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EM in Slovenia Andrej Zmavc

EM in Slovenia Andrej Zmavc. C3_09 ID 210. Slovenia - Country information 1. Slovenia is a small middle European country, situated at the top corner of the Adriatic sea; the longest diameter is 400 km

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EM in Slovenia Andrej Zmavc

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  1. EM in Slovenia Andrej Zmavc • C3_09 ID 210

  2. Slovenia - Country information 1 • Slovenia is a small middle European country, situated at the top corner of the Adriatic sea; the longest diameter is 400 km • It borders to Italy on the west, to Austria on the north, to Hungary on the east and to Croatia on the south. • It used to be the most developed part of the former Yugoslavia; independence attained in 1991.

  3. Slovenia - Country information 2 • Heterogeneous climate/geographic regions within a short distance • Alpine, Panonian, Continental, Karst, Mediterranean environment

  4. Slovenia - Population 1 • 2 million • Disperse settlement, only two cities bigger than 100.000 • >90% Slovene nationality • Ageing population, current life expectancy F 75, M 67; active-retired ratio estimation for year 2015 = 1:1 • Typical European socio-economic structure; GDP $7000 • Obligatory health insurance (almost 100% of pop.) • Health care budget = 8%GDP + 1% other resources

  5. Slovenia - Population 2 • Major morbidity & mortality problems: Cardiovascular, Cancer, Trauma • High rate of alcoholism, traffic accidents, suicide

  6. Slovenia - Health care system 1 • Dense net of Community health care centers CHCC (basic institutions of primary health care system), well developed primary HCS • 10 general hospitals, 2 university hospitals • Since 1991 no major changes in structure of HCS (in type and number of institutions) • Changes in funding system - Establishment of the National health insurance company in 1992 • Establishingthe private practice

  7. Slovenia - Health care system 2 • A uniform nationwide health care system conducted by the Ministry of health, medical supervision by the Medical chamber, funded by the National health insurance co. • All hospitals are public, private practices in primary HCS (30% general/family physicians, 70% dentists)

  8. Slovenia - Health care system - primary health care • Community health care center (CHCC) - the basic primary HC institution • CHCC encompasses: general/family medicine, pediatric and school medicine, occupational medicine, stomathology, physiotherapy, home nursing care, patient transportation (ambulances), etc. • Bigger CHCC have as well some specialistic services (gynaecology, psychiatry, pulmology, dermatology, etc.) and prehospital EMS units

  9. Slovenia - Health care system - education • Physicians: 6y medical faculty, 2y obligatory postgraduate clinical training (6m emergency medicine), 2-4y specialisation • All physicians must have a licence to work with patients (renewal each 7y - Medical chamber) • Medical technicians - nurses: 4y medical school, 6m practice, optionally 3y nursing faculty

  10. Slovenia - Health care system - EM speciality status • No specialty in EM • Prehospitaly - physicians specialists in GM/FM with additional training in EM • Hospitaly - each speciality care for own patients • The process of introducing a license for EM and the first steps of putting up an EM speciality has started • Activities in organisation of emergency departments in bigger hospitals

  11. Slovenia - Health care system - professional orgs concerned for EM • Pre-hospital: The project of EMS (Ministry of health), CHCC, Society for EM • In-hospital: The project of EMS (Ministry of health), hospitals, Society for EM

  12. Slovenia - EM System information - the basics • EM care should be available to every person in need regardless of his/hers insurance status • Each physician must (by the law) offer first medical aid • Each CHCC and hospital must provide EM care as a part of its regular activity • All EMS system is public

  13. Slovenia - EM - Prehospital system 1 • All prehospital EMS system is based on primary health care facilities • Prehospital EMS units (62 of them) are situated and organized within CHCC • Generally there are two types of prehospital EMS units • City PEMS units • Peripheral EMS units

