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SCIENTIFIC NETWORKING AND THE GLOBAL HEALTH SUPERCOURSE FOR THE
PREVENTION OF THREAT FROM MAN MADE AND NATURAL DISASTERS
August 8-11 2005, Kaunas, Lithuania
Emergency preparedness
in the Baltics
Dinas Vaitkaitis
Kaunas University of Medicine
Lithuanian Society for Emergency Medicine
1
Topics
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Background info
Risks
Emergency management
Emergency services
Education and training
2
THE BALTICS
3
Background info
Geography/Demographics/Economy

LT
LV
EST
Geographic size, th km2
65,3
64,5
45,0
Population size, M
3.6
2.44
1.5
GDP, bn
$45.23
$26.53
$19.23
GDP, per person
$12,500
$11,500
$14.300
% of GDP spent on
healthcare
5.2
5.1
5.1
Sources: WHO, CIA
4
Differences
Estonia and Latvia 66% located on 33% of territory,
rest of the population very sparsely
situated
5
DISASTER RISKS

Natural
disasters:
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floods
forests’ fire
stormy winds
drought
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Man-made
disasters:
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nuclear disasters
chemical disasters
traffic accidents
terrorism and war
infections
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IGNALINA NPP
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Two RBMK-1500
reactors since 1983
and 1987 – one of
them is still working
1,5 Billion kWh/month
Personnel: 3900 (April,
2003)

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day shift :
2500
night shift: 230
security service: 530
shelter for: 800
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Risk of nuclear disasters

1994 Tammiku, Estonia


Cs-137 from dump
3 persons irradiated 1 person died
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Risk
Vecumnieki 1999
9
Risk
Kemeri 1999
10
Risk
28 September 1994
989 people on board
138 rescued
11
Explosion in shopping centre
“Centrs” (RIGA, 17 August ,2000)
1 cilvēks miris slimnīcā
30 cilvēki cietuši
Multitrauma, neirotrauma
izolēti skeleta bojājumi
apdegumi
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DISASTER MANAGEMENT
LEVELS IN LITHUANIA
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National (country) level
Regional (county) level
Local (municipality) level
13
DISASTER MANAGEMENT LEVELS
NATIONAL LEVEL
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Government of the Republic of Lithuania
Emergency Management Commission
Emergency Management Center
Civil Protection Department
Ministries
Emergency Management Centers
Fire Department
Health Emergency Situation Center
Maritime Search and Rescue Center
Air Search and Rescue Centre
Other Governmental Institutions
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DISASTER MANAGEMENT LEVELS
REGIONAL LEVEL
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Regional Authority
Regional Emergency Management
Center
Regional Warning and
Information Service
Civil Protection Services
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DISASTER MANAGEMENT LEVELS
MUNICIPALITY LEVEL
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Local Authority
Local Emergency Management
Center
Fire and rescue Departments
Local Warning and Information
Service
Business and Industry
Civil Protection Services
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EMERGENCY MANAGEMENT SYSTEM IN
HEALTH CARE SECTOR
GOVERNMENT
Emergency Management Commission
Emergency Management Center
MINISTRY OF HEALTH
Disaster Management Center
Health Emergency Situation Center
COUNTY ADMINISTRATION
County Emergency Management Center
County Doctor’s Institution
MUNICIPALITY ADMINISTRATION
Municipality Emergency Management Center
Municipality Doctor’s Institution
State level
hospitals
County level
hospitals
Municipality
level
hospitals
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HEALTH CARE ORGANIZATION LEVELS IN CASE OF DISASTER:
STATE LEVEL
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MINISTRY OF HEALTH
DISASTER MANAGEMENT CENTER OF THE MOH
HEALTH EMERGENCY SITUATIONS CENTER TO THE MOH
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Radiation Protection Center
Centre of Communicable
Diseases Prevention and
Control
Public Health Services
Institute of Hygiene
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Kaunas Medical University
Clinics
Vilnius University Hospital
,,Santariskiu Clinics”
Vilnius University Emergency
Hospital
Lithuanian Oncology Center
VU Children Hospital
VU Zalgirio Clinics (stomatol.
surgery)
VU Psichiatry Hospital
Other special. hospitals
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HEALTH CARE ORGANIZATION LEVELS IN CASE OF DISASTER:
COUNTY AND MUNICIPALITY LEVELS
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COUNTY LEVEL
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County hospitals (60)
Public Health Centers
(11)
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MUNICIPALITY
LEVEL
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Municipality hospitals
(50)
Branches of Public
Health Centers (39)
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Emergency services in Lithuania
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Fire and Rescue Services
Police
Ambulance Services / Hospitals
20
The Fire and Rescue Services
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rescue work
protection of persons
and property
first aid at the
accident site
transportation of
injured from the
accident site to
assembly area
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The police
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Coordination of work of all three
emergency services at the accident
site
Protection of persons and property
Traffic control
Registration of the victims and
bystanders.
22
Health services
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Assessing injured and
setting care priorities
Life saving first aid
measures near the
accident site and
while transporting
victims to hospitals
Medical transport
Allocation of injured
to different hospitals
63 Ambulance stations/services
265 teams – day time, 210 – night time
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All three services
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planning
helping with
information to the
relatives, public
and the mass
media
co-operation
24
Other services in the relief operations
See search and rescue
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Air search and rescue
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Under guidance of Captain
of Klaipeda See-Port
Rescue ship “Šakiai”
7 helicopters of the Airforce
Center of Aeronautics and
Air Search
Emergency Management
Centers under guidance
of Crisis Management
Center
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Training
26
Training
www.acls.kmu.lt
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Training
28
Training

