Emergency medical services in Poland
Encyclopedia
Emergency Medical Services in Poland
is a service of public pre-hospital emergency healthcare, including (but not limited to) ambulance
service, provided by individual Polish cities and counties. These services are typically provided by the local, publicly operated hospital, and funded by the government of Poland. In a number of cases, the hospitals contract these services to private operators. In addition to publicly-funded services, there are also a variety of private-for-profit ambulance services operating independently, as well.
is similar of the Austrian- Franco-German-Spanish delivery model, and is physician-led and an Integrated EMS of Public Health (IEMS). Physicians (usually anaesthetists) respond to most emergency calls, and a great deal of definitive care and even simple physician consultation and discharge occur at the scene. These physicians are often referred to as Emergency Physicians. Emergency medicine has been recognized as a medical specialty since 1999. Due to shortage of specialists in emergency medicine, selected other medical specialists (anesthesiology and intensive care, internal diseases, general surgery, pediatrics, pediatric surgery, orthopaedics and traumatology) are allowed to work in the system until 2020. Unlike the German
system, the physicians do not respond in separate vehicles, instead staffing the appropriate types of ambulances directly. Transportation to hospital
may, or may not, be an outcome it depends of decision the MICU Physician . The variation occurs in that the physician
may be supported by either paramedics or nurses, or some mix of the two roles. Each ambulance
also has a dedicated Ambulance Technician who drives, with minimal medical training. As the system evolves, however, it will be changing. Paramedic-led ambulances will respond to most emergency calls, as in the Anglo-American model, with physicians being "sent" only to those calls where there is a potential critical threat to life.
. Ambulances and equipment used do comply with the technical standards outlined. While design and technical standards are voluntarily complied with, there is no current compliance with the visual identity standards described in the Standard. There are also no immediate plans to do so. While plans are in place for the restructuring of some aspects of the EMS system, these are mostly related to staffing configurations and deployment, which are not covered by the technical Standard. It appears unlikely that the proposed changes will have any effect on Standard compliance.
and Pediatric Advanced Life Support
, among others.
, Poland has decided to ratify most aspects of the requirements of European standard CEN 1789 for ambulances, as reflected in the Polish EN 1789 (Classes A-C) Standard. The visual identity requirements of the European standard for ambulances are not yet being followed.
The three major types of vehicle are:
In addition, the system also operates specialty ambulances which are equipped for and dedicated to neonatal transport (Type N), which are not used for any other purpose.
air ambulance
s strategically located in large cities throughout Poland. In addition, fixed wing aircraft are used for longer distance transports. Many of the aircraft used continue to be of the old era of Soviet domination, however, this is gradually changing. The government of Poland placed an order for 23 new Eurocopter EC-135 aircraft in August, 2008, with delivery expected in 2009-2010. Now (december 2010) LPR use 13 new EC-135. These will replace all of the old Soviet-era aircraft, and will bring Poland into full compliance with the existing European Standard JAR OPS-3 for air ambulances.
for ambulances in Poland in the POTS
telephone system is 999. The standard European Emergency Number, 1-1-2
also works in Poland, including mobile systems, and is gradually replacing 999. Calls are then triaged by interview process, and the closest and most correct type of ambulance resource is sent to the call.
E112 is a location-enhanced version of 112. The telecom operator transmits the location information to the emergency centre. The EU Directive E112 (2003) requires mobile phone networks to provide emergency services with whatever information they have about the location a mobile call was made. This directive is based on the American Federal Communications Commission
's Enhanced 911 ruling in 2001.
ambulances (Type N) will remain in their current configurations. The new types of ambulances and staffing patterns will be as follows:
Poland
Poland , officially the Republic of Poland , is a country in Central Europe bordered by Germany to the west; the Czech Republic and Slovakia to the south; Ukraine, Belarus and Lithuania to the east; and the Baltic Sea and Kaliningrad Oblast, a Russian exclave, to the north...
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 Polish cities and counties. These services are typically provided by the local, publicly operated hospital, and funded by the government of Poland. In a number of cases, the hospitals contract these services to private operators. In addition to publicly-funded services, there are also a variety of private-for-profit ambulance services operating independently, as well.
