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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%

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

FINANCING

  • 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

 

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

 

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

 

DISPATCH

  • 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

 

REFERENCES

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