Emergency medical services in Iceland

Last updated

Emergency medical services in Iceland include the provision of ambulance service. They provide all emergency ambulance service for a population of in excess of 320,000 people in one of the most sparsely settled countries in Europe. [1] The system is government-funded for the first 85 percent of cost, with 15 percent being charged to the individual as a deterrent fee. [2] All services in Iceland are provided by the Icelandic Red Cross, [3] with individual ambulances often co-located with local fire brigades.

Contents

Organization

Land ambulance

There are currently approximately 77 operational land ambulances in Iceland. These are distributed across almost all communities, usually at fire stations. They are owned and equipped by the Icelandic Red Cross, but are crewed by fire service personnel. In larger centres, such as Reykjavík, the ambulances are staffed by full-time, paid Emergency medical technicians. In smaller centres, EMTs may be part-time, or even on-call from home in some cases. All ambulance personnel are either the equivalent of EMT-B or EMT-I. Staffing of ambulances is normally 2 people, with two EMT-Bs, or, where available, an EMT-B and an EMT-I. [4] Paramedics are usually found only in Reykjavík, which operates a single, Advanced Life Support ambulance with a crew of three. Ambulances are organized according to the country's multiple Health Service Districts, but are centrally dispatched. At 2014, the ambulances were converted Mercedes vans.

Air ambulance

Icelandic Coast Guard Air Ambulance AS-365N Dauphin 2 of The Iceland Coast Guard.JPEG
Icelandic Coast Guard Air Ambulance

Because of the sparse population, bad weather, and large numbers of airports, most air ambulance service in Iceland is accomplished using fixed-wing aircraft. The government of Iceland has contracted out this service since 2001. [5] The type of aircraft normally used is a Beechcraft Super King Air 200 operated by the airline Mýflug (Myflug Air). Mýflug has one dedicated air ambulance in Iceland, based at Akureyri, the site of the country's second largest hospital. There are normally 2 aircraft available (one dedicated, one as a charter), with a third charter aircraft being provided during the winter months. When weather conditions or other circumstances make fixed-wing inappropriate, the system has access to three helicopters (Aerospatiale Dauphin or Super Puma) operated by the Icelandic Coast Guard, and based at Reykjavík. On medical missions, Coast Guard helicopters are normally staffed by physicians. Iceland's Air Ambulance system responds to approximately 450 fixed-wing calls per year, and an additional 130-160 helicopter calls per year.

Model of care

An attempt to describe the model of care used quickly becomes complex. At the ALS end of the spectrum, the model closely resembles the German version of the Franco-German model, [6] with paramedics working with and under the direction of a physician. This represents, however, only the 5 percent of EMS personnel in the entire country who are paramedics, and only a single ambulance, out of 77 units in service. For the balance, the model much more closely resembles the Anglo-American model, [7] with EMTs making their treatment decisions based upon local guidelines, albeit at a basic life support level, or at best, with the limited skill set of an EMT-I.

Training

Basic and Intermediate

There is not currently an official national training standard for EMS personnel in Iceland. As a result, the training levels which operate by default are those currently in use in the United States. Training for EMT Basic, and EMT Intermediate are directly comparable with the U.S. standards. These are conducted by the Icelandic Centre for EMS Education. [8]

Paramedic

Since paramedic training is currently unavailable in Iceland, most of these were trained and certified in the United States at the University of Pittsburgh's Center for Emergency Medicine. [9] Paramedics scope of practice is similar to what paramedics in USA are used to, this includes stong analgesia, vasopressors and cardiac drugs. in Iceland. Paramedics are also sometimes used to provide care on air ambulance transports. Paramedics completing training in the U.S. are validated and certified by the Icelandic directorate of health.

Skills

There is, at the moment, limited governing legislation regarding the practice of EMS personnel in Iceland. This is particularly critical regarding the administration of medications. The Icelandic Parliament has assigned responsibility for oversight to the various local health authorities, [10] and, as a result, there is considerable variation in permissible skills. The following, while far from complete, will serve as a general overview of permissible skills at the various levels of training:

EMT-Basic

  • Automatic External Defibrillator
  • Supraglottal Airways (Laryngeal Mask, Laryngeal Tube, Fast Trach)

EMT-Intermediate

  • Automatic External Defibrillator
  • Supraglottal Airways (Laryngeal Mask, Laryngeal Tube, Fast Trach)
  • IV initiation
  • Use of Epinephrine in Cardiac Arrest

EMT-Paramedic

  • Manual Defibrillation
  • Supraglottal Airways (Laryngeal Mask, Laryngeal Tube, Fast Trach)
  • IV initiation
  • Use of Epinephrine in Cardiac Arrest
  • Endotracheal Intubation
  • Surgical Cricothyrotomy

Communications

Iceland uses the European emergency telephone number 112 for all emergencies. Dispatch, which used to be a local function, merged into two dispatch centres, and is in the process of merging into a single, integrated dispatch centre for all three emergency services. [11] The new system involves both CAD and also satellite-based automatic vehicle locating for all emergency vehicles, with plans to expand the system to include snowplows and sanders to expedite emergency responses in bad weather. The system dispatches an estimated 22,000 EMS calls per year.

