You can get the same medical care in a small town as in the megapolis. Principles of Emergency Medicine in Sweden
We often write about international experience and medical systems in other countries. Our instructors have become mediators who share the knowledge and experience of the West with the fighters in the East during training. They are a bridge between two worlds: a world where human life is the greatest value and a world where this truth is yet to be fully understood.
In this article, we have tried to show how emergency medicine is organized in Sweden. Senior Instructor at “Patriot Defence” Glib Bityukov who was trained at the Regional Dispatch Center in Gothenburg in Sweden in November 2015 helped in this.
Sweden is one of the Scandinavian countries and has a population of roughly nine million people. The leading cause of morbidity and mortality is cardiovascular disease. However, the overall health status of the population is good, with an average life expectancy of 77.5 years for men and 82.1 years for women. Sweden has a large elderly population: approximately 18% of its inhabitants are over the age of 65.
The Swedish healthcare system is predominantly publicly owned with 90 public hospitals, several private clinics and 950 regional primary care clinics. Sweden currently practices the ‘multidisciplinary’ model of emergency medicine.
Patients are triaged according to both the nature of their complaint and the acuity of their illness to hospitals with emergency departments, which are staffed by specialists from differing fields. Hospitals are developing residency programs modelled after the European curriculum for emergency medicine.
Emergency medicine. Origin and basic principles
Modern emergency medicine in Sweden had its origin in the mid 1990’s, as healthcare personnel re-evaluated the overall efficacy of emergency medical care. Dispatch of ambulances is controlled by a regional dispatch center, which may also coordinate fire and rescue calls.
Dispatch centers are subdivided administratively. Stockholm’s dispatch center is the largest in Europe, and can function as a command center in case of disaster. The average response time is approximately seven minutes to the scene. Ambulance personnel are trained in basic cardiopulmonary resuscitation and defibrillator use. For calls that are triaged as critical, mobile coronary care cars may be dispatched to the scene allowing a registered nurse to deliver more advanced care in the field. These nurses have additional training in anesthesiology and advanced cardiac life support.
Public health system of this country is very similar to the Ukrainian one. They also do not have paramedics in the ambulance. There are nurses and doctors in the ambulance. In Germany and Great Britain, on the other hand, ambulances have paramedics. Nurses work only at hospitals.
Here each service has its role in the emergency response. Personnel in ambulances provide care and transport victims, rescuers are involved in the epicenter of the disaster, getting to the scene and taking victims to the safe place. Police department personnel ensure the establishment of a safe outer perimeter, collect and share the information.
The main task of the rescuers is to deliver the patient to the hospital as soon as possible. In Sweden, some part of the population lives in sparsely populated areas of the North. Sometimes it is too difficult to evacuate people from there, but there exists a strong principle: even if you live in a small town, you can get the same medical care as in the megapolis. Even on small islands there are helicopters and boats ready to take the victims to the mainland 24 hours a day.
Senior Instructor at “Patriot Defence” Glib Bityukov was trained at the Regional Dispatch Center in Gothenburg in Sweden, which coordinates 60,000 workers of different rescue services. If necessary, they work in small teams and are trained by guest instructors. Glib Bityukov with a team of international colleagues was also trained with the help of MacSim training system.
Training simulation system MacSim
The dispatch center receives a call from the coast, where terrorists took over the hotel. The closest ambulance is marked on the conventional map. In 10-15 minutes the ambulance is on the scene, rescuers and police follow.
Training system MacSim, designed by Swedish and British experts, covers all phases from the time when the accident happened until hospitalization of victims. Training takes place in real time. All the participants work on different stages of providing medical care according to their profession. Gleb, for example, worked in the prehospital care phase.
By coordinating their actions rescue teams indicate the area where the emergency happened, the place where the police officer will be standing, how the traffic will be controlled, the place where the victims will be lying, where they will be triaged, where will be those who should be immediately taken into an ambulance, and those whose state is not critical. If, for example, a helicopter is available, its location must be indicated beforehand.
Then rescue teams work with victims. Each ambulance has a ‘check list’ and sequence of actions in case of mass injuries. This is a list of what is necessary to do, what and who to notify. The first ambulance that arrives on the scene deals with coordination, the second ambulance deals with the triage of the injured and only the third ambulance provides care to the patients and transports them to the hospital. There are several hospitals. Under the terms of the game, there are certain places that are coordinated by a dispatch center, which decides who goes where and chooses transportation procedure.
Triage system has a single algorithm worldwide. Wounded are classified as mild, moderate, severe and the deceased. Sweden also added a category of people who are alive, but their injuries are incompatible with life. They can die while transporting in the ambulance or during the first hour at hospital. These are people who, for example, suffered from large-area burns.
‘If you are looking at this system from the side, you realize that all of the victims are being turned into numbers. You see a man with burns of more than 40% body surface area and you put a black sticker on the card. Then you put cards of the deceased on a separate board and that becomes simple statistics’ - Glib shares his training experience. ‘This life, which becomes mere numbers, impresses you. On the other hand, this makes it possible to pay attention to what usually slips your attention and to analyze your mistakes’.
Generally, this system was developed for training of dispatch center officers who coordinate the work of all services in case of emergencies with many victims. It is also a mirror of how the system works in Swedish Emergency Medicine today.