Emergency medical services in Italy
Encyclopedia
Emergency medical services
in Italy
currently consist primarily of a combination of volunteer organizations providing ambulance service, supplemented by physicians and nurses who perform all advanced life support
(ALS) procedures. The emergency telephone number
for emergency medical service in Italy is 118.
Emergency medical services
are under Public Health Authorities control in each Italian Region
; the ambulance subsystem is provided by a variety of different sources..
The method of delivery can vary considerably from one location to another. In some locations, responsibility for the provision of EMS has been undertaken by the local hospital, while in others, services may be provided by a range of volunteer organizations, such as the Italian Red Cross
(Croce Rossa), ANPAS (National Association for Public Assistance), other associations commonly known as "Cross" (Croce), usually followed by a colour (White Cross, Green Cross, Yellow Cross...), and by private companies. Some organizations, such as hospitals, often provide a single type of service, such as neonatal, while leaving others to provide the balance of services. How the service is actually provided, and the level of service that is provided, is driven in large measure by what the community can afford. Air ambulance
services are normally provided by the same regional authorities with a network of dedicated helicopters, or as an added service from a number of other government agencies, including the Italian Coast Guard
, Civil Defence, and the Vigili del Fuoco
(firefighters).
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How ambulances are staffed is determined to some extent by the location, and by the resources available to the community. For the most part, Italy follows the Franco-German (as opposed to Anglo-American) model of EMS service delivery. The basic model consists of Basic Life Support
ambulances, Advanced Life Support
ambulances, Modified Advanced Life Support ambulances, and physician
cars called Automedica. BLS units are typically volunteer-based, and crews consist of a minimum of two EMTs called soccorritore (one of them is a dedicated driver called autista); it is not uncommon to find three- or four-EMTs ambulance crews.
ALS units are more likely to be based in large centers, are more likely (but not always) to be staffed by paid, hospital-based personnel, and are commonly composed of a physician (usually an emergency physician
or anesthetist) and a critical care nurse. ALS units can be found either on fly-car
s (automedica) or on intensive care ambulances
(centro mobile di rianimazione, CMR). Some rural areas and smaller centers use a modified approach to ALS, with a volunteer crew supplemented by a nurse who is permitted to perform some ALS procedures.
The top end of the spectrum are the air ambulances (elisoccorso), staffed by the same personnel of ground ALS units (physician and nurse) and by a mountain rescue
specialist.
s must have 120 hours of training, attending an additional 80- or 100-hour course. Italian EMTs are able to provide non-invasive prehospital care, including PBLS, PTLS and automated external defibillation. In many regions EMTs are also trained to execute a 12 lead ECG, which will be transmitted to the hospital or to the 118-operations room, where a cardiologist can examine it before the arrival of the patient.
That being said, many Italian volunteers take their commitment very seriously, and participate in many hours of uncompensated training. This is particularly true for well-organized volunteer groups, such as the Italian Red Cross. These individuals still require support from a physician and nurse for ALS provision. While there are some ALS ambulances in Italy, they are typically not found outside larger centers, and in many cases, where they do exist, they are frequently required to have the 'emergency' physician present to perform ICU skills, in a manner very similar to the other neighbouring countries.
Nurses are required to have a critical care background; physicians are typically specialists in some field of medical specialty, often internists, surgeons or anaesthetists, although this background is not strictly required. Emergency medicine
is only now becoming slowly recognized as a medical specialty inside the hospital in Italy, and there are no real plans to create a subspecialty for pre-hospital care. Poor compensation and hours of work have reportedly resulted in a relatively high turnover rate among physicians in the system.
, as issued by the European Committee for Standardization
. The visual identity provisions of the standard are not yet being followed.
Ambulances are usually white-painted and have to display an orange and reflective stripe all around the vehicle, in addition to a star of life
on each side and the word AMBULANCE reversed on the front. Each emergency ambulance have in addition to display the emergency number 118 and the name and the logo of the organization providing the service. The use of light and sirens is authorized by the central operations and dispatch room at the beginning of the response. Only blue flashing lights are permitted by law.
Italian Red Cross
ambulances (identifiable also by special vehicle registration plates with the acronym CRI) are authorized to display a red stripe and a red cross instead of the orange stripe and the star of life.
Physician fly-car
s have the same graphic elements of ambulances except for the front word AUTOMEDICA.
and provides centralized regulation/dispatch, standards and guidelines for operation. Dispatchers answer to emergency calls and choose the best-indicated emergency care mobile resource. Medical training for dispatchers is in some region provided.
