centre are either police or dispatch operators with a locally defined education. There is no national criteria based dispatch system in use.
EMS personnel can be divided into ambulance personnel, nurses and
Denmark
Denmark at present has 55 hospitals with an ED. However the number of hospitals and EDs with free access is being reduced. All hospitals with an ED have access to surgery, internal medicine and anaesthesiology for emergency cases. EM is not established as a separate medical speciality in Denmark. No national grading of EDs is presently available. Four level one trauma centres are present in Copenhagen, Odense, Aarhus and Aalborg.
A major incident command centre (MICC) is presently being
Denmark
The dispatch centre is the key to control of EMS and use of resources. The dispatch centres are presently not under medical control, and are without a national criteria based system. Access to on-line medical advice of a physician is not available.
Documentation of skills, competence and experiences is crucial to further progress and development. A differentiated medical response should be defined nationally and an integration of care provided from the pre-hospital phase to hospital treatment
Summary
The Nordic EMS systems have more similarities than differences. One similarity is the involvement of anaesthesiologists as pre-hospital physicians [43]. Discrepancies do exist, however, especially within the ground and air ambulance service, and the EMS systems face several challenges. At the moment, Iceland is the only country that has EM as a recognised speciality. Various fora have been established to exchange ideas and co-operation within the Nordic countries, such as the Nordic Trauma
References (43)
- et al.
Resuscitation in Europe: a tale of five European regions
Resuscitation
(1999) - et al.
Quality assesment of defibrillation and advanced life support using data from the medical control module of the defibrillator
Resuscitation
(1999) - et al.
In-hospital factors associated with improved outcome after out-of-hospital cardiac arrest. A comparison between four regions in Norway
Resuscitation
(2003) - et al.
One-year survival after out-of-hospital cardiac arrest in Copenhagen according to the ‘Utstein style’
Resuscitation
(2000) - et al.
Nurse competence: advantageous in pre-hospital emergency care?
Accid. Emerg. Nurs.
(1999) - et al.
Utstein registration used as a tool in organisational development
Resuscitation
(1999) - et al.
Out-of-hospital cardiopulmonary resuscitation: a population-based Norwegian study of incidence and survival
Eur. J. Emerg. Med.
(1999) - Statistics Denmark. www.dst.dk. Last update: 31-3-2003. Access date:...
- National Board of Health. www.sst.dk. Last update: 10-10-2003. Access date:...
- The European Observatory on Health Care Systems. Health Care Systems in Transition. Norway:...
Pre-hospital tracheal intubation in severely injured patients: a Danish observational study
BMJ
Sudden noncardiac arrest out-of-hospital in the Reykjavı́k area 1987–1999
Læknablaðið
Advanced cardiac life support in the pre-hospital setting in the Reykjavik area 1987–1990
Læknablaðið
Advanced cardiac life support in the pre-hospital setting: the Reykjavik experience
J. Intern. Med.
Advanced cardiac life support in the pre-hospital setting in the Reykjavik area 1991–1996
Læknablaðið
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2020, Nurse Education in PracticeCitation Excerpt :They have 18 months’ education, a third of which is related to the EMS. The advanced level employs nurses and paramedics with 4 years of university training (Langhelle et al., 2004; Krüger et al., 2010). The translation and cultural adaptation process involved translation from source language, blind back-translation to the target language, translators’ agreement of translation synthesis, and content expert reviews (Beaton et al., 2000; Maneesriwongul and Dixon, 2004; Sousa and Rojjanasrirat, 2011).