Emergency medical services in Poland

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Polish Emergency Medical Service logo Znak PRM.jpg
Polish Emergency Medical Service logo
A Volkswagen resuscitation ambulance is used throughout the entire country AMBULANS VW CRAFTER.jpg
A Volkswagen resuscitation ambulance is used throughout the entire country
Mercedes-Benz resuscitation ambulance (Type R) used by Polish emergency services Mercedes ambulance PICT0112.jpg
Mercedes-Benz resuscitation ambulance (Type R) used by Polish emergency services

Emergency Medical Services (Polish : Państwowe Ratownictwo Medyczne, PRM) in Poland is a service of public pre-hospital emergency healthcare, including ambulance service, provided by individual Polish cities and counties. These services are typically provided by the local, publicly operated hospital, and funded by the government of Poland. In a number of cases, the hospitals contract these services to private operators. In addition to publicly funded services, there are also a variety of private-for-profit ambulance services operating independently, as well. [1]

Polish language West Slavic language spoken in Poland

Polish is a West Slavic language of the Lechitic group. It is spoken primarily in Poland and serves as the native language of the Poles. In addition to being an official language of Poland, it is also used by Polish minorities in other countries. There are over 50 million Polish language speakers around the world and it is one of the official languages of the European Union.

Poland Republic in Central Europe

Poland, officially the Republic of Poland, is a country located in Central Europe. It is divided into 16 administrative subdivisions, covering an area of 312,696 square kilometres (120,733 sq mi), and has a largely temperate seasonal climate. With a population of approximately 38.5 million people, Poland is the sixth most populous member state of the European Union. Poland's capital and largest metropolis is Warsaw. Other major cities include Kraków, Łódź, Wrocław, Poznań, Gdańsk, and Szczecin.

Ambulance vehicle equipped for transporting and care for ill and wounded people

An ambulance is a medically equipped vehicle which transports patients to treatment facilities, such as hospitals. In some instances, out-of-hospital medical care is provided to the patient.

Contents

Standards

Operating system

At the moment, the operating system of Polish EMS is similar of the Austrian- Franco-German-Spanish delivery model, and is physician-led and an Integrated EMS of Public Health (IEMS). [2] Physicians (usually anaesthetists) respond to most emergency calls, and a great deal of definitive care and even simple physician consultation and discharge occur at the scene. These physicians are often referred to as Emergency Physicians. [3] Emergency medicine has been recognized as a medical specialty since 1999. Due to shortage of specialists in emergency medicine, selected other medical specialists (anesthesiology and intensive care, internal diseases, general surgery, pediatrics, pediatric surgery, orthopaedics and traumatology) are allowed to work in the system until 2020. Unlike the German system, the physicians do not respond in separate vehicles, instead staffing the appropriate types of ambulances directly. Transportation to a hospital may, or may not, be an outcome depending on the decision of the MICU Physician. The variation occurs in that the physician may be supported by either paramedics or nurses, or some mix of the two roles. Each ambulance also has a dedicated Ambulance Technician who drives, with minimal medical training. As the system evolves, however, it will be changing. Paramedic-led ambulances will respond to most emergency calls, as in the Anglo-American model, [4] with physicians being "sent" only to those calls where there is a potential critical threat to life.

Emergency medical services type of emergency service dedicated to providing out-of-hospital acute medical care and transport to definitive care

Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services which treat illnesses and injuries that require an urgent medical response, providing out-of-hospital treatment and transport to definitive care. They may also be known as a first aid squad, FAST squad, emergency squad, rescue squad, ambulance squad, ambulance corps, life squad or by other initialisms such as EMAS or EMARS.

Emergency medicine medical specialty concerned with care for patients who require immediate medical attention

Emergency medicine, also known as accident and emergency medicine, is the medical specialty concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians care for unscheduled and undifferentiated patients of all ages. As first-line providers, their primary responsibility is to initiate resuscitation and stabilization and to start investigations and interventions to diagnose and treat illnesses in the acute phase. Emergency physicians generally practice in hospital emergency departments, pre-hospital settings via emergency medical services, and intensive care units, but may also work in primary care settings such as urgent care clinics. Sub-specializations of emergency medicine include disaster medicine, medical toxicology, ultrasonography, critical care medicine, hyperbaric medicine, sports medicine, palliative care, or aerospace medicine.

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 health insurance companies.

