Elsevier

Resuscitation

Volume 61, Issue 1, April 2004, Pages 9-21
Resuscitation

International EMS Systems: the Nordic countries

https://doi.org/10.1016/j.resuscitation.2003.12.008Get rights and content

Abstract

Emergency medicine service (EMS) systems in the five Nordic countries have more similarities than differences. One similarity is the involvement of anaesthesiologists as pre-hospital physicians and their strong participation for all critically ill and injured patients in-hospital. Discrepancies do exist, however, especially within the ground and air ambulance service, and the EMS systems face several challenges. Main problems and challenges emphasized by the authors are: (1) Denmark: 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; (2) Finland: the autonomy of the individual municipalities and their responsibility to cover for primary and specialised health care, as well as the EMS, and the lack of supporting or demanding legislation regarding the EMS; (3) Iceland is the only country that has emergency medicine (EM) as a recognised speciality but there is a need for more fully trained specialists in EM; (4) Norway: the ordinary ground ambulance is pointed out as the weakest link in the EM chain and a health reform demands extensive co-operation between the new health enterprises to re-establish a nation-wide air ambulance service; (5) Sweden: to create evidence based medicine standards for treatment in emergency medicine, a better integration of all part of the chain of survival, a formalised education in EM and a nation wide physician staffed helicopter EMS (HEMS) cover.

Sumàrio

Os Serviços de Emergência Médica (EMS) nos cinco paı́ses Nórdicos têm mais semelhanças que diferenças. Uma das semelhanças é o envolvimento de Anestesiologistas como médicos pré-hospitalares e a sua forte participação em todas as situações de doentes crı́ticos e traumatizados no hospital. No entanto, existem discrepâncias, principalmente com os serviços de ambulâncias terrestres e aéreos e, os sistemas de EMS enfrentam vários desafios. Os principais problemas e desafios enfatizados pelos autores são: (1) Dinamarca: os centros de coordenação actualmente não estão sob controlo médico não têm um sistema de critérios nacional. O acesso a conselho médico on-line não está disponı́vel; (2) Finlândia: a autonomia individual dos municı́pios e a sua responsabilidade para cobrir os cuidados de saúde primários e especializados, bem como o EMS e a sua falta de apoio ou exigência de legislação em relação ao EMS; (3) A Islândia é o único paı́s que tem a Medicina de Emergência (EM) como especialidade reconhecida, mas existe a necessidade de mais especialistas treinados em EM; (4) Noruega: o serviço normal de ambulâncias terrestres é apontado como o elo mais fraco na cadeia da EM e uma reforma da saúde exige uma cooperação extensa entre as novas empresas da área da saúde para restabelecer um serviço nacional de ambulâncias aéreas; (5) Suécia: para criar padrões médicos baseados na evidência para tratamento em medicina de emergência, é necessária melhor integração de todas as partes da cadeia de sobrevivência, uma formação formal em EM e uma cobertura nacional de serviço de helicópteros com pessoal médico.

Resumen

Los Servicios de emergencias médicas (EMS) en 5 paı́ses nórdicos tienen mas semejanzas que diferencias. Una semejanza es que involucran médicos anestesiólogos como médicos prehospitalarios y su fuerte participación para todos los pacientes crı́pticamente enfermos o lesionados en el intrahospitalario. Sin embargo existen discrepancias, especialmente en el servicio de ambulancias de terreno y aire, y los sistemas de EMS enfrentan varios desafı́os. Los principales problemas y desafı́os enfatizados por el autor son: (1) Dinamarca: los centros de despacho en este momento no están bajo control médico y no tienen un sistema basado en un criterio nacional. El acceso a consejo médico en lı́nea no está disponible; (2) Finlandia: Autonomı́a de las municipalidades individuales y su responsabilidad para dar cobertura de cuidados médicos primarios y especializados, al igual que los EMS, y la falta de legislación de apoyo o demanda con respecto a los EMS; (3) Islandia es el único paı́s que tiene medicina de emergencia(EM) como una especialidad reconocida pero existe una necesidad de especialistas mas completamente entrenados en EM; (4) Noruega: la ambulancia terrestre está enfocada como el eslabón mas débil en la cadena de EM y la reforma de salud demanda una cooperación extensa entre las nuevas empresas de salud para reestablecer un servicio de ambulancias aéreas a lo largo de la nación; (5)Suecia: crear estándares médicos basados en evidencia para tratamiento en medicina de emergencia, una mejor integración de todas las partes de la cadena de sobrevida, una educación formalizada en EM y cobertura nacional de EMS con helicópteros con médico a bordo.

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

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