Order On The Planning Of Public Health Preparedness And The Pre-Hospital Emergency And Training Of Ambulance Personnel, Etc.

Original Language Title: Bekendtgørelse om planlægning af sundhedsberedskabet og det præhospitale beredskab samt uddannelse af ambulancepersonale m.v.

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Overview (table of contents)

Chapter 1

Scope etc.


Chapter 2

Planning for public health preparedness and pre-hospital care.


Chapter 3

Ambulance preparedness


Chapter 4

Staffing of ambulances and training of ambulance personnel, etc.


Chapter 5

Commencement and transitional provisions


Appendix 1

Prehospital treatment


The full text
Order on the planning of public health preparedness and the pre-hospital emergency and training of ambulance personnel, etc.
Pursuant to § 169 and § 210, paragraph. 4 in Health Act,. Legislative Decree no. 913 of 13 July 2010, for:

Chapter 1

Scope etc.

§ 1. This Order shall apply to the local councils' responsibility for the planning of public health preparedness and regional councils, the responsibility for planning public health preparedness, including the pre-hospital emergency and training of ambulance personnel, etc. under the Health Act.

PCS. 2. The planning must be based on the daily preparedness and ensure flexible adaptation of the daily preparedness for possible emergency situations.

§ 2. Health measures include hospital preparedness, drug preparedness and response in primary care. In health resources include a therapeutic crisis preparedness and response to chemical, biological, radiological and nuclear incidents. In hospital resources include the pre-hospital emergency services including ambulance preparedness.

§ 3. Health measures to ensure that the health system can expand and adapt its treatment and care capacity, etc. in addition to the daily preparedness for major accidents and disasters, including war.

PCS. 2. Hospital Preparedness, which is preparedness in the total hospital including private hospitals, must in major accidents, disasters and in war conditions ensure that eligible for sick and injured treatment in hospital or clinics outside of hospitals.

PCS. 3. Medicines preparedness, which is the preparedness of medicines and medical equipment, to ensure that the revised requirements for consumption, supply and distribution, which is anticipated during major accidents, disasters and in war conditions can be met.

PCS. 4. preparedness in primary care, which is preparedness in the part of the health care system, which is not part of the hospital preparedness must in major accidents, disasters and in war conditions ensure a continuation of the daily tasks, adapted to the changed requirements and additional provision of prevention, treatment and care tasks.

§ 4. The pre-hospital care, which is the effort before arriving at the hospital to acutely ill, injured and women giving birth, aims to save lives, improve health prospects, reduce pain and other symptoms, shorten the overall course of the disease, provide care and provide reassurance.

PCS. 2. When an ambulance means a vehicle which is adapted for carrying acutely ill, injured and women giving birth, and where there may be certain types of treatment, see. § 29

PCS. 3. Ambulance preparedness is part of the total pre-hospital organization and includes transport by ambulance and treatment related, meaning. Annex.

PCS. 4. The response time is the time it takes from the technical dispatcher on the region AMK-control center receives the assignment from the medical assessor until the ambulance arrives at an injury site, in an acutely ill patient or at a birthing.

§ 5. Notice rules on police alarm centers also apply to the City of Copenhagen's emergency center.

Chapter 2

Planning of public health preparedness and pre-hospital care.

§ 6. The Regional Council and local councils are responsible to plan for and build a health emergency.

The municipal

§ 7. The municipal council shall once in each term elaborate and adopt a plan for public health preparedness.

PCS. 2. The municipal council shall coordinate the plan with other municipal planning field of emergency response - including plans for emergency preparedness, regional council plan for public health preparedness and pre-hospital care as well as with the surrounding municipalities health emergency plans.


PCS. 3. The municipal council shall, prior to the adoption of health emergency plan obtain an opinion from the regional council and local councils in the surrounding municipalities. The local council may also involve health Coordination Committee in the coordination of the municipal health emergency plan for the region's health emergency response plan and the other in the region located municipal health emergency plans.

PCS. 4. The local authority shall, prior to considering proposals for health emergency obtain National Board of Health and the Danish Medicines Agency's advice. After the local council's decision sent the plan and amendments thereto to the Board of Health and the region that the municipality is located.

§ 8. Based on the daily preparedness is planned for expansion of preparedness for that in an emergency can be met additional requirements, see. § 3, using the combined resources in health care.

§ 9. The plan prepared on the basis of national threat assessments and a local risk and vulnerability assessment in accordance with § 13

§ 10. The plan should outline the municipality's objective for public health preparedness, including:

1) response to extraordinary discharged patients and other sick, injured and infected people who are staying in their own home

2) cooperate with the regional council and surrounding municipalities on public health preparedness,

3) communication between persons involved in health preparedness, including the region's actors

4) activation of public health preparedness, including cooperation with Acute Medical Coordination Centre (AMK)

5) quality and quality assurance, and

6) training and exercise activities, if necessary. in cooperation with the region and adjacent municipalities.