Related Research Articles

<span class="mw-page-title-main">Emergency medical services</span> Services providing acute medical care

Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. They may also be known as a first aid squad, FAST squad, emergency squad, ambulance squad, ambulance corps, life squad or by other initialisms such as EMAS or EMARS.

<span class="mw-page-title-main">Emergency medical technician</span> Health care provider of emergency medical services

An emergency medical technician is a medical professional that provides emergency medical services. EMTs are most commonly found serving on ambulances and in fire departments in the US and Canada, as full-time and some part-time departments require their firefighters to be EMT certified.

<span class="mw-page-title-main">Paramedic</span> Healthcare professional who works in emergency medical situations

A paramedic is a healthcare professional trained in the medical model, whose main role has historically been to respond to emergency calls for medical help outside of a hospital. Paramedics work as part of the emergency medical services (EMS), most often in ambulances. They also have roles in emergency medicine, primary care, transfer medicine and remote/offshore medicine. The scope of practice of a paramedic varies between countries, but generally includes autonomous decision making around the emergency care of patients.

The Seattle & King County Emergency Medical Services System is a fire-based two-tier response system providing prehospital basic and advanced life support services.

A medical director is a physician who provides guidance and leadership on the use of medicine in a healthcare organization. These include the emergency medical services, hospital departments, blood banks, clinical teaching services, and others. A medical director devises the protocols and guidelines for the clinical staff and evaluates them while they are in use.

<span class="mw-page-title-main">Toronto Paramedic Services</span> Statutory emergency medical services provider

The City of Toronto Paramedic Services is the statutory emergency medical services provider in Toronto, Ontario, Canada. The service is operated as a division of the City of Toronto, under the Community & Social Services cluster. The service is funded by the municipal tax base, and operates similarly to other municipal divisions, such as the Toronto Parks, Forestry & Recreation division, or the Toronto Water division, but retains operational independence from other divisions. While under municipal government control, it is subject to provincial legislation and licensing. It is not the only service provider in its area; private-for-profit medical transport services also provide routine, non-emergency transports and coverage for special events, but the statutory emergency medical system is the only provider permitted to service emergency calls.

<span class="mw-page-title-main">Nontransporting EMS vehicle</span> Emergency vehicle equipped for providing care, but not transporting patients

A nontransporting EMS vehicle is a vehicle that responds to and provides emergency medical services (EMS) without the ability to transport patients. For patients whose condition requires transport, an ambulance is necessary. In some cases they may fulfill other duties when not participating in EMS operations, such as policing or fire suppression.

<span class="mw-page-title-main">Paramedics in the United States</span> Overview of paramedics in the United States of America

In the United States, the paramedic is a allied health professional whose primary focus is to provide advanced emergency medical care for patients who access Emergency Medical Services (EMS). This individual possesses the complex knowledge and skills necessary to provide patient care and transportation. Paramedics function as part of a comprehensive EMS response under physician medical direction. Paramedics often serve in a prehospital role, responding to Public safety answering point (9-1-1) calls in an ambulance. The paramedic serves as the initial entry point into the health care system. A standard requirement for state licensure involves successful completion of a nationally accredited Paramedic program at the certificate or associate degree level.

<span class="mw-page-title-main">Louisville Metro EMS</span> Life support provider based in Kentucky

Louisville Metro Emergency Medical Services is the primary provider of pre-hospital life support and emergency care within Louisville-Jefferson County, Kentucky. LMEMS is a governmental department that averages 90,000 calls for service, both emergency and non-emergency, each year.

<span class="mw-page-title-main">Emergency medical services in the United States</span>

In the United States, emergency medical services (EMS) provide out-of-hospital acute medical care and/or transport to definitive care for those in need. They are regulated at the most basic level by the National Highway Traffic Safety Administration, which sets the minimum standards that all states' EMS providers must meet, and regulated more strictly by individual state governments, which often require higher standards from the services they oversee.

Emergency Medical Service in Germany is a service of public pre-hospital emergency healthcare, including ambulance service, provided by individual German cities and counties. It is primarily financed by the German public health insurance system.

<span class="mw-page-title-main">Emergency medical services in Italy</span>

Emergency medical services in Italy currently consist primarily of a combination of volunteer organizations providing ambulance service, supplemented by physicians and nurses who perform all advanced life support (ALS) procedures. The emergency telephone number for emergency medical service in Italy is 118. Since 2017 it has also been possible to call by the European emergency number 112, although this is a general police/fire/medical number.

