# EMS in Poland



## RatMed (Nov 22, 2010)

EMS in Poland is public and financed by the government. Ambulance services, together with hospital ER's and emergency dispatch centers, form the integrated system of emergency medical rescue. Emergency call number is 999 or 112.
Ambulance services in majority are operated by publicly-funded agencies, and are either independent or, in smaller towns, attached to hospitals. A number of stations is contracted and run by private companies.

Ambulance types:
-Specjalistyczny (Specialistic). Crew: doctor, 2 paramedics (interchangable with EMS nurse; typically nurse + paramedic), optionally driver. National regulations allow for a 3-crew type 'S' ambulances but most ambulance services retain the driver. Basically an ICU on wheels, these ambulances are supposed to respond to most serious calls. 

-Podstawowy (Basic)
two paramedics (or paramedic and nurse) and a driver (also optionally). Dispatched mostly to  non-life threatening calls, although when there's no 'S' ambulance available in the area (which is often), paramedics are dispatched to all kinds of calls. Medical direction is unavailable to the paramedics in most of Poland, so we're all on our own there. In need, 'S' ambulance or HEMS may be called to support the paramedic crew.
Proportion of P to S ambulances averages between 4/1 to 1/1 in some areas. 

-HEMS. Crew: pilot, doctor and paramedic/nurse. Currently re-equipping from old Mi-2 Plus helicopters to EC-135. Operates from 17 bases all over Poland, additional bases are planned to be opened soon. HEMS responds to serious emergency calls but also transports critical patients between hospitals. 

- Transport ambulances - provided mostly by private companies. Crew and equipment varies depending on what kind of transports they do. This may range from ambulances in full 'S' or 'P' standard together with the ability to use sirens, to the van with a single untrained driver and seats only.

Ambulance crew:

- EMS doctor. 6 years of study, then 5 years of specialisation in either: emergency medicine, anesthesiology, surgery, internal diseases, orthopedics or pediatrics.

- Ratownik Medyczny (paramedic). 
Education is either: 
- paramedic school - 2 years (2100hrs), of which one semester is internship in ambulance services, ER, ICU, operating ward, EMS dispatch centre and fire departments.
- BA degree in paramedic science - 3 years, 2100hrs of profession-related material (+ another 1700hrs of unrelated, useless crap).
Education ends with national exam. Skills and competences are equal for both ways of becoming a paramedic.
Competences:
- assessing patient's condition and deciding on appropriate action.
- advanced airway management: LM, LT, intubating patients in cardiac arrest, cricothyrotomy
- IV, IO
- 12 lead ECG
- manual defibrillation
- needle decompression of tension pneumothorax
- fracture immobilsation and spinal care 
- oxygen
- administering drugs: aspirin (p.o.), amiodarone, atropine, clemastine, clonazepam, diazepam, drotaverine, epinephrine, flumazenil, furosemide, glucagon (i.m.), glucose 5%, glucose 20%, nitroglycerin (s.l.), hydrocortisone, magnesium, ketoprofen, lidocaine, metoclopramide, morphine, naloxone, NS, multi electrolyte solution, salbutamol (inhalation), Ringer's solution. 
Competences under doctor's supervision:
-intubating patients other than in cardiac arrest, using paralytics; cardioversion and electrostimulation; assisting at minor surgery (suturing, inserting drains); inserting stomach tube, stomach lavage; inserting urinary catheter; administering all other drugs.

- EMS nurse. 
Education takes 3 years of university study (BA degree), then 2,5 years of specialisation in: emergency medicine, anesthesiology, surgery, cardiology or pediatrics. Or a short 'qualification course' in one of the above after 3 years of experience in the EMS. 
EMS nurse has competences equal to paramedic.

- EMS driver.
No specific education is required. Most of ambulance drivers are trained in BLS and assisting medical crew. Some are certified paramedics themselves.


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## RNL (Nov 22, 2010)

RatMed said:


> - EMS driver.
> No specific education is required. Most of ambulance drivers are trained in BLS and assisting medical crew. Some are certified paramedics themselves.



which is the subject to be changed soon


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## RatMed (Nov 22, 2010)

Couple of random pics.


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## Melclin (Nov 29, 2010)

Sounds like a great system, thanks for posting.



> + another 1700hrs of unrelated, useless crap



That's funny, I could have sworn you were describing my degree 

Couple of questions if I may:

Is their any trouble with staffing when it comes to doctors? Are their a lot of MDs willing to work in ambulance? 

What are the response times like for the doctor based ambulances?

How far does the doctor's care extend once you arrive at the ED? Is the handover process to the EM docs largely similar to paramedics or can you order tests/procedures etc once in ED?

Do the docs bypass the ED and directly admit pts in certain circumstances? If so, what circumstances and how often does this occur?

Is the 20% dextrose used instead of 50% (We use 10% instead of 50% here and I'm wondering if its based on the same idea)?


