Preparing for Preparedness Development of Emergency and Disaster Medicine System (EDMS) in Latvia Preparing for Preparedness Development of Emergency.

Preparing for PreparednessPreparing for Preparedness Development Development of Emergency and Disaster Medicine Systemof Emergency and Disaster Medicine System (EDMS)(EDMS) in Latviain Latvia

Maija Busmane, MDChief of Department of Planning and Cooperation

Centre of Emergency and Disaster medicine,

Ministry of Health Latvia

[email protected]:

M.Sics, MD; R.Pupele, MD; E.Akitis

Centre of Emergency and Disaster MedicineCentre of Emergency and Disaster Medicine

mailto:[email protected]









What people usually know about Latvia?What people usually know about Latvia?

RIGA


The world has changed also in LatviaThe world has changed also in Latvia2004 –20052004 –2005


Uncommon nature Uncommon nature outbreaks for Latviaoutbreaks for Latvia (storms and black - out,(storms and black - out, earthquake)earthquake)

Large flood and Large flood and forest firesforest fires

Technical and traffic Technical and traffic accidents with mass accidents with mass casualtiescasualties

Real terrorismReal terrorism threatthreat

StudyStudy objectivesobjectives::

civil military crises managementcivil military crises management

AnalyseAnalyse wwhat does hat does PREPARADNESSPREPARADNESS meamean n for for health care stakeholders and how tohealth care stakeholders and how to proviprovidede it it in in the the best best possible way possible way and in and in the the context with context with

health care reformshealth care reforms

international cooperationinternational cooperation

CentreCentre of Emergency and Disaster Medicine of Emergency and Disaster Medicine

Methods usedMethods used


Site investigationSite investigation

Data collectionData collection

AssessmentAssessment ComparisonComparison

QuQuestioningestioning

ForecastingForecasting

SDR (per 100 000),SDR (per 100 000), 2003. 2003.

Transport accidents Ischaemic heart disease

Lithuania 23,76 Lithuania 327,75

Latvia 22,66 Estonia 312,53

Poland 15,5 Latvia 291,58

Hungary 14,7 Hungary 232,66

Estonia 13,64 Czech Rep. 176,09

Czech Rep. 13,33 Malta 149,77

Slovenia 13,19 Poland 124,93

Malta 3,5 Slovenia 94,37

Average EU 11,6 Average EU 105,76

Source: European HFA Datebase, June 2005.Centre of Emergency and Disaster MedicineCentre of Emergency and Disaster Medicine

Possibilities to prevent the Sudden Death

Su

rviv

al (

% )

Time till defibrillation ( % )

00

2020

4040

6060

8080

100100

55 1010 1515 2020 2525 3030

Every minute lostEvery minute lost

reducesreduces

survival rate !!!survival rate !!!


Pre-hospital Emergency Medical Services today


Dispatching Centres with different capacity and without interconnection

Municipality “Border problems”

Unique EMS call problem Costs ineffectiveness Lack of Ambulance Teams (personnel)

Irregular location of Ambulance Teams Lack of Ambulance vehicles, technical and medical equipment

EMS calls and calls completionEMS calls and calls completion(day average)(day average)

AreaCalls received by EMS

Dispatcher’sCalls

completed by EMS

Ambulance Teams

in all Including through

“112”

Riga 10001000 12 – 14 %12 – 14 % 500500

Latvia 25002500 10 – 12%10 – 12% 14001400


ConclusionsConclusions• There are no facility for effective management of There are no facility for effective management of EDMS common resources in circumstances whileEDMS common resources in circumstances while p-h EMS’s providers management is p-h EMS’s providers management is decentralized;decentralized;

• There are unequal possibilities to receive p-h EMSThere are unequal possibilities to receive p-h EMS in day-to-day and in case if Disaster occurs;in day-to-day and in case if Disaster occurs;

• New infrastructure and organization for medicalNew infrastructure and organization for medical institutions involved to prevent emergencyinstitutions involved to prevent emergency consequences is certainly consequences is certainly necessarynecessary..