The Regional Council

§ 11. The regional council shall once in each term elaborate and adopt a plan for public health preparedness and pre-hospital care.

PCS. 2. The Regional Council will coordinate the plan with police planning - including for alarm, neighboring regions plans in the region located municipal health emergency plans and plans for emergency preparedness and the regional discount epidemic commission concerning planning. measures under Epidemic Act. The plan is part of the region's total health planning, see. § 206 of the Health Act.

PCS. 3. The Regional Council shall, prior to the adoption of health emergency plan obtain an opinion from the region located municipalities. The Regional Council may also involve health Coordination Committee in the coordination of the region's health contingency plan in the region located municipal health emergency plans.

PCS. 4. The Regional Council shall, prior to the regional council's treatment of the proposed plan for public health preparedness and the prehospital obtain National Board of Health and the Danish Medicines Agency's advice. After the regional council adopting the plan sent the plan and amendments thereto to the Board of Health and local councils in the region.

§ 12. Based on the daily preparedness is planned for the expansion of preparedness for that in an emergency can be met additional requirements, see. § 3, using the combined resources in health care.

§ 13. The plan shall be prepared on the basis of national security and emergency preparedness threat assessments and a locally made risk and vulnerability assessment.

PCS. 2. Risk and vulnerability assessment shall include the following elements:

1) Identification of critical functions and tasks in health care, ie a description of products, activities and services that are necessary for the health functioning, and should be secured or maintained by accidents and disasters.

2) Identification of threats / events that may prevent the health care system can function or put it under considerable pressure, for example. pandemics, mass injuries and bioterrorism. By identifying such threats and incidents consideration shall be based on the area's population density, industry in the region, handling and transportation of dangerous goods, the presence of assemblies of large crowds, etc.

3) Analysis of health services' capacity in relation to such. hospitals with emergency medical service, the ability to perform expanded prehospital treatment and an assessment of health emergency services and other sectors interdependence, including water, electricity, IT and telecommunications, transport, road network characteristics etc.

4) Analysis of the likelihood of specific events will occur and its likely consequences, taking into account health preparedness capabilities, see. # 3.


5) Risk and vulnerability profile, which includes an overall assessment of the results of the Nos. 1-4 above analyzes.

§ 14. The plan must describe the regional council's objective for public health preparedness and pre-hospital care, including:

1) the scope, development, quality control and quality assurance,

2) efforts via ambulances, any emergency medical vehicles, emergency vehicles, emergency response teams and the like and the involvement of health professionals from primary care, etc.

3) division of tasks between the hospital system, the pre-hospital emergency services including ambulance emergency and primary care,

4) guidelines for the total pre-hospital care, including the deployment guides and visitation guidelines

5) activation of public health preparedness and pre-hospital care, including a unique approach to health preparedness via Acute Medical Coordination Centre (AMK), coordinated with neighboring regions and between the region and municipalities

6) the establishment and use of the coordinating physician (KOOL)

7) activation of additional pre-hospital support at need,

8) capacity building, including exceptional discharge of patients,

9) receiving the greater number of sick or injured,

10) activation of emergency therapeutic emergency, including cooperation with local crisis therapists

11) communication between the players in the health emergency and pre-hospital care, including actors from neighboring preparedness,

12) cooperation between the various actors in preparedness, including municipalities, neighboring regions, police and fire brigade, and

13) training and exercise activities, if necessary. in cooperation with municipalities and neighboring areas.

§ 15. The regional council will continually assess the quality of health emergency and pre-hospital care.

§ 16. The Regional Council appoints a health emergency and prehospital selection. This committee will coordinate cooperation on public health preparedness and the total pre-hospital care between hospitals, ambulance emergency, primary care, neighboring regions, municipalities in the region, police and rescue services.

PCS. 2. health emergency and prehospital committee composed of representatives of the region's health care, ambulance preparedness, municipalities in the region, the police, the national fire and rescue as well as any private ambulance. Furthermore, the head of public health preparedness and the pre-hospital resources. See § 17, committee member.

