Emergency medical services in the Netherlands

infobox country
common_name = Netherlands

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capital = Amsterdam [cite web|url=https://www.cia.gov/library/publications/the-world-factbook/geos/nl.html|title=All facts unless otherwise cited are from: The CIA World Fact Book|accessdate=2008-10-06]
area_km2 = 41526
area_sq_mi =
population_estimate = 16,645,313
population_estimate_year = July 2008
population_density_km2 = 400.84
population_density_sq_mi =
healthcare = Socialized

Emergency medical services in the Netherlands is a system of pre hospital care provided by the government in partnership with private companies.

Organization

Land Ambulance

Emergency medical service in the Netherlands is provided by a number of private carriers, operating under contract to the Dutch government. The system consists of a number of private ambulance companies, each with its own designated service area within one of fifteen service delivery regions, and with standards of operation that are provided by the government contract. All contracts stipulate that the contractor is required to meet all standards published for vehicles, equipment, training, and performance by the Dutch Ambulance Institute. [cite web|url=http://www.nederlandsambulanceinstituut.nl/|title=Dutch Ambulane Institute website (in Dutch)|accessdate=2008-09-22] All contracts for EMS in the Netherlands are sent to tender every four years, with the contract being awarded to the most successful applicants. Netherlands law forbids EMS systems to earn any profit; any surplus revenue is required to be directed to additional improvements to the system, including training, equipment, and vehicles. The Dutch system is a rare exception to the rule in Europe, in that it operates on a variation of the Anglo-American model of EMS care, [cite journal|author=Cooke MW, Bridge P, Wilson S.|title=Variation in emergency ambulance dispatch in Western Europe|journal=The Scandinavian Journal of Trauma and Emergency Medicine|volume=9|issue=2|pages=57-66|year=2001] and not on the Franco-German model, [cite journal |author=Dick WF |title=Anglo-American vs. Franco-German emergency medical services system |journal=Prehosp Disaster Med |volume=18 |issue=1 |pages=29–35; discussion 35–7 |year=2003 |pmid=14694898 |doi= |url=] which is followed by the majority of European countries.

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Typical_Dutch_AmbulanceImage:IVVP_19_mei_2005_041.jpg|Dutch_Class_B_AmbulanceImage:IVVP_19_mei_2005_064.jpg|Dutch_Class_C_Ambulance

Air Ambulance

The government of the Netherlands contracts for the provision of air ambulance service, by means of four helicopters, [cite web|url=http://www.umcg.nl/azg/nl/english/azg/|title=University of Groningen Mobile Medical Team|accessdate:2008-09-22] all of which are in service around the clock. Each of these helicopters are strategically located around the country in order to minimize response times. Air units may perform high-acuity inter-facility transfers, or may also respond to the location where an emergency is occurring, in order to assist with immediate care or facilitate rapid transport of high-acuity victims.. All air ambulance helicopters are staffed by both paramedics and physicians. The primary role of the helicopters is the rapid delivery of the Mobile Medical Team, and transport of the patient by aircraft, while possible, is not the preferred outcome. In some cases, particularly for response to offshore emergencies, the civilian air ambulance system is supplemented by the three helicopters of the Search and Rescue service of the Dutch Coast Guard; using assets provided by the Dutch Navy and Dutch Air Force services. All of these helicopters are transport-capable. Some areas of Holland also receive emergency air ambulance service from helicopters or vehicles based in Belgium and Germany, since these locations are beyond the normal flight range of the Dutch-owned aircraft.

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Dutch_Air_Ambulance_with_mobile_medical_teamImage:Klu-heli-2.jpeg|Dutch_Search_and_Rescue_Helicopter

tandards

Training

Since 1992, Dutch law has mandated that there will be at least one nurse on every ambulance in the country, at all times. [cite web|url=http://www.ambulancezorgnederland.nl/publiek/english.htm|title=AmbulanceZorg Nederlands website (english)|accessdate=2008-09-24] The nurses employed on ambulances have all completed the full training required for a registered nurse in the Netherlands, and have then completed additional training and certification in anaesthesia, cardiac care, or operating room, in order to apply for an additional year of training to qualify as a Registered Ambulance Nurse. [cite journal |author=Wulterkens D |title=EMS in the Netherlands: A Dutch Treat? |journal=Journal of Emergency Medical Services |year=2005 |pmid= |doi=2005-12-6|url=http://www.jems.com/news_and_articles/articles/EMS_in_The_Netherlands.html] All paramedics in the Netherlands are also nurses. The term ‘paramedic’ is used in the Dutch system, but is very strictly controlled to refer to a nurse with the appropriate additional training. As a result of this measure, all Dutch ambulances and rapid response vehicles are capable of providing Advanced Life Support (ALS) without online medical control. [cite book |author=Kuehl, Alexander |title=Prehospital systems and medical oversight |publisher=Kendall/Hunt Pub |location=Dubugue, Iowa |year=2002 |pages=91-92 |isbn=0-7872-7071-7 |accessdate=2008-09-22] The exceptional level of training permits what is, for the most part, independent practice, conducted according to a set of National Emergency Care Protocols, issued by the Dutch Ambulance Institute, and reviewed and revised every four years. [cite web|url=http://www.ambulancezorgnederland.nl/publiek/english.htm|title=Ambulancezorg Nederlands website|accessdate=2008-09-24] Medical oversight for protocol compliance is conducted by each service's Medical Manager, who is a licensed physician. On those occasions when the patient's condition actually exceeds the paramedic protocols, the paramedic has the option of either calling their own Medical Manager for additional instructions, or requesting the response of a mobile medical team.

