Przemyslaw Zuratynski1, *Daniel Slezak1, Kamil Krzyzanowski1, Rafal Szczepanski1, Sylwia Jaltuszewska2
State Medical Emergency System in Poland
Państwowy System Ratownictwa Medycznego w Polsce
1Emergency Medical Rescue Laboratory, Department of Emergency, Faculty of Health Sciences, Medical University of Gdansk, Poland
2Department of Medical Rescue, Institute of Health Sciences, Pomeranian Academy in Slupsk, Poland
Pierwsze pogotowie ratunkowe w Polsce powstało w 1891 roku w Krakowie. Wiele wskazówek oraz pomocy odnośnie powstania pogotowia udzielili organizatorzy pierwszego w Europie pogotowia (pogotowia wiedeńskiego istniejącego od 1883 r.). Od stycznia 2007 roku obowiązującym aktem prawnym jest Ustawa z 8 września 2006 roku o Państwowym Ratownictwie Medycznym. Celem ustawy jest wprowadzenie funkcjonowania systemu ratownictwa medycznego, zarówno poprzez wysoki poziom udzielania świadczeń zdrowotnych opierających się na obowiązujących standardach państw zachodnich, jak i zapewnienie żądanych rozwiązań w obszarze powiadamiania o stanach nagłych. System Państwowe Ratownictwo Medyczne powstał, by zapewnić pomoc każdej potrzebującej osobie, która znajduje się w stanie nagłego zagrożenia zdrowotnego. Dysponent jednostki systemu PRM musi zapewnić gotowość ludzi, zasobów i jednostek organizacyjnych. Jednostkami systemu PRM udzielającymi świadczenia wyłącznie w razie stanu nagłego zagrożenia zdrowotnego są zespoły ratownictwa medycznego, w tym lotnicze zespoły ratownictwa medycznego oraz szpitalne oddziały ratunkowe.
The first ambulance service in Poland was established in 1891 in Cracow. Many tips and assistance concerning the creation of the ambulance were provided by the organisers of the first ambulance in Europe (the Vienna ambulance in 1883). Since January 2007, the Act of 8 September 2006 on the National Medical Rescue Service has been a binding legal act. The aim of the Act is to introduce the functioning of the emergency medical system, both through a high level of health services based on the standards of Western countries and providing the required solutions in the area of emergency notification. The State Medical Rescue System was established to provide assistance to any person in need who is in a state of health emergency. The owner of the PRM system unit must ensure the readiness of people, resources and organizational units. The units of the PRM system providing services only in case of an emergency are: medical rescue teams, including airborne medical rescue teams and hospital emergency departments.
It is the duty of the public administration to have system solutions appropriate to each type of threat. Sudden illnesses and injuries have always accompanied people and every day ways to prevent them have been sought. The most important task of the state is to take medical actions against persons in acute health threats; the State Medical Emergency System (PRM) has become the main entity responsible for pre-hospital care (1). Delayed assistance, in severe health emergency, practically does not provide chances for survival. Safe transport under the care of qualified personnel ensures the maintenance and stabilization of basic life functions with the implementation of appropriate medical rescue procedures. The destination of further assistance and the unit of the PRM system is the hospital emergency department (SOR).
The history of medical rescue in Poland
The first ambulance service in Poland was established in 1891 in Cracow. Many tips and assistance concerning the creation of the ambulance were provided by the organisers of the first ambulance in Europe (the Vienna ambulance in 1883). The ambulance was located in the building of the Fire Brigade, where the assigned premises included an outpatient clinic, waiting room, and a room for students of the Jagiellonian University Medical Faculty. The Cracow Voluntary Rescue Society had one sanitary ambulance harnessed by two horses with five stretchers. The Society’s symbol was a white cross on a blue background. Since 1904, the first paid volunteer duty was introduced, but it was not until 1911 that doctors were also included. In 1908, the ambulance already had four ambulances, a folding armchair, seven accident trunks and four pairs of stretchers. The Cracow Voluntary Rescue Society ended its activity in 1950, but a few months later it settled in the Health House, where it remained until 1977. Then the ambulance changed its location again, but finally to its own building, where it functions until today (2). Shortly after the establishment of the Krakow ambulance unit, ambulance stations were also established in Lwow in 1893, Warsaw in 1897, Lodz in 1899, Lublin in 1917, and Poznan in 1928. These institutions were independent, had legal personality, and were financed from social contributions, social insurance fees, donations, own funds, and city grants. They provided 24-hour and free assistance in all emergencies (3). In 1919, the Polish Red Cross Society (PTCK) was established. Its members provided assistance to the war wounded, ran many medical facilities, as well as ambulance stations. Rescue teams were also established, sanitary training was conducted and missing persons were searched. In the years 1948-1951 the health care infrastructure (30 hospitals, 280 health clinics and 177 ambulance stations) was taken over from the Polish Red Cross by the government and handed over to the Ministry of Health. The administrative authorities divided the ambulance stations into: municipal, county and provincial ones, in which there were away teams, as well as stationary ambulatories. In 1951, the Minister of Health issued the first document after the war, which defined the principles of sanitary transport. After the administrative reform of the country in 1976, a new instruction concerning the framework organization of Provincial Sanitary Transport Columns (WKTS) was created. Units were established as independent budgetary units created in each voivodship, subject to the competent voivode. In the years 1990-1999, the WKTS continued to be organisational units of a budgetary and provincial scope. They ensured the fulfilment of transport needs for the whole health service. The budget was defined for a given year in accordance with the Budget Act, and transport tasks were performed within the framework of these resources. In 1992, the Ministry of Health purchased 80 modern ambulances, which were transferred free of charge to the WKTS in particular voivodships. Since then, it was possible to carry out rescue operations when the victim was transported to hospital. In 1989-1999, due to the lack of legal regulations and a certain amount of financial resources, the functioning of these units left much to be desired. It can be concluded that in those years, there was no medical rescue system in Poland guaranteeing the provision of specialist assistance necessary to save the life