  14. Slovenia - EM - Prehospital system 2 • City PEMS units • Most of the units located nearby hospital • EM team: trained physician, 2 trained technicians • 24-hour service for emergencies only • EM technician-dispatcher (optionally) • Peripheral EMS units • No special EM team • GP/FP on duty, med. technician, rescuer-driver • EMS is part of the regular activity of GP/FP

  15. Slovenia - EM - Prehospital system / Funding • The whole prehospital EMS system is on a fixed yearly budged • cost-effectiveness • estimation for the system once fully developed = 15 mill EUR/year • currently the cost is 10 mill. EUR/year • 350 EUR/intervention; 5 EUR/inhabitant/year

  16. Slovenia - EM - Prehospital system / Performance • All units / year 2002 • population ................... 2.000.000 • patients ....................... 26.800 • interv./1000 pop. ......... 13,4 • mean response time ... 10,9 min • CPR ............................ 766 (2,9%) • ROSC ..................... 233 (30,4%) • survivors ................. 93 (12,1%) • ET intubations ............. 822 (3,1%) • ETI/CPR ratio .............. 1,1 • dead at arrival ............. 1125 (4,2%)

  17. Slovenia - EM - Prehospital system / Performance • Peripheral units only / year 2002 • population ................... 688.000 • patients ....................... 9.630 • interv./1000 pop. ......... 14,0 • mean response time ... 13,7 min • CPR ............................ 227 (2,4%) • ROSC ..................... 46 (20%) • survivors ................. 11 (4,8%) • ET intubations ............. 182 (1,9%) • ETI/CPR ratio .............. 0,8 • dead at arrival ............. 391 (4,1%)

  18. Slovenia - EM - Prehospital system / Performance • Three most developed city units / year 2002 • population ................... 595.000 • patients ....................... 5.525 • interv./1000 pop. ......... 9,3 • mean response time ... 9,0 min • CPR ............................ 282 (5,1%) • ROSC ..................... 118 (41,8%) • survivors ................. 52 (18,4%) • ET intubations ............. 397 (7,2%) • ETI/CPR ratio .............. 1,4 • dead at arrival ............. 346 (6,2%)

  19. Slovenia - EM - Hospital care • 10 general hospitals; 2 university hospitals • No emergency departments • Patients usually transferred to local hospitals • each speciality treats its own patients • no special funding for EM care in hospitals until now • recently established “one day hospital” - the beginning of ED?

  20. Slovenia - EM - The top challenges 1 • Education/qualification of prehospital providers • huge difference in qualification • no standardised education for EM • solution: a licence for prehospital EMS • specialisation in EM • Insufficient EMS in rural areas • the shortage of physicians in rural areas • small number of emergency interventions • centralisation of service wherever feasible

  21. Slovenia - EM - The top challenges 2 • Establishment of ED in bigger hospitals • closer co-operation with city PEMS units • specialisation in EM • unification/improving effectiveness of admission and initial EM care in smaller hospitals

  22. Slovenia EM - Summary 1 • Small country, relatively old population, very limited budged for health care system • Well developed public health care system • Well developed primary HCS • Dense net of Community Health Care Centres (CHCC) • Mostly sufficient hospital capacity

  23. Slovenia EM - Summary 2 • Organization of prehospital EMS within primary health care system • cost-effectiveness • City prehospital EMS units - variable performance mostly effective • Peripheral (rural) unitsmostly insufficient • Hospital EM care more or less sufficient - could be better • Improvement proposed troughthe establishment of ED in bigger hospitals

  24. Slovenia EM - Summary 3 • Need for improvement in education/skills of prehospital providers • Standardization - Licences; Specialization in EM • More tight connection between hospitals and city PEMS units • Additional funding resources besides the budged for prehospital EMS

  25. EM in Slovenia - Conclusion • Improving EM by: • the Project of EMS in Slovenia - Ministry of health • active co-operation of all relevant institutions: Society for EM, Medical chamber, Ministry of health, National health insurance co. • organising of ED within the existed hospital structure (minimal investment) • a little help of enthusiastic individuals devoted to EM

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