Vehicles and equipment

Poland has voluntarily adopted the majority of the specifications for ambulances of European Standard CEN 1789. [5] Ambulances and equipment used do comply with the technical standards outlined. While design and technical standards are voluntarily complied with, there is virtually no compliance with the visual identity standards described in the Standard. There are also no immediate plans to do so. While plans are in place for the restructuring of some aspects of the EMS system, these are mostly related to staffing configurations and deployment, which are not covered by the technical Standard. It appears unlikely that the proposed changes will have any effect on Standard compliance.

CEN 1789

CEN 1789:2007 is the European Union standard for ambulances and medical transportation vehicles. This European standard specifies requirements for the design, testing, performance and equipping of road ambulances used for the transport and care of patients. This standard is applicable to road ambulances capable of transporting at least one person on a stretcher.

Training

Since 2006, the evolving legal standard of training for Polish paramedics is a three-year bachelor's degree. As an option, those with substantial prior experience may proceed to a degree, following two years of additional study. This program is available in a number of Polish universities, and will completely replace the prior training standard, which consisted of an assortment of short courses. Short courses of various types continue to be offered, but these are now essentially the typical short courses found elsewhere in EMS, including Advanced Cardiac Life Support and Pediatric Advanced Life Support, among others. [6]

System configuration

Ratownictwo Medyczne service delivery units

State Fire Service

State Fire Service is a fire fighting service of Poland. It is subordinate to the Ministry of Interior. History of fire fighting services in Poland dates to the medieval times. The modern State Fire Service is based on the 1992 legislation.

First aid Emergency first response medical treatment

First aid is the first and immediate assistance given to any person suffering from a serious illness or injury, with care provided to preserve life, prevent the condition from worsening, or to promote recovery. It includes initial intervention in a serious condition prior to professional medical help being available, such as performing cardiopulmonary resuscitation (CPR) while awaiting for an ambulance, as well as the complete treatment of minor conditions, such as applying a plaster to a cut. First aid is generally performed by someone with basic medical training. Mental health first aid is an extension of the concept of first aid to cover mental health.

ABC (medicine) initialism mnemonics

ABC and its variations are initialism mnemonics for essential steps used by both medical professionals and lay persons when dealing with a patient. In its original form it stands for Airway, Breathing, and Circulation. The protocol was originally developed as a memory aid for rescuers performing cardiopulmonary resuscitation, and the most widely known use of the initialism is in the care of the unconscious or unresponsive patient, although it is also used as a reminder of the priorities for assessment and treatment of patients in many acute medical and trauma situations, from first-aid to hospital medical treatment. Airway, breathing, and circulation are all vital for life, and each is required, in that order, for the next to be effective. Since its development, the mnemonic has been extended and modified to fit the different areas in which it is used, with different versions changing the meaning of letters or adding other letters.

Vehicles

Land ambulance

The vehicles of the Polish EMS system come in a wide variety of shapes and sizes. As a member of the European Union, Poland has decided to ratify most aspects of the requirements of European standard CEN 1789 for ambulances, as reflected in the Polish EN 1789 (Classes A-C) Standard. [9] The visual identity requirements of the European standard for ambulances are not yet being followed. The three major types of vehicle are:

European Union Economic and political union of European states

The European Union (EU) is a political and economic union of 28 member states that are located primarily in Europe. It has an area of 4,475,757 km2 (1,728,099 sq mi) and an estimated population of about 513 million. The EU has developed an internal single market through a standardised system of laws that apply in all member states in those matters, and only those matters, where members have agreed to act as one. EU policies aim to ensure the free movement of people, goods, services and capital within the internal market, enact legislation in justice and home affairs and maintain common policies on trade, agriculture, fisheries and regional development. For travel within the Schengen Area, passport controls have been abolished. A monetary union was established in 1999 and came into full force in 2002 and is composed of 19 EU member states which use the euro currency.

  • The patient transport ambulance (T), which is smaller, conforms to European Class A, and contains fewer staff and less equipment.
  • The ambulans specjalistyczny(S) (English: specialised ambulance), is a larger van used for serious emergencies. This unit type is the first choice for response to emergencies that appear to be immediately life-threatening. The crew of this type is minimum two paramedics (or emergency nurses) and a physician. While some CEN 1789 Class B vehicles are still present in the system, the objective is to ultimately ensure that this type of ambulance is always a Class C.
  • The ambulans podstawowy(P) (English: basic ambulance), is a van-type ambulance used for less severe emergencies. The crew of a basic ambulance is minimum two paramedics (or emergency nurses). It is currently the most common type. These vehicles conform to the CEN 1789 Class B standard, although often Class C ambulances are seen in this role.

