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in the European UnionReport of an assessment project co-ordinated by theWorld Health Organization

Address requests about publications of the WHO Regional Office for Europe to:PublicationsWHO Regional Office for EuropeScherfigsvej 8DK-2100 Copenhagen Ø, DenmarkAlternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the RegionalOffice web site (http://www.euro.who.int/pubrequest).Photographic contributionsBy Courtesy of: Falck Danmark A/S’ Archive (Denmark) Omaggio a Montisola di Fiorello Turla, edizioni Civiltà Bresciane 2002 (Italy) Ordine dei Medici Chirurghi e degli Odontoiatri della Provincia di Latina (Italy)Emergency M edical S ervices S ystems i n t he E uropean U nion Arxiu Històric de la Fundació Privada Hospital de la Santa Creu i Sant Pau (Spain) Muzeum Zamku i Szpitala Wojskowego na Ujazdowie (Poland) Peter Higginbotham’s Private Archives (United Kingdom) St Bartholomew’s Hospital Archives (United Kingdom) World Health Organization 2008All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translateits publications, in part or in full.The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on thepart of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World HealthOrganization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary productsare distinguished by initial capital letters.The mention of specific companies or of certain educational institutions does not imply that they are endorsed or recommended by the WorldHealth Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietaryproducts are distinguished by initial capital letters.All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, thepublished material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use ofthe material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressedby authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization.

Emergency Medical Services Systemsin the European UnionReport of an assessment project co-ordinated by theWorld Health OrganizationProject co-funded by:

COUNTRYList of contributors E mergency M edical S ervices S ystems i n t he E uropean U nionList of contributors4This report is published by the Regional Office for Europe of the World Health Organization. It is the result of a concertedprocess with the participation of all following contributors listed according to their role and in alphabetical order.National RepresentativesAUSTRIAReinhild StraussHead of Department III/A1,Infectious Diseases, Health Threats, CrisesMinistry of HealthBELGIUMJean Bernard GilletChairman, Federal Council for Medical Emergency CareMinistry of Public HealthBULGARIAIvian BenishevChief of "Emergency medical services" Department"Medical activities" Directorate - Ministry of HealthCYPRUSAndreas PolynikisChief Medical OfficerMinistry of HealthCZECH REPUBLICDana HlavackovaDirectorCrisis Preparedness DepartmentMinistry of HealthDENMARKFreddy K. LippertHead of Office and Advisor for the Danish National Boardof Health & Medical Director of Emergency Medicine andEmergency Medical Services in the Capital Region of Denmark

FINLANDTom SilfvastSenior Medical Officer, Health DepartmentMinistry of Social Affaires and HealthFRANCEIsabey BénédicteChargée de mission urgences et périnatalitéMinistère de SantéGERMANYHans LemkeMedical Director of Emergency Medical SystemsDortmund FirebrigadeTrauma-Surgery DepartmentKlinikum DortmundGREECEPanos EfstathiouCommander of the National Health Operation CentreHellenic Ministry of Health & Social SolidarityHUNGARYImre EngelbrechtDeputy Head of DepartmentHealth Policy DepartmentMinistry of HealthIRELANDGavin MaguireHead of Emergency Management - Health ServiceThe Health Services ExecutiveITALYFrancesco EnrichensDirector, Surgery Department, Trauma and OrthopaedicCentre, TorinoRegional Coordinator, Medical Emergency, PiedmontLATVIABiruta KleinaHead of Division of Coordination of Extraordinary SituationsDepartment of Health CareMinistry of HealthLITHUANIAVytautas GailiusDirectorHealth Emergency Situations Centre under the Ministry ofHealthL ist o f c ontributorsESTONIAMarek SeerHead of Emergency Care UnitHealth Care BoardLUXEMBOURGGérard ScharllMédecin chef de serviceMinistère de la Santé - Direction de la SantéMALTADenis Vella BaldacchinoDirector Primary HealthMinistry for Social PolicyNETHERLANDSCilie C. Alberda-Harmsen MAPolicy adviser Acute CareMinistry of Health, Welfare and SportCurative Care and Integrated Care DivisionPOLANDMichal WaszkiewiczHead of UnitDepartment of Health PolicyMinistry of HealthPORTUGALIsabel SantosHead of the Emergency Medical DepartmentPortuguese National Institute for Emergency MedicineROMANIARaed ArafatUnder Secretary of StatePresident of the EMS CommitteesMinistry of HealthSLOVAKIAAndrea SmolkovaHead DoctorNational Dispatch Center for EMS Slovak RepublicRegional Office of Presov District5

