1. Erika Frischknecht Christensen Emergency Medicine in Denmark Erika Frischknecht Christensen Ass. Professor Dept. Anesthesiology & Intensive Medicine Aarhus University Hospital Medical Director Prehospital Care County of Aarhus Denmark

2. Erika Frischknecht Christensen Denmark Population: 5.4 Mio. Area:43.000 km 2 Density: 125 /km 2 Home of the Vikings AND: Greenland Population: 57.000 Area: 410.000 mio km 2 - 0.1 per km 2

3. Erika Frischknecht Christensen Denmark Geography 407 islands 7300 km coast line Copenhagen 1.1 mill. inhab. Population and life length Men:74.5 years Women: 79.2 years 0-9 years: 12% 70+ years: 11%

4. Erika Frischknecht Christensen Burden of diseases Major causes of morbidity and mortality: Cancer: 25% of deaths Heart diseases: 25% of deaths Cerebrovascular diseases: 12% Chronic obstructive pulmonary diseases: 10% Leading cause age 1-45 years: Trauma

5. Erika Frischknecht Christensen Medical education Health science at 3 universities Study: six years Postgraduate clinical training: 1 ½ years basic 4 ½- 6 years in specialty Process evaluation Certificate by regional and national authority

6. Erika Frischknecht Christensen Health Care system - Denmark Public regional health care system: 14 counties and Capital 64 somatic hospitals and 20.800 beds in somatic hospitals (2000) 1 mio admissions/year Expected to be more centralized

7. Erika Frischknecht Christensen Health Care system - Denmark Public health insurance Good primary health care system: 4.5 mio contacts to general practioners General practioners: gate keepers

8. Erika Frischknecht Christensen Emergency Medicine in 14 Danish Counties Population 4.2 Mio (out of 5.3) GP visits in daytime: 29 Mio GP on call: 2.7 Mio A&E visits: 1.1 Mio 112-call ambulances: 250.000 All increased by 5-10% since 1996

9. Erika Frischknecht Christensen Accident & Emergency Dept. EM not a specialty Many, and several small hospitals Run by Orthopedics 90% injuries, 10% medical emergencies Life-threatening cases and critical care: anesthesiologists in and ouside hospital 4 Level-1 Trauma Centers at University Hospitals

10. Erika Frischknecht Christensen Emergency care in hospital A&E: Accidents - Injuries Self-referrals Ambulances Orthopedic, GP Surgeon Anesthesiologist Radiologist Other Emergencies From the GPs Ambulances Self-referrals Internist, Cardiologist Anesthesiologist Surgeon,Gynaecologist Pediatrics etc

11. Erika Frischknecht Christensen Pre-hospital emergency care Defined by law: Ambulance personell: –Level 1: basic life support –Level 2: BLS+ symptomatic relief: –NTG, broncodilator, diazepam etc –Level 3: BLS+medication for ALS One level 2 EMT on each ambulance Medical director in each county

12. Erika Frischknecht Christensen Pre-hospital emergency are 112 calls: police Alarm central Denmark: 7 regions Dispatch center: ambulance services Major ambulance services: Copenhagen Firebrigade Group 4 Falck Contracts with each County

13. Erika Frischknecht Christensen Physicians = Anesthesiologists in Prehospital Care Experienced and trained in Airway Breathing Circulation Pain treatment

14. Erika Frischknecht Christensen Endotracheal intubation in the field 1998-2000 Aarhus 14.000 calls 75% medical emergencies 370 patients, intubated on scene Majority after anaesthesia

15. Erika Frischknecht Christensen Physicians in prehospital Care Physicians in cars as rendez-vous, dispatched to 10 % - 35% calls – Covering 25-30% of population Expanding

16. Erika Frischknecht Christensen EM in Denmark Challenges and Strategies will be presented at the meeting.