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International Perspectives: Finnish Ambulance Services in 2020
Abstract
Emergency medical services and paramedic practice has developed rapidly in the past decades in Finland and in Europe. Demographic change in Europe means that more changes are needed to keep up with the growing demand for social and health services. Education has moved to universities, and with higher education, paramedic profession has developed to be an important part of emergency medicine. New technology makes it possible to transfer information from the field directly to emergency department and specialized MD. That makes decision-making process safer and more accurate. When patients are treated at home, they get better service and money, and time is saved.
Advanced skill set demands high-quality continuing education system and good basic educational system. There is a demand for master’s level education, Ph.D. and research in the paramedic science to improve the overall quality of emergency medical services and quality of care in Finland.
... In Finland, the introduction of paramedic training occurred in 1998 and is undertaken in higher education institutions ( Jormakka and Saikko, 2015). This reflects the need for a more specialised clinician in clinical practice. ...
... This reflects the need for a more specialised clinician in clinical practice. The degree-level training is similar to the UK, however, it involves a four-year dual role programme, comprising both nursing and paramedic education ( Jormakka and Saikko, 2015). Nevertheless, the undergraduate course content, structure, skill set and knowledge are all similar to the UK, with a focus on assessment, treatment and referral as clinicians directly refer patients to operating theatres and intensive care, bypassing the emergency department ( Jormakka and Saikko, 2015). ...
... The degree-level training is similar to the UK, however, it involves a four-year dual role programme, comprising both nursing and paramedic education ( Jormakka and Saikko, 2015). Nevertheless, the undergraduate course content, structure, skill set and knowledge are all similar to the UK, with a focus on assessment, treatment and referral as clinicians directly refer patients to operating theatres and intensive care, bypassing the emergency department ( Jormakka and Saikko, 2015). There are different clinical roles within the ambulance service in Finland, with first responders, basic and advanced-level paramedics, and in some areas a medical unit. ...
Purpose
The purpose of this paper is to explore English and Finnish paramedic perceptions of the healthcare blame culture, its relationship to complaints, the use of defensive practice and if this impacts on paramedic practice and clinical care.
Design/methodology/approach
Participants were recruited from English and Finnish ambulance services that have similar organisational and professional scopes of practice. The aim was to gain insight into the similarities and differences between the countries regarding the existence of a blame culture in paramedic practice. Semi-structured focus groups and interviews involving 20 English and Finnish paramedics were undertaken. Qualitative perceptions concerning the reality of a blame culture in paramedic practice and its impact on professional roles were sought.
Findings
Three major themes that were identified in the thematic analysis included: blame culture and its influences; the impact of complaints against paramedics; and the use of defensive practice within their roles. These data themes were similar for both groups of participants. The majority of participants thought the healthcare blame culture to be widespread and believed that this was likely to directly influence paramedics’ working practices.
Originality/value
Whilst the impact of blame culture and complaints on the medical profession has previously been examined, this study makes an important contribution by exploring the factors that impact on paramedics’ lives and their practice, within two European countries. The inappropriate use of social media by some members of the public in both countries was a disturbing issue for many participants and was identified as an area for further research.
... examining leadership and management challenges, lack of a conclusive evidence base about patient safety and systemic influences on paramedic decision making(McCann et al., 2013;Fisher et al., 2015;O'Hara et al., 2015;Turner et al., 2015;Newton and Harris, 2015;Evans et al., 2014). Globally, ambulance services are facing similar challenges surrounding rising activity, a growing older population, societal and cultural issues and a drive for professionalisation of practice leading to similar cultural challenges for evolving into a professional healthcare providers(Vincent-Lambert, 2015;Jormakka and Saikko, 2015;Hou, et al., 2013). Findings from this study thus have international implications and can be relevant in other settings equally. ...
Purpose
There is a growing academic interest in the examination and exploration of work intensification in a wide range of healthcare settings. The purpose of this paper is to explore the differing staff perceptions in emergency ambulance services in the UK. It provides evidence on the challenges for the paramedic professionalisation agenda and managing operational demands and work intensity in emotionally challenging circumstances, with significant implications for patient safety.
Design/methodology/approach
Drawing on the evidence from an empirical study in a large National Health Service ambulance trust in England, this paper examines the challenges and differing staff perceptions of the changing scope and practice of ambulance personnel in the UK. Amidst the progress on the professionalisation of the paramedic agenda, individual trusts are facing challenges in form of staff attitudes towards meeting performance targets, coupled with rising demand, fear of loss of contracts and private competition.
Findings
Research findings highlight differing perceptions from various sub-cultural groups and lack of clarity over the core values which are reinforced by cultural and management differences. Need for greater management to explore the relationship between high sickness levels and implications for patient safety including the need for policy and research attention follows from this study. The implications of work intensity on gender equality within the ambulance settings are also discussed.
Research limitations/implications
Ambulance services around the world are witnessing a strain on their operational budgets with increasing demand for their services. Study evidence support inconclusive evidence for patent safety despite the growing specialist paramedic roles. Organisational implications of high staff sickness rates have been largely overlooked in the management literature. This study makes an original contribution while building upon the earlier conceptions of work intensification.
