Emergency medical services in Austria
Encyclopedia
Emergency Medical Service (Rettungsdienst or more frequently just Rettung) (EMS) in Austria
is a service of public pre-hospital emergency healthcare, including (but not limited to) ambulance
service, provided by individual Austrian municipalities, cities and counties. It is primarily financed by the Austrian health insurance
companies.
In Austria the individual Austrian states (Bundesländer) are legally responsible for the provision of emergency services, but typically delegate these responsibilities to the individual community level. Municipalities, including both smaller communities (Gemeinden) and cities (Städte) are given responsibility by the State for operating EMS. Austrian law mandates the provision of rescue and fire services, including EMS, staffing and equipping according to levels which correspond to local population. Apart from Vienna, which operates its own EMS organisation (Wiener Berufsrettung, also called Magistratsabteilung 70), all communities and cities delegate the responsibility to provide EMS to the Austrian Red Cross
, or in some cases to other minor organisations as mentioned below. Unlike other countries EMS in Austria is never provided by the fire department, the city of Admont
being the only exception to this rule.
Apart from the Austrian Red Cross
some minor organisations such as the
can have contracts to provide EMS in small municipalities or supplement with the EMS services of the Red Cross. In most areas, however, these smaller organisations just provide non-emergency ambulance services in addition to the Red Cross to be able to respond to all non-emergency calls in a timely manner.
In addition to regular emergency and non-emergency services, there are Mobile Intensive Care Units MICU stationed in most of the major cities. These units correspond to the Critical Care Transport function found in other places. They are brought into action whenever a patient with a serious and complex medical condition, requiring advanced levels of support during transit needs to be transferred between hospitals. This service usually applies to intensive-care unit patients, hence the German name Intensivtransport.
While not formally affiliated with the EMS system, the General Practitioner
(GP) frequently interacts with that system. In Austria, it is still commonplace for physicians to make house calls for those patients who are not able to visit a medical practice. Additionally, most cities and counties run a service called Ärztefunkdienst or Ärztenotdienst (Physician Home Call Service), which provides a GP to make housecalls for all people in the specific area. The physician will not only respond to patients from their own practice, but will also visit and treat patients all over the area. The GP service is usually only used for minor illnesses (i.e. fever, common cold), where a hospital stay is not necessary but the intervention of a Physician may be advisable. The availability of this service provides a better treatment option to those patients who, in other EMS systems, might generate low-acuity ambulance calls or emergency department
visits. Occasionally, the visiting GP will contact the EMS dispatcher and order a Krankentransport, should it be determined following medical assessment, that the patient could be cared for in a safer and better manner in a hospital.
operates ambulances all over Austria there is a huge variety of non-emergency numbers such as 14844 for Styria, 1484 for Carinthia
or 01 52144 for Vienna
.
As already described above, in addition to the emergency and non-emergency services provided by the different organisations there is also a service called Ärztefunkdienst or Ärztenotdienst (Physician Home Call Service), which provides a GP to make housecalls for all people in the specific area and can be reached by dialling 141 everywhere in Austria.
. The visual identity requirements of the European standard are deliberately not being followed, as they contradict to the traditional Austrian ambulance colours white and red (derived from the colours of the Red Cross' logo). Some organisations such as the Grünes Kreuz, however, have started to paint their new ambulances according to the requirements of the new standard. The five major types of vehicle are:
Other vehicles that are also employed include helicopter
s for the performance of air ambulance
services or off-road vehicles to be able to access remote and impenetrable places.
In rural areas the most commonly used vehicles are NKTWs as they can be used for both, Krankentransports and emergencies. In bigger cities, however, a combination of RTWs and NKTWs is used to respond to emergencies. If a RTW or a NKTW is used to respond to an incident depends on two factors: The severity of the reported incident and the proximity of the vehicle. Both vehicles are staffed with similar personnel (at least two Rettungssanitäter, more commonly one Rettungssanitäter who acts as the ambulance driver and one Notfallsanitäter which takes care of the patient during the transport). If a severe incident such as, for example, a myocardial infarction
is reported the dispatcher always sends the closest NKTW or RTW and a NEF to the scene. (See rendezvous system below for more information.)
Depending on the type of the vehicle, there are numerous items which have to be on the ambulance, among them are:
Additionally, several different kinds of drugs are found on an Ambulance, typically a selection of analgesic
s, anaesthetics, cardiac stimulants, substances for circulatory problems and antidotes.
