Transcript Prehospital care in Denmark and the Nordic Countries

Emergency Medicine
in Denmark
Erika Frischknecht Christensen
Ass. Professor
Dept. Anesthesiology & Intensive Medicine
Aarhus University Hospital
Medical Director Prehospital Care
County of Aarhus
Denmark
Erika Frischknecht Christensen
Denmark
• Population: 5.4 Mio.
• Area:
43.000 km2
• Density: 125 /km2
• Home of the Vikings
AND:
• Greenland
• Population: 57.000
• Area: 410.000 mio
km2 - 0.1 per km2
Erika Frischknecht Christensen
Denmark
Geography
• 407 islands
• 7300 km coast line
• Copenhagen 1.1
mill. inhab.
Population and
life length
• Men:74.5 years
• Women: 79.2 years
• 0-9 years: 12%
• 70+ years: 11%
Erika Frischknecht Christensen
Burden of diseases
Major causes of morbidity and mortality:
• Cancer: 25% of deaths
• Heart diseases: 25% of deaths
• Cerebrovascular diseases: 12%
• Chronic obstructive pulmonary diseases:
10%
• Leading cause age 1-45 years: Trauma
Erika Frischknecht Christensen
Medical education
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Health science at 3 universities
Study: six years
Postgraduate clinical training:
1 ½ years basic
4 ½- 6 years in specialty
Process evaluation
Certificate by regional and national
authority
Erika Frischknecht Christensen
Health Care system - Denmark
• Public regional health care system:
• 14 counties and Capital
• 64 somatic hospitals and 20.800
beds in somatic hospitals (2000)
• 1 mio admissions/year
• Expected to be more centralized
Erika Frischknecht Christensen
Health Care system - Denmark
• Public health insurance
• Good primary health care system:
• 4.5 mio contacts to general
practioners
• General practioners: gate keepers
Erika Frischknecht Christensen
Emergency Medicine in
14 Danish Counties
• Population 4.2 Mio (out of 5.3)
• GP visits in daytime: 29 Mio
• GP on call: 2.7 Mio
• A&E visits: 1.1 Mio
• 112-call ambulances: 250.000
• All increased by 5-10% since 1996
Erika Frischknecht Christensen
Accident & Emergency Dept.
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EM not a specialty
Many, and several small hospitals
Run by Orthopedics
90% injuries, 10% medical emergencies
Life-threatening cases and critical care:
anesthesiologists in and ouside hospital
• 4 Level-1 Trauma Centers at University
Hospitals
Erika Frischknecht Christensen
Emergency care in hospital
A&E:
Accidents - Injuries
Self-referrals
Ambulances
Other Emergencies
From the GPs
Ambulances
Self-referrals
Orthopedic, GP
Surgeon
Anesthesiologist
Radiologist
Internist, Cardiologist
Anesthesiologist
Surgeon,Gynaecologist
Pediatrics etc
Erika Frischknecht Christensen
Pre-hospital emergency care
• Defined by law:
• Ambulance personell:
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Level 1: basic life support
Level 2: BLS+ symptomatic relief:
NTG, broncodilator, diazepam etc
Level 3: BLS+medication for ALS
• One level 2 EMT on each ambulance
• Medical director in each county
Erika Frischknecht Christensen
Pre-hospital emergency are
• 112 calls: police
• Alarm central Denmark: 7 regions
• Dispatch center: ambulance services
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Major ambulance services:
Copenhagen Firebrigade
Group 4 Falck
Contracts with each County
Erika Frischknecht Christensen
Physicians = Anesthesiologists
in Prehospital Care
Experienced and
trained in
• Airway
• Breathing
• Circulation
• Pain treatment
Erika Frischknecht Christensen
Endotracheal intubation
in the field
1998-2000 Aarhus
• 14.000 calls
• 75% medical
emergencies
• 370 patients,
intubated on scene
• Majority after
anaesthesia
Erika Frischknecht Christensen
Physicians in prehospital Care
• Physicians in cars as rendez-vous,
dispatched to 10 % - 35% calls
– Covering 25-30% of population
• Expanding
Erika Frischknecht Christensen
EM in Denmark
• Challenges
• and
• Strategies
• will be presented at the meeting.
Erika Frischknecht Christensen