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  1. SCIENTIFIC NETWORKING AND THE GLOBAL HEALTH SUPERCOURSE FOR THE PREVENTION OF THREAT FROM MAN MADE AND NATURAL DISASTERS August 8-11 2005, Kaunas, Lithuania Emergency preparedness in the Baltics Dinas Vaitkaitis Kaunas University of Medicine Lithuanian Society for Emergency Medicine

  2. Topics • Background info • Risks • Emergency management • Emergency services • Education and training

  3. THE BALTICS

  4. Background info • Geography/Demographics/Economy Sources: WHO, CIA

  5. Differences Estonia and Latvia - 66% located on 33% of territory, rest of the population very sparsely situated

  6. Natural disasters: floods forests’ fire stormy winds drought Man-made disasters: nuclear disasters chemical disasters traffic accidents terrorism and war infections DISASTER RISKS

  7. 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

  8. Risk of nuclear disasters • 1994 Tammiku, Estonia • Cs-137 from dump • 3 persons irradiated 1 person died

  9. Risk Vecumnieki 1999

  10. Risk Kemeri 1999

  11. Risk 28 September 1994 989 people on board 138 rescued

  12. Explosion in shopping centre “Centrs”(RIGA, 17 August ,2000) 1 cilvēks miris slimnīcā 30 cilvēki cietuši Multitrauma, neirotrauma izolēti skeleta bojājumi apdegumi

  13. DISASTER MANAGEMENT LEVELS IN LITHUANIA • National (country) level • Regional (county) level • Local (municipality) level

  14. 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

  15. DISASTER MANAGEMENT LEVELSREGIONAL LEVEL • Regional Authority • Regional Emergency Management Center • Regional Warning and Information Service • Civil Protection Services

  16. 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

  17. EMERGENCY MANAGEMENT SYSTEM IN HEALTH CARE SECTOR

  18. 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

  19. COUNTY LEVEL County hospitals (60) Public Health Centers (11) MUNICIPALITY LEVEL Municipality hospitals (50) Branches of Public Health Centers (39) HEALTH CARE ORGANIZATION LEVELS IN CASE OF DISASTER:COUNTY AND MUNICIPALITY LEVELS

  20. Emergency services in Lithuania • Fire and Rescue Services • Police • Ambulance Services / Hospitals

  21. 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

  22. 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.

  23. 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

  24. All three services • planning • helping with information to the relatives, public and the mass media • co-operation

  25. 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

  26. Training

  27. Training www.acls.kmu.lt

  28. Training

  29. Training • EmergoTrain – system, Lithuanian version

  30. Large scale exercises

  31. 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

  32. 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

  33. 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.

  34. Estonian EMS - resources available • There are 87 EMS teams in 46 geographic locations

  35. 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

  36. 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

  37. 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

  38. AmbulanceServicesin Latvia 52 Ambulance stations in 70 localization points 173 teams –day time, 143 – night time

  39. 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

  40. 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

  41. Catchment area LV-EE Valmiera- Pärnu Catchment area LV-LT Jelgava- Siauliai International co-operation(“Disasters do not know borders”) Neighbouring countries: cross - border co-operation

  42. Acknowledgements • Mārtiņš Zuteris • Raul Adlas • Ursel Kedars • Ago Kõrgvee

  43. Thank you!