Emergency preparedness in the Baltics

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Emergency preparedness in the Baltics
SCIENTIFIC NETWORKING AND THE GLOBAL HEALTH
SUPERCOURSE FOR THE PREVENTION OF THREAT FROM MAN
MADE AND NATURAL DISASTERS August 8-11 2005,
Kaunas, Lithuania

• Dinas Vaitkaitis
• Kaunas University of Medicine
• Lithuanian Society for Emergency Medicine

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Topics

• Background info
• Risks
• Emergency management
• Emergency services
• Education and training

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THE BALTICS
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Background info

• Geography/Demographics/Economy

LT LV EST
Geographic size, th km2 65,3 64,5 45,0
Population size, M 3.6 2.44 1.5
GDP, bn 45.23 26.53 19.23
GDP, per person 12,500 11,500 14.300
of GDP spent on healthcare 5.2 5.1 5.1
Sources WHO, CIA
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Differences
Estonia and Latvia -

• 66 located on 33 of territory,
• rest of the population very sparsely situated

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DISASTER RISKS

• Man-made disasters
• nuclear disasters
• chemical disasters
• traffic accidents
• terrorism and war
• infections

• Natural disasters
• floods
• forests fire
• stormy winds
• drought

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IGNALINA NPP

• Two RBMK-1500 reactors since 1983 and 1987 one
  of them is still working
• 1,5 Billion kWh/month
• Personnel 3900 (April, 2003)
• day shift 2500
• night shift 230
• security service 530
• shelter for 800

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Risk of nuclear disasters

• 1994 Tammiku, Estonia
• Cs-137 from dump
• 3 persons irradiated 1 person died

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Risk
Vecumnieki 1999
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Risk
Kemeri 1999
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Risk
28 September 1994 989 people on board 138
rescued
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Explosion in shopping centre Centrs (RIGA, 17
August ,2000)
1 cilveks miris slimnica 30 cilveki
cietuši Multitrauma, neirotrauma izoleti skeleta
bojajumi apdegumi
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DISASTER MANAGEMENT LEVELS IN LITHUANIA

• National (country) level
• Regional (county) level
• Local (municipality) level

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DISASTER MANAGEMENT LEVELSNATIONAL LEVEL

• Government of the Republic of Lithuania
• Emergency Management Commission
• Emergency Management Center
• Civil Protection Department
• Ministries
• Emergency Management Centers
• Fire Department
• Health Emergency Situation Center
• Maritime Search and Rescue Center
• Air Search and Rescue Centre
• Other Governmental Institutions

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DISASTER MANAGEMENT LEVELSREGIONAL LEVEL

• Regional Authority
• Regional Emergency Management Center
• Regional Warning and Information Service
• Civil Protection Services

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DISASTER MANAGEMENT LEVELSMUNICIPALITY LEVEL

• Local Authority
• Local Emergency Management Center
• Fire and rescue Departments
• Local Warning and Information Service
• Business and Industry
• Civil Protection Services

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EMERGENCY MANAGEMENT SYSTEM IN HEALTH CARE SECTOR
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HEALTH CARE ORGANIZATION LEVELS IN CASE OF
DISASTER STATE LEVEL

• MINISTRY OF HEALTH
• DISASTER MANAGEMENT CENTER OF THE MOH
• HEALTH EMERGENCY SITUATIONS CENTER TO THE MOH

• Kaunas Medical University Clinics
• Vilnius University Hospital ,,Santariskiu
  Clinics
• Vilnius University Emergency Hospital
• Lithuanian Oncology Center
• VU Children Hospital
• VU Zalgirio Clinics (stomatol. surgery)
• VU Psichiatry Hospital
• Other special. hospitals

• Radiation Protection Center
• Centre of Communicable Diseases Prevention and
  Control
• Public Health Services
• Institute of Hygiene

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HEALTH CARE ORGANIZATION LEVELS IN CASE OF
DISASTER COUNTY AND MUNICIPALITY LEVELS

• COUNTY LEVEL
• County hospitals (60)
• Public Health Centers (11)

• MUNICIPALITY LEVEL
• Municipality hospitals (50)
• Branches of Public Health Centers (39)

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Emergency services in Lithuania

• Fire and Rescue Services
• Police
• Ambulance Services / Hospitals

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The Fire and Rescue Services

• rescue work
• protection of persons and property
• first aid at the accident site
• transportation of injured from the accident site
  to assembly area

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The police

• Coordination of work of all three emergency
  services at the accident site
• Protection of persons and property
• Traffic control
• Registration of the victims and bystanders.