Operating system
At the moment, the operating system of Polish EMSEmergency 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...
is similar of the Austrian- Franco-German-Spanish delivery model, and is physician-led and an Integrated EMS of Public Health (IEMS). Physicians (usually anaesthetists) respond to most emergency calls, and a great deal of definitive care and even simple physician consultation and discharge occur at the scene. These physicians are often referred to as Emergency Physicians. Emergency medicine has been recognized as a medical specialty since 1999. Due to shortage of specialists in emergency medicine, selected other medical specialists (anesthesiology and intensive care, internal diseases, general surgery, pediatrics, pediatric surgery, orthopaedics and traumatology) are allowed to work in the system until 2020. Unlike the German
Emergency medical services in Germany
Emergency Medical Service in Germany is a service of public pre-hospital emergency healthcare, including ambulance service, provided by individual German cities and counties...
system, the physicians do not respond in separate vehicles, instead staffing the appropriate types of ambulances directly. Transportation to hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
may, or may not, be an outcome it depends of decision the MICU Physician . The variation occurs in that the 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...
may be supported by either paramedics or nurses, or some mix of the two roles. Each 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...
also has a dedicated Ambulance Technician who drives, with minimal medical training. As the system evolves, however, it will be changing. Paramedic-led ambulances will respond to most emergency calls, as in the Anglo-American model, with physicians being "sent" only to those calls where there is a potential critical threat to life.
Vehicles and equipment
Poland has voluntarily adopted the majority of the specifications for ambulances 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...
. Ambulances and equipment used do comply with the technical standards outlined. While design and technical standards are voluntarily complied with, there is no current compliance with the visual identity standards described in the Standard. There are also no immediate plans to do so. While plans are in place for the restructuring of some aspects of the EMS system, these are mostly related to staffing configurations and deployment, which are not covered by the technical Standard. It appears unlikely that the proposed changes will have any effect on Standard compliance.
Training
Since 2006, the evolving legal standard of training for Polish paramedics is a three year Bachelor's degree. As an option, those with substantial prior experience may proceed to a degree, following two years of additional study. This program is available in a number of Polish universities, and will completely replace the prior training standard, which consisted of an assortment of short courses. Short courses of various types continue to be offered, but these are now essentially the typical short courses found elsewhere in EMS, including Advanced Cardiac Life SupportAdvanced cardiac life support
Advanced cardiac life support or Advanced Cardiovascular Life Support refers to a set of clinical interventions for the urgent treatment of cardiac arrest and other life threatening medical emergencies, as well as the knowledge and skills to deploy those interventions.Extensive medical knowledge...
and Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support is a 2 day American Heart Association training program. The goal of the course is to aid the pediatric healthcare provider in developing the knowledge and skills necessary to efficiently and effectively manage critically ill infants and children, resulting in...
, among others.
Ratownictwo Medyczne service delivery units
- Pogotowie Ratunkowe (EMS stations)
- Lotnicze Pogotowie Ratunkowe (LPR) (Air ambulance stations)
- Fire Brigade - In the Polish system firefighters provide a level of tiered response to assist Polish EMS in exceptional circumstances, including fires and motor vehicle accidents. The training provided to Polish firefighters is limited to 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...
and what might be described as ABC (medicine). As a result, their participation in emergency medical responses is less common than what those in North AmericaNorth AmericaNorth America is a continent wholly within the Northern Hemisphere and almost wholly within the Western Hemisphere. It is also considered a northern subcontinent of the Americas...
would be accustomed to.
Land ambulance
The vehicles of the Polish EMS system come in a wide variety of shapes and sizes. As a member of the European UnionEuropean Union
The European Union is an economic and political union of 27 independent member states which are located primarily in Europe. The EU traces its origins from the European Coal and Steel Community and the European Economic Community , formed by six countries in 1958...
, Poland has decided to ratify most aspects of the requirements of European standard CEN 1789 for ambulances, as reflected in the Polish EN 1789 (Classes A-C) Standard. The visual identity requirements of the European standard for ambulances are not yet being followed.
The three major types of vehicle are:
- The patient transport ambulance (T), which is smaller, conforms to European Class A, and contains fewer staff and less equipment.
- The ambulans reanimacyjny (R) (English: resuscitation ambulanceAmbulanceAn 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...
), is a larger van used for serious emergencies. This unit type is the first choice for response to emergencies that appear to be immediately life-threatening. While some CEN 1789 Class B vehicles are still present in the system, the objective is to ultimately ensure that this type of ambulance is always a Class C. - The ambulans wypadkowy (W) (English: emergency ambulance), is a van-type ambulance used for emergencies when a Type R ambulance is unavailable. They are used for physician consultation calls or for non-emergency transport. These vehicles conform to the CEN 1789 Class B standard, although sometimes Class C ambulances are seen in this role.
In addition, the system also operates specialty ambulances which are equipped for and dedicated to neonatal transport (Type N), which are not used for any other purpose.
Air ambulance
Polish Lotnicze Pogotowie Ratunkowe (LPR) currently operates about 18 helicopterHelicopter
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...