SSeveral principles and approaches consideredeveral principles and approaches considered f foror creating a new scheme of EMC to cover the creating a new scheme of EMC to cover the patients` needs for equal availability of services patients` needs for equal availability of services (on time and qualitative)(on time and qualitative)


Subsidiarity Subsidiarity CoordinationCoordination SuccessionSuccession Consolidation of resourcesConsolidation of resources Intersectoral scopeIntersectoral scope

EEssential attention must be paid to all ssential attention must be paid to all transitionstransitions ofof Health Care System and Healt Health Care System and Healthh Professionals`Professionals`

attitude towards Reformsattitude towards Reforms

Pre-hospital EMS in the foreseeable future


Unified managementUnified management systemsystem

Central Management Unit (CMU)

Three levels:Three levels:

Regional Management and Dispatcher Centres (RMDC)

Ambulance Location Points Network and Ambulance teams

RMDC RMDC Call completion business processesCall completion business processes

Calltaking

I

Identificationof competence

Interview

Support algoritm

for interview

Decisionabout Callcompletion

Support from SeniorDoctorCall Card

complition

Decisiondelivery

Call Carddelivery

Callcompletion

Support for Call

completion

Call completion

Final Report

Call Card closing

Maintainance of basic data

Event analysis

System Functions

User Functions


Now and afterNow and after

20052005 20102010

Dispatcher CentresDispatcher Centres 37 1+5

Ambulance LocationAmbulance LocationPointsPoints

80 115

Ambulance TeamsAmbulance Teams 192 240

EM professionalsEM professionals 1728 2560


Benefits expected after implementationBenefits expected after implementation new new pre-hospital pre-hospital EMSEMS D Dispatchispatch SystemSystem I I

SSupport upport EEDMDMS S planning planning


IncreasIncreasee EMS accessibility to meet EMS accessibility to meet international international standardsstandards (response time(response time,, unitary call number unitary call number,, quality) quality)

Increase EMS management Increase EMS management role role as a support foras a support for

internationalinternational cooperation, for Civil Military Crisis cooperation, for Civil Military Crisis

Management assistanceManagement assistance,, especially in case of CBRN threats especially in case of CBRN threats

increase capacities for NATO Crisis Responseincrease capacities for NATO Crisis Response SystemSystem

MModel odel can be used ascan be used as EU co-operation system EU co-operation system

Save more people livesSave more people lives

Benefits expected after implementationBenefits expected after implementation new new pre-hospital pre-hospital EMSEMS D Dispatchispatch SystemSystem II II


ProvideProvide:: uunitary quality control and statisticnitary quality control and statisticss system system synsynergy effect ergy effect and eand efficient use of available resourcesfficient use of available resources

bbetter co-operation and co-ordination with otheretter co-operation and co-ordination with other rescue rescue services,services, institutionsinstitutions etetc.c.

cco-ordination of o-ordination of SSpecialized Emergency carepecialized Emergency care, , CConsultaonsultancyncy serviceservice, , RReserveseserves, , HospitalHospital services, services, MMedicaledical transportation service transportation service and other Health resourcesand other Health resources

ccapacity for PHC call management (PHC central) apacity for PHC call management (PHC central) and and possibility for call separationpossibility for call separation

Matter of Opinion – direct call to EMSMatter of Opinion – direct call to EMS

Statement of EMS developmentof EMS development determinesdetermines

112 + ”xx3” ((direct Call to EMSdirect Call to EMS))

TODAY TODAY 112 + 03 (direct Call to EMS)112 + 03 (direct Call to EMS)

Overwise – mindersDemands

Only 112

DISCUSSION:DISCUSSION:

Which of above mentioned two ways is more relevant to save people lives and keep them well ?


MANAGEMENTMANAGEMENT AND COORDINATIONAND COORDINATION - t- the most relevant factor for preparednesshe most relevant factor for preparedness,, particularly ifparticularly if resources are limitedresources are limited

COORDINATIONCOORDINATION

MANAGEMENTMANAGEMENT

Pyramid of PreparednessPyramid of Preparedness

High developed Hospital’s Admission and Emergency units High developed prehospital EMS – the basic Operational Unit of EDMS


Provision of EDMS Resources

Methodological management of EDMS in “peace time” Education, Training and International cooperation Monitoring of every day EMS

CORNERSTONES:CORNERSTONES:

The Government of Latvia has adopted

Policy Statement of EMS development2005 –2010

(12.07. 2005.)


To beTo be continued ...continued ...

Thank youThank you for for your your attentionattention ! !


To be To be continued ...continued ...

Preparing for Preparedness Development of Emergency and Disaster Medicine System (EDMS) in Latvia Preparing for Preparedness Development of Emergency.

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