Lithuania

General

Capital – Vilnius

Land Size – 62,680 sq km

Population – 3,545,319

Language(s) – Lithuanian (official) 82%; Russian 8%; Polish 5.6%; other/unspecified 4.4%

63 EMS stations
- 265 day teams; 210 night teams
Suggested RTs of 15min Urban; 30min Rural
- Achieved in Urban areas, but difficult in rural
Bypass policy not operated
- Pt info passed to dispatch center but Pt usually transported to nearest hospital
MICUs available for inter-facility transport
“The worse feature of the pre-hospital system … is the lack of standard operating procedures” (Vaitkaitis, 331)
- MDs on-board in bigger cities
- Clear need for SOPs and Protocols to improve quality of care, particularly in rural areas.
Biggest problem is “physician-on-call” mentality of population
- 1/3 of all calls are non-emergency
  - Ambulance services doing work of family doctors
AEDs can be used by laypersons and use is not regulated by law
- No implementation of national program for public use of AED
Formal obligations for first aid and laypersons
- 12h first aid training is legally binding for persons applying for driver’s license
- 18h course for Police, FD and military personnel
  - Courses delivered at public health centers, driving schools and Lithuanian Red Cross

Emergency care is free of charge
- Financed from Compulsory Health Insurance Fund (CHIF) and Government (for citizens w/o health insurance)
- CIHF
  - Main source of health care financing
  - Constitutes 90% of all public sector expenditure on health

Ambulance Crew consist of 2 or 3 persons
MDs and RNs are clinical staff
- Regular MD allowed to work with ambulance services
  - Does not have permission to perform medical procedures
- Licensed Specialty MDs typically employed in ambulance services in bigger cities
Rural areas – most teams consist of RN/Feldsher and Driver
- Feldsher – “Field Barber”, RNs qualified to perform certain medical procedures
  - Soon expected to be replaced by Emergency RNs
- Driver – 12h or formal First Aid training
  - Soon expected to be replaced by Paramedics
Currently no national curriculum/standards in prehospital care for RNs/MDs
- National Medical Qualifications not defined
- Formal Certification (i.e. ALS) not mandatory
- Ministry of Health recently issued national standard for Paramedics in ambulance service including medical competence requirements

2008 – Univ. Hospitals are planning to start residency programs for emergency MDs
Basic emergency procedures formally included in study programs of all medical schools
- All students are trained in BLS and First Aid procedures
- ALS training available as continuous medical education according to international standards
- Run by medical societies, NGOs and private companies
Legislation being prepared to introduce paramedics into ambulance services.
- 1000h of training
- According to the National Concept of Ambulance Services, paramedics should replace ambulance drivers in near future.

Decentralized dispatch system
Each ambulance center has own 24h dispatcher
Experienced RNs answer calls, advise Pt’s and send ambulance if necessary
- Consulting MDs may give phone consultation in larger cities

Majority of country hospitals serve populations of less than 60,000
- Results in “insufficient case load to maintain full emergency services” (Vaitkaitis, 331)
“Until 2005 there was no national system for in-hospital organization of emergency departments” (Vaitkaitis, 331)
Ministry of Health recently set out requirements for EDs
- Majority of EDs still only able to carry out functions of admission/registration
- Very restricted capabilities in terms of provision of urgent procedures in emergency cases
  - Emergency care provided on wards and ICU
    - Resuscitation referred to ICU
    - Trauma referred to Surgery
    - Urgent Cases (Internal Bleeding) referred direct to OR
  - Acute specialists provide consultation in EDs
  - Less complicated cases cared for by:
    - Internist (medical)
    - Surgeon/Orthopedic-Traumatologist (Surgical/Trauma)
    - Anesthesiologist-Reanimatologist (Major Trauma/Life-threatening)
  - Consultations with different specialists can be time-consuming
No current national grading of trauma centers exists
- One hospital (Kaunas Univ. Hosp.) meets international criteria for Level I trauma center
  - Specialties needed in one hospital for trauma care are often spread between number of hospitals
  - Results in increased interfacility transfers
“Emergency medicine expected to become established as separate medical specialty in Lithuania, possibly by 2008” (Vaitkaitis, 331)