E mergency M edical S ervices S ystems i n t he E uropean U nionCOUNTRY6SLOVENIAAndrej ŽmavcHead of Emergency Medical Services, CeljeHead of National Board of EM at Ministry of HealthNETHERLANDSPeter J. WognumAdvisor/project manager patientsafetyHealth Care InspectorateSPAINJosé Javier García del ÁguilaManager of the EMS in Almería EPES-061EPES - Public Utility for Health EmergenciesRegional Government of AndalusiaPOLANDPrzemyslaw KlamanHead of DivisionEuropean Union Division, Department of InternationalCooperationMinistry of HealthSWEDENJonas HolstMedical directorUnit of Emergency Preparedness - National Board of Health and WelfarePORTUGALNelson PereiraFormer Medical Services DirectorPortuguese National Institute for Emergency MedicineUNITED KINGDOMPenelope BevanDirector of Emergency PreparednessDepartment of HealthSLOVAKIAPatrícia EftimováHead of Department of Education, Science and ResearchNational Dispatch Center for EMS Slovak RepublicNational ContributorsTechnical contributorsAUSTRIARobert MuchlHead of Department III/A1Federal Ministry of Health, Family and Youth, BMGFJ –III/A/1 (Infectious Diseases, Health Threaths, Crisis Management), AustriaRaed ArafatUnder Secretary of StatePresident of the EMS CommitteesMinistry of HealthHUNGARYGabor GoblAdviserHungarian National Ambulance and Emergency ServiceLITHUANIAVladas MireckasHead of Planning and Control DivisionHealth Emergency Situations Centre, Ministry of Health, LithuaniaFrancesco Della CorteChair, Department of Anesthesia, Intensive Care and CriticalEmergency MedicineAzienda Integrata Universitaria Ospedaliera "Maggioredella Carità"University of Eastern Piedmont, Novara, ItalyViliam DobiášAssociate Professor and Medical DirectorLife Star Emergency Ltd. Prehospital Emergency MedicalServicesConstantive the Philosopher Unversity, Nitra, Slovakia

L ist o f c ontributorsFrancisco EpeldeShort Stay Unit Coordinator Emergency ServiceHospital Universitari Parc Tauli. Universitat Autonoma deBarcelona, Sabadell, SpainAlberto GiudiceandreaConsultant General SurgeonS. Anna General Hospital - Brescia, Italygency MedicineMaggiore Hospital School of Medicine, Novara, ItalyDemetrios G. PyrrosPresident-ElectWorld Association for Disaster and Emergency Medicine(WADEM)Technical reviewersPierluigi IngrassiaPhD StudentResearch Centre in Emergency and Disaster Medicine andInformatics applied to medical practice(C. R. I. M. E. D. I. M.)University of Eastern Piedmont, Novara, ItalyPer KullingSeconded national expertEuropean Commission, Health Threats Unit -SANCO C/3Roberta PetrinoChair of professional education in EM, Department of Emer-Gautam G. BodiwalaPresident of the IFEMInternational Federation for Emergency MedicineHerman DeloozEM Disaster Medicine- Executive Committee MemberEuSEM and Professor of Emergency and Disaster MedicineFree University of Brussels, BelgiumDavid J WilliamsEuSEM Immediate Past PresidentEuropean Society for Emergency MedicinePublisher and co-ordinator of the project:enrico DavoliEmergency Medical Services ProgrammeRegional Office for Europe of the World Health OrganizationProject OfficerFederica RighiCommunication and disseminationTania Calleja ReinaWith the help of:Eva Abelló, Ellinor Bengtsson, Maribel Gené Cases, Silvia Gilardi, Mina Lahlal, Alessandra Rollandoz, Oana Roman,Sebastián Sarrias Manresa.Language editing: Breeda HickeyDesign and layout: Fco. Javier Rodríguez RamosThe European Society for Emergency Medicine, represented by the President Gunnar Öhlen has supported the project offeringimportant opportunities for disseminating the results on two occasions in international conferences.7

