Overview A European Standard for Paramedic Practice – A Pipe Dream or an Achievable Reality? n The need for paramedics n Personell Situation n Educational Situation n Education in the „future“ n Practice in the future n Goals
Prof. Christoph Redelsteiner, PhDr.
www.rallye-rejviz.com
Comparison Overview n Berlin, Hamburg, Munich n Zurich n The need for paramedics n Praha n Personell Situation n Budapest n Educational Situation n Bratislava n Education in the „future“ n Lubljana n Practice in the future n Belgrad n Goals n Pristina n Vienna n Venice n ….
„Professions“ in European Overview Emergency Medical Services n The need for paramedics n Driver n Personell Situation n Attendant Societal triggers n Ambulance Attendant n Educational Situation n Emergency Medical Technicians n Rescue Assistants n Education in the „future“ n Paramedics n Practice in the future n Registered Paramedics n Rescue Officers n Goals n Registered Nurses n Physicians e.g. small family n Ambulance Physicians n Emergency Physicians structures n > 10 Cave: no common terminology
1 No common definitions, no common skill levels Austrian EMT Law 2002
Class Hospital EMS Hours of Total hours hours hours EMT level hours AA-B 100 - 160 260 260
AA-B 40 - - 300 300 career EMT-A 160 40 280 480 900-940
EMT-IV 50 40 - 90 990-1030
EMT-ET 30 80 - 110 1600-1640
Redelsteiner, Christoph (2009): Präklinische Notfallversorgung durch unterschiedliche Professionen. Ein Vergleich von in der rettungsdienstlichen Versorgung eingesetzten Berufsgruppen.Rigorosumsarbeit an der St. Elisabeth Universität für Gesundheitswesen
Condensed National Condensation Kosovo, Bosnia, Serbia
n Ambulance Attendant _ PL, CZ, SK, UA, HR, E, B, P, I,… n Paramedic NL, S?, FIN, N n Nurse n Medical Doctor Amb A, D, F
n MD with Emergency Specialization UK
n = highest training level that serves as a regular tier Rescue Officer (+ Emergency Physician H Redelsteiner, Christoph (2009): Präklinische Notfallversorgung durch unterschiedliche of EMS response Professionen. Ein Vergleich von in der rettungsdienstlichen Versorgung eingesetzten Berufsgruppen.Rigorosumsarbeit an der St. Elisabeth Universität für Gesundheitswesen
„Commonalities“ of the professions Trends „Commonalities“ of the professions
n ALS interventions not performed by the offically n Lack of MD, RN ⇒ Paramedicsystems n High variation of quality responsible persons n Professional Migration East ⇒ West n …also within singular service n n Nomenclatur / Terminology unprotected and legal scope of practice unfounded for „paramedical“ n Increased Professionalisation leads to Reduction of professions de facto ALS, de jure BLS ~ Team Partner Training Degree unstandardized RN, Registered Paramedics ⇒ Driver n standards of treatment similar (on paper) n Titel of profession, Type of training do not correlate with - scope of practice - amound of training
2 Educational System University Educational System University Entrance Entrance Overview University Diploma University Diploma Entrance Entrance n Diploma Reg. Diploma The need for paramedics Vocational Vocational Vocational Nursing 3 Vocational Gymnasium Gymnasium n Personell Situation Trade Gymn- Vocational- Trade Gymn- Vocational- school 4 5 school 4 5 Training 3 asium 4 Training 3 asium 4 n Educational Situation Polyt. 1 Polyt. 1 n Education in the „future“ Middle- Middle- Secondary Secondary n Practice in the future school 5 Gymn- school 5 Gymn- School 4 School 4 asium 4 asium 4 n Goals – achievable?
Elementary Elementary School 4 School 4
Educational System University Entrance University Diploma University System University System Entrance Reg. Diploma Vocational Nursing 3 Vocational Ambulance Gymn- Vocational- Gymnasium Att. Trade school 4 5 PhD 3 PhD 3 Training 3 asium 4
Polyt. 1 Postgradual Masters 2 Postgraduale Masters 2
Middle- Masters 2 Nursing Science Masters 2 Secondary school 5 Gymn- Medicine Midwifery School 4 Bachelor Bachelor asium 4 Ergotherapy 3 3 Physiotherapy..
