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

Erika Frischknecht Christensen

EM in Denmark

• Challenges• and• Strategies• will be presented at the

meeting.