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## RatMed (Nov 29, 2010)

> Is their any trouble with staffing when it comes to doctors? Are their a lot of MDs willing to work in ambulance?


There is a serious shortage of doctors meeting specialisation requirements AND willing to work in the EMS. For now it's so bad that some companies hire other specialists just to have a doctor on board of an 'S' ambulance. The problem should be solved in another couple of years after enough emergency medicine specialists will be trained. 



> What are the response times like for the doctor based ambulances?


All ambulances have to arrive at the call site within 8 minutes after the call in a city and 15 minutes in rural areas. Highest priority calls (code 1) have to leave the station within 1 minute after the call.



> How far does the doctor's care extend once you arrive at the ED? Is the handover process to the EM docs largely similar to paramedics or can you order tests/procedures etc once in ED?


ED personnel takes full responsibility for patient and further treatment after the handover and this is where ambulance doc's work ends. He may have some suggestions but it's the ED doctor who makes all the decisions.
This may be different in smaller town hospitals though, where ambulance MD is at the same time hired by the hospital, often in the same ED he's hauling his patients to.



> Do the docs bypass the ED and directly admit pts in certain circumstances? If so, what circumstances and how often does this occur?


I can't think of any such circumstances. AFAIK patients from the ambulance always have to pass through ER.



> s the 20% dextrose used instead of 50% (We use 10% instead of 50% here and I'm wondering if its based on the same idea)?


Yes, 5% and 20% dextrose. Higher concentrations may be damaging to peripheral veins (at least this is what we've been taught).


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## RNL (Nov 29, 2010)

Sounds like a great system, thanks for posting.



That's funny, I could have sworn you were describing my degree 

Couple of questions if I may:

Is their any trouble with staffing when it comes to doctors? Yes, all the time. 

There Are their a lot of MDs willing to work in ambulance? Rather not. Usually those who are working are just after the University, or just a while before being retired. Salaries arn't good enough to atract doctors on whose diplomas ink has already dried, though doesn't peel yet...


What are the response times like for the doctor based ambulances?For the "S"  (specialized) in the "Code One" which means with the sirens- 90sec. In "Code Two" without sirens- 3min. For the family team- 1 hour. 

How far does the doctor's care extend once you arrive at the ED? Is the handover process to the EM docs largely similar to paramedics or can you order tests/procedures etc once in ED?
We fight with the ED doctors to leave the patient there quite often  Sometimes it happens, especially in mass accident we extend our care once in ED if there was not enough people to handle with all the victims. 

Do the docs bypass the ED and directly admit pts in certain circumstances?Only in case of the transport between facilities.

If so, what circumstances and how often does this occur?Depends. I used to work in a private company which performed only such transports. 

Is the 20% dextrose used instead of 50% (We use 10% instead of 50% here and I'm wondering if its based on the same idea)?
Honestly? I'll have to check it in ambulance (What an ignorance on my side...)


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## clibb (Nov 29, 2010)

I'll be attending the medical school in Poznan next year so this should be fun to see the EMS at work in Poland.
Is there any chance to get a ride-a-long with the EMS system there?


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## RatMed (Nov 29, 2010)

Slim chance but you can try. Contact me when you get here


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## clibb (Nov 29, 2010)

RatMed said:


> Slim chance but you can try. Contact me when you get here



Awesome. Well, it would be an awesome experience! Will do!


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## Outbac1 (Nov 29, 2010)

We have a Polish Dr. at our local hosp who used to work on the ambulance in Poland before he immigrated to Canada. When I did my OR rotation for ACP school I spent some time with him and he told me about working in Poland. He works here as an anesthesiologist, and a good one too. This fills in some of the gaps in what he was telling me. Sounds like it could be a good system. Definatly interesting.


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## RNL (Nov 29, 2010)

clibb said:


> I'll be attending the medical school in Poznan next year so this should be fun to see the EMS at work in Poland.
> Is there any chance to get a ride-a-long with the EMS system there?



I am from Poznan. Let me know once you get here B)


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## sihi (Mar 26, 2011)

Some times Polish paramedics can call to EM phisician for consult about unstable patient. 
One paramedic from Katowice said me that when  phician by a phone allows to intubate live patient, they(paramedics alone) intubate using anestetics.
But usually is called Specialized team for help.


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## GrimmyGrimes (Jul 28, 2020)

If immigrating from US as an experienced Paramedic, but only with a US National Registry Certification, would I need a bachelor's in paramedicine to be hired? Could I challenge the proficiency exam? How does all that work? Also, how is the pay for Paramedics?


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## MJG (Nov 3, 2020)

GrimmyGrimes said:


> If immigrating from US as an experienced Paramedic, but only with a US National Registry Certification, would I need a bachelor's in paramedicine to be hired? Could I challenge the proficiency exam? How does all that work? Also, how is the pay for Paramedics?


sure that you want to go to Poland or are there any other European countries of interest to you?


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