EmergoTrain – system, Lithuanian version
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Large scale exercises
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Education, research and
training
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University studies of medicine at two
universities (+1 public health)
Health faculties at five colleges
Postgraduate training
Exercises
Emergency medicine – research
programme at Kaunas University of
Medicine
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Organisation of Pre-hospital
Emergency Medical Care in Estonia


Provided entirely by Emergency Medical
Services with minimal involvement of
GPs in rural areas
There is no governmental body
regulating the EMS activities nor is
there any functioning legal framework
governing the area
32
Union of Estonian Emergency Medical
Services is a nonprofit organisation for
EMS professionals (physicians, nurses
and EMTs), devoted to quality of
emergency medical care by providing
training and guidance to its members,
consulting the government in questions
vital for the development of EMS etc.
33
Estonian EMS resources available

There are 87 EMS teams in 46
geographic locations
34
The qualification of EMS
teams in Estonia
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6 reanimobiles with anaesthesiologist
on board (based in Tallinn and Tartu)
40 physician manned ambulances
(generalists with training in EM)
41 teams lead by a specialist nurse
All EMS teams consist of 3 members: a
doctor or a specialised nurse, a nurse
and a driver trained as EMT
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Education and Training
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Undergraduate medical education
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Physicians - Tartu University
Nurses - 3 schools (Tallinn, Tartu, Kohtla-Järve)
Specialisation
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EM physicians in residency progam at Tartu
University Hospital
Nurses at Tallinn EMS
EMTs at Tallinn and Tartu EMS, Centre of Disaster
Medicine of Tallinn Mustamäe Hospital
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Medical disaster preparedness
organisation in Latvia
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State level - Ministry of Health
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Centre of Emergency and Disaster medicine
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District level - responsibility for
preparedness
Local level
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Operative reserves
Ambulance Service
Hospitals
DM planning – for each level
37
Ambulance Services in Latvia
52 Ambulance stations in 70 localization points
173 teams –day time, 143 – night time
38
EMS – “ stay and play” concept
EMS teams in Latvia:
• IT teams – MD + MD assistant + driver (53day
time/36 night time)
• EM teams – MD assistant + driver (123/110)
• Legislation demand – 2 medical educated persons
on each team
39
EMS – today
• Lack of co-ordination;
• “Border problems”
• Management and dispatch problems (many
dispatch “centres”);
• Different levels of accessibility of EMH
– Cities 15 minutes
– Country side 25-90 min.
• Lack of unitary communication system
• Personnel problems
• Different EM numbers
40
International co-operation
(“Disasters do not know borders”)
Neighbouring countries: cross border co-operation
Catchment area LV-EE
Valmiera- Pärnu
Catchment area LV-LT
Jelgava- Siauliai
41
Acknowledgements
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Mārtiņš Zuteris
Raul Adlas
Ursel Kedars
Ago Kõrgvee
42
Thank you!
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