Last night in Zadar

With one night left in Zadar, we are all reminiscent of the spectacular success of this event.

ZADAR EMS COMMUNICATIONS

One of the challenges faced by Zadar EMS is communicating between widely dispersed fixed medical stations and mobile ambulance teams. They do not have a county-wide EMS radio communications system, and currently rely on cellular telephones for much of the communications with their mobile ambulance teams.

Zadar County extends from the west to the east across the entire country of Croatia. The County's terrain is diverse, extending from coastal plains in the West, through fertile mountain valleys, across a high central mountain range, and on to the border in the East. Compounding this already challenging topography are more than 120 islands scattered off the coast of Zadar County.

Law enforcement uses a nation-wide TETRA radio system, consisting of a digital system in the 400 MHz band. TETRA is the European standard for digital radio systems. EMS, Fire, and Mountain Rescue agencies have not fully transitioned the system. Zadar County EMS plans to join the system in the future, and looks forward to having more reliable, consistent mobile communications after the transition.

Our Team Leader

Our team Leader Rick Larkin (St. Paul, Emergency Management Director) has done a tremendous job at being our diplomatic spokesman.  

Here Rick presents the chief of the Zadar Police department the City of St. Paul Coin.  Rick has done a great job at keeping us on task, and organized.  

Today we met with Mayor of Starigrad, who hosted us for lunch in a villa on the side of a mountain.  To describe it as amazing would be a gross understatement.

We have been treated so well here!!!    

MVA Drill

Today we had the opportunity to witness a multi-discipline exercise that involved all of the emergency response agencies of Zadar County - EMS, Fire, and Police.

The drill was staged just outside the Zadar County Team Two Site of Seline. They drilled a response to a simulated one-vehicle crash with one-patient. The terrain in this area includes winding two-lane switch-back roads packed with tourists on their cars, bicycles, motorcycles, and on foot - with absolutely no shoulder on the roads. It's not difficult to imagine such a crash occurring on roads like this.

Generally, the drill was very similar to what we might have seen the USA. Police arrived first with the ambulance right behind, followed by the fire department who took charge of the extrication. Procedures and techniques were nearly all very familiar to us American observers.

One key difference of course, is the fact that the women in the photo with the stethoscope around her neck is a physician, representative of their staffing model here. Everyone enjoyed being able to witness this drill.

Afterwards, we were treated to a tour of the near-by mountain rescue headquarters in a National Park. More on that below.

Croatian Mountain Rescue at Paklencia National Park

We are just returning from an amazing visit to the Croatian mountain rescue brigades at Paklenica National Park. This is an area where visitors from all over the world come to rock and Mountain-climb. Even with the use of appropriate safety harnesses, ropes and helmets there are still multiple injuries that this team encounters every week. Unfortunately they even had a fatality in the last week.

This team has taken some standard EMS equipment and modified it for better use in the unique environment in which they practice. For example they have modified a Stokes basket by breaking into two distinct pieces each of which can be carried by a single rescue climber. After reaching the patient the two rescuers can combine each of their pieces to form a single Stokes basket which is then used either to lower the victim to the ground or to attach to a helicopter pulley system and lift the patient up. These advanced technical rescuers apply their medical knowledge in an environment which contains unique challenges and operational hurdles. Their innovative approaches to addressing these challenges were impressive and we think there are aspects of their extrication systems which may have a role in our (very vertically challenged) EMS operations in Minnesota.

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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Zadar Police Department

Today we had the privilege of visiting the main Zadar Police Department headquarters. There are several different police agencies that respond to calls in the County of Zadar; however unlike law enforcement agencies in the US where responsibilities are divided by geography (local, sheriff, state patrol) the police departments in Croatia have their responsibilities divided by call classification. One type of department will respond to in progress crimes while another will function as more of an investigative unit for crimes which have already been completed. While the law-enforcement officers have access to firearms they may not carry them on their person at all times. In our discussions with both the medical and law enforcement professionals we have met here in Croatia, it appears that there is approximately one gunshot victim in Zadar county every three months. This is in contrast to the several gunshot victims who routinely arrive at regions Hospital every week.