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BRAZILIAN JOURNAL OF EMERGENCY MEDICINE VOLUME 02 / 34-47

Figure 1: number of physicians in Europe.

For emergency calls, particularly in the UK, Sweden, EMERGENCY IN THE WORLD
Belgium and Finland, the operator is a technician, nurse
or paramedic using intervention protocols. In 30% of The growth in emergency room activity is also observed
European countries, Dispatch Centers don’t have a in almost all countries in Europe, Asia and North America
supervising doctor on the phone. They use a national with multifactorial causes (Figure 4). In Germany, Italy and
standard categorization tool from A (life-threatening 25%) Spain, emergency services are experiencing an increase in
to C (non-emergency). The dispatch center in Stockholm their attendance, but there are no national figures due to
is the largest in Europe, almost 60% of pre-hospital EMS the decentralization of their health systems . Comparative
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use the dispatch center dispatch calls for emergencies, data in Europe on the distribution of doctors per thousand
but only 30% have a doctor on the phone. Overall, the inhabitants shows significant differences from country
number of EMS phone calls continues to grow without to country, but with a reduction of nearly 30% in the
an increasing number of ambulances likely related to number of beds in hospitals (see Figure 5). As a corollary,
better medical advice with a doctor on the phone. The there has been an increase in the number of visits to the
management of emergency telephone calls is organized emergency room over the past 20 years and the problem
with a Emergency Physician in France, Spain, Portugal of overcrowding has become a daily challenge without
and Italy. universal solutions.
There are no studies in Europe that analyze and demonstrate
that the regulation system could be more effective if GERMANY:
an ambulance driver, nurse, or doctor is on the phone.
Nevertheless, a good organization of the “dispatch Center” N of Doctors/inhab: 4.25‰ i.e. +53% in 30 years;
of the ambulances seems to avoid overcrowding of the
emergencies. No specialty in MU;

35 | REBRAME | REVISTA BRASILEIRA DE MEDICINA DE EMERGÊNCIA