Emergency medical services in Italy: Difference between revisions
→Dispatch of Emergency Mobile Resource and medical regulation of the Italian IEMS SAMU 118: shorter section title |
→Organization: ~~~~ |
||
| Line 4: | Line 4: | ||
[[Image:Modena ambulance.jpg|thumb|left|An ambulance and its crew in Modena, Italy]] |
[[Image:Modena ambulance.jpg|thumb|left|An ambulance and its crew in Modena, Italy]] |
||
[[Emergency medical services]] are under Public Health Authorities control in each sanitary in Region of [[Italy]], |
|||
| ⚫ | |||
| ⚫ | The ambulance subsystem is provided by a variety of different sources.<ref>The Italian organisation of Medical Emergencies is not an EMS in the US sense of the term. It is an Public Health and Medical Professionals Integrated Emergency System (IEMS) managed by Sanitary Regional Authorities and not only an prehosital anglosaxon EMS . It has a similar organisation to other neighbouring European countries' IEMS. Its Medical Regulation of Emergencies Regional Center is called SAMU 118 in international terminology.</ref> The method of delivery can vary considerably from one location to another. In some locations, responsibility for the provision of EMS has been undertaken by the local hospital, while in others, services may be provided by a range of [[volunteer]] organizations, such as the [[Italian Red Cross]] (Croce Rossa),<ref>{{cite web|url=http://www.cri.it/pages/get?cat=VSNEW&n=1&sec=VOS&type=news|title=Italian Red Cross Rescue Volunteers|accessdate=2009-01-18}}</ref> ANPAS (National Association for Public Assistance),<ref>{{cite web|url=http://www.anpas.org/SitoA/sitoA/connect.asp?xsl=home.xsl|title=National Association for Public Assistance|accessdate=2009-01-18}}</ref> other associations known as "Cross" (''Croce''), followed by a colour (White Cross, Green Cross, Yellow Cross), and by private companies displaying a blue cross. Some organizations, such as hospitals, often provide a single type of service, such as [[neonatal]], while leaving others to provide the balance of services. How the service is actually provided, and the level of service that is provided, is driven in large measure by what the community can afford. [[Air ambulance]] services are normally provided by a network of dedicated helicopters, or as an added service from a number of other government agencies, including the Italian [[Coast Guard]], [[Civil Defence]], and the [[Carabinieri]]. |
||
The Hospital anfd Primary Care emergencies subsystem are integrated in this IEMS. |
|||
==Standards== |
==Standards== |
||
Revision as of 08:30, 8 October 2010
Emergency medical services in Italy currently consist primarily of a combination of volunteer organizations providing ambulance service, supplemented by physicians and nurses who perform all advanced life support (ALS) procedures. The emergency telephone number for emergency medical service in Italy is 118.
Organization
Emergency medical services are under Public Health Authorities control in each sanitary in Region of Italy,
The ambulance subsystem is provided by a variety of different sources.[1] The method of delivery can vary considerably from one location to another. In some locations, responsibility for the provision of EMS has been undertaken by the local hospital, while in others, services may be provided by a range of volunteer organizations, such as the Italian Red Cross (Croce Rossa),[2] ANPAS (National Association for Public Assistance),[3] other associations known as "Cross" (Croce), followed by a colour (White Cross, Green Cross, Yellow Cross), and by private companies displaying a blue cross. Some organizations, such as hospitals, often provide a single type of service, such as neonatal, while leaving others to provide the balance of services. How the service is actually provided, and the level of service that is provided, is driven in large measure by what the community can afford. Air ambulance services are normally provided by a network of dedicated helicopters, or as an added service from a number of other government agencies, including the Italian Coast Guard, Civil Defence, and the Carabinieri.
The Hospital anfd Primary Care emergencies subsystem are integrated in this IEMS.
Standards
Staffing
.jpg)
How ambulances are staffed is determined to some extent by the location, and by the resources available to the community. For the most part, Italy follows the Franco-German (as opposed to Anglo-American) model of EMS service delivery.[4] The basic model consists of Basic Life Support ambulances, Advanced Life Support ambulances, Modified Advanced Life Support ambulances, and physician cars called Automedica. BLS units are typically volunteer-based and operate in rural locations. Crews consist of a minimum of two EMTs called soccorritore (one of them is a dedicated driver called autista); it is not uncommon to find three- or four-EMTs ambulance crews. ALS units are more likely to be found in larger centers, are more likely (but not always) to be staffed by paid, hospital-based staff, and are physician-led.[5] Some rural areas and smaller centers use a modified approach to ALS, with a volunteer crew supplemented by a nurse who is permitted to perform some ALS procedures. The top end of the spectrum is a rapid response unit, staffed by a physician (usually an emergency physician or anesthetist) and a critical care nurse.
Training
There is a great deal of variation in the training of EMS personnel in Italy, where no distinction is made between voluteers and paid EMTs. Non-emergency services (such non-critical patient transports) use purely volunteers, who are required to have 20 or 40 hours of BLS training;[6] all EMTs must have 120 hours of training, attending an additional 80- or 100-hour course. Italian EMTs are able to provide non-invasive prehospital care, including PBLS, PTLS and automated external defibillation.[6] In many regions EMTs are also trained to execute a 12 lead ECG, which will be transmitted to the hospital, where a cardiologist can examine it before the arrival of the patient.
