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Saturday, 07.09.2024, 04:31
Making Lithuanian emergency medical service system more urgent
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According to the official statistics on average 50 thousand people left Lithuania annually during the timeframe of 2010 to 2017. The emigration rates per thousand people are the highest in the EU. The negative impact of the emigration is offset a little by an increased immigration flow to Lithuania. Natural population change is a change of the population and its composition that are related to birth and death. There are three main causes of death in Lithuania: cardiovascular diseases, malignant tumours and external factors. These three causes account for 84% of all deaths, according to the 2015 data.
First let’s look at the main
external causes of death because EMS should be focused on the service demand.
Difficult to understand why? But suicide is one of the biggest external causes
of death in Lithuania. Suicide rates in Lithuania exceed the EU average suicide
rate by more than three times. Other external causes are car accidents and
falling accidents. Also, many deaths are caused by the large alcohol
consumption. An ischemic heart disease is another factor influencing the EMS
demand in Lithuania. Statistical data about the Lithuanian EMS is not
collected. The extent of the EMS is best represented by the absolute number of
ambulance care services, which has decreased by 2010 but it reached 1993 level
again by 2015. The number of the ambulance care services increased due to the
closures of some hospitals in regional centres. The ambulance care services
consist of four main groups: acute illnesses and conditions, accidents,
transportation of patients and pregnancy/perinatal pathology. The volume of
ambulance care services for the urgent illnesses and pregnancy related
conditions have decreased but the numbers for the injuries and patient
transportation increased. Urgent illness group consists of patients that seek
care for the circulatory system diseases, oncological illnesses or respiratory
failures. Although the volume of the ambulance care services from 2001 to 2015
has been increasing very slightly, the dynamics of the ambulance care staff
undergone more significant changes – the nursing staff dropped by 25% and the
medical doctor staff decreased by 81%.
Such a sharp decline in doctor staff
is related to the new ambulance care service concept that was approved in 2002,
according to which patients in most cases are transported to the doctors in
ambulances, the so called Anglo-American model. Doctors are replaced by the
paramedic staff. Lithuania’s Health care system is divided into three political
and administrative levels: National Health, County Health, and Municipal
Health. Its emergency care is free which is financed from Compulsory Health
Insurance Fund and by the Government (for citizens without health insurance).
The scope and requirements for the provision of the emergency care, including
urgent care and ambulance work, are regulated by the Ministry of Health.
Emergency care is commonly provided by general practitioners during services
hours. Alternatively, and during the general practitioner out-of-hours
services, it could be provided by the emergency departments at the hospitals. Lithuanian
EMS system was built taking into account the most effective EMS management
models and applications from other countries. Lithuanian EMS includes: 1)
pre-hospital phase, during which an initial medical care is provided to a
patient at the place of an accident before the patient is taken to the nearest
hospital; 2) inhospital phase at the nearest hospital, during which urgent and
effective medical care is provided to a patient to minimize the trauma or
illness effects and the possibility of death; 3) inter-hospital or transfer
phase when the patient‘s condition has been stabilized and the continuation of
the medical care could be provided at another medical institution based on the
specific patient needs; 4) post-hospital phase, during which the patient is
transferred to the rehabilitation facilities for further treatment. The
research of the Lithuanian EMS system and its management was carried out
jointly by scientists of Klaipeda University and Klaipeda University Hospital
during 2015-2016.
The research method was a
Quantitative Analysis, and the instrument was four types of surveys. Respondents
were chosen based on the competency: managers of the inpatient personal health
care facilities and ambulance care services, managers of the intensive care
units, and Heads of the Emergency departments. General set consisted of 168
persons related to the EMS system management. Survey volume was 117 from all
over Lithuania. Survey sites included 60 hospitals and 19 ambulance care
centres. The following EMS management tools were analyzed during the study: the
optimal number of the emergency care categories, their names and service times;
the introduction of the fee for the non-urgent care services; initial
assessment of the patient’s condition performed by the nursing staff; location
of the patient transportation; the determination of the Emergency Department
employment indicators; the introduction of payment for the patients transfer
between hospitals; emergency care coordination; a separate phone number for the
ambulance care; mixed pre-hospital service model; use of the military medical
staff; determination of the performance criteria; control of the emergency
patient external and internal flows; regulating the patient transportation
between hospitals; implementation of the standard protocol of the patient
examination; providing information to the family doctors.
EMS process that includes
coordination, command, urgent medical care at the place of accident,
pre-hospital transportation, assessing patient’s condition and providing first
care, and transportation between the hospitals was analyzed during the
research. Since the proposed model has both American and German emergency care
elements, it was proposed to have a mixed emergency care model. The analysis of
the research data revealed that legal and general management methods should be
used to achieve Lithuanian EMS system management goals and objectives. The
study identified the following control weaknesses within the Lithuanian EMS
system: lack of legal regulation within EMS system; inadequate assessment
categories resulting in excessive patients flows; lack of approved protocols,
algorithms and performance standards; lack of skilful and qualified resources;
lack of EMS quantitative and qualitative performance measures; lack regulation
within patient transportation between hospitals; lack of emergency care system
funding; inadequate public awareness and education. The following EMS
availability and quality improvement measures have been proposed: patient selection
should be optimized; quantitative and qualitative indicators within Lithuanian
EMS should be developed and implemented; competencies of the nursing staff
should be enhanced and the military medical staff should be used; establishment
of regulations within; external and internal patients’ flows should be
regulated; long-term EMS management system should be developed and implemented;
public knowledge and awareness should be enriched. In summary, the
possibilities for the improvement of the management of the EMS system, the
scope of EMS further application remains broad, and the presented improvement
measures and developed model can already be successfully used to improve the
availability and quality of the Lithuanian EMS. The proposed management of the
patient flows and the regulation for the payment of emergency and emergency
medical service is already being discussed by the Lithuanian Health Policy
owners; therefore, it can be expected that the emergency medical service in
Lithuania will become even more urgent in the future.