1 Emergency preparedness in the Baltics Dinas Vaitkaitis Kaunas University of Medicine Lithuanian Society for Emergency Medicine SCIENTIFIC NETWORKING AND THE GLOBAL HEALTH SUPERCOURSE FOR THE PREVENTION OF THREAT FROM MAN MADE AND NATURAL DISASTERS August , Kaunas, Lithuania

2 Topics Background info Risks Emergency management Emergency services Education and training

3 THE BALTICS

4 Background info LTLVEST Geographic size, th km 2 65,364,545,0 Population size, M GDP, bn$45.23$26.53$19.23 GDP, per person$12,500$11,500$ % of GDP spent on healthcare Geography/Demographics/Economy Sources: WHO, CIA

5 Differences 66% located on 33% of territory, rest of the population very sparsely situated Estonia and Latvia -

6 DISASTER RISKS Natural disasters: floods forests’ fire stormy winds drought Man-made disasters: nuclear disasters chemical disasters traffic accidents terrorism and war infections

7 IGNALINA NPP Two RBMK-1500 reactors since 1983 and 1987 – one of them is still working 1,5 Billion kWh/month Personnel: 3900 (April, 2003) day shift :2500 night shift: 230 security service: 530 shelter for: 800

Tammiku, Estonia Cs-137 from dump 3 persons irradiated 1 person died Risk of nuclear disasters

9 Risk Vecumnieki 1999

10 Kemeri 1999 Risk

11 Risk 28 September people on board 138 rescued

12 Explosion in shopping centre “Centrs” (RIGA, 17 August,2000) 1 cilvēks miris slimnīcā 30 cilvēki cietuši Multitrauma, neirotrauma izolēti skeleta bojājumi apdegumi

13 DISASTER MANAGEMENT LEVELS IN LITHUANIA National (country) level Regional (county) level Local (municipality) level

14 DISASTER MANAGEMENT LEVELS NATIONAL LEVEL Government of the Republic of Lithuania Emergency Management Commission Emergency Management Center Civil Protection Department Ministries Emergency Management Centers Fire Department Health Emergency Situation Center Maritime Search and Rescue Center Air Search and Rescue Centre Other Governmental Institutions

15 DISASTER MANAGEMENT LEVELS REGIONAL LEVEL Regional Authority Regional Emergency Management Center Regional Warning and Information Service Civil Protection Services

16 DISASTER MANAGEMENT LEVELS MUNICIPALITY LEVEL Local Authority Local Emergency Management Center Fire and rescue Departments Local Warning and Information Service Business and Industry Civil Protection Services

17 EMERGENCY MANAGEMENT SYSTEM IN HEALTH CARE SECTOR

18 HEALTH CARE ORGANIZATION LEVELS IN CASE OF DISASTER: STATE LEVEL MINISTRY OF HEALTH DISASTER MANAGEMENT CENTER OF THE MOH HEALTH EMERGENCY SITUATIONS CENTER TO THE MOH Radiation Protection Center Centre of Communicable Diseases Prevention and Control Public Health Services Institute of Hygiene Kaunas Medical University Clinics Vilnius University Hospital,,Santariskiu Clinics” Vilnius University Emergency Hospital Lithuanian Oncology Center VU Children Hospital VU Zalgirio Clinics (stomatol. surgery) VU Psichiatry Hospital Other special. hospitals

19 HEALTH CARE ORGANIZATION LEVELS IN CASE OF DISASTER: COUNTY AND MUNICIPALITY LEVELS COUNTY LEVEL County hospitals (60) Public Health Centers (11) MUNICIPALITY LEVEL Municipality hospitals (50) Branches of Public Health Centers (39)

20 Emergency services in Lithuania Fire and Rescue Services Police Ambulance Services / Hospitals

21 The Fire and Rescue Services rescue work protection of persons and property first aid at the accident site transportation of injured from the accident site to assembly area

22 The police Coordination of work of all three emergency services at the accident site Protection of persons and property Traffic control Registration of the victims and bystanders.

23 Health services Assessing injured and setting care priorities Life saving first aid measures near the accident site and while transporting victims to hospitals Medical transport Allocation of injured to different hospitals 63 Ambulance stations/services 265 teams – day time, 210 – night time

24 All three services planning helping with information to the relatives, public and the mass media co-operation

25 Other services in the relief operations See search and rescue Under guidance of Captain of Klaipeda See-Port Rescue ship “Šakiai” Air search and rescue 7 helicopters of the Airforce Center of Aeronautics and Air Search Emergency Management Centers under guidance of Crisis Management Center

26 Training

27 Training

28 Training

29 Training EmergoTrain – system, Lithuanian version

30 Large scale exercises

31 Education, research and training University studies of medicine at two universities (+1 public health) Health faculties at five colleges Postgraduate training Exercises Emergency medicine – research programme at Kaunas University of Medicine

32 Organisation of Pre-hospital Emergency Medical Care in Estonia Provided entirely by Emergency Medical Services with minimal involvement of GPs in rural areas There is no governmental body regulating the EMS activities nor is there any functioning legal framework governing the area

33 Union of Estonian Emergency Medical Services is a nonprofit organisation for EMS professionals (physicians, nurses and EMTs), devoted to quality of emergency medical care by providing training and guidance to its members, consulting the government in questions vital for the development of EMS etc.

34 Estonian EMS - resources available There are 87 EMS teams in 46 geographic locations

35 The qualification of EMS teams in Estonia 6 reanimobiles with anaesthesiologist on board (based in Tallinn and Tartu) 40 physician manned ambulances (generalists with training in EM) 41 teams lead by a specialist nurse All EMS teams consist of 3 members: a doctor or a specialised nurse, a nurse and a driver trained as EMT

36 Education and Training Undergraduate medical education Physicians - Tartu University Nurses - 3 schools (Tallinn, Tartu, Kohtla-Järve) Specialisation EM physicians in residency progam at Tartu University Hospital Nurses at Tallinn EMS EMTs at Tallinn and Tartu EMS, Centre of Disaster Medicine of Tallinn Mustamäe Hospital

37 Medical disaster preparedness organisation in Latvia State level - Ministry of Health Centre of Emergency and Disaster medicine Operative reserves District level - responsibility for preparedness Local level Ambulance Service Hospitals DM planning – for each level

38 Ambulance Services in Latvia 52 Ambulance stations in 70 localization points 173 teams –day time, 143 – night time

39 EMS – “ stay and play” concept EMS teams in Latvia: IT teams – MD + MD assistant + driver (53day time/36 night time) EM teams – MD assistant + driver (123/110) Legislation demand – 2 medical educated persons on each team

40 EMS – today Lack of co-ordination; “Border problems” Management and dispatch problems (many dispatch “centres”); Different levels of accessibility of EMH –Cities 15 minutes –Country side min. Lack of unitary communication system Personnel problems Different EM numbers

41 International co-operation (“Disasters do not know borders”) Catchment area LV-LT Jelgava- Siauliai Catchment area LV-EE Valmiera- Pärnu Neighbouring countries: cross - border co-operation

42 Acknowledgements Mārtiņš Zuteris Raul Adlas Ursel Kedars Ago Kõrgvee

43 Thank you!