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Emergency preparedness in the Baltics

Dinas VaitkaitisKaunas University of Medicine

Lithuanian Society for Emergency Medicine

SCIENTIFIC NETWORKING AND THE GLOBAL HEALTH SUPERCOURSE FOR THE PREVENTION OF THREAT FROM MAN MADE AND NATURAL DISASTERS

August 8-11 2005, Kaunas, Lithuania

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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

LT LV ESTGeographic 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

Geography/Demographics/Economy

Sources: WHO, CIA

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Differences

66% located on 33% of territory,rest of the population very

sparsely situated

Estonia and Latvia -

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DISASTER RISKS

Natural disasters:

floods forests’ fire stormy winds drought

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

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

Risk of nuclear disasters

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RiskVecumnieki 1999

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Kemeri 1999

Risk

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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 cilvēks miris slimnīcā30 cilvēki cietuši

Multitrauma, neirotrauma izolēti skeleta bojājumi

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 LEVELS

NATIONAL 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 LEVELS

REGIONAL LEVEL

Regional Authority Regional Emergency

Management Center Regional Warning and

Information Service Civil Protection Services

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DISASTER MANAGEMENT LEVELS

MUNICIPALITY 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

GOVERNMENT Emergency Management Commission Emergency Management Center

MINISTRY OF HEALTH Disaster Management Center Health Emergency Situation Center

COUNTY ADMINISTRATION County Emergency Management Center County Doctor’s Institution

MUNICIPALITY ADMINISTRATION Municipality Emergency Management Center Municipality Doctor’s Institution

County level hospitals

State level hospitals

Municipality level

hospitals

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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

Radiation Protection Center

Centre of Communicable Diseases Prevention and Control

Public Health Services Institute of Hygiene

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

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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”)

Catchment area LV-LT

Jelgava- Siauliai

Catchment area LV-EE Valmiera- Pärnu

Neighbouring countries: cross - border co-operation

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Acknowledgements

Mārtiņš Zuteris Raul Adlas Ursel Kedars Ago Kõrgvee

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Thank you!