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[How long does it
take for an ambulance to arrive?]
Tidsskr Nor Laegeforen 2001 Mar 20;121(8):904-7
added 12/31/01
[Article in Norwegian]
Steen-Hansen JE, Folkestad EH.
AMK/Ambulanseseksjonen Avdeling for anestesiologi Sentralsykehuset i Vestfold,
Tonsberg Postboks 2168 3103 Tonsberg. jesh2@online.no
BACKGROUND: There are few Norwegian recommendations for quality and
efficacy of ambulance performance. A report commissioned by the Ministry of
Health and Social Affairs concluded that the ambulance service was the weakest
link in the chain of survival. The report proposed standards for response
intervals in emergencies: 90% of the population in cities and urban areas should
be reached by an ambulance within eight minutes. In rural areas, 90% should be
reached within 25 minutes. MATERIAL AND METHODS: This study describes the
ambulance response interval for the 2,589 red code emergencies in the 15
municipalities in Vestfold County in 1998, a county with a population of
208,687, or 97.5 inhabitants per square kilometre, with seven ambulance
stations. A retrospective analysis was made of data for the year 1998. RESULTS:
The proposed standard was not reached in any municipality in the county. The
city of Tonsberg had the best performance, but even here only 48.9% of the
population were reached by ambulance within eight minutes. The worst performance
was found in the rural municipality of Tjome; here, only 63.3% were reached
within 25 minutes. INTERPRETATION: Achieving the standards proposed will
require a major restructuring of existing ambulance services.
Am J Emerg Med 2000 Nov;18(7):828-32
Wright SW, Stack LB, McMurray BR, Bolyukh S.
Department of Emergency Medicine, Vanderbilt University Medical Center,
Nashville, TN 37232, USA. seth.wright@mcmail.vanderbilt.edu
The practice of emergency medicine in Ukraine is markedly different from the
practice in North America. The emergency physician counterpart in Ukraine
attends 6 years of medical school then 18 months of prehospital physician
training at an EMS base station. Once trained, prehospital physicians work 160
hours/month in 24-hour shifts at the base station as part of a physician-nurse
team which answers ambulance requests. Most patients are seen and treated on
site of the ambulance call. Patients are transported to the hospital only 20% of
the time. Prehospital physicians can expect to earn $35 to $65 per month. Nearly
all prehospital physicians are government employees. Since becoming an
independent democratic republic, Ukraine's turbulent economy has negatively
affected health care. Deaths from infectious diseases, including
vaccine-preventable illnesses are 10-fold to that of Western countries. A 90%
income tax discourages the private practice of medicine. Medical care is
provided free of charge, however, if a patient wants a higher standard of care,
they may have to pay an attending physician up to $200. Most medications used to
treat emergencies are free, but if thrombolytics are required, the patient will
have to pay for them before they are administered. Budgetary constraints limit
equipment and technology. The disparity between urban and rural resources is
striking as even the most basic equipment is antiquated and in need of repair.
Despite the economic challenges facing Ukranian physicians, they are
enthusiastic about the care and services they provide. EMS is well organized and
offers services not seen in the United States. Prehospital physicians in Ukraine
are viewed as an integral part of the health care system by their hospital-based
colleagues