§ 17. The Regional Council shall appoint a person as the head of public health preparedness and the pre-hospital emergency with a view to ensuring a high level of health professional level of effort. The head of public health preparedness and the pre-hospital emergency among other things the task

1) ensure the coordinated planning of the pre-hospital care and public health preparedness,

2) collect and process data for quality assurance and development of public health preparedness and the pre-hospital emergency services including ambulance preparedness,

3) draft guidelines on the overall pre-hospital care, see. § 14, no. 4, in cooperation with AMK-control center, ambulance preparedness, hospitals and health emergency and prehospital Committee, including drawing up guidelines for the professional triage of emergency calls related the need for a pre-hospital effort

4) verifying that the personnel involved in health preparedness and the pre-hospital emergency services including ambulance crews have received the necessary training and maintenance training, including participation in exercises

5) ensure the establishment of guidelines regarding medical delegation of processing tasks for ambulance crews and medical prescription of treatment, see. Annex, telemedicine and remote triage of patient transports mm

Chapter 3

Ambulance preparedness

§ 18. The Regional Council is committed to providing ambulance available to people who need it because of sudden illness, accident or childbirth. Ambulance preparedness is part of the region's total health and is part of the hospital preparedness, see. § 2.

PCS. 2. The Regional Council may choose to establish ambulance with its own ambulance or ambulances by arrangement made available by other regions, municipalities or private ambulance.

§ 19. Ambulance services shall include a day preparedness. In addition to the fixed day emergency regional councils establish contingency plans that cover only part of the year or part of a day.

PCS. 2. The Regional Council determines preparedness extent in each geographical area based on local needs, see. § 13.


PCS. 3. The Regional Council establishes the response times at emergency area. These response times can be supplemented with differentiated response. The specified response times are published, and the Regional Council regularly monitors the actual response times.

Chapter 4

Manning of ambulances and training of ambulance personnel, etc.

§ 20. An ambulance must be staffed by at least two people. Of this, a person must have completed training for paramedic, see. § 23, or equivalent education. Moreover, ambulance crews have completed the training for emergency medical technician, see. § 22 or equivalent education.

PCS. 2. The Regional Council shall determine the number of persons to be trained paramedic with special competence under. § 24, taking into account the organization of pre-hospital care in the region in general.

§ 21. ambulance crew should be able to

1) initiate treatment with ambulance equipment as a minimum in accordance with the Annex section. A

2) handle an injury situation

3) master driving techniques, including emergency and gentle transport of acutely injured, sick and birthing,

4) evaluate different types of accident to provide accurate feedback to ensure proper and adequate assistance

5) master lifting and carrying techniques,

6) carry out rescue work in accidents, including initiating release of injured and

7) engage in proper cooperation with other participants in the pre-hospital care, hospital, police and the municipal and national emergency, etc.

PCS. 2. Ambulance crews must have knowledge of the then-current legal framework.

§ 22. The basic training for emergency medical technician must include at least 6 months of theoretical courses with clinical content, 4-month internship, see. Paragraph. 4, and 2-month internship ambulance.

PCS. 2. The program must put the skills to assist ambulance practitioners and ambulance officers with special expertise.

PCS. 3. The program must include training in anatomy, physiology, hygiene, symptom learn pathology, including infectious diseases, observation techniques, basic care, birth teach and care of the newborn, pharmacology, handles including defibrillation, ergonomics, psychology, psychiatry, social and legislative factors , ethnology, health care organization, partners and information technology.

PCS. 4. The program includes clinical internship with practicing skills that are part of the theoretical teaching. The practice occurs in hospital and possibly in the medical service, in nursing homes and home care as well as by social and psychiatric institutions.

PCS. 5. The program includes, in addition to in paragraph. 1 said, teaching in ambulance engineering, including driving techniques, lifting and carrying techniques, basic rescue work accident and the then-current legal framework, including in order that ambulance assistant must be able to engage in proper cooperation with other participants in the pre-hospital care, hospital, police and the municipal and national emergency, etc.

§ 23. Training for paramedic requires a completed training for emergency medical technician, see. § 22 equivalent education or basic education for pre-existing training rules, and work as emergency medical technician for at least 1.5 years. The program has a duration of at least 5 weeks and includes theoretical and practical training at an educational institution, see. § 27, hospital internships, skills and simulation training and ambulance internship.

PCS. 2. The program must put the skills to perform prehospital cases referred. Appendix, point. A.

PCS. 3. In addition, the program put ambulances practitioner able to perform monitoring and treatment during transport of patients by medical delegation and ordination, including in telemedical monitoring.

PCS. 4. Training includes in relation to emergency medical technician training further training in anatomy, physiology, hygiene, symptom learn pathology, including infectious diseases, observation techniques, pharmacology and management of medication, patient care, transmission of 12-lead ECG to the hospital, monitoring and defibrillation, and information technology in telemedicine.