Practical implications
The study findings have significant implications for the ambulance services for better understanding of the staff perceptions on work intensity and implications for patient safety, high sickness absence rates amidst increasing ambulance demand. Study findings will help prepare the organisational policies and design appropriate response.
Social implications
Societal understanding about the organisational implications of the work intensity in an important emergency response service will encourage further debate and discussion.
Originality/value
This study makes an original contribution by providing insights into the intra-organisational dynamics in an unusual organisational setting of the emergency ambulance services. Study findings have implications for further research inquiry into staff illness, patient safety and gender issues in ambulance services. Evidence cited in the paper has further relevance to ambulance services globally.
Emergency medicine service (EMS) systems in the five Nordic countries have more similarities than differences. One similarity is the involvement of anaesthesiologists as pre-hospital physicians and their strong participation for all critically ill and injured patients in-hospital. Discrepancies do exist, however, especially within the ground and air ambulance service, and the EMS systems face several challenges. Main problems and challenges emphasized by the authors are: (1) Denmark: the dispatch centres are presently not under medical control and are without a national criteria based system. Access to on-line medical advice of a physician is not available; (2) Finland: the autonomy of the individual municipalities and their responsibility to cover for primary and specialised health care, as well as the EMS, and the lack of supporting or demanding legislation regarding the EMS; (3) Iceland is the only country that has emergency medicine (EM) as a recognised speciality but there is a need for more fully trained specialists in EM; (4) Norway: the ordinary ground ambulance is pointed out as the weakest link in the EM chain and a health reform demands extensive co-operation between the new health enterprises to re-establish a nation-wide air ambulance service; (5) Sweden: to create evidence based medicine standards for treatment in emergency medicine, a better integration of all part of the chain of survival, a formalised education in EM and a nation wide physician staffed helicopter EMS (HEMS) cover.
In Scandinavia, scattered populations and challenging geographical and climatic conditions necessitate highly advanced medical treatment by qualified pre-hospital services. Just like every other part of the health care system, the specialized pre-hospital EMS should aim to optimize its resource use, and critically review as well as continuously assess the quality of its practices. This study aims to provide a comprehensive profile of the pre-hospital, physician-manned EMS in the Scandinavian countries.
The study was designed as a web-based cross-sectional survey. All specialized pre-hospital, physician-manned services in Scandinavia were invited, and data concerning organization, qualification and medical activity in 2007 were mapped.
Of the 41 invited services, 37 responded, which corresponds to a response rate of 90% (Finland 86%, Sweden 83%, Denmark 92%, Norway 94%). Organization and education are basically identical. All services provide advanced life support and have short response intervals. Services take care of a variety of patient groups, and skills are needed not only in procedures, but also in diagnostics, logistics, intensive care, and mass-casualty management. Consistent and detailed medical documentation was often lacking, however. Differences are mainly related to time variables, patient volume, and service area. The Danish and Swedish services have higher volumes of patient care encounters while the Finnish and Norwegian ones provide a wider variety of medical services.
This survey documented several significant similarities among pre-hospital physician-staffed EMS systems in Scandinavia. Although medical data registration is currently under-developed, Scandinavian physician-manned EMS is a feasible arena for future multi-centre research.
The benefit of the Helicopter Emergency Medical Service (HEMS) is not well documented. The aim of our study was to investigate the potential health benefits of HEMS, and their relation to cost of the service in a rural area in Finland. We also evaluated whether the patient benefit is due to early Advanced Life Support (ALS) procedures performed on-scene, or due to rapid transport of patients to definitive care.
We reviewed all helicopter missions during 1 year (1999). Based on given prehospital care, we divided these missions into various categories. At the time of discharge, in-hospital records were reviewed for patients who received prehospital ALS care in order to estimate the potential benefit of HEMS.
There were 588 missions. In 40% (n = 233/588), the mission was aborted. ALS care was given on-scene to 206 patients. It was estimated that in this group lives of three patients (1.5%) were saved, and 42 (20%) patients, mostly with cardiovascular disease, otherwise benefited from the service. The majority (84%) of the patients benefited from on-scene ALS procedures only. The cost for beneficial mission was euro 28 444.
A minority of all patients did benefit from HEMS. Benefit was related to early ALS care and the cost per beneficial mission was 28 444.
ensihoitoasetus (Finnish law)
- Finlex
On-call social and healthcare services in Finland
- E Reissell
Jouni Ensihoitopalvelut osana sairaanhoitopiirien toimintaa
- J Kurola
Interview (Senior lecturer, doing research in continuing education
- A Kosonen
Interview (South Karelia Social and Health Care District
- J Palviainen
Interview (Prehospital specialist, ministry on health and social services)
- M Saarinen
Interview (Principal lecturer
- Simo Saikko
Interview (Field manager, The Hospital District of Helsinki and
- S Takala
Jouni Ensihoitopalvelut osana sairaanhoitopiirien toimintaa. Finnanest
- J Kurola
- J. Kurola