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22 July 2024 | Country Update
Mandatory availability of external automatic defibrillators in public places for prompt first aid
5.5. Emergency care
Emergency care in Latvia is provided by EMA teams or ambulances, emergency departments in hospitals and urgent medical aid points. Since 1 July 2010, one centralized institution – the SEMS – has provided all EMA services. The SEMS consists of five call centres, which receive emergency calls from all over Latvia. The SEMS is a state agency under the direct control of the MoH and operates under a fixed budget. Medical personnel are employed and ambulances are owned by the SEMS.
The SEMS has 191 ambulance teams, consisting of at least two (para-) medical staff and one driver. The rest are physicians’ teams (including six highly specialized ones, e.g. cardiology), consisting of one medical doctor and a nurse or doctor’s assistant, and 167 teams with two paramedical staff. Ambulances are stationed at 103 locations across the country and transport patients to the nearest appropriate hospital according to the plan of hospitalization. In 2017, the SEMS ambulance teams have been on 440 501 calls, about 0.9% (n = 4111) more than in 2016. Some 53.8% of total calls responded to patients in critical and life-threatening conditions, and the patients were taken to hospitals in 48.9% of cases (SEMS, 2018).
Emergency ambulance teams have to respond to calls within specified time limits. These are:
- responding to 75% of calls within 15 minutes in cities and towns; and
- responding to 75% of calls within 25 minutes in rural areas.
A specific part of the SEMS is the Specialized Medical Centre (SMC), which:
- provides telephone consultations to hospitals, SEMS teams and ships;
- provides operations, procedures, on-site hospital counselling and critical medical transportation of sick patients to other hospitals;
- provides patient medical transportation to/from abroad; and
- coordinates and provides medical assistance for public events of national importance.
Operational activities in 24-hour mode are provided by two SMC controllers, four specially equipped resuscitation teams (two for adult patients, one for children, one for neonates) and medical professionals of more than 18 different specialties, drivers and operational nurses in standby mode.
Telemedicine (visual diagnostics, ECG) services are becoming increasingly widespread providing opportunities for timelier assessments of patients’ needs, types of help and recognizing cases for advice by phone. Therefore, it is possible to avoid unnecessary SMC specialist visits, rationalize the workload and better assess situations that might need an SEMS team. The technological potential of telemedicine is present in all hospitals which provide emergency assistance all over the country.
The SMC can also be called by patients, relatives or employers who are not satisfied by the care provided in the hospital in which the patient is being treated (even outside Latvian borders). However, in these cases, the services are not covered by the state budget but have to be paid directly by the service recipients.
Urgent medical aid points provide services for patients with trauma, sudden illness or an exacerbation of chronic illness requiring urgent intervention by medical practitioners and the need for help goes beyond the competence of primary health care physicians. These points are outpatient units located in either health centres or hospitals, and one is situated at the Children’s Clinical University Hospital in Rīga. Urgent medical aid points have three levels.
At Level 1, care is provided by one doctor and one nurse or a doctor’s assistant – on holidays and on public holidays: 24 hours; working days: 16:00 hours to 8:00 hours. At Level 2, two doctors (surgeon/traumatologist and internist or anaesthesiologist/reanimatologist) and one nurse provide care on weekdays, weekends and holidays: 8:00–24:00 hours; during night time – one doctor and one nurse or doctor’s assistant. At Level 3, care is provided by two doctors (surgeon/traumatologist and internist or anaesthesiologist/reanimatologist) and one nurse – on weekdays, weekends and holidays: 8:00–24:00 hours; during night time – by two doctors and one nurse or doctor’s assistant.
At the end of 2017, there were 15 urgent medical aid points (7 points – Level 1; 5 points – Level 2; and 3 points – Level 3).
One example of a patient pathway in an emergency situation is given below.
A man with broken pelvic bones and substantial bleeding after a car accident:
- the police or person who was first at the scene of the accident calls an ambulance;
- an SEMS call centre dispatcher receives the call;
- an SEMS team provides emergency aid at the scene and while transporting the patient to the nearest appropriate local emergency hospital;
- after surgery at the local hospital, the surgeons realize that internal blood loss from pelvic fractures cannot be stopped with the hospital’s available resources. Therefore, the local surgeons call the Centre of Emergency and Disaster Medicine (CEDM) who transport the patient to the closest specialized trauma hospital and perform the crucial functions to sustain life while transporting the patient.
In public places with large gatherings, external automatic defibrillators will be required to ensure immediate assistance for individuals experiencing life-threatening arrhythmia. This mandate was established by the Cabinet of Ministers on 16 July 2024, along with specific implementation timelines, locations and technical requirements.
Currently, in Latvia, defibrillators are available in major retail chains, the airport, embassies and large companies. Several health organizations have recommended increasing their availability.
The introduction of defibrillators in Latvia will be implemented gradually:
- from 2026, defibrillators must be installed in public places where the maximum occupancy exceeds 1500 people;
- By 2028, this requirement will extend to locations with a maximum occupancy between 701 and 1500 people. It is also recommended to voluntarily install defibrillators in places with a maximum occupancy of fewer than 700 people; and
- from 1 September 2025, defibrillators must be available in educational institutions with basic, general secondary and vocational secondary education. These defibrillators will be funded through state budget procurement.