[accordion] [acc_item title=”General”] Capital – Vilnius
Land Size – 62,680 sq km
Population – 3,545,319
Language(s) – Lithuanian (official) 82%; Russian 8%; Polish 5.6%; other/unspecified 4.4%
[/acc_item] [acc_item title=”Overview”]

  • Ÿ63 EMS stations
    • 265 day teams; 210 night teams
  • ŸSuggested RTs of 15min Urban; 30min Rural
    • Achieved in Urban areas, but difficult in rural
  • ŸBypass policy not operated
    • Pt info passed to dispatch center but Pt usually transported to nearest hospital
  • ŸMICUs available for inter-facility transport
  • Ÿ“The worse feature of the pre-hospital system … is the lack of standard operating procedures” (Vaitkaitis, 331)
    • MDs on-board in bigger cities
    • Clear need for SOPs and Protocols to improve quality of care, particularly in rural areas.
  • ŸBiggest problem is “physician-on-call” mentality of population
    • 1/3 of all calls are non-emergency
      • Ambulance services doing work of family doctors
  • ŸAEDs can be used by laypersons and use is not regulated by law
    • No implementation of national program for public use of AED
  • ŸFormal obligations for first aid and laypersons
    • 12h first aid training is legally binding for persons applying for driver’s license
    • 18h course for Police, FD and military personnel
      • Courses delivered at public health centers, driving schools and Lithuanian Red Cross
[/acc_item] [acc_item title=”History”]
  • Ÿ“Concept of Ambulance Services”
    • Standards for EMS system adopted by Ministry of Health in 2002
    • Required changes in whole EMS systems:
      • Re-equipment of ambulances
      • Establishing paramedics
      • Developing EDs at hospitals
[/acc_item] [acc_item title=”Lead Agency”]
  • ŸMinistry of Health
[/acc_item] [acc_item title=”Funding”]
  • ŸEmergency care is free of charge
    • Financed from Compulsory Health Insurance Fund (CHIF) and Government (for citizens w/o health insurance)
    • CIHF
      • Main source of health care financing
      • Constitutes 90% of all public sector expenditure on health
[/acc_item] [acc_item title=”Levels of Care”]
  • ŸAmbulance Crew consist of 2 or 3 persons
  • ŸMDs and RNs are clinical staff
    • Regular MD allowed to work with ambulance services
      • Does not have permission to perform medical procedures
    • Licensed Specialty MDs typically employed in ambulance services in bigger cities
  • ŸRural areas – most teams consist of RN/Feldsher and Driver
    • Feldsher – “Field Barber”, RNs qualified to perform certain medical procedures
      • Soon expected to be replaced by Emergency RNs
    • Driver – 12h or formal First Aid training
      • Soon expected to be replaced by Paramedics
  • ŸCurrently no national curriculum/standards in prehospital care for RNs/MDs
    • National Medical Qualifications not defined
    • Formal Certification (i.e. ALS) not mandatory
    • Ministry of Health recently issued national standard for Paramedics in ambulance service including medical competence requirements
[/acc_item] [acc_item title=”Education and Training”]
  • Ÿ2008 – Univ. Hospitals are planning to start residency programs for emergency MDs
  • ŸBasic emergency procedures formally included in study programs of all medical schools
    • All students are trained in BLS and First Aid procedures
    • ALS training available as continuous medical education according to international standards
    • Run by medical societies, NGOs and private companies
  • ŸLegislation being prepared to introduce paramedics into ambulance services.
    • 1000h of training
    • According to the National Concept of Ambulance Services, paramedics should replace ambulance drivers in near future.
[/acc_item] [acc_item title=”Specialty Services”]
  • Ÿ“In general only ground ambulances are available” (Vaitkaitis, 330)
    • Air Force participates in SAR operations
      • 5 large military helicopters available
      • Also available for donor organ transplantation
        • Medical Crews with ALS level
    • Need for HEMS under debate because country is mostly low-lying with hospitals usually w/in a 50km radius
[/acc_item] [acc_item title=”Dispatch”]
  • ŸDecentralized dispatch system
  • ŸEach ambulance center has own 24h dispatcher
  • ŸExperienced RNs answer calls, advise Pt’s and send ambulance if necessary
    • Consulting MDs may give phone consultation in larger cities
[/acc_item] [acc_item title=”Public Access Numbers”]
  • ŸThree separate phone numbers for emergencies:
    • ŸRescue Services (01)
    • ŸPolice (02)
    • ŸAmbulance Services (03)
      • 112 – Common access emergency number (free of charge)
      • ŸFunded by CHIF
[/acc_item] [acc_item title=”Emergency Medicine”]
  • ŸMajority of country hospitals serve populations of less than 60,000
    • Results in “insufficient case load to maintain full emergency services” (Vaitkaitis, 331)
  • Ÿ“Until 2005 there was no national system for in-hospital organization of emergency departments” (Vaitkaitis, 331)
  • ŸMinistry of Health recently set out requirements for EDs
    • Majority of EDs still only able to carry out functions of admission/registration
    • Very restricted capabilities in terms of provision of urgent procedures in emergency cases
      • Emergency care provided on wards and ICU
        • Resuscitation referred to ICU
        • Trauma referred to Surgery
        • Urgent Cases (Internal Bleeding) referred direct to OR
      • Acute specialists provide consultation in EDs
      • Less complicated cases cared for by:
        • Internist (medical)
        • Surgeon/Orthopedic-Traumatologist (Surgical/Trauma)
        • Anesthesiologist-Reanimatologist (Major Trauma/Life-threatening)
      • Consultations with different specialists can be time-consuming
  • ŸNo current national grading of trauma centers exists
    • One hospital (Kaunas Univ. Hosp.) meets international criteria for Level I trauma center
      • Specialties needed in one hospital for trauma care are often spread between number of hospitals
      • Results in increased interfacility transfers
  • Ÿ“Emergency medicine expected to become established as separate medical specialty in Lithuania, possibly by 2008” (Vaitkaitis, 331)
[/acc_item] [acc_item title=”References”] [/acc_item] [/accordion]
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