The Danish prehospital emergency healthcare system and research possibilities

Tim Alex Lindskou, Søren Mikkelsen, Erika Frischknecht Christensen, Poul Anders Hansen, Gitte Jørgensen, Ole Mazur Hendriksen, Hans Kirkegaard, Peter Anthony Berlac, Morten Breinholt Søvsø, Tim Alex Lindskou, Søren Mikkelsen, Erika Frischknecht Christensen, Poul Anders Hansen, Gitte Jørgensen, Ole Mazur Hendriksen, Hans Kirkegaard, Peter Anthony Berlac, Morten Breinholt Søvsø

Abstract

The emergency medical healthcare system outside hospital varies greatly across the globe - even within the western world. Within the last ten years, the demand for emergency medical service systems has increased, and the Danish emergency medical service system has undergone major changes.Therefore, we aimed to provide an updated description of the current Danish prehospital medical healthcare system.Since 2007, Denmark has been divided into five regions each responsible for health services, including the prehospital services. Each region may contract their own ambulance service providers. The Danish emergency medical services in general include ambulances, rapid response vehicles, mobile emergency care units and helicopter emergency medical services. All calls to the national emergency number, 1-1-2, are answered by the police, or the Copenhagen fire brigade, and since 2011 forwarded to an Emergency Medical Coordination Centre when the call relates to medical issues. At the Emergency Medical Coordination Centre, healthcare personnel assess the situation guided by the Danish Index for Emergency Care and determine the level of urgency of the situation, while technical personnel dispatch the appropriate medical emergency vehicles. In Denmark, all healthcare services, including emergency medical services are publicly funded and free of charge. In addition to emergency calls, other medical services are available for less urgent health problems around the clock. Prehospital personnel have since 2015 utilized a nationwide electronic prehospital medical record. The use of this prehospital medical record combined with Denmark's extensive registries, linkable by the unique civil registration number, enables new and unique possibilities to do high quality prehospital research, with complete patient follow-up.

Keywords: Denmark; EMS; Emergency number; General practitioner; Out-of-hours; Prehospital.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Denmark. The five Danish regions with population as of the first quarter of 2019
Fig. 2
Fig. 2
Medical service accesses. The options available for citizens in need of medical services. GP, General practitioner. OOH GP cooperatives, Out-of-hours general practitioner cooperatives. OOH 1813, Out-of-hours Medical Helpline 1813 in the Capital Region

