Emergency medicine Emergency medicine in Romaniain Romania

system & personnelsystem & personnel1990 1990 -- 20092009

RaedRaed Arafat MD. Arafat MD.

Understate SecretaryUnderstate Secretary

Ministry of Health Ministry of Health

RomaniaRomania

ACCES First Response

EarlyDefibrillation

ALS Hospital

Communications

Romanian system in Romanian system in 20092009

Romanian system 2009Romanian system 2009

Integrated dispatch Integrated dispatch center center

Integrated dispatch Integrated dispatch centercenter

Integrated dispatch Integrated dispatch centercenter

First responders First responders

First respondersFirst responders

Advanced Life Advanced Life supportsupport

Advanced life Advanced life supportsupport

PrehospitalPrehospital

emergency dept.emergency dept.

Integrated Integrated eded

Emergency dept.Emergency dept.

telemedicinetelemedicine

•• PrePre--hospital to ED or dispatch hospital to ED or dispatch (700 type B ambulances)(700 type B ambulances)•• EKG real time monitoringEKG real time monitoring•• 12 lead EKG12 lead EKG•• PulsePulse--oxymetryoxymetry•• Blood pressureBlood pressure

•• Hospital to hospital Hospital to hospital (40 small emergency rooms to main regional emergency (40 small emergency rooms to main regional emergency department)department)•• Video and audioVideo and audio•• EKG real time monitoringEKG real time monitoring•• 12 lead EKG12 lead EKG•• PulsePulse--oxymetryoxymetry•• Blood pressureBlood pressure•• Ultrasound (in the future)Ultrasound (in the future)

BSC

SD

D

C

L

0

BTS

E EA AR

SDH WLP CK D

SGSN

GGSN

Telemedicine solutionusing VPN-GPRS data transmission

DHCP Server

Security Server

Server DNS

Gateway

Internal LAN

VPN

GPRS / GSM

112 Integrated Dispatch CenterFieldFirst response unit

FieldFirst response unit

Telemedicine Telemedicine

The emergency system The emergency system actors in actors in romaniaromania

•• GPs GPs

•• NursesNurses

•• Ambulance driversAmbulance drivers

•• MidwivesMidwives

•• Dispatchers Dispatchers •• MedicalMedical•• Integrated call taking Integrated call taking

and dispatchingand dispatching

•• Fire fightersFire fighters•• Paramedics Paramedics –– EMTsEMTs•• Basic life support Basic life support

•• NursesNurses•• No special training for No special training for

the momentthe moment•• Will be trained for 3 Will be trained for 3

months in EMmonths in EM

•• GPs GPs –– 6 month training6 month training

•• Emergency medicine Emergency medicine specialists specialists –– 5 yrs 5 yrs trainingtraining•• Emergency medicine Emergency medicine

Romanian system in Romanian system in 20092009

•• Legislation in Emergency medicineLegislation in Emergency medicine•• Main health reform law in 2006 includes Main health reform law in 2006 includes a chapter on emergency medical care a chapter on emergency medical care

•• Secondary legislation between 2006 and Secondary legislation between 2006 and 20082008•• Establishing competencies for different Establishing competencies for different levels of prelevels of pre--hospital emergency care hospital emergency care teamsteams

•• Standardization of different levels of Standardization of different levels of ambulancesambulances

•• Standardization of emergency departments Standardization of emergency departments and establishing functioning rules, and establishing functioning rules, equipping equipping ……etc.etc.

•• Classification of hospitals in accordance Classification of hospitals in accordance of their level of emergency care capacity of their level of emergency care capacity into 4 levels.into 4 levels.

•• Establishing transfer protocols forEstablishing transfer protocols for

Disaster Disaster preparedness preparedness

Disaster Disaster preparednesspreparedness

Disaster Disaster preparednesspreparedness

disaster disaster PREPAREDNESSPREPAREDNESS

Disaster Disaster preparednesspreparedness

Training Training -- evaluationevaluation

•• Training centers for first responders Training centers for first responders / paramedics under the coordination of / paramedics under the coordination of the fire servicethe fire service

•• Simulation centers for doctors and Simulation centers for doctors and nurses at emergency departmentsnurses at emergency departments•• Full simulation using Full simulation using simsim--man and babyman and baby--simsim

•• Virtual computer simulationVirtual computer simulation

•• Ultrasound simulation (6 centers / WB Ultrasound simulation (6 centers / WB project)project)

•• Special training for GPs and nurses Special training for GPs and nurses working actually on ambulances (6 working actually on ambulances (6

Simulation centerSimulation center

Training Training -- evaluationevaluation

Training Training -- evaluationevaluation

Training Training -- evaluationevaluation

Training Training -- evaluationevaluation

Training Training -- evaluationevaluation

ConclusionsConclusions

•• Emergency medicine is Emergency medicine is evolving allover the evolving allover the world, being at different world, being at different stages in different stages in different countriescountries

•• There is no perfect There is no perfect solution or perfect solution or perfect systemsystem

•• It has to be developed It has to be developed based on international based on international experience taking into experience taking into account local aspectsaccount local aspects

•• There are no unique There are no unique countries or cities or countries or cities or regions.. There are just regions.. There are just local solutions based on local solutions based on global concepts !!!global concepts !!!

•• Training / monitoring/ Training / monitoring/ evaluation are basic evaluation are basic requirements for any requirements for any

temergency system