In addition, the system also operates specialty ambulances which are equipped for and dedicated to neonatal transport (Type N), which are not used for any other purpose.

Air ambulance

Polish Lotnicze Pogotowie Ratunkowe (LPR) operates helicopter air ambulances strategically located in cities throughout Poland. [10] In addition, fixed wing aircraft (Piaggio P180 Avanti) stationed in Warsaw are used for longer range transport. Beginning in the summer of 2011, LPR exclusively operated EC-135. [11]

LPR operated a single AgustaWestland AW109 from 2005 to 2009 when the aircraft was lost (without loss of life) in a training accident and subsequently written off.

Mountain rescue uses the Polish-built PZL W-3 Sokół.

Equipment

Polish paramedics at work Wypadek zabezpieczenie glowy poszkodowanej.JPG
Polish paramedics at work

The basic required equipment of the Type S and Type P ambulances (former Type R and Type W ambulances) is as follows. This equipment is obligatory and represents minimal requirements:

Communications

All ambulances in Poland are dispatched from centralized regional dispatch centers (Polish: Centrum Powiadamiania Ratunkowego)(CPR). The traditional standardized emergency telephone number for ambulances in Poland in the POTS telephone system is 999. The standard European emergency number, 112, also works in Poland, including mobile systems, and is gradually replacing 999. Calls are then triaged by interview process, and the closest and most correct type of ambulance resource is sent to the call.

E112 is a location-enhanced version of 112. The telecom operator transmits the location information to the emergency centre. The EU Directive E112 (2003) requires mobile phone networks to provide emergency services with whatever information they have about the location a mobile call was made. [12] This directive is based on the American Federal Communications Commission's Enhanced 911 ruling in 2001. [13]

System changes

Polish paramedics in uniform Ratownicy medyczni w Staszowie.JPG
Polish paramedics in uniform

Previous systems

In Poland, there were two types of emergency ambulances, type R (now S), and type W (P), [14] which are staffed as follows:

Current system

The government of Poland has mandated significant changes within the EMS system. These will include more paramedic-led ambulances and less physician-led ambulances. In the proposed system Polish paramedics will perform ALS skills without a physician present. These changes are proposed to occur in 2010, with the acquisition of some 600 new ambulances by the Polish government; the result of industrial action by Polish paramedics. [15] Patient transport ambulances (Type T) and neonatal transport ambulances (Type N) will remain in their current configurations. The new types of ambulances and staffing patterns will be as follows:

Primary health care and non-emergency medical transport

In Poland, ambulances are also used for non-emergency transport, such as:

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Paramedic healthcare professional who works in emergency medical situations

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References

  1. "Falck Website". Archived from the original on 2008-08-03. Retrieved 2009-01-05.
  2. 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.
  3. "Polish Society for Emergency Medicine website (in Polish)" . Retrieved 2009-01-02.
  4. 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.
  5. Committee on European Standards (2007). "Medical Vehicles and their Equipment 2". Cen En 1789.[ dead link ]
  6. "Polish EMS Education website" . Retrieved 2009-01-02.
  7. "LPR website (translated from Polish)" . Retrieved 2009-01-05.
  8. "Polish National Fire Service website (translated from Polish)" . Retrieved 2009-01-05.
  9. Ferreira, Hignett, JS (2005). "Reviewing Ambulance Design for Clinical Efficiency and Paramedic Safety" (PDF). Applied Ergonomics. 36: 97–105. doi:10.1016/j.apergo.2004.07.003. PMID   15627427. Archived from the original (PDF) on 2006-09-02.CS1 maint: Multiple names: authors list (link)
  10. "LPR homepage (in Polish)". Archived from the original on 2011-10-06. Retrieved 2009-01-03.
  11. "Poland's Ministry of Health Orders 23 EC-135s for Nationwide Emergency Medical Service". Archived from the original on August 28, 2008. Retrieved 2009-01-05.
  12. "European Commission Technical Specification TSGS#21(03)0372" (PDF). Retrieved 2009-01-03.
  13. "Enhanced 911 (FCC website)" . Retrieved 2009-01-03.
  14. Guła P, Hładki W, Górski K, Popławska M (2008). "[Simplified schema of action of the ambulance rescue services during mass casualty]". Prz. Lek. (in Polish). 65 (1): 1–3. PMID   18669100.
  15. "Medical rescue workers stage protest for better conditions and pay" . Retrieved 2009-01-05.

Coordinates: 52°14′49″N21°00′31″E / 52.2469°N 21.0086°E / 52.2469; 21.0086