Narcotics are not widely carried on ambulances. Usually only the Notarzt will carry a small amount of Morphine
, Fentanyl or Piritramide and closely guard them.
All emergency calls, regardless of the emergency number on which they originate, are routed to Dispatch Centres; in German Leitstelle. Until the year 2000 it was very common that every district had its own dispatch centre which, in a way, was quite ineffective. At present more and more trans-regional dispatch centres are being built. That means that all 144 calls in Styria, for example, are routed to the same dispatch centre in Graz no matter where in Styria the caller is located. The same trend can be seen in other federal states. A system similar to the U.S.-based 911
Public Safety Answering Point concept is not being used due to the significantly different nature of the calls for EMS, the fire brigade or the police.
Once a call via the local emergency number is placed, a call taker will answer and ask the caller about the nature of the emergency. While the caller is being interviewed about call specifics, the call taker is already working on the computer, which will provide prompt questions, provide advice, and suggest response resources for this emergency. Whilst the call taker is still talking to the caller a dispatcher will already look up the ambulance which is the closest to the scene and dispatch it. This computer system, while operating in German, is more or less similar to the AMPDS algorithm
used by Emergency Medical Dispatcher
s in the United States but varies from one federal state to the other.
To illustrate, a call is received in the dispatch center about a possibly unconscious person. The call taker will immediately identify the call location, and will then ask further questions, in order to assess precipitating symptoms, specific location, and any special circumstances (no house number, a neighbor is calling, etc.). While this interview is occurring, the call taker will enter the command Bewusstlose Person (unconscious person) into the dispatch computer, resulting in an automatic suggestion to dispatch of a RTW (emergency ambulance) or NKTW and a NEF (emergency doctor's car). Upon entering the address of the patient, the computer will look for the emergency vehicles closest to this address. Now the dispatcher can send the whole package over the air and those two vehicles are alarmed, similar to Computer-assisted dispatch
(CAD) in the United States. Whilst the vehicles are being alarmed by the dispatcher, the call taker may remain on the line with the caller, providing telephone advice or assistance until the EMS resources arrive on the scene. Whilst might still be on the line with the caller the dispatcher is able to guard the ambulance to the scene and provide the crew with additional and more precise information about the incident. This, of course, happens without any notice of the caller and will help to get the EMS resources on scene more quickly.
the maximum response time (the maximum time in which an ambulance must be on scene) is not governed in Austria. The Red Cross
, however, follows the self-imposed policy that every place next to a street has to be reached in at least 15 minutes in 95 % of all cases. These requirements are met in most cases but one has to keep in mind, that response times differ very much depending on whether the incident occurred in a rural area or in a city as EMS stations are mostly located in cities. In cities the average response time is between five and ten minutes, in rural areas it is about eight to 15 minutes.
Austria
Austria , officially the Republic of Austria , is a landlocked country of roughly 8.4 million people in Central Europe. It is bordered by the Czech Republic and Germany to the north, Slovakia and Hungary to the east, Slovenia and Italy to the south, and Switzerland and Liechtenstein to the...
is a service of public pre-hospital emergency healthcare, including (but not limited to) ambulance
Ambulance
An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...
service, provided by individual Austrian municipalities, cities and counties. It is primarily financed by the Austrian health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
companies.
Organisation
Austrian Red Cross
The Austrian Red Cross is the national Red Cross-Organization in Austria and is part of the International Red Cross and Red Crescent Movement...
, or in some cases to other minor organisations as mentioned below. Unlike other countries EMS in Austria is never provided by the fire department, the city of Admont
Admont
Admont is a town in Styria, Austria, with a population of 2775 . It is historically most notable for Admont Abbey, a monastery founded in 1074.-External links:* *...
being the only exception to this rule.
Apart from the Austrian Red Cross
Austrian Red Cross
The Austrian Red Cross is the national Red Cross-Organization in Austria and is part of the International Red Cross and Red Crescent Movement...
some minor organisations such as the
- Arbeiter-Samariter-Bund Österreichs (Labor-Samaritan-Alliance),
- the Malteser Hospitaldienst Austria (the Austrian organisation of the Order of Malta Ambulance CorpsOrder of Malta Ambulance CorpsThe Order of Malta Ambulance Corps is the largest voluntary ambulance and first aid organisation of its kind in Ireland. The Order of Malta is engaged in teaching first aid, providing ambulance cover at large events, patient transport, community and nursing services...