and health of citizens (2). The process of establishment of the State Medical Rescue System was carried out in many stages. The concept of the present system dates back to the 1990s. Poland, following the experience of other countries, undertook further initiatives aimed at creating a fully modern and integrated PRM system. In 1999, the Health Policy Program “Integrated Medical Rescue” was implemented, which was planned for the years 1999-2003. The most important goal of the Program was both to prepare qualified medical personnel and infrastructure, as well as to develop procedures for proper functioning of the medical rescue system throughout the country. In 2001, the programme was divided into six task packages, the main links of which included the creation of rescue notification centres (CPR), hospital emergency wards or a network of ambulances (2). A great breakthrough in the creation of the State Medical Rescue System was the first act on the State Medical Rescue passed on July 25, 2001, although it regulated many issues only briefly (4). The act marked the beginning of a new era in the development of emergency medical services in Poland. However, its dysfunctionality resulted in new solutions. The works on amendments lasted until September 6, 2006; on October 12, 2006, the President of Poland signed the Act on Medical Emergency Services (3). According to the Act of September 8, 2006 on the National Medical Rescue Service (5), the system includes: medical rescue teams (ZRM) – using the land (ambulances), air (Air Rescue – LPR/HEMS) and waterways, as well as hospital emergency departments. The ambulances are operated by specially trained rescue teams, which are part of the integrated system saving human life (6). The medical rescue in Poland has undergone dynamic changes over the years. Initially, the personnel and equipment were not as qualified as nowadays; therefore, the mortality rate among people assisted under the system was much higher.
The Legal Acts of the State Medical Rescue in Poland
Since January 2007, the Act of 8 September 2006 on the National Medical Rescue Service (5) has been in force. The aim of the act is to introduce the functioning of the medical rescue system, both through a high level of health services based on the current standards of Western countries and to provide the required solutions in the area of emergency notification (3). The executive act to the act in the area of requirements concerning the personal composition of medical rescue teams and their equipment is the Regulation of the Minister of Health of August 28, 2009 on guaranteed emergency medical services (7). The act describes the guaranteed emergency medical services and the conditions of their provision (8). As of 1 January 2014, the Act of 22 November 2013 on the Emergency Notification System (9) governing the technical functioning of the system entered into force, which provides for the separation of the function of receiving emergency calls from the function of disposing of rescue resources. The assumption of the system is the functioning of professional Rescue Notification Centres handling all emergency calls according to the same procedures (10). The accepted and qualified call in the CPR was forwarded to the appropriate rescue service, which, thanks to the information received, deals with disposal of appropriate forces and resources. A very well-trained emergency number operator in the CPR should collect relevant information related to the call to shorten the time of the assistance process (11). Another legal act which entered into force over two years ago (20 May 2014) is the Regulation of the Minister of Administration and Digitization of 28 April 2014 on the organisation and functioning of emergency call centres (12). It defines the positions of the centre’s employees, requirements concerning the premises and technical equipment, and in particular, it regulates the uniform way of handling the emergency notification, including the conversations with the notifying party, passing this notification to the services which dispose of, decide on and send rescue resources (13). The legal provisions concerning the State Emergency Medical System are regulated by the above mentioned legal acts, thanks to which the system should function efficiently.
Units of the State Medical Emergency System in Poland
The State Medical Rescue System was established to provide assistance to any person in need who is in a state of emergency. The owner of the PRM system unit must ensure that people, resources and organizational units are ready. The units of the PRM system providing services only in the case of an emergency are: emergency medical rescue teams, including airborne medical rescue teams and hospital emergency departments (5).
Emergency Medical Services Team
The Act of 8 September 2006 on the National Medical Rescue Service allowed for the establishment of a uniform medical rescue system in Poland, with the same standards of both personnel and equipment. According to art. 36 of this act, “Emergency medical rescue teams are equipped with a specialized means of sanitary transport, meeting the technical and quality characteristics specified in the Polish Standards transposing European harmonised standards”. Rescue teams are divided into:
– Steam “S” – a specialist team consisting of at least three persons authorized to perform medical rescue operations, such as: system doctor and system nurse or paramedic,
– “P” team – a basic team consisting of two persons qualified to perform medical rescue operations. This team has a means of sanitary transport, but it is not specified who should manage it. However, it is not forbidden to employ an additional person to the team for the position of a driver; for economic reasons, this function is performed simultaneously by one of the two rescuers (8, 14).
However, if none of the persons mentioned in the medical rescue teams has the B driving license and does not meet the conditions specified in art. 95a sec. 1 of the Act – Road Traffic Law, the ZRM must additionally include a driver (1, 15). Organisational arrangement of rescue teams must ensure the following parameters of the time of arrival at the incident site from the moment of acceptance of the notification by the emergency call centre:
– the travel time median – on a monthly basis is no more than 8 minutes in a city with more than 10,000 inhabitants and 15 minutes outside the city with more than 10,000 inhabitants,
– the third quartile of travel time – on a monthly basis is no more than 12 minutes in a city with more than 10,000 inhabitants and 20 minutes outside the city with more than 10,000 inhabitants,
– the maximum time of travel cannot be longer than 15 minutes in the city with more than 10,000 inhabitants and 20 minutes outside the city with more than 10,000 inhabitants (16).
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