Emergency medical services
Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...
in Italy
Italy
Italy , officially the Italian Republic languages]] under the European Charter for Regional or Minority Languages. In each of these, Italy's official name is as follows:;;;;;;;;), is a unitary parliamentary republic in South-Central Europe. To the north it borders France, Switzerland, Austria and...
currently consist primarily of a combination of volunteer organizations providing ambulance service, supplemented by physicians and nurses who perform all advanced life support
Advanced Life Support
Advanced Life Support is a set of life-saving protocols and skills that extend Basic Life Support to further support the circulation and provide an open airway and adequate ventilation .-Components of ALS:These include:...
(ALS) procedures. The emergency telephone number
Emergency telephone number
Many countries' public telephone networks have a single emergency telephone number, sometimes known as the universal emergency telephone number or occasionally the emergency services number, that allows a caller to contact local emergency services for assistance. The emergency telephone number may...
for emergency medical service in Italy is 118.
Organization
Emergency medical services
Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...
are under Public Health Authorities control in each Italian Region
Regions of Italy
The regions of Italy are the first-level administrative divisions of the state, constituting its first NUTS administrative level. There are twenty regions, of which five are constitutionally given a broader amount of autonomy granted by special statutes....
; the ambulance subsystem is provided by a variety of different sources..
The method of delivery can vary considerably from one location to another. In some locations, responsibility for the provision of EMS has been undertaken by the local hospital, while in others, services may be provided by a range of volunteer organizations, such as the Italian Red Cross
Italian Red Cross
The Italian Red Cross is the Italian national Red Cross society that has its origin in the Comitato dell'Associazione Italiana per il soccorso ai feriti ed ai malati in guerra that was formed in Florence in 1863, and in Milan on June 15, 1864. Other committees were formed later...
(Croce Rossa), ANPAS (National Association for Public Assistance), other associations commonly known as "Cross" (Croce), usually followed by a colour (White Cross, Green Cross, Yellow Cross...), and by private companies. Some organizations, such as hospitals, often provide a single type of service, such as neonatal, while leaving others to provide the balance of services. How the service is actually provided, and the level of service that is provided, is driven in large measure by what the community can afford. 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 are normally provided by the same regional authorities with a network of dedicated helicopters, or as an added service from a number of other government agencies, including the Italian Coast Guard
Coast guard
A coast guard or coastguard is a national organization responsible for various services at sea. However the term implies widely different responsibilities in different countries, from being a heavily armed military force with customs and security duties to being a volunteer organization tasked with...
, Civil Defence, and the Vigili del Fuoco
Vigili del Fuoco
The Vigili del Fuoco, literally the Fire Watch, is Italy's institutional agency for fire and rescue service...
(firefighters).
Staffing
Basic life support
Basic life support is the level of medical care which is used for patients with life-threatening illnesses or injuries until the patient can be given full medical care at a hospital. It can be provided by trained medical personnel, including emergency medical technicians, paramedics, and by...
ambulances, Advanced Life Support
Advanced Life Support
Advanced Life Support is a set of life-saving protocols and skills that extend Basic Life Support to further support the circulation and provide an open airway and adequate ventilation .-Components of ALS:These include:...
ambulances, Modified Advanced Life Support ambulances, and physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
cars called Automedica. BLS units are typically volunteer-based, and crews consist of a minimum of two EMTs called soccorritore (one of them is a dedicated driver called autista); it is not uncommon to find three- or four-EMTs ambulance crews.
ALS units are more likely to be based in large centers, are more likely (but not always) to be staffed by paid, hospital-based personnel, and are commonly composed of a physician (usually an emergency physician
Emergency physician
An emergency physician is a physician who works at an emergency department to care for acutely ill patients. The emergency physician is a specialist in advanced cardiac life support , trauma care such as fractures and soft tissue injuries, and management of other life-threatening situations.In...
or anesthetist) and a critical care nurse. ALS units can be found either on fly-car
Fly-car
An ambulance emergency response vehicle is a vehicle operated by an emergency medical service to respond to medical emergencies either in addition to, or in place of, an ambulance capable of transporting patients....
s (automedica) or on intensive care ambulances
Intensive care medicine
Intensive-care medicine or critical-care medicine is a branch of medicine concerned with the diagnosis and management of life threatening conditions requiring sophisticated organ support and invasive monitoring.- Overview :...
(centro mobile di rianimazione, CMR). Some rural areas and smaller centers use a modified approach to ALS, with a volunteer crew supplemented by a nurse who is permitted to perform some ALS procedures.
