1. Pre-hospital Emergency Medical Care in Estonia Ago Kõrgvee Union of Estonian Emergency Medical Services

2. Topics: Estonia -background information Organisation of pre-hospital emergency care Economic aspects Education of staff Resources and equipment

3. Estonia - small country with big variabilities

4. Population1.5 million Territory45 000 sq km Population density varies greatly –550 000 Tallinn and Harju county –200 000Ida-Virumaa county –150 000Tartu and Tartu county –100 000Pärnu and Pärnu county 1 000 000 (66%) located on 33% of territory, rest of the population very sparsely situated

6. Organisation of Prehospital Emergency Medical Care Provided entirely by Emergency Medical Services with minimal involvement of GPs in rural areas There is no governmental body regulating the EMS activities nor is there any functioning legal framework governing the area

7. Union of Estonian Emergency Medical Services is a nonprofit organisation for EMS professionals (physicians, nurses and EMTs), devoted to quality of emergency medical care by providing training and guidance to its members, consulting the government in questions vital for the development of EMS etc.

8. (Missing) Legal Framework Regulation by the minister of social affairs (no 34 dated may 9, 1995) on the licensing requirements of EMS teams. The regulation covers –the equipment –the qualifications of staff –the composition of teams (3 members) Licensing is carried out every 3 years

9. Development Concept for EMS In 1999 a consensus document was prepeared on the future of Estonian Emergency Medical Services The panel of experts included specialists of health care, emergency medicine and rescue services Information on present status of EMS was collected and analysed and strategy for developing special areas in EMS was addressed by several working-parties

10. Development Concept for EMS Consists of 6 functional parts: Basic definitions General overview of present situation SWOT analysis Vision of the future system of pre-hospital emergency care Principles of development presented as proposals to administrative bodies of different levels A list of legislative acts needed for regulating EMS

11. Development Concept for EMS has been submitted to the Ministry of Social Affairs for implementation and has already been used as a basis for a chapter on EMS in the draft law on health care.

12. Estonian EMS - resources available There are 87 EMS teams in 46 geographic locations

13. The Ownership Forms of EMS

14. General Statistics on Workload EMS visits/10 000 inhabitants in different regions

15. General Statistics on Workload Patient types

16. Economic Aspects The EMS has been financed from different sources: –1996 Regional Sick Funds and state support –1997Central Sick Fund –1998State Budget –1999State Budget –2000State Budget Millions of DEM

17. Economic aspects - Structure of costs (1999, 9 first months)

18. The qualification of EMS teams 6 reanimobiles with anaesthesiologist on board (based in Tallinn and Tartu) 40 physician manned ambulances (generalists with training in EM) 41 teams lead by a specialist nurse All EMS teams consist of 3 members: a doctor or a specialised nurse, a nurse and a driver trained as EMT

19. Eduaction and Training Undergraduate medical education –Physicians - Tartu University –Nurses - 3 schools (Tallinn, Tartu, Kohtla- Järve) Specialisation –EM physicians in residency progam at Tartu University Hospital –Nurses at Tallinn EMS –EMTs at Tallinn and Tartu EMS, Centre of Disaster Medicine of Tallinn Mustamäe Hospital

20. Continuous Education and Training is provided by Tartu University Clinics, Tallinn and Tartu EMS, Center of Disaster Medicine of Tallinn Mustamäe Hospital, Estonian Union of Emergency Medical Services and other professional organisations

21. (Re)Certification of Medical Staff Re-certification by the Ministry of Social Affairs in every 5 years is a must for physicians. Re-certification of nurses is carried out in every 5 years by a certification commission of their professional organisation.

22. EMS Team Equipment (1999)

24. EMS Team Equipment (1999) Types of Defibrillators

25. Perspectives Further co-operation of different governmental and non-governmental bodies for –implementation of the development concept –preparing the legislation on EMS –developing standards, administrative protocols and treatment guidelines for EMS –introducing a functioning quality assurance system