), - the Johanniter-Unfall-Hilfe (the Austrian organisation of the St. John AmbulanceSt. John AmbulanceSt John Ambulance, branded as St John in some territories, is a common name used by a number of affiliated organisations in different countries dedicated to the teaching and practice of medical first aid and the provision of ambulance services, all of which derive their origins from the St John...
) or - the Grünes Kreuz (Green Cross)
can have contracts to provide EMS in small municipalities or supplement with the EMS services of the Red Cross. In most areas, however, these smaller organisations just provide non-emergency ambulance services in addition to the Red Cross to be able to respond to all non-emergency calls in a timely manner.
Roles
As in many other places, in Austria, the EMS system performs two major functions:- Emergency Services - Responding to all calls concerning immediate danger to the life and/or health of a person. This is the core component of the service, which is called Notfallrettung or Rettungsdienst in German. This service addresses acute onset illness and injury conditions, such as myocardial infarctionMyocardial infarctionMyocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
, or accidents with severe injuries, to name just two.
- Non-Emergency Services - Arranging and performing the transport of non-emergency patients (i.e. transfer to, from, and between hospitals). This service is called Krankentransport in German, and provides service to non-ambulatory patients with low-acuity or chronic conditions, or to those who are recovering from acute care situations, and who lack the ability to use other means of transport (i.e. by taxi, own car or public transport).
In addition to regular emergency and non-emergency services, there are Mobile Intensive Care Units MICU stationed in most of the major cities. These units correspond to the Critical Care Transport function found in other places. They are brought into action whenever a patient with a serious and complex medical condition, requiring advanced levels of support during transit needs to be transferred between hospitals. This service usually applies to intensive-care unit patients, hence the German name Intensivtransport.
While not formally affiliated with the EMS system, the General Practitioner
General practitioner
A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...
(GP) frequently interacts with that system. In Austria, it is still commonplace for physicians to make house calls for those patients who are not able to visit a medical practice. Additionally, most cities and counties run a service called Ärztefunkdienst or Ärztenotdienst (Physician Home Call Service), which provides a GP to make housecalls for all people in the specific area. The physician will not only respond to patients from their own practice, but will also visit and treat patients all over the area. The GP service is usually only used for minor illnesses (i.e. fever, common cold), where a hospital stay is not necessary but the intervention of a Physician may be advisable. The availability of this service provides a better treatment option to those patients who, in other EMS systems, might generate low-acuity ambulance calls or emergency department
Emergency department
An emergency department , also known as accident & emergency , emergency room , emergency ward , or casualty department is a medical treatment facility specialising in acute care of patients who present without prior appointment, either by their own means or by ambulance...
visits. Occasionally, the visiting GP will contact the EMS dispatcher and order a Krankentransport, should it be determined following medical assessment, that the patient could be cared for in a safer and better manner in a hospital.
Emergency telephone numbers
The nationwide emergency number for emergency medical services in Austria is 144. This number can be called toll-free from any phone (fixed-line, mobile or phone booth). This also applies to all the other emergency and most of the non-emergency numbers mentioned below. Alternatively the European emergency number 112 can also be used but by calling it one will end up at the nearest police station (which is nationwide available by calling 133) which will then pass the information to the EMS provider. In most cases it thus is advisable to call 144 as the call will be taken by a professional emergency medical dispatcher and help will be on its way more quickly. The European emergency number, however, must not be confused with the 122 which in Austria is the fire department. Dispatchers speak German and at least an intermediate level of English with focus on medical terms and issues.Non-emergency telephone numbers
Apart from the emergency number there also is a huge variety of non-emergency numbers which should be used in non-emergency cases such as Krankentransport, for example. These numbers differ from region to region and provider to provider. Even though the Austrian Red CrossAustrian Red Cross
The Austrian Red Cross is the national Red Cross-Organization in Austria and is part of the International Red Cross and Red Crescent Movement...
operates ambulances all over Austria there is a huge variety of non-emergency numbers such as 14844 for Styria, 1484 for Carinthia
Carinthia (state)
Carinthia is the southernmost Austrian state or Land. Situated within the Eastern Alps it is chiefly noted for its mountains and lakes.The main language is German. Its regional dialects belong to the Southern Austro-Bavarian group...
or 01 52144 for Vienna
Vienna
Vienna is the capital and largest city of the Republic of Austria and one of the nine states of Austria. Vienna is Austria's primary city, with a population of about 1.723 million , and is by far the largest city in Austria, as well as its cultural, economic, and political centre...
