The foundation of the system of the National Emergency Medical Service in Poland is based on the Act of National Emegency Medical Service of 8th September 2006 and the last of its amendment dated on 9th October, 2015. The goal of the article is to show the Polish system of Emergency Medical Service at the example of the Provincial Emergency Station in Gorzow Wielkopolski, which besides Rescue Crews type “S” and “B” is Poland’s first fully functioning Centralised Medical Dispatch Centre. I will provide the British reader with the knowledge on the system units, personnel, tasks and challenges facing the Employees, Medical Rescurers in particular.
KEYWORDS: act , system units, paramedic.
Gorzow Wielkopolski, a town in western Poland, situated on the river Warta, the largest in Lubuskie region, about 60 km from the border with Germany. It is a place where Provincial Emergency Station, managed by Dr. Andrew Szmit specialist in anaesthesiology and intensive care specialist, emergency medicine, as well as regional consultant for Emergency Medicine, Regional Emergency Station PICTURE OF EMERGENCY STATION and its DIRECTOR
The region is inhabited by approximately 170,000 residents. The area of operation has 6 fixed duty ambulances: 4 specialized crews with a doctor, and 2 basic crews (two paramedics), all crews meet the standard equipment of ALS.
In my article I want to present the example of Provincial Emergency Station (abbreviation in Polish: WSPR) Gorzow Wielkopolski, the leading Unit System, its structure and location as the unit system of National Emergency Medical Services, people creating this system, as well as demands facing them, and finally the prospects and challenges for the future.
The system is legally based on the Act of National Emergency Medical Service in Poland of 8th September 2006 and the last of its amendment dated on 9th October, 2015. These documents determine the rules of organization, functioning, financing of the system and rules to provide education in first aid. The objective of the system is to ensure that any person in emergency will be provided with health assistance. Supervision and control of the system shall be exercised by the government administration. The minister responsible for health shall supervise the system throughout the country, and the provinces, which are the Polish equivalent of the English counties, are supervised by provincial governors using the “Regional Action Plan of the National Emergency Medical Service System” .
The units of the system, which in the state of health hazards bring medical assistance include:
– Hospital Emergency Departments (SOR )
– Emergency Medical Crews (ZRM), and the Air Medical Rescue Crews ( HEMS)
SOR is the first and the target unit for each Emergency Medical Crew providing health services, consisting of Triage – initial diagnosis and providing treatment necessary for the stabilization of vital functions of persons who are in health emergency.
SOR, in addition to units of the system, provides assistance to any person who believes that their health is in danger-without any referral. The segregation takes place here (PICTURE) resulting in the verification divided into those who are in direct health hazards, or are in a position that does not require immediate medical attention. Admission to emergency department is not conditioned by applicable zoning, place of residence or address.
ZRM (Crews of National Emergency Medical Service) are another unit of National Emergency Medical Service and in our case they include 4 Specialist Crews and 2 Basic Crews ( PICTURES OF AMBULANCES IN THE AREA, IN THE PARKING, INSIDE) providing services only in the case of emergency in the pre-hospital setting. Specialized team “S” which includes at least three persons authorized to carry out medical emergency treatment, including physician and nurse of the system or a paramedic.
A doctor of the system, a physician specializing in the field of emergency medicine or with work experience of 3,000 hours in exercising the medical profession on the SOR, ZRM, HEMS or the Emergency Room of the hospital.
A nurse of the system, a nurse who holds a specialist title or is specialized in the field of emergency nursing, anesthesiology and intensive care, surgery, cardiology, pediatrics. It is also a nurse who completed qualification course in the field of emergency nursing in anesthesiology and intensive care, surgery, cardiology, pediatrics, and has at least 3 years work experience in the wards of these specialties, emergency department, in emergency rooms or hospital emergency station.
The occupation of a paramedic appeared in Poland in the 90s of the twentieth century to replace the profession “first-aid worker” or “stretchers – carrier” and to prepare professional medical staff to assist patients in health or life emergency.
In Poland, a group of paramedics does not have a medical licence. Such a licence is required in the case of doctors, pharmacists, nurses and even some professions related to medicine. ” Paramedics practice their profession according to the skills obtained in the course of training, on the basis of their diploma conferring certain qualifications”. In Poland, this profession can be performed by a person with full legal capacity, adequate health, fluent Polish and finally having suitable qualifications. At the moment, the educational “path” includes higher education of the first degree lasting 3 years or specialization in Emergency Medical Services. Paramedics may practice in the form of a contract of employment or a civil-legal- contract. The professional environment in Poland finds it controversial that paramedics must take further training in the form of service course and self-study, which is documented in the data sheet of vocational training, and the credits must be scored within five years – at least 200 education credits, including at least 120 credits for participation in the course finished with an examination. (PICTURE OF VOCATIONAL TRAINING CARD)
The professional paramedic in Poland is to protect persons on the scene of the accident, and to perform most activities known as medical rescue activities outside the system i.e. when working in hospital wards and in other centers of wider health service -these activities are defined in the Act as health care services other than medical rescue activities.
