Greece

General

Capital – Athens

Land Size –131,957 sq km

Population – 10,749,943

Language(s) – Greek 99% (official); Other 1% (includes French & English)

“Before 1985, healthcare was mostly in private hands or provided by the Red Cross and the Samaritans” (Papaspyrou, 255).
Ethniko Systime Ygeias (ESY):
- National Healthcare System founded in 1985
- 140 public hospitals; 36,400 beds, 23,000 MDs
Private sector still plays significant role in healthcare
2/3 of country composed of mountains
Large population live on islands

First Aid station situated next to Parliament in Athens established in 1915 – “Sotir” (Saviour)
1932-1988 – Hellenic Red Cross founded several first aid stations with own ambulances Athens, Thessaloniki and Patras
1965 – Social Insurance Institute (IKA) created first aid stations with own ambulances in parallel with Samaritans
1975 – Center for Emergency Care (KAB) founded within Athens General Hospital
- “166” – Access Number
- Different numbers for Hellenic Red Cross and IKA
1986 – Personnel and Equipment of IKA and Red Cross first aid stations merged into KAB
- “166” became common access national telephone number
Ethniko Kentro Amesis Boitheias (EKAB) – Greek EMS
- Est. 1987 by national law (1985)
Major Advantages:
- Free of charge for all citizens
- MDs involved at all levels
- Education considered especially important part of improving quality of treatment for Pt’s
  - Public Institution for vocational training
  - Large number of educational programs offered as continuing vocational education

Structure:
- Central Offices in Athens with 11 other regional stations in major cities
  - Cover 96.2% of urban population
  - Each station has own:
    - Personnel
    - AdministrationCommunication
    - Dispatch Centers
    - MDs and EMTs
    - Ambulance Cars
    - Medical Equipment
Operations: Two-tier system
- In 5 major cities, motorcycles staffed with either EMT (BLS/AED) or one MD and one Paramedic
  - Used to improve provision of rapid medical care
  - Introducing motorcycles to larger cities where traffic is contributing to longer response times
Two types of Ambulances:
- Basic:
  - Majority in use
  - Staffed by EMTs
  - Equipment:
    - Simple Airway Equipment and Suction
    - First Aid Equipment for Wound Management/Immobilization
    - IV access kit
    - Oxygen
    - AEDs (soon)
- MICU
  - Staffed by MD and EMT
  - Equipment:
    - Advanced Airway equipment
    - Pulse Oximeters
    - Ventilators
    - Manual Defib w/3-lead ECG
    - Non-invasive TCP
    - IV access
    - Fluids/Drugs
    - Various Immobilization Devices
      - Thessaloniki EMS
        
        CPAP
        
        Difficult Airway mgmt
        
        Surgical Chest Drainage

Ethniko Kentro Amesis Boitheias (EKAB) – Subordinate of Ministry of Health
- National Public Organization

1987 – Training Center established
- Education centers founded at almost all EKAB stations
- Also offer Continuing Training Courses for RNs, EMTs, MDs and others; PHTLS, BLS/AED
- Government-funded; Free of charge
EMT-Basic:
- training program introduced under regulation of Ministry of Health (1989)
  - 1yr; 1000h teaching
    - Ax of critically ill
    - Triage
    - Rx
    - Basic Airway mgmt
    - BLS
    - CPR
    - Wound mgmt
    - Immobilization of fractures/spine
    - Reassessment
    - Safe transport
- As of 2000 – more advanced education instituted for EMTs
  - 2yrs; 1400h: 800h theory; 600h clinical/field
    - Anatomy & Physiology
    - Infectious Diseases
    - Pharmacology
    - Common Emergencies
    - Rx protocols and algorithms
    - Comm Systems and Technologies
    - ALS
    - IV access techniques
    - ECG-monitoring
    - Manual Defib
    - Disaster Mgmt
    - Safe Driving
    - English/Computer Training
Prehospital Physicians
- 1995 – 1yr; 400h training course for MDs in prehospital emergency medicine
  - 75h classroom
  - 25h workshops
  - 300h clinical
    - ED, ICU, Anesthesia, NICU, Coronary Care, OB, MICU
- Diploma awarded
- Course free of charge

HEMS
- 3 helicopters
  - Owned by Ministry of Health
  - Operated by Air Force (who have additional helicopters and airplanes)
- 96% of transports come from islands

Committee for Safe Driving (Ministry of Health)
- Works in cooperation with EKAB Sector for prevention of accidents
- Gathers information on all types of accidents
- Proposes preventative measures

All EKAB stations have own dispatch centers
- Equipped with:
  - Telephone Center
  - Radio
  - Computer network for data entry and processing
Dispatchers:
- All receive EMT, communication technology, triage and protocol/algorithm application training
- One to answer calls from public, another to communicate via radio with units in the field
- Prioritize according to need
- Give instructions to public and EMTs
- Decide transport destination
- Communicate with destination hospital (in cooperation with and under supervision of EKAB MDs on-call)
- In disaster, center is responsible for communication and coordination with other institutions (FD, PD, Military)

No Emergency Medicine specialty in Greece
- Emergency Medicine Society recently founded
Emergency Pt’s are sorted into surgical or medical emergencies and treated by appropriate specialists
Anesthetists immediately involved in life-threatening situations
- Further specialists called to ED depending on case
2003 – law passed governing organization and operation of EDs in public hospitals with >200 beds
- Will function as independent departments and staffed by specialist MDs with emergency medicine experience

Special division of EKAB for disaster medicine
- Domestic and international deployment capabilities

https://www.cia.gov/library/publications/the-world-factbook/geos/gr.html
Papaspyrou E, Setzis D, Grosomanidis V, Manikis D, Boutlis D, Ressos C: “International EMS Systems: Greece.” Resuscitation 2004;63:255-9
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