EMS in Czech Republic

Thank you for visiting www.zachrannasluzba.cz, the most popular, independent and non-profit Emergency Medical Service (EMS) web in Czech Republic, Europe. As the whole web is written in Czech language (it is very nice, but a little bit difficult to learn), we have prepared at least a small English summary about EMS system in our country. Feel free to mail to info@zachrannasluzba.cz for any questions and comments. Also do not forget to visit our photogallery containing pictures not only, but mostly from Czech Republic EMS.

In the Czech Republic (10.000.000 inhabitants), EMS has a long and famous tradition (the first "EMS" named "The Prague Volunteer Rescue Corps" in the capital of Prague was established in 1857). As it is based on the traditions of German-speaking countries, a physician is usually a member of the crew. This exists for a number of reasons. First of all - we belive, that well-educated physician on the scene can provide higher quality of care, better then can do the best paramedic or EMT - especially in life-threating situations. In addition - only few hospitals have an Emergency Department. The ”pavilion” system of older hospitals, whereby each division or medical service is housed in a geographically separate area, requires precise pre-hospital triage based on clinical signs and symptoms with limited monitoring and diagnostic capabilities. This triage challenge requires skilled and advanced levels of providers, which is generally felt to be a physician.

But - on the other hand - EMT or nurse-only staffed ambulances are in service as well in a lot of regions, responding life-nonthreating emergencies with lower priorites.

There is another tier of out of hospital care by physicians making ”non-emergency” house calls. In a country that does not have Emergency Departments such a service is a necessity. This service is primarily an after hours and weekend service. During the day sometimes ambulances will transport some of these patients to their doctors office directly.

Additional staffing on the ambulance is in the form of a driver who has formal training in prehospital care comparable to at least a BASIC EMT. Rounding out the team is a nurse with critical care experience. There have arisen in the last few years a number of training programs for EMTS (paramedics). The programs are 3 years in length and require a considerable amount of hospital ward time. The challenge currently is that paramedics have no legal standing or recognition, and cannot function independently of the physician even under protocol.

Overwhelming majority of our ambulances is well-equiped, meeting european and world standards in this field. Most of them are based on well-known vans as Mercedes, Ford, Renault, Volkswagen or Iveco.

EMS is a separate service and has its own emergency number – 155. Each service (EMS, Police,Fire dept.) has usually its own dispatch. The "single europaen emergency number 112" is also available in Czech Republic, but we belive, that the possibility of direct access to EMS dispatcher is the time-saving advantage of our system, as well as it gives us better chance to set priority of individual calls. All EMS dispatch centres are staffed at least by EMS nurses, some of the centres have an EMS physician on duty, too. 

A key principle of the EMS system is a 15-minute response interval for all citizens. The network of basic ambulance stations is already established, and the quality of performance is to be guaranteed by the regional authorities. 

The ground based EMS system is backed up by an extensive system of helicopters strategically stationed so that no one is more then 50 km from an other helicopter. Our country has 10 such helicopters available. Most centers average between 400-500 runs, and in 2004 there were 5.471 patients transported by helicopters. Six of the helicopters have private operator, Police flies at three stations and one is operated by Army. The flying medical staff is usually provided by appropriate regional EMS service.

The system is financed by general healthcare insurance, in cooperation with local authorities‘ financial resources. Some specialized activities (especially the air ambulance service) is organized and financed directly by the Ministry of Health.

From the educational point of view, continuing pre- and postgraduate education in the field of Emergency Medicine is of great importance. Detailed and dedicated curriculum provided by gifted teachers from all fields of medicine, targeted to the needs of a newly established Emergency Medicine, will be required.

Traditionally the majority of doctors practicing emergency medicine in the Czech Republic have been anesthesiologists. Emergency Medicine has been established as a subspecialty in 1999 with a two-year curriculum. It requires prior training in anesthesia, internal medicine or some other field.  More than two hundred physicians already received their board certification, based on in-hospital training within different fields of medicine, and pre-hospital emergency care. Officially, there are no in-hospital Emergency Departments with bed facilities. However, up to ten in-hospital Emergency Departments have opened throughout the country, varying in size from 2 to 10 beds, and with varying degrees of acuity and admissions. Most doctors work 14-16 12-hour shifts in a month.

Prepared by Ondrej Franek, M.D., www.zachrannasluzba.cz, in cooperation with Francis Mencl, M.D., Ohio, U.S.A.