Preparing for Preparedness
Development of Emergency and Disaster Medicine System (EDMS) in Latvia
Maija Busmane, MD
Chief of Department of Planning and Cooperation
Centre of Emergency and Disaster medicine,
Ministry of Health Latvia
maija.busmane@kmc.gov.lv
Co-authors:
M.Sics, MD; R.Pupele, MD; E.Akitis
Centre of Emergency and Disaster Medicine
What people usually know about Latvia?
RIGA
Centre of Emergency and Disaster Medicine
The world has changed also in Latvia
2004 –2005
Uncommon nature
outbreaks for Latvia
(storms and black - out,
earthquake)
Large flood and
forest fires
Technical and traffic
accidents with mass
casualties
Real terrorism
threat
Centre of Emergency and Disaster Medicine
Study objectives:
Analyse what does PREPARADNESS mean for
health care stakeholders and how to provide it in
the best possible way and in the context with
 health care reforms
 civil military crises management
 international cooperation
Centre of Emergency and Disaster Medicine
Methods used
 Site investigation
 Data collection
 Questioning
 Assessment
 Comparison
 Forecasting
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SDR (per 100 000), 2003.
Transport accidents
Lithuania
23,76
Latvia
Ischaemic heart disease
327,75
22,66
Lithuania
Estonia
Poland
15,5
Latvia
291,58
Hungary
Estonia
14,7
Hungary
Czech Rep.
232,66
149,77
105,76
13,64
Czech Rep.
Slovenia
Malta
13,33
3,5
Malta
Poland
Slovenia
Average EU
11,6
Average EU
13,19
312,53
176,09
124,93
94,37
Source: European HFA Datebase, June 2005.
Centre of Emergency and Disaster Medicine
Possibilities to prevent the Sudden Death
100
Every minute lost
survival rate !!!
Survival ( % )
reduces
80
60
40
20
0
5
10
15
20
25
Time till defibrillation ( % )
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30
Pre-hospital Emergency Medical Services
 Dispatching Centres with
today
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
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EMS calls and calls completion
(day average)
Area
Riga
Latvia
Calls received by EMS
Dispatcher’s
in all
Including
through
“112”
1000
12 – 14 %
2500
10 – 12%
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Calls
completed
by EMS
Ambulance
Teams
500
1400
Conclusions
• There are no facility for effective management of
EDMS common resources in circumstances while
p-h EMS’s providers management is
decentralized;
• There are unequal possibilities to receive p-h EMS
in day-to-day and in case if Disaster occurs;
• New infrastructure and organization for medical
institutions involved to prevent emergency
consequences is certainly necessary.
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Several principles and approaches considered for
creating a new scheme of EMC to cover the
patients` needs for equal availability of services
(on time and qualitative)
 Subsidiarity
 Coordination
 Succession
 Consolidation
of resources
 Intersectoral scope
Essential attention must be paid to all transitions
of Health Care System and Health Professionals`
attitude towards Reforms
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Pre-hospital EMS in the foreseeable future
Unified management
system
Three levels:
 Central Management
Unit (CMU)
 Regional Management
and Dispatcher
Centres (RMDC)
 Ambulance Location
Points Network
and Ambulance teams
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RMDC
Call completion business processes
User Functions
Calltaking
Identification
of competence
I
Interview
Support
algoritm
for
interview
Call Card
complition
Decision
about Call
completion
Support
from
Senior
Doctor
Call
completion
Decision
delivery
Maintainance
of basic data
Support
for Call
completion
Event
analysis
Call
completion
Final Report
Call Card
delivery
Call Card
closing
System Functions
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Now and after
2005
2010
Dispatcher Centres
37
1+5
Ambulance Location
Points
Ambulance Teams
80
115
192
240
EM professionals
1728
2560
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Benefits expected after implementation new
pre-hospital EMS Dispatch System I

Save more people lives
Increase EMS accessibility to meet international
standards (response time, unitary call number, quality)


Increase EMS management role as a support for
international cooperation, for Civil Military Crisis
Management assistance, especially in case of CBRN threats
increase capacities for NATO Crisis Response System

Model can be used as EU co-operation system

Support EDMS planning
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Benefits expected after implementation new
pre-hospital EMS Dispatch System II
Provide:
 unitary quality control and statistics system
 synergy
effect and efficient use of available resources
 better co-operation and
co-ordination with other
rescue services, institutions etc.
 co-ordination of
Specialized Emergency care,
Consultancy service, Reserves, Hospital services,
Medical transportation service and other Health resources
 capacity for
PHC call management (PHC central)
and possibility for call separation
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Matter of Opinion – direct call to EMS
TODAY
112
+ 03 (direct Call to EMS)
Statement of EMS development
determines
112
+
”xx3”
(direct Call to EMS)
Overwise – minders
Demands
Only 112
DISCUSSION:
Which of above mentioned two ways is more
relevant to save people lives and keep them well ?
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Pyramid of Preparedness
CORNERSTONES:
 Provision
of EDMS Resources
 Methodological
management of
EDMS in “peace time”
 Education, Training and
International cooperation
 Monitoring of every day EMS
COORDINATION
MANAGEMENT
 High
developed Hospital’s
Admission and Emergency units
 High developed prehospital EMS –
the basic Operational Unit of EDMS
MANAGEMENT AND COORDINATION
- the most relevant factor for preparedness,
particularly if resources are limited
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The Government of Latvia
has adopted
Policy Statement of EMS development
2005 –2010
(12.07. 2005.)
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To
be
To be
continued
...
continued ...
Thank you
for your attention !
Centre of Emergency and Disaster Medicine