That being said, many Italian volunteers take their commitment very seriously, and participate in many hours of uncompensated training. This is particularly true for well-organized volunteer groups, such as the Italian Red Cross. In most cases, their response to serious emergencies will often be supplemented by a car with an emergency physician and nurse, the only means of providing ALS service. These individuals still require support from a physician and nurse for ALS provision. While there are some ALS ambulances in Italy, they are typically not found outside larger centers, and in many cases, where they do exist, they are frequently required to have the 'emergency' physician present to perform ALS skills, in a manner very similar to the German model. Nurses are required to have a critical care background. Physicians are typically specialists in some field of medical specialty, often internists, surgeons or anaesthetists, although this background is not strictly required. Emergency medicine is only now becoming slowly recognized as a medical specialty inside the hospital in Italy,[7] and there are no real plans to create a subspecialty for pre-hospital care. Poor compensation and hours of work have reportedly resulted in a relatively high turnover rate among physicians in the system.
Vehicles
Vehicles used as ambulances in Italy comply with most aspects of the European standard for ambulances, CEN 1789, as issued by the European Committee for Standardization.[8] The visual identity provisions of the standard are not yet being followed.
Ambulances are usually white-painted and have to display an orange and reflective stripe all around the vehicle, in addition to a star of life on each side and the word AMBULANCE reversed on the front. Each emergency ambulance have in addition to display the emergency number 118 and the name and the logo of the organization providing the service. The use of light and sirens is authorized by the central operations and dispatch room at the beginning of the response. Only blue flashing lights are permitted by law.
Italian Red Cross ambulances (identifiable also by the vehicle registration plates with the acronym CRI) are authorized to display a red stripe and a red cross instead of the orange stripe and the star of life.
Physician fly-cars have the same graphic elements of ambulances except for the front word AUTOMEDICA.
Dispatch and regulation
The entire system is coordinated and regulated by the 118 exclusive Medical Call Centers within an Integrated Public Health System organization and a Physician Regulated emergency call center. It is internationally called Samu 118, as in other countries. It operates in each of Italy's governmental regions and provides centralized regulation/dispatch, standards and guidelines for operation. Medical Doctor Regulators answer to emergency calls and choose the best-indicated emergency care mobile resource. Medical training for Regulation Assistants and Regulator Physicians is provided in some regions.[9][10]
Response time
Italy currently has a response time standard for urban areas of eight minutes or less for life-threatening emergencies. This standard is not currently being consistently met[9] since there is a great disparity in healthcare efficiency, depending on which region is being analyzed. Therefore, the law establishes a maximum response time of twenty minutes for exta-urban areas, such as isolated places.
See also
References
- ^ The Italian organisation of Medical Emergencies is not an EMS in the US sense of the term. It is an Public Health and Medical Professionals Integrated Emergency System (IEMS) managed by Sanitary Regional Authorities and not only an prehosital anglosaxon EMS . It has a similar organisation to other neighbouring European countries' IEMS. Its Medical Regulation of Emergencies Regional Center is called SAMU 118 in international terminology.
- ^ "Italian Red Cross Rescue Volunteers". Retrieved 2009-01-18.
- ^ "National Association for Public Assistance". Retrieved 2009-01-18.
- ^ Dick WF (2003). "Anglo-American vs. Franco-German emergency medical services system". Prehosp Disaster Med. 18 (1): 29–35, discussion 35–7. PMID 14694898.
- ^ Bertini G, Giglioli C, Rostagno C; et al. (1993). "Early out-of-hospital lidocaine administration decreases the incidence of primary ventricular fibrillation in acute myocardial infarction". J Emerg Med. 11 (6): 667–72. doi:10.1016/0736-4679(93)90624-G. PMID 8157902.
{{cite journal}}: Explicit use of et al. in:|author=(help)CS1 maint: multiple names: authors list (link) –see comment in
Pigman E, Smith M (1993). "Prehospital prophylactic lidocaine for uncomplicated acute myocardial infarction". J Emerg Med. 11 (6): 753–5. doi:10.1016/0736-4679(93)90637-M. PMID 8157915. - ^ a b "EMS City of Prague". Retrieved 2008-09-15.
- ^ Mitchell J (2005). "911 in Italy: Physician aids in overhaul of Tuscan emergency medical system". Tufts Journal.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ "European Committee for Standards website". Retrieved 2008-09-19.
- ^ a b "EMS Benchmarking in Europe" (PDF). Retrieved 2008-09-15.
- ^ ↑ (it)SAMU 118 da Italia [archive] in www.118italia.net. Italian Samu 118 Portal http://www.sis118.it/pagine/index.htm [archive] ↑ SAMU 118 di Liguria http://www.118italia.net/regioni/fr_regione.asp?IDReg=8 [archive] ↑ Samu 118 di Piemonte http://www.118italia.net/regioni/fr_regione.asp?IDReg=12 [archive] ↑ Samu 118 de Aosta http://www.118italia.net/regioni/fr_regione.asp?IDReg=19 [archive] ↑ SAMU 118 de Veneccia http://www.118italia.net/regioni/fr_regione.asp?IDReg=20 [archive]