Austria

General

Capital – Vienna
Land Size – 83,781 sq km
Population – 8,214,160
Language(s) – German (official nationwide) 88.6%; Turkish 2.3%; Serbian 2.2%: Croatian (official in Burgenland) 1.6%: others 5.3%

Prehospital Care

Overview

• “Austria has a well-advanced EMS that covers the whole country and provides a high level of prehospital care” (Weninger, 252)
• “At present, there is still a lot of uncertainty regarding the optimal approach … as well as the optimal means of transportation for different groups of emergency patients” (Weninger, 252)
  • Urban Areas – “Load and go” strategy due to short transport times
    • Mean Transport duration time: 13min (8min in Vienna)
  • Rural Areas – “Stay and Play” – Most Pt’s stabilized on-scene
    • Mean transport 35min by ground
    • Secondary transport necessary if specialist care required

History

• Wiener Rettung –has oldest known ambulance service in Europe, since 1881
• System with MDs began in 1970s “in rural areas where rescue times were unacceptably long” (Weninger, 250)
  • 1987 – Austrian Society for Emergency and Disaster Medicine (ÖNK):
    • Began coordination of prehospital medicine
    • Nonprofit organization
    • Educates and trains MDs, Paramedics and Nursing staff in statewide emergency medical systems
    • Coordinates research activities in prehospital medicine
• 1987 – ÖNK collaborates with Austrian Medical Association to develop criteria for education and training of emergency physicians
  • 1998 – Curriculum becomes national law
• 2002 – “Sanitätergesetz”
  • Standards introduced to provide uniform training and education for EMTs
  • EMTs “gained more competences and treatment of emergencies is now performed to a more sophisticated level” (Weninger, 252)

EMS System Model

• EMS strategies vary according to geographical factors (50-50 rural/urban split); not uniform throughout Austria
  • Systems left to 9 individual states to organize
    • Obliges state to provide financial support
    • Very little contributed from federal gov’t
    • Majority of resources provided by Austrian Red Cross
• Physician-Staffed EMS
  • Notarztwagen (NAW):
    • Physician-staffed ambulance
    • ALS/ATLS equipment
    • Direct transportation and extended monitoring of emergency Pt’s
    • Used most frequently in urban areas
  • Notarzteinsatzfahrzeug (NEF):
    • Physician-staffed car
    • ALS equipment and limited monitoring options
    • Provides treatment while ambulance is en route
    • Used most frequently in rural areas
    • Reduces response times (‘rendezvous-system’)
    • Transport performed by paramedic-staffed ambulance
      • MD will join team in serious cases
  • Notarzthubschrauber (NAH):
    • Physician-staffed helicopter
    • ALS/ATLS equipment
    • Extended monitoring options
    • Rapid/Smooth transportation over large distances
    • Predominantly used in rural areas
    • Used mainly for trauma Pt’s
    • Also used for interhospital transport of critically ill/seriously injured Pt’s
• EMT/AEMT-staffed EMS
  • Professional and Volunteer (majority)
  • Provide preclinical treatment of minor injuries/diseases
• EMS Providers
  • Wiener Rettung – Vienna EMS
    • Managed/funded by city board since 1938
    • 12 stations throughout Vienna
    • NAW & NEF response vehicles utilized
  • Austrian Red Cross
    • In 2003, 427 EMS stations provided close 2,000 ambulances 24h/day
    • 108 MD-staffed stations (72 NAW, 53 NEF)
    • Majority of EMTs are volunteer and at basic level (<10% professional)
  • Arbeitersamariterbund (ASB)
    • 36 stations in Austria
    • Majority provide EMT-staffed ambulances only, and are primarily volunteer
  • Johanniter
  • Malteser

Lead Agency

Funding

• Most funding comes from:
  • Fees for services
    • Paid for by regional social insurances
  • Contributions from states
  • Federal Gov’t (partly)
  • Donations
• All organizations, except Vienna EMS, are dependant on volunteer work

Level of Care and Education/Training

• Lay providers – minor emergencies
  • Professional and Volunteer
  • Basic EMT – “Rettungssanitäter”
    • 260h – theoretical and practical
      • BLS
      • Defibrillation
      • First Aid
      • Basic CPR
      • Oxygen and BVM
      • Blood Pressure
      • Pulse Oximetry
  • Advanced EMT – “Notfallsanitäter”
    • 480h – theoretical and practical (in-hospital)
    • Work with MDs or independently
      • Fluid Administration
      • Tracheal Intubation
      • Pharmacotherapy
  • Zivildiener
• Physicians – major emergencies
  • Only board-certified MDs with at least 3yrs of postgraduate training are eligible
    • 60h training
    • ALS
    • Specialties
      • Neurology
      • Pediatrics
      • Obstetrics
    • Followed by 1 month of practical training:
      • Anesthesia Department
      • Coronary Care Unit
      • Surgical Department
    • Oral, Written, Practical Exams
    • Eligible for Notarzt (Emergency Physician) degree, and can subsequently work in ground EMS
• Austrian Resuscitation Council (ARC):
  • Established as interdisciplinary overhead org that provides special resuscitation training for active Emergency MDs

Medical Direction

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Specialty Services

• HEMS
  • Originally organized by Ministry of Interior with private institutions
  • 2001 – System is privatized, provided by Austrian Automobile and Touring Association (ÖAMTC)
    • 15 stations with 24 helicopters statewide
    • HEMS MDs need 4yrs ground experience, and most are specialists in anaesthesia, critical care, trauma or internal medicine.
    • HEMS paramedics are all certified at advanced level
• Public Access Defibrillation – introduced in 2001

Public Access Numbers

• 144 or 112 – toll free
• Call typically goes to nearest EMS station
  • Mobile phones present difficulties
• Dispatchers
  • Responsible for coordinating transport and care
  • Determine appropriate mode of transport
    • Physician-staffed ambulance/helicopter
    • Paramedic-staffed ambulance for first aid and transport
    • Transport car to bring Pt to hospital
    • General practitioner to visit Pt at home
  • Can provide first aid instructions
• Since 2002, majority of systems use centralized dispatch center
  • In Vienna, dispatcher is emergency physician

Emergency Medicine

• Emergency physicians provide prehospital care only
  • ERs (“shockrooms”) are run by physicians of various specialties
• Trauma PTs – diagnosed and stabilized in ER, and then transferred to OR or ICU
• Medical PTs – stabilized in ER or transferred directly to specialty ward
• Patients requiring higher level of definitive secondary care may be transported to secondary facility
  • Transports are typically handled by MD-staffed HEMS

Disaster

References

• https://www.cia.gov/library/publications/the-world-factbook/geos/au.html
• Wenniger P, Hertz H, Mauritz W: “International EMS: Austria.” Resuscitation 2005;65:249-54.