[accordion] [acc_item title=”General”] Capital – Lisbon
Land Size – 91,470 sq km
Population – 10,735,765
Language(s) – Portuguese (official), Mirandese (official – but locally used)
[/acc_item] [acc_item title=”Prehospital Care Overview”]

  • “Relatively recent achievement … starting in Lisbon in the late 1980’s” (Gomes 257)
    • Spread rapidly to most urban centers across country
    • Not uniform throughout country
  • Health care is mostly a public service funded mainly through taxation.
    • “Health subsystems and insurance companies are charged retrospectively for the medical service delivered” (Gomes, 257)
  • Most components of system adopted from French ‘SAMU’ Model

Madeira Floods, Feb. 20, 2010; ©Simon Zino – via Flickr
[/acc_item] [acc_item title=”History”]

  • 1965 – First EMS system started in Lisbon
    • Staffed with unpredictably trained crew (usually consisting of policemen)
  • 1971 – National Ambulance Service created
  • 1980 – National integrated EMS system implemented
    • National Institute for Emergency Medicine (INEM)
      • Governmental organization directly responsible to Ministry of Health
      • Responsible for delivery of all aspects of prehospital emergency care across country
      • Funded principally by government and partially by insurance companies
        • 1% of all monies spent on health, vehicle and accident insurance transferred to INEM
    • 1987 – First dispatching center specifically created for EMS in Lisbon
    • 1989 – First physician-staffed ALS vehicle
  • 2004 – EMS covers 75% of population with 4 dispatching centers and 21 physician-staffed vehicles
[/acc_item] [acc_item title=”EMS System Model”]
  • Franco-German
  • Most components of system adopted from French ‘SAMU’ Model
  • Not possible to activate full chain of resources in rural areas presently
    • Call transferred to nearest ambulance service if coming from area not served by Dispatching Health Center (CODU) – usually police- or fire-based
      • Ambulance with two BLS providers sent

©Michael Agostinho – via Flickr
[/acc_item] [acc_item title=”Levels of Care”]

  • Hospital-Based Rapid Intervention Vehicle
    • Sent when ALS is required
    • Staffed with MD and RN (driver)
      • Manual Defibrillator
      • 12-lead ECG
      • Advanced Airway Mgmt
      • Suction
      • O2 Therapy
      • Fluids
      • Fracture Immobilization
      • Pharmacotherapy
      • Vital Signs Monitor
      • Portable Automatic Ventilator
  • Ambulance Centers
    • Staffed by two trained BLS responders
      • BLS and Rescue Equipment
[/acc_item] [acc_item title=”Education and Training”]
  • Most personnel are volunteer (weakness)
  • Three levels of care:
    • Basic First Responders: typically police and fire service personnel
      • Basic First Aid and BLS
      • 40h of training
    • National Standard Ambulance Technician
      • Staff all INEM ambulances
      • 210h of training
        • BLS
        • Uncomplicated obstetric delivery
        • Basic Wound Mgmt
        • Spine/Fracture Immobilization
        • O2 administration
        • Pt Extrication
        • Transport
    • Medical Team: MD and RN
      • Highest level of prehospital care capabilities
      • Anesthesiologists most common
        • MDs, surgeons and general practitioners
      • RNs from ED, ICU or OR
      • National Minimum Curriculum and Addt’l Training
        • 74h for MDs
        • 104h for RNs (addt’l 40 is driving)
      • All are able to deliver ALS, PALS, ATLS
[/acc_item] [acc_item title=”Medical Direction”]
  • All 112 medical calls transferred to Dispatching Health Center (CODU) from police dispatch
    • Dispatcher technician completes questionnaire under supervision of regulating MD
      • Non-urgent: Advice is given, no team sent
      • Urgent: Vehicle sent staffed by MD and RN
        • Helicopters in specific situations
      • Urgent, Non-Life Threatening: Ambulance with two technicians
    • Pt transported to most appropriate hospital (with MD and RN if necessary)
    • Receiving hospital contacted by CODU with clinical details
[/acc_item] [acc_item title=”Public Access Numbers”]
  • 112 – free common telephone number to access all emergency services (Fire, police, EMS)
[/acc_item] [acc_item title=”Emergency Medicine”]
  • No national standards for hospital EDs
    • Individual institutions determine the organization of their departments
    • Increasing awareness that this is unsatisfactory, optimism that common structure will emerge in near future
  • Rarely have own medical staff
  • Physical structure and organization varies considerably between hospitals
  • Close relationships between EDs and EMS
    • Bypass protocols for Coronary Disease, Stroke and Trauma for more appropriate facilities
[/acc_item] [acc_item title=”Future Aims”]
  • Meet rise in demand
  • Investment in training and technology required for extension of EMS skills
    • Exceptional Situation Intervention Teams
      • Group of MDs, RNs, Psychologists, Ambulance Technicians and Planning Experts in MCIs
  • Process of continuous Quality Improvement concerning:
    • Optimization of Protocols
    • Databases
    • Training Standards
  • Improving shortfalls/deficiencies of EDs
    • Full-time involvement of medical staff with emergency medicine training
    • Use of specific Triage Models
      • “Manchester Triage System”
[/acc_item] [acc_item title=”References”] [/acc_item] [/accordion]
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