References

    1. Thomson N. Emergency medical services in Zimbabwe. Resuscitation. 2005;65(1):15–19. doi: 10.1016/j.resuscitation.2005.01.008.
    1. Van Gelder CM, Frantz R, Bogucki S. Emergency medical services in Connecticut. Prehosp Emerg Care. 2005;9(2):219–226. doi: 10.1080/10903120590924861.
    1. Krüger AJ, Skogvoll E, Castrén M, Kurola J, Lossius HM. Scandinavian pre-hospital physician-manned emergency medical services-same concept across borders? Resuscitation. 2010;81:427–433. doi: 10.1016/j.resuscitation.2009.12.019.
    1. Vaitkaitis D. EMS systems in Lithuania. Resuscitation. 2008;76(3):329–332. doi: 10.1016/j.resuscitation.2007.07.028.
    1. Pozner CN, Zane R, Nelson SJ, Levine M. International EMS systems: the United States: past, present, and future. Resuscitation. 2004;60(3):239–244. doi: 10.1016/j.resuscitation.2003.11.004.
    1. Tanigawa K, Tanaka K. Emergency medical service systems in Japan: past, present, and future. Resuscitation. 2006;69(3):365–370. doi: 10.1016/j.resuscitation.2006.04.001.
    1. Chiang WC, Ko PCI, Wang HC, Yang CW, Shih FY, Hsiung KH, et al. EMS in Taiwan: past, present, and future. Resuscitation. 2009;80(1):9–13. doi: 10.1016/j.resuscitation.2008.10.010.
    1. Langhelle A, Lossius HM, Silfvast T, Björnsson HM, Lippert FK, Ersson A, et al. International EMS systems: the Nordic countries. Resuscitation. 2004;61(1):9–21. doi: 10.1016/j.resuscitation.2003.12.008.
    1. Lowthian JA, Jolley DJ, Curtis AJ, Currell A, Cameron PA, Stoelwinder JU, et al. The challenges of population ageing: accelerating demand for emergency ambulance services by older patients, 1995-2015. Med J Aust. 2011;194(11):574–578. doi: 10.5694/j.1326-5377.2011.tb03107.x.
    1. Christensen EF, Bendtsen MD, Larsen TM, Jensen FB, Lindskou TA, Holdgaard HO, et al. Trends in diagnostic patterns and mortality in emergency ambulance service patients in 2007−2014: a population-based cohort study from the North Denmark region. BMJ Open. 2017;7(8):e014508. doi: 10.1136/bmjopen-2016-014508.
    1. National Audit Office. NHS Ambulance Services. NHS Ambulance Services. 2017 p. 12–23. [Internet]. [cited 2019 May 22]. Available from:
    1. Schmidt M, Pedersen L, Sørensen HT. The Danish civil registration system as a tool in epidemiology. Eur J Epidemiol. 2014;29(8):541–549. doi: 10.1007/s10654-014-9930-3.
    1. Pedersen CB. The Danish civil registration system. Scand J Public Health. 2011;39(7 Suppl):22–25. doi: 10.1177/1403494810387965.
    1. Ministry of Health. BEK nr 971 af 28/06/2016 (Gældende) Bekendtgørelse om planlægning af sundhedsberedskabet [Executive Order No. 971 of 28 June 2016 on health preparedness planning]. Sundheds- og Ældreministeriet; 2016. [Internet]. [cited 2019 May 22]. Available from:
    1. Ministry of Health. BEK nr 1264 af 09/11/2018 (Gældende) Bekendtgørelse om ambulancer og uddannelse af ambulancepersonale m.v. [Executive Order No. 1264 of 09 November 2018 on ambulances and training of ambulance staff etc]. 2018. [Internet]. [cited 2019 May 22]. Available from:
    1. Ministry of Health. VEJ nr 9399 af 16/08/2012 (Gældende) Vejledning om uddannelse til ambulancebehandler og ambulancebehandler med særlig kompetence [Guidance No. 9399 of 19 August 2016 on training programmes for paramedics and paramedics with special competencies]. Ministeriet for Sundhed og Forebyggelse; 2012. [Internet]. [cited 2019 May 22]. Available from:
    1. Ministry of Education. BEK nr 663 af 01/06/2018 (Gældende) Bekendtgørelse om erhvervsuddannelsen til ambulancebehandler Executive Order No. 663 of 01 June 2018 on vocational education to become a paramedic]. Sundheds- og Ældreministeriet; 2016. [Internet]. [cited 2019 May 22]. Available from:
    1. Ministry of Health. LOV nr 1555 af 18/12/2018 (Gældende) Lov om ændring af lov om autorisation af sundhedspersoner og om sundhedsfaglig virksomhed, lov om apoteksvirksomhed, sundhedsloven og forskellige andre love [ACT No. 1555 of 18 December 2018 on amendments of the Act on authorization of heathcare professionals and health care practice, act on pharmacies, health act and different other acts]. Sundheds- og Ældreministeriet; 2018. [Internet]. [cited 2019 May 22]. Available from:
    1. Danish HEMS. Akutlægehelikopter [HEMS] [Internet]. [cited 2019 May 22]. Available from:
    1. Alstrup K, Petersen JAK, Barfod C, Knudsen L, Rognås L, Møller TP. The Danish helicopter emergency medical service database: high quality data with great potential. Scand J Trauma Resusc Emerg Med. 2019;27(1):1–10. doi: 10.1186/s13049-019-0615-5.
    1. Defence Command Denmark. The Search and Rescue System in Denmark [Internet]. 2016 [cited 2019 May 22]. Available from:
    1. TrygFonden. Bliv hjerteløber [Become a heart runner] [Internet]. [cited 2019 May 22]. Available from:
    1. The North Denmark Region. 1-1-2 Akuthjælperordningen [1-1-2 Acute Helper System] [Internet]. 2018 [cited 2019 May 22]. Available from:
    1. TrygFonden. Find hjertestarter på kortet [Find automatic electronic defibrillator on the map] [Internet]. [cited 2019 May 22]. Available from:
