Pre-hospital emergency services

The Intermunicipal Hospital District of Southwest Finland has made a service standard decision covering the time from 1 January 2022 to 31 December 2022.

Written and approved by the Steering group of the center for pre-hospital emergency services of the special responsibility area of the Turku University Hospital: 12 October 2021

Written and approved by the Board of directors on part of the public utility of Pre-hospital and in-hospital emergency services:  28 October 2021

Approved by the Board of the intermunicipal hospital district: 9 November 2021

Approved by the Council of the intermunicipal hospital district: 30 November 2021

1. Working environment

The service level decision concerns pre-hospital emergency services in the region of the Intermunicipal Hospital District of Southwest Finland.  The Intermunicipal Hospital District of Southwest Finland has the responsibility to organize this service.  Unified goals have been set and they have been approved as required by the Health Care Act 39 § by the Steering group of the pre-hospital center of the special responsibility area.  Basic information about the region is presented in Table 1 and the risk classification of the special possibility area is presented in Attachment 1.  We perform about 63,000 pre-hospital emergency assignments annually.

Basic information on the region  

(1)= Sotkanet.fi 31 December 2020, (2)= National land survey of Finland 1 January 2021, (3)= CGI 2021

• Name of the Intermunicipal Hospital District: Intermunicipal Hospital District of Southwest Finland
• Population at end of previous year (1):  484,188
• 0–14 yrs. (1): 14.6 %
• 15–64 yrs. (1): 61.7%
• 65– yrs. (1): 23.8%
• THL’s morbidity index, not standardized for age 2016 (1): 95.6
• Total are of region (2): 20,902 km2
• Of this, covered by water or sea (2): 9,876 km2
• Number and distribution of land area pixels with risk (3)
  • Centers of population, number:  36, 0.3%
  • Other populated areas, number: 1,239, 9.1%
  • Inhabited rural areas, number: 6,761, 49.6%
  • Other areas, number: 5,593, 41.1%

2. Organization of pre-hospital emergency services

The Intermunicipal Hospital District will produce the pre-hospital emergency services by involving several service producers. The Intermunicipal Hospital District has signed agreements with the Rescue department of Varsinais-Suomi (Southwest Finland) and the Intermunicipal Hospital District of Pirkanmaa. Pre-hospital emergency services are also produced through purchasing service agreements. 

3. Contents of pre-hospital emergency services

The responsibilities of pre-hospital (medical) emergency services are laid down in the Health Care Act (40 §) and regulation 585/2017 (2 §). Pre-hospital (emergency) medical services include first response services, primary emergency medical services, management of patients requiring emergency medical services, field management of pre-hospital emergency services and services provided by a physician-run emergency unit.   A responsible physician is employed by the Intermunicipal Hospital District. The Intermunicipal Hospital District of Southwest Finland (Varsinais-Suomi) organizes pre-hospital emergency on-call services by physicians.  These services operate 24/7 within the special responsibility area.

The field managers of pre-hospital emergency services are responsible for the operative management subject to the on-call pre-hospital emergency services physician and the physician of the Intermunicipal Hospital District responsible for pre-hospital emergency services.

4. Education requirements of the pre-hospital emergency services personnel

4.1. First response unit

At least two of the personnel of the first response unit must have the training and competency required for pre-hospital emergency service. 

4.2. Primary-level first response unit

The personnel working in primary-level first response units are required to have the competency stated in the regulation (585/2017) on first response units. However, at least one of the paramedics must fulfil the requirements of a health care professional as stated in the Health Care Professionals Act (559/1994) and have had training oriented toward pre-hospital emergency services.

4.3. First response unit for patient management

The personnel working with management of patients in first response units are required to have the competency stated in the regulation  on first response units (585/2017) with due consideration of transitional provisions.   However, nurses in the first response unit for patient management must fulfil the requirements of a health care professional as stated in the Health Care Professionals Act (559/1994).

4.4. First response unit run by one person

The regulation on first response units (585/2017, 8 § section 4) includes the provision that  one person may constitute a first response unit.  This unit run by one person has the following tasks: assessment of need for treatment of patients; initiating necessary immediate treatment; and supporting the functions of other first response units.  According to the same regulation (8 § section 3a) this person must have the competency of working in a first response unit for patient management or fulfil the criteria laid down in 11 § of the transitional provision.  This unit does not transport patients.

4.5.  Field manager of first response services

The field manager of first response services must fulfil the competency requirements of working with patient management in a first response unit. In addition, he/she must have sufficient knowhow and experience in administration and operating first response services.

4.6. First response physician

The requirements of specialist physicians working as first response physicians is authorization to work as a specialist physician within an appropriate field of specialization; profound insight and knowledge in first response medicine; and adequate knowledge of anesthesiology.  The requirements of physicians in training are authorization to work as a licensed physician and sufficient experience in examining and managing patients of various medical specialties.  Working in the FinnHEMS unit requires, in addition, fulfilling the requirements for aviation activity.

4.7. Exceptions to training requirements

Under special circumstances, e.g. patient overcrowding, temporary exceptions to the training requirements of the personnel of first response units, primary-level first response units and first response units for patient management are allowed. 

5. Target times to reach patients

The target times to reach patients are presented in Table 2.  Delays are recorded from the time from transfer of assignment responsibility to the first response unit to the time of arrival to the target site.

A- and B-assignments

Target times of A- and B-assignments.
Area type	Median	90%
Center of population	6 min	9 min
Other populated area	8 min	17 min
Inhabited rural area	15 min	26 min

C- and D-assignments

Target times for C- and D-assignments.
Entire county	90 %
C	30 min
D	120 min

A report of the activities of pre-hospital emergency services is provided every quarter of the year, as legally required.

6. Transfers related to pre-hospital emergency services

As stated in the Health Care Act 40 §, pre-hospital emergency services include transfers of patients who have become acutely ill or injured, when the patients need advanced and continuous treatment or monitoring during the transfer. 

7. Other important circumstances to consider for organization of pre-hospital emergency services

For assignments that cross county borders and under conditions of patient overcrowding and other special circumstances it is the duty of the field managers to agree on the operational procedures required.

The following instructions are followed by pre-hospital emergency services: national instructions as published by Duodecim Publishing Company Ltd (2022): Tom Silfvast, Sanna Hoppu, Jouni Kurola, Vesa Lund, Matti Martikainen (ed.) Ensihoito-opas; instructions reconciled by the pre-hospital emergency service center; and/or the instructions approved by the responsible physician of pre-hospital emergency services.