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Health services

• Assessing injured and setting care priorities
• Life saving first aid measures near the accident
  site and while transporting victims to hospitals
• Medical transport
• Allocation of injured to different hospitals

63 Ambulance stations/services 265 teams day
time, 210 night time
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All three services

• planning
• helping with information to the relatives, public
  and the mass media
• co-operation

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Other services in the relief operations

• See search and rescue
• Under guidance of Captain of Klaipeda See-Port
• Rescue ship Šakiai
• Air search and rescue
• 7 helicopters of the Airforce
• Center of Aeronautics and Air Search
• Emergency Management Centers under guidance of
  Crisis Management Center

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Training
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Training
www.acls.kmu.lt
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Training
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Training

• EmergoTrain system, Lithuanian version

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Large scale exercises
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Education, research and training

• University studies of medicine at two
  universities (1 public health)
• Health faculties at five colleges
• Postgraduate training
• Exercises
• Emergency medicine research programme at Kaunas
  University of Medicine

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Organisation of Pre-hospital Emergency Medical
Care in Estonia

• Provided entirely by Emergency Medical Services
  with minimal involvement of GPs in rural areas
• There is no governmental body regulating the EMS
  activities nor is there any functioning legal
  framework governing the area

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• Union of Estonian Emergency Medical Services is
  a nonprofit organisation for EMS professionals
  (physicians, nurses and EMTs), devoted to quality
  of emergency medical care by providing training
  and guidance to its members, consulting the
  government in questions vital for the development
  of EMS etc.

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Estonian EMS - resources available

• There are 87 EMS teams in 46 geographic locations

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The qualification of EMS teams in Estonia

• 6 reanimobiles with anaesthesiologist on board
  (based in Tallinn and Tartu)
• 40 physician manned ambulances (generalists with
  training in EM)
• 41 teams lead by a specialist nurse
• All EMS teams consist of 3 members a doctor or
  a specialised nurse, a nurse and a driver trained
  as EMT

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Education and Training

• Undergraduate medical education
• Physicians - Tartu University
• Nurses - 3 schools (Tallinn, Tartu, Kohtla-Järve)
• Specialisation
• EM physicians in residency progam at Tartu
  University Hospital
• Nurses at Tallinn EMS
• EMTs at Tallinn and Tartu EMS, Centre of Disaster
  Medicine of Tallinn Mustamäe Hospital

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Medical disaster preparedness organisation in
Latvia

• State level - Ministry of Health
• Centre of Emergency and Disaster medicine
• Operative reserves
• District level - responsibility for preparedness
• Local level
• Ambulance Service
• Hospitals
• DM planning for each level

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Ambulance Services in Latvia
52 Ambulance stations in 70 localization points
173 teams day time, 143 night time
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EMS stay and play concept

• EMS teams in Latvia
• IT teams MD MD assistant driver (53day
  time/36 night time)
• EM teams MD assistant driver (123/110)
• Legislation demand 2 medical educated persons
  on each team

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EMS today

• Lack of co-ordination
• Border problems
• Management and dispatch problems (many dispatch
  centres)
• Different levels of accessibility of EMH
• Cities 15 minutes
• Country side 25-90 min.
• Lack of unitary communication system
• Personnel problems
• Different EM numbers

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International co-operation(Disasters do not
know borders)
Neighbouring countries cross - border
co-operation
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Acknowledgements

• Martinš Zuteris
• Raul Adlas
• Ursel Kedars
• Ago Kõrgvee

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Thank you!