taffing

All ambulances are staffed by a crew of two. These include one paramedic, with the training and skill set described above, and one dedicated driver. The medical training of the driver is minimal, and that individual is not permitted to participate in patient care, apart from assisting with the lifting of patient and equipment. [cite journal |author=Wulterkens D |title=EMS in the Netherlands: A Dutch Treat? |journal=Journal of Emergency Medical Services |year=2005 |pmid= |doi=2005-12-6|url=http://www.jems.com/news_and_articles/articles/EMS_in_The_Netherlands.html] Mobile medical teams (MMT) are generally staffed by a senior surgical resident with additional training to function in the prehospital environment and additional nurses. MMT aircraft are designed for team delivery, not medical transport. Transport is usually accomplished by means of the ambulance that originated the call, with the team on board. In case of weather which restricts flight operations, each MMT is also equipped with a special van for land response.

Vehicles

The Netherlands government mandates that all ambulances must meet the standards outlined by the Netherlands Ambulance Institute, in addition to the European standard CEN 1789, as published by the European Committee for Standards. [cite web|url=http://www.cen.eu/cenorm/homepage.htm|title=European Committee for Standards website|accessdate+2008-09-19,] These standards are applied to the types of vehicles and the types of medical equipment required. However, the Dutch system does not comply with all of the elements of the visual identity program beyond the basic colors of vehicles and warning systems, and has no plans to comply with the marking schemes standards. In addition to conventional ambulances, in some areas, particularly those subject to urban traffic congestion, some Dutch paramedics also use ALS equipped motorcycles as Rapid Response Vehicles.

Dispatch

All 25 EMS regions in the Netherlands are self-dispatching. Some regions have more than one centre, but all are interconnected. The technologies involved in the dispatch of EMS resources are generally equivalent to the American and British standards. All EMS dispatch centers participate in the national emergency number scheme. The emergency telephone number for ambulances in the Netherlands is 112. All EMS calls in the Netherlands are nurse-triaged. [cite book |author=Kuehl, Alexander |title=Prehospital systems and medical oversight |publisher=Kendall/Hunt Pub |location=Dubugue, Iowa |year=2002 |pages= |isbn=0-7872-7071-7 |oclc= |doi= |accessdate=] Triage is conducted using national evidence-based triage protocols and guidelines developed by the Dutch Ambulance Institute. Most dispatch centers use computer-based decision-support systems. [>cite journal|author=Grol R, Giesen P and van Uden C|title=After-Hours Care In The United Kingdom, Denmark, And The Netherlands: New Models|journal=Health Affairs|year=2006 |volume=25|issue=6|pages=1733-1737|pmid= |doi=10.1377/hlthaff.25.6.1733|url=http://content.healthaffairs.org/cgi/content/full/25/6/1733] As a result of this approximately 30 percent of all requests for service are dealt with by some other means of service at the scene, and in approximately 40 percent of cases, the call is triaged with a result that an ambulance response is avoided entirely. [cite journal|author=J . Dib , S . Naderi , I . Sheridan , K . Alagappan|title=Analysis and applicability of the Dutch EMS system into countries developing EMS systems|journal=Journal of Emergency Medicine|year=2006 |volume=30|issue=1|pages=111-115|pmid= |doi=|url=http://linkinghub.elsevier.com/retrieve/pii/S0736467905003860]

Response time

Dutch law provides support for all standards published by the Netherlands Ambulance Institute, which currently mandates that an ambulance must be in place on the scene of any emergency in the country within 15 minutes. That standard is currently being met approximately 95 percent of the time. [cite journal |author=Wulterkens D |title=EMS in the Netherlands: A Dutch Treat? |journal=Journal of Emergency Medical Services |year=2005 |pmid= |doi=2005-12-6|url=http://www.jems.com/news_and_articles/articles/EMS_in_The_Netherlands.html]

ee also

*Emergency medical services
*Emergency medical services by country
*International Red Cross and Red Crescent Movement

References