Emergency medical services in Italy

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Emergency medical services in Italy are currently at an early stage of development. The system currently consists primarily of a combination of volunteers and private companies providing ambulance service, supplemented by physicians and nurses who perform all ALS procedures.

Italian Ambulance
Ambulance in Venice
Hospital-based, physician-led ALS Unit

Organization

Emergency Medical Service in Italy is provided from a variety of different sources. The method of delivery can vary considerably from one location to another. In some locations, responsibility for the provision of EMS will have been undertaken by the local hospital, while in others, services may be provided by a range of volunteer organizations, including the Croce Rossa [1] (Italian Red Cross), Croce Verde [2] (Green Cross - Public Assistance Association), Croce Bianco [3] (White Cross - Public Assistance Association), Croce Giallo [4](Yellow Cross - Civil Protection Association), and by private companies displaying a blue cross. In some cases, emergency ambulance service may be provided by the police, or the Carabinieri. To further complicate matters, it is not uncommon for more than one organization to be operating in the same area, or for organizations, such as hospitals, to provide a single type of service, such as neonatal, while leaving others to provide the balance of services. How the service is actually provided, and the level of service that is provided, is driven in large measure by what the community can afford. Air ambulance services are normally provided by a network of dedicated helicopters, or as an added service from a number of other government agencies, including the Italian Coast Guard, Civil Defence, and the Carabinieri. The emergency telephone number for emergency medical service in Italy is 118.

Standards

Staffing

How ambulances are staffed is determined to some extent by the location, and by the resources available to the community. For the most part, Italy follows the Franco-German (as opposed to Anglo-American) model of EMS service delivery[5]. The basic model consists of Basic Life Support ambulances, Advanced Life Support ambulances, Modified Advanced Life Support ambulances, and Physician cars called Automedica. BLS units are typically volunteer-based and operate in rural locations. Crews consist of a dedicated driver called an autista di ambulanza and a separate, fulltime, attendant called a lettighiere or barelliere which literally means "the one who operates the stretcher" [6]. ALS units are more likely to be found in larger centers, are more likely (but not always) to be staffed by paid, hospital-based staff, and are physician-led [7]. Some rural areas and smaller centers use a modified approach to ALS, with a volunteer crew supplemented by a nurse who is permitted to perform some ALS procedures. The top end of the spectrum is a rapid response unit, staffed by a physician (usually an emergency physician or anesthetist) and a critical care nurse.

Training

There is a great deal of variation in the training of EMS personnel in Italy. Some services use purely volunteers, who are required to have 40 hours of training [8]. That being said, many Italian volunteers take their commitment very seriously, and participate in many hours of uncompensated training. This is particularly true for well organized volunteer groups, such as the Italian Red Cross. In most cases, their response to serious emergencies will often be supplemented by a car with an emergency physician and nurse; the only means of providing ALS service. For those in paid services, there is a mandatory 120 hour training course, permitting the individual to function at a BLS level. These individuals still require support from a physician and nurse for ALS provision with the exception of the use of an automatic external defibrillator[9]. While there are some ALS ambulances in Italy, they are typically not found outside larger centers, and in many cases, where they do exist, they are frequently required to have the emergency physician present to perform ALS skills, in a manner very similar to the German model. Nurses are required to have a critical care background. Physicians are typically either specialists in emergency medicine or anesthetists, although this background is not strictly required. Poor compensation and hours of work have reportedly resulted in a relatively high 'turnover' rate among physicians in the system.

Vehicles

Vehicles used as ambulances in Italy comply with most aspects of the European standard for ambulances, CEN 1789. The visual identity provisions of the standard are not yet being followed.

Coordination

The entire system is coordinated by the 118 organizations, which operate in each of Italy's governmental regions. Medical training provided for dispatchers is typically minimal [10]. These organizations provide centralized dispatch, standards and guidelines for operation. These guidelines can vary greatly between regions; procedures which are permitted in one region may not be permitted in the region next door. Regions may also have completely different standards for the training of staff and the staffing and equipment of ambulances.

Response Time

Italy currently has a response time standard for urban areas of eight minutes or less for life-threatening emergencies. This standard is not currently being consistently met [11].

See also

References

  1. ^ "Italian Red Cross". Retrieved 2008-09-15.
  2. ^ "Green Cross Public Assistance Association". Retrieved 2008-09-15.
  3. ^ "White Cross Public Assistance Association". Retrieved 2008-09-15.
  4. ^ "Yellow Cross Civil Protection Association". Retrieved 2008-09-15. {{cite web}}: Check |url= value (help)
  5. ^ "PreHospital and Disaster Medicine (article) 1". Retrieved 2008-09-18.
  6. ^ "Wordreference". {{cite web}}: Text "accessdate 2008-09-15" ignored (help)
  7. ^ Bertini G, Giglioli C, Rostagno C, Conti A, Russo L, Taddei T et al. Early out-of-hospital lidocaine administration decreases the incidence of primary ventricular fibrillation in acute myocardial infarction [see comments]. J Emerg Med 1993; 11(6):667-672.
  8. ^ "EMS City of Prague 1". Retrieved 2008-09-15.
  9. ^ "EMS City of Prague 2". Retrieved 2008-09-15.
  10. ^ "EMS Benchmarking in Europe 1" (PDF). Retrieved 2008-09-15.
  11. ^ "EMS Benchmarking in Europe 2" (PDF). Retrieved 2008-09-15.
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