Medical rescue activities carried out by the Polish paramedics involve medical evaluation of the patient to establish the procedure and the decision whether taking or withdrawal of life-saving medical activities. Putting the patient in the correct position for the patient’s condition or injuries. Taking and conducting basic and advanced CPR in adults and children according to current standards, restoration of airway patency with or without equipment, using in particular:
– Tubes oro – pharyngeal, nasopharyngeal tube, face mask, laryngeal, laryngeal tubes, suction the airway and, conicopunction if necessary. Adoption of reactive oxygen or assisted ventilation breathing or replacement air or oxygen: manually – with: face mask, one-way valve and a breathing bag, mechanically – using a ventilator. In the end – endotracheal intubation in direct laryngoscopy in cardiac arrest through the mouth or nose, without the use of muscle relaxants and running ventilation replacement. Performing manual defibrillation based on the ECG, implementation of automated defibrillation, ECG monitoring respiratory function, monitoring the activities of cardiovascular non-invasive methods, percutaneous electrical stimulation of heart in bradyarrythmia, performing cardioversion tachyarrythmia, in the case of hemodynamically unstable patients, implementation and evaluation of ECG .Execution of peripheral vein cannulation of upper and lower limbs and the external jugular vein , execution of reaching intramedullary using a kit. The administration of medicaments by intravenous, intramuscular, subcutaneous, intratracheal, oral, rectal and inhalation, and intramedullary, using a kit. Presne pneumothorax decompression by puncture pleural cavity, downloading venous and capillary blood for laboratory tests.
In addition, wound healing, damming bleeding, immobilization of fractures, dislocations and sprains, spinal immobilization with particular emphasis on the cervical i.e. typical BLS. Receiving emergency child birth outside hospitals, measuring the deep temperature and medical segregation, undertaking protective measures to reduce the health effects of events, preparation of the patient and medical care during transport.
There is also a group of medical rescue operations, which are undertaken by us under medical supervision, e.g.: endotracheal intubation in direct laryngoscopy in the case other than sudden cardiac arrest with the use of muscle relaxants, catheterization of the bladder, inserting gastric probes after securing the airway, assisting in minor surgical procedures (stapling of wounds, donning the drains) and other medical procedures.
Medical dispatcher -Centralization of medical dispatching in Poland.
I have been working on the position of medical dispatcher for more than 8 years. The position and the profession of dispatcher plays a key role in the system of the National Emergency Medical Service system. We can call Dispatcher “first rescuer”, which is in contact with the patient or person requesting assistance through the phone. The dispatcher decides about sending a medical rescue team, or about refusal, but they must give instructions for further proceedings in case of refusal. The Law on National Emergency Medical Service system specifies who can become a medical Dispatcher and what are the tasks involved.
Dispatchers in Poland ” collect” information on the basis of the procedures for answering calls and dispatching rescue teams containing algorithms of interview -a set of questions and recommendations to support decision making, determined on the basis of recommendations resulting from current medical knowledge. In Poland, there are several guidelines for the dispatchers, so the dispatcher chooses those appropriate ones for the station or leaves it at the discretion of the Head, who also is responsible for the proper functioning of the Dispatch centre. Regulations define the qualifications. Medical dispatcher in Poland may be a person who has at least secondary education in the profession of nurse or paramedic, was trained in dispatching and had been employed for at least five years while providing health benefits to the Hospital Emergency Department, Emergency Medical Service at the Emergency Room in hospital or the Department of Anesthesiology and Intensive Care. Just as a paramedic – medical dispatcher must use different forms of vocational training which are: improvement courses and seminars.
SWD PRM-System of Command Support of National Emergency Medical service
For several years in Poland, we have been observing the process of centralization of medical dispatch centres.
Poland’s first SWD PRM was introduced at our station WSPR Gorzow Wielkopolski on June 23, 2016
It initially included the disposal of six ZRM, currently (as of January 5, 2017) Concentrated Medical Dispatch manages and has 17 ZRM in the city of Gorzow Wielkopolski helicopter HEMS (labelled as Lifeguard 24). Successive joining the following areas of operational is on the way and until June 30, 2017 SDM will be fully functional and will cover the entire area of activity of Lubuskie total of 51 medical rescue teams.
SWD PRM functioning in our station consists of several modules:
Module of Administrator – user rights management, data of ambulances at the regional level and the particular administrators.
Module dispatcher – receiving and managing requests from the emergency numbers 112, 999; Medical Rescue Teams disposal in the area of operation ( PICTURE OF DISPATCHING POSITION)
Mobile Module – taking orders on the tablet of departures from the dispatcher – completion of documentation of departure (Card Departure Orders), the creation of medical documentation (Medical Card of Rescue Operations), generating status of ZRM. (PICTURE OF TABLETS)
Reporting Module – reporting.
Place of stationing – starting and ending the duty (login to the system), ability to take orders, the ability to complete the data of departure.
The Ministry of Health has prepared a draft of changes to the rules governing the National Emergency Medical Service. He wants to, among others, move away private medical companies from the provision of services and introduce motorcycle medical rescue crews operating for 12 hours during five months in the year to the end of September. The ambulances will have three person crews, but no doctors, as well as the statement of death by the head of ZRM if this took place during the visit.
The occupation of paramedic is relatively young in Poland, but we can see that the legislator intends to provide paramedics with a wider range of medical services at the prehospital stage and increase their powers, making the profession of a paramedic increasingly independent, which results in the need of constant improvement of their skills as they are responsible for the life of patients. The rescue environment, and other medical areas there are asking questions about the future, and whether the entire system of prehospital medical assistance will be based solely on paramedics?
Author: Robert Rajtar, 14 years of experience as a paramedic-driver, 9 year experience as medical dispatcher: SOR in Gorzow Wielkopolski, Medical Rescue Crews in Szczecin, and Berlin (Germany). Currently working at the Provincial Emergency Station in Gorzów (ZRM and SDM )
Contact:
Robert Rajtar 66-400 gorzów wielkopolski ul: Dowbora Musnickiego 38/16 województwo lubuskie Polska
