سیستم های EMS بین المللی : کشورهای اسکاندیناوی

Emergency medicine service (EMS) systems in the five Nordic countries have more similarities than differences. One similarity is the involvement of anaesthesiologists as pre-hospital physicians and their strong participation for all critically ill and injured patients in-hospital. Discrepancies do exist, however, especially within the ground and air ambulance service, and the EMS systems face several challenges. Main problems and challenges emphasized by the authors are: (1) Denmark: the dispatch centres are presently not under medical control and are without a national criteria based system. Access to on-line medical advice of a physician is not available; (2) Finland: the autonomy of the individual municipalities and their responsibility to cover for primary and specialised health care, as well as the EMS, and the lack of supporting or demanding legislation regarding the EMS; (3) Iceland is the only country that has emergency medicine (EM) as a recognised speciality but there is a need for more fully trained specialists in EM; (4) Norway: the ordinary ground ambulance is pointed out as the weakest link in the EM chain and a health reform demands extensive co-operation between the new health enterprises to re-establish a nation-wide air ambulance service; (5) Sweden: to create evidence based medicine standards for treatment in emergency medicine, a better integration of all part of the chain of survival, a formalised education in EM and a nation wide physician staffed helicopter EMS (HEMS) cover.

The Nordic countries encompass Scandinavia (Denmark, Norway, Sweden) together with Iceland and Finland. This region shares some common geographical, climatic and historical phenomena making it natural to give a united account of the Emergency Medical Service (EMS) system. The EMS system in this region has gone through major changes during the last few years and has common features, but also obvious diversities. The EMS system for some Nordic cities and counties has been described previously [1], [2], [3], [4] and [5] but a mutual national description has not been given before. We give a collective update of the EMS system in the five Nordic countries.

The Nordic EMS systems have more similarities than differences. One similarity is the involvement of anaesthesiologists as pre-hospital physicians [43]. Discrepancies do exist, however, especially within the ground and air ambulance service, and the EMS systems face several challenges. At the moment, Iceland is the only country that has EM as a recognised speciality. Various fora have been established to exchange ideas and co-operation within the Nordic countries, such as the Nordic Trauma Forum, Scandinavian Resuscitation Council, the Scandinavian Society for Disaster Medicine, and the Northern Hypothermia Network. These bodies arrange on a regular basis, meetings and congresses, and may also be suitable to discuss some of the common problems and future challenges within the Nordic EMS systems.