Operations

Greetings all!  We’ve spent a great deal of time to better understand the EMS system in Croatia.  We’ve discussed and continue to learn about their response system, procedures and protocols.  In some ways they have advantages over our system in the US.  The have national EMS legislation that drives what is being termed EMS reform.  This gives the leaders the ability to determine best practices and deploy them across the entire nation.  This will take a period of years, as the reform just began in 2009. 

 

We have seen some good equipment.  Having one voice for EMS across a country has tremendous strength.  They will be able to move quickly as they learn from successes and failures while they grow.  Imagine if EMS in the US began with things like good diagnostic equipment, GPS, strong physician leadership and a unified voice.

 

One striking difference is that they do not respond to all calls. In fact nearly 80% of callers do not get an ALS ambulance response. They might be referred to a wheel chair and/or general transportation option. Additionally, because they staff the ambulance with doctors, often citizens will simply show up at the all ambulance bases where a doctor can treat them right there is they choose to do so.  It would be like having a clinic at your base. 

 

You call an ambulance by dialing 194 for an ambulance or 112, which is a European standard for calling Police, Fire, or EMS.  194, in Croatia is a one call number for an ambulance.  Calls route to what would be similar to our PSAP, and then transferred to the ambulance dispatch.  So how can they not respond to all call?  Good question! 

 

The Croatians use a process similar to our EMD, where they question the caller.  If it’s determined that their medical condition doesn’t require an ambulance then they explain where they can go to get the help they need, and an ambulance is not dispatched.  They color code their responses, and if it’s a yellow or red the ambulance goes.  There are 10-ambulances for the Zadar County.  There are 21 Counties in Croatia.  

 

In the city of Zadar there are only 2 ALS ambulances for a population of just over 90,000.  I’m sure you’re scratching your head wondering how that’s possible.  We did too...  For you EMS folks, consider what our call volume would look like if we spoke to most of those that needed an ambulance?  Then triaged the calls, and only responded to what would be in our system would only be considered Delta or Charley calls?  It would be considerably less responses. 

 

We explained that in the US we have no choice, and anyone can call an ambulance for any reason and we must respond.  “Dr. Turbo-Skeeter” asked with a strong Croatian accent: (think Grew from Despicable me accent) “so, if I have a mosquito bite and I call an ambulance then you must take me to hospital?” We explained that although our crew may try and discourage such a request, if the patient adamantly wanted to go to the hospital, then yes we would have to do so!  Dr. Turbo said, “well that is stupidest thing I ever heard.”  We all laughed and agreed. 

 

As we continue to learn the operation we are looking for areas we can collaborate, and learn from one another.  They are a wonderful group of professionals here!    

 

 

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