Preparing for Preparedness: Development of Emergency and Disaster Medicine System in Latvia

1. Preparing for PreparednessDevelopment 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

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

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

4. Centre of Emergency and Disaster Medicine Studyobjectives: Analysewhat does PREPARADNESSmean for health care stakeholders and how toprovide itin the best possible way and in the context with • health care reforms • civil military crises management • international cooperation

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

6. Centre of Emergency and Disaster Medicine SDR (per 100 000), 2003. Source: European HFA Datebase, June 2005.

7. 100 80 60 Survival ( % ) 40 20 0 5 10 15 20 25 30 Time till defibrillation ( % ) Centre of Emergency and Disaster Medicine Possibilities to prevent the Sudden Death Every minute lost reduces survival rate !!!

8. Centre of Emergency and Disaster Medicine Pre-hospital Emergency Medical Services today • Dispatching Centreswith different capacityand 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

9. Centre of Emergency and Disaster Medicine EMS calls and calls completion (day average)

10. Centre of Emergency and Disaster Medicine Conclusions • There are no facility for effective management of • EDMS common resources in circumstances while • p-h EMS’s providers management is • decentralized; • There are unequal possibilities to receive p-h EMS • in day-to-day and in case if Disaster occurs; • New infrastructure and organization for medical • institutions involved to prevent emergency • consequences is certainly necessary.

11. Centre of Emergency and Disaster Medicine Several principles and approaches considered for creating a new scheme of EMC to cover the patients` needs for equal availability of services (on time and qualitative) • Subsidiarity • Coordination • Succession • Consolidation of resources • Intersectoral scope Essential attention must be paid to all transitions of Health Care System and HealthProfessionals` attitude towards Reforms

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

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

14. Centre of Emergency and Disaster Medicine Now and after

15. Benefits expected after implementationnew pre-hospital EMS DispatchSystem I Centre of Emergency and Disaster Medicine • Save more people lives • Increase EMS accessibility to meet international standards(response time, unitary call number, quality) • Increase EMS management role as a support for internationalcooperation, for Civil Military Crisis Management assistance, especially in case of CBRN threats increase capacities for NATO Crisis ResponseSystem • Model can be used as EU co-operation system • Support EDMS planning

16. Benefits expected after implementationnew pre-hospital EMS DispatchSystem 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,institutionsetc. • co-ordination of Specialized Emergency care, Consultancyservice, Reserves, Hospital services, Medicaltransportation service and other Health resources • capacity for PHC call management (PHC central) and possibility for call separation

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

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

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

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