Challenges in the organization of the emergency care units in Skopje

Abstract

Background: Emergency ambulance care is regulated at national level, where services are provided manly at the public health centers with free access to all, as integrated care consists of ambulance services, home visits and night shifts services. Aim: This study provides an evaluation of emergency medicine preparedness, national response plan to manage health threads and outlines the current demands on the health care system. Methods: Retrospective analysis on patient's medical records was conducted to review emergency care, including ambulance services provided on the territory of the capital city, Skopje. Operational, human resources capacity, availability and time response were the assessed outcome measures, compared with community needs and national operational minimum standards for care, equipment and qualifications. Results: In our study we have analyzed 181785 medical records of provided integrated ambulance services per 700,000 inhabitants in 2018, recorded by the Health Center. The average rate of emergency calls per day was 88, out of which 22 were level 1 emergency, with response time of 36 minutes. The delay in time response is the result of lack of operational and human resources. According to the population there should be minimum of 100 teams, but the public emergency units have only 28 teams with total of 57 medical doctors and 11 emergency vehicles, out of which, two type A for patient transport and nine emergency ambulances type B. Conclusion: Enhancing the capacity of emergency and ambulance care is an important demand on the health care system in order to meet community and local needs. Introducing a paramedic workforce in the ambulance services and collaboration with social and mental health teams to improve access and quality of services are proposed interventions.