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

3. What people usually know about Latvia? RIGA Centre of Emergency and Disaster Medicine

4. The world has changed also in Latvia 2004 –2005 Centre of Emergency and Disaster Medicine  Uncommon nature outbreaks for Latvia outbreaks for Latvia (storms and black - out, (storms and black - out, earthquake) earthquake)  Large flood and forest fires forest fires  Technical and traffic accidents with mass accidents with mass casualties casualties  Real terrorism threat threat

5. Study objectives: civil military crises management 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  international cooperation Centre of Emergency and Disaster Medicine

6. Methods used Centre of Emergency and Disaster Medicine  Site investigation  Data collection  Assessment  Comparison  Questioning  Forecasting

7. SDR (per 100 000), 2003. Transport accidentsIschaemic 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 Medicine

8. Possibilities to prevent the Sudden Death Survival ( % ) Time till defibrillation ( % ) 0 20 40 60 80 100 51015202530 Every minute lost reduces survival rate !!! Centre of Emergency and Disaster Medicine

9. Pre-hospital Emergency Medical Services today Centre of Emergency and Disaster Medicine  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

10. EMS calls and calls completion (day average) Area Calls received by EMS Dispatcher’s Calls completed by EMS Ambulance Teams in allIncluding through “112” Riga1000 12 – 14 % 500 Latvia2500 10 – 12% 1400 Centre of Emergency and Disaster Medicine

11. Conclusions There are no facility for effective management of There are no facility for effective management of EDMS common resources in circumstances while EDMS 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 EMS There 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 medical New infrastructure and organization for medical institutions involved to prevent emergency institutions involved to prevent emergency consequences is certainly necessary. consequences is certainly necessary. Centre of Emergency and Disaster Medicine

12. Several principles and approaches considered for Several principles and approaches considered for 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) Centre of Emergency and Disaster Medicine  Subsidiarity  Coordination  Succession  Consolidation of resources Intersectoral scope  Intersectoral scope Essential attention must be paid to all transitions Essential attention must be paid to all transitions of Health Care System and Health Professionals` of Health Care System and Health Professionals` attitude towards Reforms attitude towards Reforms

13. Pre-hospital EMS in the foreseeable future Centre of Emergency and Disaster Medicine Unified management system system  Central Management Unit (CMU) Three levels:  Regional Management and Dispatcher Centres (RMDC)  Ambulance Location Points Network and Ambulance teams

14. RMDC Call completion business processes Calltaking I Identification of competence Interview Support algoritm for interview Decision about Call completion Support from Senior Doctor Call Card complition Decision delivery Call Card delivery Call completion Support for Call completion Call completion Final Report Call Card closing Maintainance of basic data Event analysis System Functions User Functions Centre of Emergency and Disaster Medicine

15. Now and after 20052010 Dispatcher Centres 371+5 Ambulance Location Points 80115 Ambulance Teams 192240 EM professionals 17282560 Centre of Emergency and Disaster Medicine

16. Benefits expected after implementation new pre-hospital EMS Dispatch System I  Support EDMS planning Centre of Emergency and Disaster Medicine  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 international cooperation, for Civil Military Crisis Management assistance, especially in case of CBRN threats Management assistance, especially in case of CBRN threats increase capacities for NATO Crisis Response System increase capacities for NATO Crisis Response System  Model can be used as EU co-operation system  Save more people lives

17. Benefits expected after implementation new pre-hospital EMS Dispatch System II Centre of Emergency and Disaster Medicine 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. rescue services, institutions etc.  co-ordination of Specialized Emergency care, Consultancy service, Reserves, Hospital services, Consultancy service, Reserves, Hospital services, Medical transportation service and other Health resources Medical transportation service and other Health resources  capacity for PHC call management (PHC central) and possibility for call separation and possibility for call separation

18. Matter of Opinion – direct call to EMS of EMS development Statement of EMS development determines determines 112 + ”xx3” ( direct Call to EMS ) ( direct Call to EMS ) TODAY 112 + 03 (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 ? Centre of Emergency and Disaster Medicine

19. MANAGEMENT AND COORDINATION MANAGEMENT AND COORDINATION - the most relevant factor for preparedness, - the most relevant factor for preparedness, particularly if resources are limited particularly if resources are limited COORDINATION MANAGEMENT MANAGEMENT Pyramid of Preparedness  High developed Hospital’s Admission and Emergency units  High developed prehospital EMS – the basic Operational Unit of EDMS Centre of Emergency and Disaster Medicine  Provision of EDMS Resources  Methodological management of EDMS in “peace time”  Education, Training and International cooperation  Monitoring of every day EMS CORNERSTONES:

20. The Government of Latvia has adopted Policy Statement of EMS development 2005 –2010 (12.07. 2005.) Centre of Emergency and Disaster Medicine

21. To be To be continued... continued... Thank you for your attention ! Centre of Emergency and Disaster Medicine To be continued...