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....
s strategically located in large cities throughout Poland. In addition, fixed wing aircraft are used for longer distance transports. Many of the aircraft used continue to be of the old era of Soviet domination, however, this is gradually changing. The government of Poland placed an order for 23 new Eurocopter EC-135 aircraft in August, 2008, with delivery expected in 2009-2010. Now (december 2010) LPR use 13 new EC-135. These will replace all of the old Soviet-era aircraft, and will bring Poland into full compliance with the existing European Standard JAR OPS-3 for air ambulances.
Equipment
The basic required equipment of the Type R and Type W ambulances (and in the future the Type S and Type P ambulances) is as follows. This equipment is obligatory and represents 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
- Spinal immobilization equipment such as 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... - 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, such as blood-pressure cuffs
- Portable defibrillator
- 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...
- 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...
- 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 stretcherStretcherA stretcher is a medical device used to carry casualties or an incapacitated person from one place to another. It is a simple type of litter, and still called by that name in some cases....
, also called a Reeves stretcher - Rigid or collapsible transport chair (called a stair chair in the United StatesUnited StatesThe United States of America is a federal constitutional republic comprising fifty states and a federal district...
) - RescueRescueRescue refers to responsive operations that usually involve the saving of life, or prevention of injury during an incident or dangerous situation....
equipment
Communications
All ambulances in Poland are dispatched from centralized regional dispatch centers (Polish: Centrum Powiadamiania Ratunkowego)(CPR). The traditional standardized emergency telephone numberEmergency 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 ambulances in Poland in the POTS
Plain old telephone service
Plain old telephone service is the voice-grade telephone service that remains the basic form of residential and small business service connection to the telephone network in many parts of the world....
telephone system is 999. The standard European Emergency Number, 1-1-2
1-1-2
112 is the principal emergency telephone number that can be dialed free of charge from any telephone or any mobile phone in order to reach emergency services in the European Union , its candidates for accession, members of the EEA agreement, as well as several other countries in the world...
also works in Poland, including mobile systems, and is gradually replacing 999. Calls are then triaged by interview process, and the closest and most correct type of ambulance resource is sent to the call.
E112 is a location-enhanced version of 112. The telecom operator transmits the location information to the emergency centre. The EU Directive E112 (2003) requires mobile phone networks to provide emergency services with whatever information they have about the location a mobile call was made. This directive is based on the American Federal Communications Commission
Federal Communications Commission
The Federal Communications Commission is an independent agency of the United States government, created, Congressional statute , and with the majority of its commissioners appointed by the current President. The FCC works towards six goals in the areas of broadband, competition, the spectrum, the...
's Enhanced 911 ruling in 2001.
System changes
Current staffing
In Poland, there were two types of emergency ambulances, type R (now S), and type W (P), which are staffed as follows:- Ambulance type S (specialized) - 3 people including a physician, paramedic or nurse, and a driver-paramedic.
- Ambulance type P - 3 including a physician or paramedic or nurse, 1 paramedic or nurse, and a driver-paramedic. Or 2 people Nurse or paramedic and driver-paramedic.
Planned reforms
The government of Poland has mandated significant changes within the EMS system. These will include more paramedic-led ambulances and less physician-led ambulances. The proposed system will more closely resemble the Anglo-American model, with ALS and BLS units, except that this would be something of a poor analogy. Polish paramedics do perform ALS skills without a physician present, so a better description might be "ALS" and "More ALS". These changes are proposed to occur in 2010, with the acquisition of some 600 new ambulances by the Polish government; the result of industrial action by Polish paramedics. Patient transport ambulances (Type T) and neonatal transportNewborn transport
Newborn transport is used to move premature and other sick infants from hospitals without specialist, intensive care facilities require for optimal care of the baby to hospitals with neonatal intensive care and other specialist services...
ambulances (Type N) will remain in their current configurations. The new types of ambulances and staffing patterns will be as follows:
- The ambulans specialistyczny (S) (English: specialist ambulance) will be a larger van used for serious emergencies. This will be used only for potentially life-threatening responses. Standard personnel staffing will consist of a doctor (with emergency medicine specialization), two paramedics or nurses, and a driver/orderly. The vehicle used will be in all cases a CEN 1789 Class C ambulance. The new ambulance category, Type S will replace the Type R ambulance in the "More ALS" category.
- The ambulans podstawowy (P) (English: basic ambulance) will be a standard van-type ambulance used for emergency responses when a Type S unit is unavailable, and for lower priority emergency calls. Such vehicles will not be used for consultations, or for non-emergency transport. Standard staffing of personnel will consist of 2 paramedics and a driver/orderly. The new category, Type P will replace the old Type W vehicle configuration. Type P ambulances will conform to, at minimum, CEN 1789 Class B, with the option at a local level to use Class C vehicles instead.