An advanced emergency medical technician is a provider of emergency medical services in the United States. A transition to this level of training from the emergency medical technician-intermediate, which have somewhat less training, began in 2013 and has been implemented by most states. AEMTs are not intended to deliver definitive medical care in most cases, but rather to augment prehospital critical care and provide rapid on-scene treatment. AEMTs are usually employed in ambulance services, working in conjunction with EMTs and paramedics; however they are also commonly found in fire departments and law enforcement agencies as non-transporting first responders. Ambulances operating at the AEMT level of care are commonplace in rural areas, and occasionally found in larger cities as part of a tiered-response system, but are overall much less common than EMT- and paramedic-level ambulances. The AEMT provides a low-cost, high-benefit option to provide advanced-level care when the paramedic level of care is not feasible. The AEMT is authorized to provide limited advanced life support, which is beyond the scope of an EMT.

In the United States, the licensing of prehospital emergency medical providers and oversight of emergency medical services are governed at the state level. Each state is free to add or subtract levels as each state sees fit. Therefore, due to differing needs and system development paths, the levels, education requirements, and scope of practice of prehospital providers varies from state to state. Even though primary management and regulation of prehospital providers is at the state level, the federal government does have a model scope of practice including minimum skills for EMRs, EMTs, Advanced EMTs and Paramedics set through the National Highway Traffic Safety Administration (NHTSA).

Emergency medical services in the Netherlands is a system of pre hospital care provided by the government in partnership with private companies.

Emergency medical services in Israel are provided by the Magen David Adom (MDA) organization, and in some places by the Palestinian Red Crescent Society. The phone number to call for an ambulance is 101

<span class="mw-page-title-main">Emergency medical services in Poland</span> Overview of emergency medical services in Poland

State Medical Rescue in Poland is a system of free public emergency healthcare established by Ustawa o Państwowym Ratownictwie Medycznym, including ambulance service and Emergency Departments (EDs). While in Polish public hospitals and clinics NFZ common public insurance is required, PRM medical services in ambulances and EDs are completely free for everyone. Since 2018 emergency ambulances that operates in PRM, that is Polish 112 and 999 emergency numbers, are operated by public entities only.

Emergency medical services in New Zealand are provided by the Order of St John, except in the Greater Wellington region where Wellington Free Ambulance provides these services. Both have a history of long service to their communities, St John since 1885 and Free beginning in 1927, traditionally having a volunteer base, however the vast majority of response work is undertaken by paid career Paramedics. Strategic leadership of the sector is provided by NASO which is a unit within the Ministry of Health responsible for coordinating the purchasing and funding of services on behalf of the Ministry and the Accident Compensation Corporation.

Emergency medical services in Sri Lanka is being established using a public/private system aimed at the provision of emergency ambulance service, including emergency care and transportation to hospitals. The Pre-Hospital Care Committee is part of the Trauma Secretariat of the Sri Lanka Ministry of Healthcare and Nutrition and was established following the 2004 tsunami. The goal of the Pre-Hospital Care Sub-Committee is “During this generation and continuing for future generations, everyone in Sri Lanka will have access to trained pre-hospital medical personnel, ambulances are available to transport the sick and injured safely to hospitals, complications from harmful or inadequate pre-hospital care is eliminated so physician and nursing personnel at hospitals are delivered patients they are able to professionally treat and rehabilitate back to society as contributing citizens.” Pre-Hospital care is an essential, core component of trauma system.

<span class="mw-page-title-main">Emergency medical services in Austria</span>

Emergency Medical Service in Austria is a service of public pre-hospital emergency healthcare, including ambulance service, provided by individual Austrian municipalities, cities and counties. It is primarily financed by the Austrian health insurance companies.

References

  1. "Ambulance Transport and Services in the Rural Areas of Iceland, Scotland and Sweden (JEPHC webpage)" . Retrieved 2009-02-07.
  2. "Health Services Iceland (gov't website)". Archived from the original on 2009-01-31. Retrieved 2009-02-07.
  3. "Icelandic Red Cross (IFRC website)" (PDF). Archived from the original (PDF) on January 14, 2009. Retrieved 2009-02-07.
  4. "Centre for EMS Education (1) (webpage) (in Icelandic)" . Retrieved 2009-02-07.
  5. "Air Ambulance (JEPHC website)" . Retrieved 2009-02-07.
  6. Dick WF (2003). "Anglo-American vs. Franco-German emergency medical services system". Prehosp Disaster Med. 18 (1): 29–35, discussion 35–7. doi:10.1017/s1049023x00000650. PMID   14694898.
  7. Cooke MW, Bridge P, Wilson S (2001). "Variation in emergency ambulance dispatch in Western Europe". The Scandinavian Journal of Trauma and Emergency Medicine. 9 (2): 57–66.
  8. "Centre for EMS Education (2) (webpage) (in Icelandic)" . Retrieved 2009-02-07.
  9. McDevitt B (February 2004). "On top of the world. Iceland delivers high-quality EMS". JEMS. 29 (2): 62–7. PMID   14990899.
  10. "Icelandic Parliament website (in Icelandic)" . Retrieved 2009-02-07.
  11. "Iceland Police, Fire and Ambulance (APD Communications Ltd. website)" (PDF). Retrieved 2009-02-07.[ permanent dead link ]