COUNTRYContentsEmergency Medical Services Systems in the European UnionAcronymsGlossaryE mergency M edical S ervices S ystems i n t he E uropean U nionAbstract881.Introduction1.1EMS systems1.2Objectives of the study1.3Description and methodology1.4Constraints and opportunities of the project2.Legislation and financing of EMS2.1Legislation relating to the EMS System2.2Financing2.3Legislation regarding crisis preparedness and ospital EMS3.1European emergency call number 1123.2Dispatch centres3.3Ambulance services3.4Coordination with other emergency tal EMS4.1Triage system4.2I-H-EMS as a safety net4.3Referral network system4.4Quality of care4.5Social care4.6Conclusions4.7Recommendations5.Education in EMS5.1Education and training in EM5.2EM as a recognized accredited specialty5.3Qualifications of EM providers5.4Conclusions5.5Recommendations6.Crisis management and EMS systems6.1EMS in crisis management6.2Education and training in disaster management6.3International co-operation in disaster management6.4Patient safety in disaster nnex 1: RecommendationsAnnex 2: QuestionnaireAnnex 3: SynopsisAnnex 4: EducationAnnex 5: Application form

N/AO-H-EMSWHOWHO/EUROaccident and emergencyadvanced life supportbasic life supportcrisis preparedness plandispatch centreEuropean Commissionemergency departmentEuropean emergency dataemergency health servicesemergency medicineemergency medical servicesEuropean UnionEuropean Union of Medical Specialists (also named UEMS)European Society of Emergency MedicineGeneral Practitionerincident command and controlintensive care unitin-hospital emergency medical servicesmass casualty incidentMultidisciplinary Joint CommitteeMinistry of HealthMember StateNational Academy of Sciences/National Research Councilnon-governmental organizationnational representativedata not availableout-of-hospital emergency medical servicesWorld Health OrganizationWorld Health Organization Regional Office for EuropeList of CountriesAUT AustriaBEL BelgiumBUL BulgariaCYP CyprusCZH Czech RepublicDEN DenmarkEST EstoniaFIN FinlandFRA FranceDEU GermanyGRE GreeceHUN HungaryIRE IrelandITA ItalyLVA LatviaLTU LithuaniaLUX LuxembourgMAT MaltaNET NetherlandsPOL PolandPOR PortugalROM RomaniaSVK SlovakiaSVN SloveniaSPA SpainSWE SwedenUNK United Kingdom of GreatBritain and Northern IrelandSource:The European Regional Office of theWorld Health Organization.99

COUNTRYGlossaryAE mergency M edical S ervices S ystems i n t he E uropean U nionAccessThe ability of an individual or a defined population to obtain or receive appropriate health care. This involves theavailability of programmes, services, facilities and records. Access can be influenced by such factors as finances (insufficient monetary resources); geography(distance to providers); education (lack of knowledge ofservices available); appropriateness and acceptability ofservice to individuals and the population; and sociologicalfactors (discrimination, language or cultural barriers)1.10Advanced Life Support (ALS)A generic term for resuscitation efforts that extend beyond basic Cardio-Pulmonary resuscitation (CPR)2.Automated external defibrillator (AED)A portable device to electronically assess a patient’s cardiac rhythm and to shock if appropriate3.AmbulanceVehicle or craft intended to be crewed by a minimum oftwo appropriately trained staff for the provision of careand transport of at least one stretchered patient4.Ambulance type AType A: patient transport ambulanceRoad ambulance designed and equipped for the transport of patients who are not expected to become emergency patients.Two types of patient transport ambulance exist:Type A1: suitable for transport of a single patient;Type A2: suitable for transport of one or more patient(s)(on stretcher(s) and/or chair(s))5.Ambulance type BType B: emergency ambulanceRoad ambulance designed and equipped for the transport, basic treatment and monitoring of patients6.Ambulance type CType C: mobile intensive care unitRoad ambulance designed and equipped for the transport, advanced treatment and monitoring of patients7.BBasic Life Support (BLS)Emergency medicine The constellation of emergencyprocedures needed to ensure a person's immediate survival, including Cardio-Pulmonary resuscitation (CPR),control of bleeding, treatment of shock and poisoning,stabilization of injuries and/or wounds, and basic firstaid8.CCatchment areaCore definition: A geographic area defined and served bya health plan or a health care provider9.Catchment populationThe population served by a health facility.The catchment population is the population in the catchment area10.Crisis Preparedness PlanThe Crisis Preparedness Plan is the written document ormap for medical crisis management generated by anyappropriate authority or private organisation that clearly