Elementary School 4
University System Master of Science in Overview Emergency Health Services n The need for paramedics Emergency Medical Service Management n Personell Situation PhD 3 manager n Educational Situation Postgraduale Masters 2 Nursing Science Masters 2 n Education in the „future“
Medicine Midwifery n Practice in the future Ergotherapy Bachelor 3 Physiotherapy.. n Goals
3 Make the field and profession Checklist Training attractive! Standard for the future Applies for all colours
n Broader and not only tasked oriented aquisation of knowledge -> think and act in standards and variations
n Education and not only Employability
n Regular training model and not „Sidemodel“
n Permeability between health care professions
Duration of Training in Years Duration of Training in Years / 4 University System Medical Doctor 6 Medical Doctor 6 Socialworker 5 Socialworker 5 Midwife 3 Midwife 3 Emergency Emergency Medical Service Physician PhD 3 manager Nurse 3 Nurse 3 Firefighter 1 Firefighter 1 Postgradual Masters 2 Health Care Masters 2 Psychologist 5 Psychologist 5 Medicine Paramedic Race Car driver ? Race Car driver ? Bachelor Nursing Science 3 Manager 6 Manager 6 Midwifery,… Mechanic 3 Mechanic 3
„Paramedic“ 32 years „Paramedic“ at least 7 years
EMS Education on Overview EMS Hardware Bachelor Level n The need for paramedics Road Ambulances European Standards n Hungary > Bachelor CEN 1789 Vehicles + equipment n Personell Situation n Slovakia CEN 1865 Stretchers + patient n Educational Situation handling equipment n Czech n Education in the „future“ n Poland (§ = ?) n Practice in the future n United Kingdom n Goals – achievable? n Netherlands? Air Rescue Standards Jarops n Germany? Austrian Standard ON S 4132 Helicopters ON S 4130 n Switzerland? Definitions, Requirements, Equipment
4 Berlin, 2008: Standardized care concepts? MIRIPCC Multiple Institutionspecific Regional n ITLS/PHTLS - ATLS Individual Patient Care Concepts n ILCOR ERC ACLS sometimes great regional concepts n AMLS
n EPLS, PLS,…. common training? Common procedures? n MIRITVK Comparable - case # great enough ? Supervising institution ?
The clinical view Foundation of clinical judgement The best case 83 EMS Calls per MD p.a. in Germany 9,7% cancelled / no patients
75 Calls 28 % Trauma n = 21
? The prehospital x-ray view? Cave: Hospital = Prehospital
The best and worst case?
Redelsteiner, Christoph (2009): Präklinische Notfallversorgung durch unterschiedliche Redelsteiner, Christoph (2009): Präklinische Notfallversorgung durch unterschiedliche Professionen. Ein Vergleich von in der rettungsdienstlichen Versorgung eingesetzten Professionen. Ein Vergleich von in der rettungsdienstlichen Versorgung eingesetzten Berufsgruppen.Rigorosumsarbeit an der St. Elisabeth Berufsgruppen.Rigorosumsarbeit an der St. Elisabeth Universität für Gesundheitswesen Universität für Gesundheitswesen
5 Skills - ? Overview
n The need for paramedics n Release on scene after certain indications (e.g. Headache, thoracic pain,…) n Personell Situation n n Death certificate Educational Situation n n General anaesthesia with RSI Education in the „future“ n n Chest tube Practice in the future n Goals n Surgical Tracheotomy n Central Venous Access
New roads into the future Options for the Future
n Accept reduced level of care n Telemedicine n Higher integration of nursing and ambulance work n Higher involvement of ?? Paramedics, nurses, family doctors as -> Gatekeepers n ………
Needs and rights of patients Status quo EMS
m Do callers get phone instructions to deliver first aid ? m Do high priority patients get the closest and the appropriate high ambulance? degree m Is care provided according to ERC, AMLS…guidelines? m Do patients get treatment against pain? of variation m Are patients admitted to hospitals with simple illnesses / injuries due to lack of skilled prehospital screening? m Are basic data such as response times measured and publicly available (Freedom of Information)
Redelsteiner, Christoph (2009): Präklinische Notfallversorgung durch unterschiedliche Professionen. Ein Vergleich von in der rettungsdienstlichen Versorgung eingesetzten m …… Berufsgruppen.Rigorosumsarbeit an der St. Elisabeth Universität für Gesundheitswesen
6 EuroPass Emergency Paramedicine 2020+ Paramedic
Professor Scientific Director Emergency Department Health Services Management • Common symbol Health and Social Work Program, Danube University Krems • Common definitions • Common indicator set/data for EMS Systems • Harmonized provider training in EC Mag. PhDr. Christoph Redelsteiner M.Sc. in Emergency Health Services • Duty to register providers • Applied minimumun standards of care [email protected]
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