Erika Frischknecht Christensen
Emergency Medicine in Denmark
Erika Frischknecht ChristensenAss. Professor
Dept. Anesthesiology & Intensive Medicine Aarhus University Hospital
Medical Director Prehospital CareCounty of Aarhus
Denmark
Erika Frischknecht Christensen
Denmark
• Population: 5.4 Mio.• Area: 43.000
km2
• Density: 125 /km2
• Home of the VikingsAND:• Greenland• Population: 57.000 • Area: 410.000 mio
km2 - 0.1 per km2
Erika Frischknecht Christensen
Denmark
Geography• 407 islands • 7300 km coast
line
• Copenhagen 1.1 mill. inhab.
Population and life length • Men:74.5 years • Women: 79.2
years
• 0-9 years: 12%• 70+ years: 11%
Erika Frischknecht Christensen
Burden of diseases
Major causes of morbidity and mortality:• Cancer: 25% of deaths• Heart diseases: 25% of deaths• Cerebrovascular diseases: 12%• Chronic obstructive pulmonary
diseases: 10%• Leading cause age 1-45 years: Trauma
Erika Frischknecht Christensen
Medical education
• Health science at 3 universities• Study: six years• Postgraduate clinical training:• 1 ½ years basic • 4 ½- 6 years in specialty• Process evaluation• Certificate by regional and national
authority
Erika Frischknecht Christensen
Health Care system - Denmark
• Public regional health care system:
• 14 counties and Capital • 64 somatic hospitals and 20.800
beds in somatic hospitals (2000)
• 1 mio admissions/year• Expected to be more centralized
Erika Frischknecht Christensen
Health Care system - Denmark
• Public health insurance• Good primary health care
system:• 4.5 mio contacts to general
practioners• General practioners: gate
keepers
Erika Frischknecht Christensen
Emergency Medicine in 14 Danish Counties
• Population 4.2 Mio (out of 5.3)• GP visits in daytime: 29 Mio• GP on call: 2.7 Mio • A&E visits: 1.1 Mio • 112-call ambulances: 250.000• All increased by 5-10% since
1996
Erika Frischknecht Christensen
Accident & Emergency Dept.
• EM not a specialty• Many, and several small hospitals• Run by Orthopedics • 90% injuries, 10% medical emergencies• Life-threatening cases and critical care:
anesthesiologists in and ouside hospital • 4 Level-1 Trauma Centers at University
Hospitals
Erika Frischknecht Christensen
Emergency care in hospital
A&E:Accidents - InjuriesSelf-referralsAmbulances
Orthopedic, GPSurgeonAnesthesiologistRadiologist
Other EmergenciesFrom the GPsAmbulancesSelf-referrals
Internist, CardiologistAnesthesiologistSurgeon,Gynaecologis
tPediatrics etc
Erika Frischknecht Christensen
Pre-hospital emergency care
• Defined by law:• Ambulance personell:
– Level 1: basic life support– Level 2: BLS+ symptomatic relief:– NTG, broncodilator, diazepam etc– Level 3: BLS+medication for ALS
• One level 2 EMT on each ambulance• Medical director in each county
Erika Frischknecht Christensen
Pre-hospital emergency are • 112 calls: police
• Alarm central Denmark: 7 regions• Dispatch center: ambulance services
• Major ambulance services: • Copenhagen Firebrigade • Group 4 Falck• Contracts with each County
Erika Frischknecht Christensen
Physicians = Anesthesiologists in
Prehospital CareExperienced and
trained in• Airway• Breathing• Circulation• Pain treatment
Erika Frischknecht Christensen
Endotracheal intubation in the field
1998-2000 Aarhus
• 14.000 calls • 75% medical
emergencies• 370 patients,
intubated on scene
• Majority after anaesthesia
Erika Frischknecht Christensen
Physicians in prehospital Care
• Physicians in cars as rendez-vous, dispatched to 10 % - 35% calls– Covering 25-30% of population
• Expanding