.
As already described above, in addition to the emergency and non-emergency services provided by the different organisations there is also a service called Ärztefunkdienst or Ärztenotdienst (Physician Home Call Service), which provides a GP to make housecalls for all people in the specific area and can be reached by dialling 141 everywhere in Austria.
Land Ambulance
The Austrian EMS system's vehicles come in a wide variety of shapes and sizes. All of its vehicles must conform to most aspects of the requirements of European standard CEN 1789CEN 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...
. The visual identity requirements of the European standard are deliberately not being followed, as they contradict to the traditional Austrian ambulance colours white and red (derived from the colours of the Red Cross' logo). Some organisations such as the Grünes Kreuz, however, have started to paint their new ambulances according to the requirements of the new standard. The five major types of vehicle are:
- The Krankentransportwagen (KTW), a van-type ambulance used for non-emergency transport.
- The Notfallkrankentransportwagen (NKTW), a multi-purpose vehicle serves a dual role as patient transport vehicle and as backup for emergency responses.
- The Rettungswagen (RTW), a larger van used for emergencies.
- The Notarztwagen (NAW), basically the same as a RTW but staffed with an emergency doctor in addition to the other personnel.
- The Notarzteinsatzfahrzeug (NEF), a station wagon or small van. Its purpose is to bring the Notarzt (emergency doctor) to the scene of the emergency, when required.
Other vehicles that are also employed include helicopter
Helicopter
A helicopter is a type of rotorcraft in which lift and thrust are supplied by one or more engine-driven rotors. This allows the helicopter to take off and land vertically, to hover, and to fly forwards, backwards, and laterally...
s for the performance of air ambulance
Air ambulance
An air ambulance is an aircraft used for emergency medical assistance in situations where either a traditional ambulance cannot reach the scene easily or quickly enough, or the patient needs to be transported over a distance or terrain that makes air transportation the most practical transport....
services or off-road vehicles to be able to access remote and impenetrable places.
In rural areas the most commonly used vehicles are NKTWs as they can be used for both, Krankentransports and emergencies. In bigger cities, however, a combination of RTWs and NKTWs is used to respond to emergencies. If a RTW or a NKTW is used to respond to an incident depends on two factors: The severity of the reported incident and the proximity of the vehicle. Both vehicles are staffed with similar personnel (at least two Rettungssanitäter, more commonly one Rettungssanitäter who acts as the ambulance driver and one Notfallsanitäter which takes care of the patient during the transport). If a severe incident such as, for example, a myocardial infarction
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
is reported the dispatcher always sends the closest NKTW or RTW and a NEF to the scene. (See rendezvous system below for more information.)
Equipment
The basic equipment of the above mentioned vehicles are obligatory and are minimal requirements:- Basic First AidFirst aidFirst aid is the provision of initial care for an illness or injury. It is usually performed by non-expert, but trained personnel to a sick or injured person until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care...
kit. - Dressings and Bandages
- GurneyGurneyA gurney, known as a trolley in British medical context, is the U.S. term for a type of stretcher used in modern hospitals and ambulances in developed areas. A hospital gurney is a kind of narrow bed on a wheeled frame which may be adjustable in height. For ambulances, a collapsible gurney is a...
and blankets - Flexible stretcher, also called a Reeves stretcher.
- Rigid or collapsible transport chair, also called a stair chair in the United States
- Mobile medical ventilatorMedical ventilatorA medical ventilator can be defined as any machine designed to mechanically move breatheable air into and out of the lungs, to provide the mechanism of breathing for a patient who is physically unable to breathe, or breathing insufficiently....
- Basic diagnostic equipment, like blood-pressure cuffs.
- Portable defibrillator
Depending on the type of the vehicle, there are numerous items which have to be on the ambulance, among them are:
- An ECG monitorElectrocardiogramElectrocardiography is a transthoracic interpretation of the electrical activity of the heart over a period of time, as detected by electrodes attached to the outer surface of the skin and recorded by a device external to the body...
