EMS in Czech Republic
last update: 25.2.2013
In emergency call 155 for EMS, 158 for Police or 150 for Fire dept. European emergency number 112 is also available, served by Fire Departement.
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In the Czech Republic (10.000.000 inhabitants), EMS has a long and famous tradition (the first "EMS" named "The Prague Volunteer Rescue Corps" in the capital of Prague was established in 1857). As it is based on the traditions of German-speaking countries, a physician is usually a member of the crew. This exists for a number of reasons. First of all - we belive, that well-educated physician on the scene can provide higher quality of care, better then can do the best paramedic or EMT - especially in life-threating situations. In addition - only few hospitals have an Emergency Department. The ”pavilion” system of older hospitals, whereby each division or medical service is housed in a geographically separate area, requires precise pre-hospital triage based on clinical signs and symptoms with limited monitoring and diagnostic capabilities. This triage challenge requires skilled and advanced levels of providers, which is generally felt to be a physician.
But - on the other hand - EMT or nurse-only staffed ambulances are in service as well in a lot of regions, responding life-nonthreating emergencies with lower priorites.
There is another tier of out of hospital care by physicians making ”non-emergency” house calls. In a country that does not have Emergency Departments such a service is a necessity. This service is primarily an after hours and weekend service. During the day sometimes ambulances will transport some of these patients to their doctors office directly.
Additional staffing on the ambulance is in the form of a driver who has formal training in prehospital care comparable to at least a BASIC EMT. Rounding out the team is a nurse with critical care experience. There have arisen in the last few years a number of training programs for EMTS (paramedics). The programs are 3 years in length and require a considerable amount of hospital ward time. The challenge currently is that paramedics have no legal standing or recognition, and cannot function independently of the physician even under protocol.
Overwhelming majority of our ambulances is well-equiped, meeting european and world standards in this field. Most of them are based on well-known vans as Mercedes, Ford, Renault or Volkswagen.
EMS is a separate service and has its own nationalwide emergency number 155. There is a specialized EMS dispatch in each region (size of the regions varying between 300.000 and 1.500.000 inhabitants) providing both call-taking of emergency calls and dispatching of ambulance resources. The "single european emergency number 112" is also available in Czech Republic, served by reginal Fire department call centres. Nevertheless 112 calls are switched to 155 centers and evaluated by EMS dispatchers. All EMS dispatch centres are staffed at least by EMS nurses or certified paramedics, some of the centres have an EMS physician on duty, too.
A key principle of the EMS system is a 20-minute response interval for all citizens, but in fact, average respnse time in cities is up to 10 minutes. The network of basic ambulance stations is already established, and the quality of performance is to be guaranteed by the regional authorities.
The ground based EMS system is backed up by an extensive system of helicopters strategically stationed so that no one is more then 50 km from an other helicopter. Our country has 10 such helicopters available. Most centers average between 400-500 runs. Eight of the helicopters have private operators, Police flies at one station and one is operated by Army. The flying medical staff is provided by appropriate regional EMS service (with exception of military helicopter, which is staffed my military personell).
The whole EMS system is financed by general healthcare insurance, in cooperation with local authorities‘ financial resources. Some specialized activities (especially the air ambulance service) is organized and financed directly by the Ministry of Health.
Traditionally the majority of doctors practicing emergency medicine in the Czech Republic have been anesthesiologists. Emergency Medicine has been established as a subspecialty in 1999 with a two-year curriculum. It requires prior training in anesthesia, internal medicine or some other field. More than three hundred physicians already received their board certification, based on in-hospital training within different fields of medicine, and pre-hospital emergency care. There are only a few in-hospital Emergency Departments with bed facilities - up to twenty in-hospital Emergency Departments have opened throughout the country, varying in size from 2 to 10 beds, and with varying degrees of acuity and admissions. Most doctors and paramedics work 14 -16 12-hour shifts in a month.
Prepared by Ondrej Franek, M.D., www.zachrannasluzba.cz, in cooperation with Francis Mencl, M.D., Ohio, U.S.A.