Page 44 - Rebrame - 2022 - Ed. 1

BRAZILIAN JOURNAL OF EMERGENCY MEDICINE VOLUME 02 / 34-47

The organization of prehospital EMS have 4 types of centers, and paying city medicine for patients without
ambulances, all belonging to the regional health service: complementary insurance, creating a 2-speed medicine.

• “Heavy” ambulance with medical support, carrying 1 The tenured doctors are salaried civil servants belonging
doctor, 1 nurse, and 2 technicians; to a single body.

• Rapid Intervention Vehicle (VIR), transporting 1 doctor, The average gross monthly salary of a head of department
1 nurse and 1 technician is €4,500, and €2,000 for a simple senior manager.

• Home care unit or “Unidad d’Attencion Domicilaria The average salary of an emergency physician is around
(UAD)” for “urgencias”, transport a doctor or nurse with €2,500 /month.
a technician;
Interns are paid by the university around €700/month.
• “Light” ambulances or basic support, 2 technicians.
UK (UNITED KINGDOM)
There is no university specialty in emergency medicine
in Spain, the doctors working in the emergency system,
estimated > 10,000, are family generalists who have most • Speciality: 1972
often followed additional training (14). Senior doctors work • N Doctors/inhabitant: 2.80‰ (+251% in 60 years)
around 52 hours a week According to the Collegiate
Medical Organization (OMC), in the next ten years, 40% of • Number of emergency physicians: 1632
employees in the Spanish public health system will retire. The UK pioneered the creation of the specialty of
However, the number of positions offered for the various emergency medicine in the world with its formal
competitions is insufficient and the working conditions are establishment in 1972. The health system, NHS in order
unfavorable (low salary, fixed-term contract) in particular to regulate the overcrowding of emergency departments
216
for the recruitment of emergency physicians . (A&E) called “corridors of shame” was illustrated by a
radical decision in the 2000s. The NHS having decided
ITALY to financially penalize hospitals that did not respect the
4-hour rule (“4 hours target”) total management (entrance
N of Doctors/inhabitant: 3.98‰ (-15% in 30 years) exit) for any patient who presents to the emergency room.
This financial penalty was very effective in forcing the entire
N Emergency physicians: 3,000 (2021) hospital to organize patient admissions from the emergency
room, but inevitably led to failures and overflows: long
The Italian health system is close to the UK National Health waiting time for ambulances in front of the A&E . The
319
System (NHS) but organized by region . emergency physicians subsequently called for a 6-hour rule
17
with no effect on the reduction in A&E waiting times and
Emergency medicine has been a medical specialty
since 2008: it corresponds to a specific 3-year training the situation was notably exacerbated during the COVID
20
course, accessible only to medical specialists (mainly pandemic .
anesthesiologists, resuscitators and cardiologists).
SWEDEN:
Consumerism is emerging in emergency departments,
as well as issues of violence, both in emergency Speciality: 2002
departments and during pre-hospital interventions. Health
policies in recent years have reduced the number of N of Doctors/inhabitant: 3.98‰ + 298% in 60 years
acute hospitalization beds in medicine, resulting in the
overwhelmed emergency services . Special features: Person Centered Care mobile geriatric
18
teams
Pre-hospital emergencies run with a single call number
linked to the police but independent of the fire brigade. The Swedish healthcare system is organized into three
The emergency call centers depend on the hospital with levels: national, regional and local.
specialized nurses and doctors.
The Health and Medical Services Act clarifies that
Hospital emergencies do not have a uniform organization responsibility for ensuring that everyone living in Sweden
:the triage is organized by hospitalization decision has access to good health care rests with county councils/
support protocols. Unscheduled ambulatory care seems regions and municipalities. Therefore, the type of health
to be failing with incompetent and overloaded health services available may vary. Full emergency services are

39 | REBRAME | REVISTA BRASILEIRA DE MEDICINA DE EMERGÊNCIA