Emergency medical services in Spain

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Emergency Medical Services in Spain (Servicios de Emergencias Médicas, SEM) (EMS) are public services usually provided by regional Governments.[1]

Catalonia EMS. ALS Ambulance

Organization[edit]

Spanish organization for medical emergencies is a Public Health Integrated EMS (IEMS) that has a network of SAMU/IEMS Medical Emergency Regulation Centers (MERC = SAMU in international appellation). Emergency Primary Care and GP are fully integrated in Spanish IEMS.

Spain has 17 autonomous communities with 17 regional Health Departments. The National Health System is the agglomeration of these 17 Health Departments. So each autonomous community has its own regional IEMS that depend on Regional Health Department. Some EMS have their own staff and vehicles, others outsource the vehicles and staff to private companies. Public EMS departments usually outsource the vehicles and BLS staff. ALS staff are usually government employees.

In addition, some cities have local EMS too (e.g. SAMUR-Madrid).

There are also Emergency Medical Services in some fire departments: cities of Barcelona, Sevilla, Valencia, Zaragoza, Malaga, Bilbao, and Catalonia community.In these EMS work doctors and nurses with firefighters in advanced life support (ALS) ambulances or helicopters.

Furthermore, non-profit organizations (Spanish Red Cross, DYA) and Civil Defense Groups provide ambulances (usually BLS) with volunteers for some situations (disasters, mass incidents, special events: sports, concerts,...)

Standards[edit]

National Minimum Staff Requirements[edit]

New legislation was published in June 2012.

Type Old Royal Decree 619/1998[2] New Royal Decree 836/2012[3] Comments
Type A: Patient Transport Ambulance A driver and an assistant(*), when the type of service so requires A driver (and an assistant when the type of service so requires), both with a PCP(**) (Professional Certificate of Proficiency for Emergency Technicians) (*)Before the new legislation was enacted each region had their own training requirements for drivers and assistants: Courses from 60 to 600 hours (TTS, ATA, TEM, first aid courses...)

(**)This is a certificate for employees who worked before the development of the new national qualification of EMT-B (TES)

Type B: BLS Ambulance (Basic Life Support Ambulance) A driver and at least one other person with appropriate training(*) 2 EMT-B (TES), one of them a driver (*)Before the new legislation was enacted each region had their own training requirements for drivers and technicians: Courses from 60 to 600 hours (TTS, ATA, TEM...)
Type C: ALS Ambulance (Advanced Life Support Ambulance) A driver, an emergency physician and an emergency nurse An EMT-B/driver and an emergency nurse (and a physician when the type of service so requires)

Usual types of ambulances and their staff[edit]

Spanish EMS is a physician led system with physicians, emergency nurses and technicians in the field. It's a two-tiered response system (Advanced Life Support with physicians and nurses,[4] and Basic Life Support with technicians).

Staff
Type Spanish term Physician Emergency Nurse EMT (driver included) Comments
ALS Ambulance (Advanced Life Support Ambulance or MICU) Ambulancia de SVA / UVI móvil
1
1
1-2
-
ALS/ILS Ambulance (Advanced/Intermediate Life Support Ambulance) Ambulancia de SVA / SVI / SVE
0
1
1-2
Newly created/only in some regions
BLS Ambulance (Basic Life Support Ambulance) Ambulancia de SVB
0
0
2 (sometimes 3)
-
Non-Caring Ambulance Ambulancia no-asistencial
0
0
1-2
EMT-B certificate or Professional Certificate of Proficiency for emergency technicians is mandatory since June 2012
HEMS (Helicopter Emergency Medical Service) Helicóptero de Emergencias Médicas
1
1
0 (sometimes 1)
+1 or 2 pilots

In addition there are fast vehicles (non-ambulance) for emergency interventions:

  • RRU (Rapid Response Units / VIR: Vehículo de Intervención Rápida), staffed by a driver/technician and a physician (sometimes an emergency nurse).
  • Logistics and communications vehicles for disasters.

Training[edit]

Profession Level of education Years Postgraduate Education Level of skills
Emergency Physician (Médico de Emergencias) University (Degree in Medicine) 6 years Master of Emergency Medicine (1–2 years), Medical Specialty (4–5 years): Cardiology, Anesthesiology, Family Medicine, Intensive Care Medicine,... ALS
Emergency Nurse (Enfermero de Emergencias) University (Degree in Nursing) 4 years Master of Emergency Nursing (1–2 years) -optional in several regions. Nursing Specialty (2 years) (currently developing): Community nursing, Medical/Surgical Nursing,... ILS/ALS
EMT/Emergency Medical Technician (EMT-basic) (TES/Técnico en Emergencias Sanitarias) Vocational/Community college (since 2007) 2 years - BLS+AED
Patient Transport Assistant, Patient Transport Technician, rescuer, life guard (Auxiliar de Transporte Sanitario, Técnico de Transporte Sanitario, socorrista) Non official education before 2007/Private courses/Red Cross Courses 4–8 weeks - First Aids

Before 2007 there was not a national standard for EMT (TES/Técnico en Emergencias Sanitarias) education, so each region had their own rules (courses from 60 to 600 hours or sometimes only a first aid course; no reciprocity between regions; different terms: TTS-Técnico de Transporte Sanitario, ATTS-Auxiliar de Transporte Sanitario, ATA-Auxiliar de Transporte en Ambulancia, TEM-Técnico en Emergencias Médicas,...). Since 2007 there is a 2 years training occupational course (vocational-Community College)[5]

Telephone number[edit]

Madrid 112 Emergency Call Center Building

The emergency dial is 112 (European Emergency Number).[6] in all regions. However, the emergency number for medical services, 061, is available in several regions.

In Spain, the emergency dispatch is a physician regulated system. Each region has its own emergency call center with phone operators (telefonistas), emergency medical dispatchers (gestores de recursos/coordinadores/locutores), medical-regulators (physician) and sometimes nurses.

Curiosities[edit]

In Spain, the law (motor vehicle code) only allows the police vehicles to use blue lights. Ambulances and fire engines have to use amber lights. However some ambulances use red/amber, white/amber, blue/amber, blue/red lights although this is illegal. In 2006, the Spanish Parliament approved a motion to amend the law, but the motor vehicle code has not changed yet.[7]

See also[edit]

Sources[edit]

External links[edit]