- Rescue equipment
- Immobilization equipment like Cervical collarCervical collarA cervical collar is an orthopedic medical device used to support a patient's neck and head. It is also used by emergency personnel for victims of traumatic head or neck injuries, and can be used to treat chronic medical conditions....
s or spine boardsLong spine boardA spinal board, also known as a long spine board , longboard, spineboard, or backboard, is a patient handling device used primarily in pre-hospital trauma care designed to provide rigid support during movement of a patient with suspected spinal or limb injuries... - Equipment for intravenous therapyIntravenous therapyIntravenous therapy or IV therapy is the infusion of liquid substances directly into a vein. The word intravenous simply means "within a vein". Therapies administered intravenously are often called specialty pharmaceuticals...
Additionally, several different kinds of drugs are found on an Ambulance, typically a selection of analgesic
Analgesic
An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....
s, anaesthetics, cardiac stimulants, substances for circulatory problems and antidotes.
Narcotics are not widely carried on ambulances. Usually only the Notarzt will carry a small amount of Morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...
, Fentanyl or Piritramide and closely guard them.
Dispatch
911
Year 911 was a common year starting on Tuesday of the Julian calendar.-Africa:* Rebellion of the Kutama Berbers against the Fatimid Caliphate...
Public Safety Answering Point concept is not being used due to the significantly different nature of the calls for EMS, the fire brigade or the police.
Once a call via the local emergency number is placed, a call taker will answer and ask the caller about the nature of the emergency. While the caller is being interviewed about call specifics, the call taker is already working on the computer, which will provide prompt questions, provide advice, and suggest response resources for this emergency. Whilst the call taker is still talking to the caller a dispatcher will already look up the ambulance which is the closest to the scene and dispatch it. This computer system, while operating in German, is more or less similar to the AMPDS algorithm
Algorithm
In mathematics and computer science, an algorithm is an effective method expressed as a finite list of well-defined instructions for calculating a function. Algorithms are used for calculation, data processing, and automated reasoning...
used by Emergency Medical Dispatcher
Emergency medical dispatcher
An Emergency medical dispatcher is a professional telecommunicator, tasked with the gathering of information related to medical emergencies, the provision of assistance and instructions by voice, prior to the arrival of Emergency Medical Services, and the dispatching and support of EMS resources...
s in the United States but varies from one federal state to the other.
To illustrate, a call is received in the dispatch center about a possibly unconscious person. The call taker will immediately identify the call location, and will then ask further questions, in order to assess precipitating symptoms, specific location, and any special circumstances (no house number, a neighbor is calling, etc.). While this interview is occurring, the call taker will enter the command Bewusstlose Person (unconscious person) into the dispatch computer, resulting in an automatic suggestion to dispatch of a RTW (emergency ambulance) or NKTW and a NEF (emergency doctor's car). Upon entering the address of the patient, the computer will look for the emergency vehicles closest to this address. Now the dispatcher can send the whole package over the air and those two vehicles are alarmed, similar to Computer-assisted dispatch
Computer-assisted dispatch
Computer-assisted dispatch, also called Computer Aided Dispatch , is a method of dispatching taxicabs, couriers, field service technicians, or emergency services assisted by computer. It can either be used to send messages to the dispatchee via a mobile data terminal and/or used to store and...
(CAD) in the United States. Whilst the vehicles are being alarmed by the dispatcher, the call taker may remain on the line with the caller, providing telephone advice or assistance until the EMS resources arrive on the scene. Whilst might still be on the line with the caller the dispatcher is able to guard the ambulance to the scene and provide the crew with additional and more precise information about the incident. This, of course, happens without any notice of the caller and will help to get the EMS resources on scene more quickly.
Average response times
Apart from BurgenlandBurgenland
Burgenland is the easternmost and least populous state or Land of Austria. It consists of two Statutarstädte and seven districts with in total 171 municipalities. It is 166 km long from north to south but much narrower from west to east...
the maximum response time (the maximum time in which an ambulance must be on scene) is not governed in Austria. The Red Cross
Austrian Red Cross
The Austrian Red Cross is the national Red Cross-Organization in Austria and is part of the International Red Cross and Red Crescent Movement...
, however, follows the self-imposed policy that every place next to a street has to be reached in at least 15 minutes in 95 % of all cases. These requirements are met in most cases but one has to keep in mind, that response times differ very much depending on whether the incident occurred in a rural area or in a city as EMS stations are mostly located in cities. In cities the average response time is between five and ten minutes, in rural areas it is about eight to 15 minutes.