G lossarydetails what needs to be done, how, when, and bywhom—before and after the time an anticipated disastrous event occurs. It aims at providing policy for preparedness and response to both internal and externaldisaster situations that may affect staff, patients, visitorsand the community. A crisis is any critical situation thatcauses a disruption on the equilibrium between the demand and the supply of medical services11.Crisis ResponseA sum of decisions and actions taken during and after disaster, including immediate relief, rehabilitation, and reconstruction12.Co-paymentThe specified portion (cost amount or percentage) thathealth insurance, or a service programme, may require aperson to pay towards his or her medical bills or services13.CPRcardio-pulmonary resuscitationDDiagnosis Related GroupA prospective payment system used by Medicare andother insurers to classify illnesses according to diagnosisand treatment14.Dispatch centerDispatch centres collect the request for ambulance services by telephone handling and organize the responseby coordinating movements and dispatch all available resources, cars and personnel. In other words, dispatchcentre is about getting the right resources, to the right patients, in the appropriate amount of time15.EEmergency medical service system (EMS system)The arrangement of personnel. Facilities and equipmentfor the effective and coordinated delivery of EMS required in the prevention and management of incidents whichoccur either as a result of a medical emergency or of anaccident, natural disaster or similar situation. EMSsystems refer to the broad range of emergency care fromthe pre-hospital first responder to the intensive care unitsetting16.Emergency management (crisis management / disaster management)A range of measures to manage risks to communitiesand the environment; the organisation and managementof resources for dealing with all aspects of emergencies.Emergency management involves the plans, structuresand arrangements which are established to bring together the normal endeavors of government, voluntary andprivate agencies in a comprehensive and coordinatedway to deal with the whole spectrum of emergency needsincluding prevention, response, and recovery17.Emergency PatientPatient who through sickness, injury or other circumstances is in immediate or imminent danger to life unlessemergency treatment and/or monitoring and suitabletransport to diagnostic facilities or medical treatment isprovided18.11

COUNTRYFOFirst responder(1) The first individual designated to provide medical assistance in an Emergency. The degree of training variesby jurisdiction but include a minimum first aid instructionson the airway management, cervical spine control, breathing assistance, circulation assistance, hemorrhagecontrol, and basic patient movement skills (2)a term thatmay refer to the first bystander or witness to render assistance, no matter what their training19.Out-of-hospital EMS (Synonymous Out-of-facilityEMS)Remote from medical facility. In the case of EMS it pertains to those components of the emergency health caredelivery system that occur outside of the traditional medical setting (e.g., pre hospital care, transportation, andothers)22.E mergency M edical S ervices S ystems i n t he E uropean U nionM12Medical dispatch centerAny agency that routinely accepts calls for emergencymedical assistance from the public and/or that dispatchespre-hospital emergency medical personnel pursuant forsuch requests20.Minimum standardMinimum standard A level of quality that all health plansand providers are required to meet in order to offer services to clients/customers21.PParamedicA health professional certified to perform advanced lifesupport procedures (e.g., intubation, defibrillation and administration of drugs under a physician's direction). Paramedics provide urgent care from an emergency vehicleor air service23.WWrist bandAn identifying bracelet attached to a patient’s wrist at thetime of admission to a health care facility, which may be theonly identifier used during a person's stay in a hospital24.References:1, 13, 21 A Glossary of Terms for Community Health Care and Services for Older Persons. WHO, Centre for Health Development, 2004.2, 8, 14, 23, 24 McGraw-Hill Concise Dictionary of Modern Medicine. 2002 by The McGraw-Hill Companies, Inc.3, 16, 19, 20, 22 Kuehl, AE. (Ed). Prehospital Systems and Medical Oversight, 3rd edition. National Association of EMS Physicians, 2002.4, 5, 6, 7, 18 Medical vehicles and their equipment - Road ambulances (EC Standard EN 1789:2007).9 European Observatory on Health Care Systems, 2001.10 PAHO glossary - Definitions and Terms in Implementation Research and Health Systems Research.11 Davoli E. ed. A practical tool for the preparation of a hospital crisis preparedness plan, with special focus on pandemic influenza. WHO Regional Office for Europe, Copenhagen, 2006.12 United Nations. Internationally agreed glossary of basic terms related to disaster management.15 Pan American Health Organization, Emergency Medical Services Systems Development, 2003, 107, Washington D.C.17 Health Disaster Management: Guidelines for Evaluation and Research in the “Utstein Style.” Glossary of terms. Prehosp Disast Med2002;17(Suppl 3):144–167.

AbstractDescription and Methodology of the projectThis document is the result of a project whose aim was to describe and assess emerg