The top end of the spectrum are the air ambulances (elisoccorso), staffed by the same personnel of ground ALS units (physician and nurse) and by a mountain rescue
Mountain rescue
Mountain rescue refers to search and rescue activities that occur in a mountainous environment, although the term is sometimes also used to apply to search and rescue in other wilderness environments. The difficult and remote nature of the terrain in which mountain rescue often occurs has resulted...
specialist.
Training
There is a great deal of variation in the training of EMS personnel in Italy like in many countries, where no distinction is made between voluteers and paid EMTs. Non-emergency services (such non-critical patient transports) use purely volunteers, who are required to have 20 or 40 hours of BLS training; all EMTEmergency medical technician
Emergency Medical Technician or Ambulance Technician are terms used in some countries to denote a healthcare provider of emergency medical services...
s must have 120 hours of training, attending an additional 80- or 100-hour course. Italian EMTs are able to provide non-invasive prehospital care, including PBLS, PTLS and automated external defibillation. In many regions EMTs are also trained to execute a 12 lead ECG, which will be transmitted to the hospital or to the 118-operations room, where a cardiologist can examine it before the arrival of the patient.
That being said, many Italian volunteers take their commitment very seriously, and participate in many hours of uncompensated training. This is particularly true for well-organized volunteer groups, such as the Italian Red Cross. These individuals still require support from a physician and nurse for ALS provision. While there are some ALS ambulances in Italy, they are typically not found outside larger centers, and in many cases, where they do exist, they are frequently required to have the 'emergency' physician present to perform ICU skills, in a manner very similar to the other neighbouring countries.
Nurses are required to have a critical care background; physicians are typically specialists in some field of medical specialty, often internists, surgeons or anaesthetists, although this background is not strictly required. Emergency medicine
Emergency medicine
Emergency medicine is a medical specialty in which physicians care for patients with acute illnesses or injuries which require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a variety of illnesses and undertake acute...
is only now becoming slowly recognized as a medical specialty inside the hospital in Italy, and there are no real plans to create a subspecialty for pre-hospital care. Poor compensation and hours of work have reportedly resulted in a relatively high turnover rate among physicians in the system.
Vehicles
Vehicles used as ambulances in Italy comply with most aspects of the European standard for ambulances, 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...
, as issued by the European Committee for Standardization
European Committee for Standardization
The European Committee for Standardization or Comité Européen de Normalisation , is a non-profit organisation whose mission is to foster the European economy in global trading, the welfare of European citizens and the environment by providing an efficient infrastructure to interested parties for...
. The visual identity provisions of the standard are not yet being followed.
Ambulances are usually white-painted and have to display an orange and reflective stripe all around the vehicle, in addition to a star of life
Star of Life
The Star of Life is a blue, six-pointed star, outlined with a white border which features the Rod of Asclepius in the center, originally designed and governed by the U.S. National Highway Traffic Safety Administration...
on each side and the word AMBULANCE reversed on the front. Each emergency ambulance have in addition to display the emergency number 118 and the name and the logo of the organization providing the service. The use of light and sirens is authorized by the central operations and dispatch room at the beginning of the response. Only blue flashing lights are permitted by law.
Italian Red Cross
Italian Red Cross
The Italian Red Cross is the Italian national Red Cross society that has its origin in the Comitato dell'Associazione Italiana per il soccorso ai feriti ed ai malati in guerra that was formed in Florence in 1863, and in Milan on June 15, 1864. Other committees were formed later...
ambulances (identifiable also by special vehicle registration plates with the acronym CRI) are authorized to display a red stripe and a red cross instead of the orange stripe and the star of life.
Physician fly-car
Fly-car
An ambulance emergency response vehicle is a vehicle operated by an emergency medical service to respond to medical emergencies either in addition to, or in place of, an ambulance capable of transporting patients....
s have the same graphic elements of ambulances except for the front word AUTOMEDICA.
Dispatch and regulation
The entire system is coordinated and regulated by the 118 operations and dispatch rooms within an Integrated Public Health System organization and a Physician Regulated emergency call center. It usually operates in each of Italy's governmental ProvinceProvinces of Italy
In Italy, a province is an administrative division of intermediate level between a municipality and a region .-Overview:...
and provides centralized regulation/dispatch, standards and guidelines for operation. Dispatchers answer to emergency calls and choose the best-indicated emergency care mobile resource. Medical training for dispatchers is in some region provided.