    1. . Emergencies [Internet]. 2018 [cited 2019 May 22]. Available from:
    1. Frischknecht E, Berlac PA, Nielsen H. The Danish quality database for prehospital emergency medical services. Clin Epidemiol. 2016;8:667–671. doi: 10.2147/CLEP.S100919.
    1. Danish Regions. Dansk Indeks for Akuthjælp [Danish Index for Emergency Care]. Ver. 1.8. Laerdals Fond for Akuttmedisin; 2016.
    1. Andersen MS, Johnsen SP, Sørensen JN, Jepsen SB, Hansen JB, Christensen EF. Implementing a nationwide criteria-based emergency medical dispatch system: a register-based follow-up study. Scand J Trauma Resusc Emerg Med. 2013;21(1):53. doi: 10.1186/1757-7241-21-53.
    1. World Health Organization. International Statistical Classification of Diseases and Related Health Problems 10th Revision [Internet]. 2016 [cited 2019 May 21]. Available from:
    1. . Healthcare [Internet]. 2018 [cited 2019 May 22]. Available from:
    1. The Capital Region of Denmark. Medical Helpline 1813 [Internet]. 2017 [cited 2019 May 22]. Available from:
    1. Søvsø MB, Hermansen SB, Færk E, Lindskou TA, Ludwig M, Møller JM, et al. Diagnosis and mortality of emergency department patients in the North Denmark region. BMC Health Serv Res. 2018;18(1):548. doi: 10.1186/s12913-018-3361-x.
    1. Danish Regions. Når du har brug for os, 24 nye indsatser når du bliver akut syg eller kommer til skade [When you need us, 24 new efforts for when you get acutely ill or injured]. 2018. [Internet] [cited 2019 May 22]. Available from:
    1. Christensen HC, Nielsen H. Præhospitalsdatabasen - Pilotrapport [The Danish Quality Database for Prehospital Emergency Medical Services - Pilot report]. 2018 p. 6. [Internet] [cited 2019 May 22]. Available from:
    1. VIVE – The Danish Center of Social Science Research. Regionale lægevagter og Akuttelefonen 1813 – En kortlægning med fokus på organisering, aktivitet og økonomi [Regional out-of-hours general practitioner and and the medical helpline 1813 - A survey focusing on organization, activity and finances]. 2018 p. 141. [Internet] [cited 2019 May 22]. Available from:
    1. Persson KB, Virtanen M, Smedby B. The use of clinical classifications in the Nordic countries. Heal Inf Manag. 2003;31(1):8–14.
    1. Schmidt M, Schmidt SAJ, Sandegaard JL, Ehrenstein V, Pedersen L, Sørensen HT. The Danish national patient registry: a review of content, data quality, and research potential. Clin Epidemiol. 2015;7:449–490. doi: 10.2147/CLEP.S91125.
    1. The Danish Health Data Authority. SKS Klassifikationer - Sundhedsdatastyrelsen [SKS Classifications - The Danish Health Data Authority] [Internet]. 2018 [cited 2018 Jun 18]. Available from:
    1. The Danish Health Data Authority. SKS-browseren [The SKS browser] [Internet]. 2017 [cited 2019 May 22]. Available from:
    1. Toft Sørensen H, Christensen T, Schlosser HK, Pedersen L. Use of medical databases in clinical epidemiology. Toft Sørensen H, Christensen T, Schlosser HK, Pedersen L, editors. Department of Clinical Epidemiology, Aarhus University Hospital; 2009. p 1–120.
    1. The Danish Clinical Registries. In English - RKKP [Internet]. 2016 [cited 2019 May 22]. Available from:
    1. The Danish Clinical Registries. Præhospitalsdatabasen - RKKP [Danish quality database for prehospital emergency medical services - RKKP] [Internet]. 2018 [cited 2019 Jan 23]. Available from:
    1. European Union. Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation). Off J Eur Communities. 2016;2014(October 1995):1–88. [Internet] [cited 2019 May 22]. Available from:
    1. The Ministry of Justice. LOV nr 502 af 23/05/2018 Gældende: Lov om supplerende bestemmelser til forordning om beskyttelse af fysiske personer i forbindelse med behandling af personoplysninger og om fri udveksling af sådanne oplysninger (databeskyttelsesloven) [ACT No. 502 of 23 June 2018 on supplementary provisions to the regulation on the protection of natural persons with regard to the processing of personal data and on the free movement of such data (the Data Protection Act). Justitsministeriet; 2018 p. 1–118. [cited 2019 May 22]. Available from:
    1. Ministry of Health. LBK nr 903 af 26/08/2019 (Gældende) Bekendtgørelse af sundhedsloven [Consolidation Act no 903 of 26 August 2019 Executive Order of the Health Act]. Sundhedsloven; 2019. [Cited 2019 May 22]. Available from:
    1. The National Committee on Health Research Ethics. The National Committee on Health Research Ethics | National Videnskabsetisk Komité [Internet]. 2017 [cited 2019 May 22]. Available from:
    1. The Danish Medicines Agency. Clinical trials of medicines [Internet]. 2014 [cited 2019 May 22]. Available from:
    1. The Danish Patient Safety Authority. Patientjournaloplysninger til forskning - Styrelsen for Patientsikkerhed [Patient medical records for research - The Danish Patient Safety Authority] [Internet]. 2018 [cited 2019 May 22]. Available from:

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다