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GENERAL
Capital – Athens
Land Size –131,957 sq km
Population – 10,749,943
Language(s) – Greek 99% (official); Other 1% (includes French & English)

OVERVIEW

  • “Before 1985, healthcare was mostly in private hands or provided by the Red Cross and the Samaritans” (Papaspyrou, 255).
  • Ethniko Systime Ygeias (ESY):
    • National Healthcare System founded in 1985
    • 140 public hospitals; 36,400 beds, 23,000 MDs
  • Private sector still plays significant role in healthcare
  • 2/3 of country composed of mountains
  • Large population live on islands

 

HISTORY

  • First Aid station situated next to Parliament in Athens established in 1915 – “Sotir” (Saviour)
  • 1932-1988 – Hellenic Red Cross founded several first aid stations with own ambulances Athens, Thessaloniki and Patras
  • 1965 – Social Insurance Institute (IKA) created first aid stations with own ambulances in parallel with Samaritans
  • 1975 – Center for Emergency Care (KAB) founded within Athens General Hospital
    • “166” – Access Number
    • Different numbers for Hellenic Red Cross and IKA
  • 1986 – Personnel and Equipment of IKA and Red Cross first aid stations merged into KAB
    • “166” became common access national telephone number
  • Ethniko Kentro Amesis Boitheias (EKAB) – Greek EMS
    • Est. 1987 by national law (1985)
  • Major Advantages:
    • Free of charge for all citizens
    • MDs involved at all levels
    • Education considered especially important part of improving quality of treatment for Pt’s
      • Public Institution for vocational training
      • Large number of educational programs offered as continuing vocational education

 

EMS SYSTEM MODEL

  • Structure:
    • Central Offices in Athens with 11 other regional stations in major cities
      • Cover 96.2% of urban population
      • Each station has own:
        • Personnel
        • AdministrationCommunication
        • Dispatch Centers
        • MDs and EMTs
        • Ambulance Cars
        • Medical Equipment
  • Operations: Two-tier system
    • In 5 major cities, motorcycles staffed with either EMT (BLS/AED) or one MD and one Paramedic
      • Used to improve provision of rapid medical care
      • Introducing motorcycles to  larger cities where traffic is contributing to longer response times
  • Two types of Ambulances:
    • Basic:
      • Majority in use
      • Staffed by EMTs
      • Equipment:
        • Simple Airway Equipment and Suction
        • First Aid Equipment for Wound Management/Immobilization
        • IV access kit
        • Oxygen
        • AEDs (soon)
    • MICU
      • Staffed by MD and EMT
      • Equipment:
        • Advanced Airway equipment
        • Pulse Oximeters
        • Ventilators
        • Manual Defib w/3-lead ECG
        • Non-invasive TCP
        • IV access
        • Fluids/Drugs
        • Various Immobilization Devices
          • Thessaloniki EMS
            • CPAP
            • Difficult Airway mgmt
            • Surgical Chest Drainage

 

 

 

 

 

 

 

LEAD AGENCY

 

FUNDING

  • Funded entirely by national government

 

EDUCATION AND TRAINING

  • 1987 – Training Center established
    • Education centers founded at almost all EKAB stations
    • Also offer Continuing Training Courses for RNs, EMTs, MDs and others; PHTLS, BLS/AED
    • Government-funded; Free of charge
  • EMT-Basic:
    • training program introduced under regulation of Ministry of Health (1989)
      • 1yr; 1000h teaching
        • Ax of critically ill
        • Triage
        • Rx
        • Basic Airway mgmt
        • BLS
        • CPR
        • Wound mgmt
        • Immobilization of fractures/spine
        • Reassessment
        • Safe transport
    • As of 2000 – more advanced education instituted for EMTs
      • 2yrs; 1400h: 800h theory; 600h  clinical/field
        • Anatomy & Physiology
        • Infectious Diseases
        • Pharmacology
        • Common Emergencies
        • Rx protocols and algorithms
        • Comm Systems and Technologies
        • ALS
        • IV access techniques
        • ECG-monitoring
        • Manual Defib
        • Disaster Mgmt
        • Safe Driving
        • English/Computer Training
  • Prehospital Physicians
    • 1995 – 1yr; 400h training course for MDs in prehospital emergency medicine
      • 75h classroom
      • 25h workshops
      • 300h clinical
        • ED, ICU, Anesthesia, NICU, Coronary Care, OB, MICU
    • Diploma awarded
    • Course free of charge

 

SPECIALTY SERVICES

  • HEMS
    • 3 helicopters
      • Owned by Ministry of Health
      • Operated by Air Force (who have additional helicopters and airplanes)
    • 96% of transports come from islands

 

PREVENTION

  • Committee for Safe Driving (Ministry of Health)
    • Works in cooperation with EKAB Sector for prevention of accidents
    • Gathers information on all types of accidents
    • Proposes preventative measures

 

DISPATCH

  • 112 (166) common access national telephone number; covers almost all of Greece
  • All EKAB stations have own dispatch centers
    • Equipped with:
      • Telephone Center
      • Radio
      • Computer network for data entry and processing
  • Dispatchers:
    • All receive EMT, communication technology, triage and protocol/algorithm application training
    • One to answer calls from public, another to communicate via radio with units in the field
    • Prioritize according to need
    • Give instructions to public and EMTs
    • Decide transport destination
    • Communicate with destination hospital (in cooperation with and under supervision of EKAB MDs on-call)
    • In disaster, center is responsible for communication and coordination with other institutions (FD, PD, Military)

 

EMERGENCY MEDICINE

  • No Emergency Medicine specialty in Greece
    • Emergency Medicine Society recently founded
  • Emergency Pt’s are sorted into surgical or medical emergencies and treated by appropriate specialists
  • Anesthetists immediately involved in life-threatening situations
    • Further specialists called to ED depending on case
  • 2003 – law passed governing organization and operation of EDs in public hospitals with >200 beds
    • Will function as independent departments and staffed by specialist MDs with emergency medicine experience

 

DISASTER

  • Special division of EKAB for disaster medicine
    • Domestic and international deployment capabilities

 

REFERENCES

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