§ 24. Training for ambulance dealing with specific competence requires a completed training for paramedic, see. § 23, or equivalent education and work as a paramedic at least 3 years. The program has a duration of at least 5 weeks and includes theoretical and practical training at the educational institution, see. § 27, hospital internships, skills and simulation training and ambulance internship with acute lægebil or similar medical supervision.

PCS. 2. The program must put the skills to perform advanced prehospital care, including administering certain medications intravenously, see. Annex points. B.

PCS. 3. In addition, the program put the skills to assist the doctor in an emergency lægebil or the like and perform monitoring and treatment in certain patient transports to special wards for medical delegation and ordination, including in telemedical monitoring.

PCS. 4. Training includes in relation to paramedic training further training in anatomy and physiology, hygiene, symptom learn pathology, including infectious diseases, observation techniques, pharmacology and management of medication, patient care, transmission of 12-lead ECG to the hospital, monitoring and defibrillation.

PCS. 5. Ambulance Therapists with special competence to participate in maintenance training for a week once a year.

§ 25. To be included in the ambulance emergency and pre-hospital as emergency medical technician, paramedic or ambulance dealing with specific competence, a candidate must have completed the training to do so, as listed in this notice or equivalent foreign qualifications approved by the Board of Health.

PCS. 2. Before a person with foreign education temporarily or occasionally exercising the profession of emergency medical technician, paramedic or ambulance dealing with specific competence, the Board of Health have approved his training etc.

§ 26. Board of Health shall lay down specific rules for the program for paramedic and paramedic with special expertise, including access requirements and requirements for similar training according to § 23 paragraph. 1 and § 24 paragraph. 1.

PCS. 2. The training shall determine the cases in which additional training gives merit in the training of ambulance crews under §§ 22-24. The decision can be appealed to the Board of Health.

§ 27. Training for emergency medical technician is an integral part of vocational training to save. Training for paramedic and paramedic with special competence under. §§ 23-24 takes place at a school for social and health education, a nursing school or the like.

§ 28. The regional council shall make available internships on their own hospitals or by appointment at other hospitals as part of the training of ambulance personnel.

Ambulance design and equipment

§ 29. Ambulances should be equipped so that there may be sick, injured and birthing a gentle pick-up, monitoring and treatment and gentle transport to hospital or other treatment facility.

PCS. 2. Ambulances should be equipped with tools that enable basal release of patients and firefighting equipment to put out small fires.

PCS. 3. Ambulances be via radio, cell phone or the like to communicate with the control panel, AMK-Control Centre and relevant hospital departments etc.

PCS. 4. Ambulances must also be designed and equipped to be granted in § 21, see. Annex, stated ambulance help.

Chapter 5

Commencement and transitional provisions

§ 30. This Order shall enter into force on 1 January 2012.

PCS. 2. At the same time, Executive Order no. 977 of 26 September 2006 on the planning of the pre-hospital care and training of ambulance personnel, etc., as amended by Decree no. 22 of 9 January 2007.

Ministry of Health, December 9, 2011
Astrid Krag
/ John Erik Pedersen



Appendix 1

Prehospital treatment
By medical delegation shall mean the transfer of a specific processing task, under the law is reserved to physicians and through medical prescriptions mean a physician's specific position on the treatment to be undertaken.
A)
Ambulance crews who have received training for ambulance treat to be able to make:



1) Basic assessment of the patient's condition.

2) Gentle picking up injuries with special equipment.

3) Establishment and maintenance of a patent airway.


4) Resuscitation by artificial maintenance of breathing with supplemental oxygen and CPR.

5) ECG monitoring and resuscitation using the defibrillator.

6) Haemostatic and anti-shock treatment.

7) Bridal treatment so that the whole body or parts of the body including the cervical spine can be supported.

8) Emergency treatment of severed body parts.

9) Acute treatment of burns injuries, burns, cold damage etc.

10) Obstetric and care of newborns.

11) Medical pain relief, for example. by inhalation of oxygen and nitrous oxide.

12) The relief of angina pectoris pain, for example. with nitroglycerin was administered to the oral cavity.

13) Mitigation of asthma attacks by inhaling bronchodilator drugs.

14) Mitigation of seizures by administering anticonvulsant medications (benzodiazepines) in the rectum.

15) Initial treatment if signs of heart attack with aspirin.

16) Mitigation of insulin shock with glucagon by intramuscular injection.

17) Alleviation of allergic reactions with adrenaline by intramuscular injection.

18) Mitigating the effects of intake of morphine-like substances with naloxone by intramuscular injection.

19) The construction and flushing of the intravenous access.

20) Start of intravenous fluid treatment of severely injured and patients with severe circulatory failure due to hypovolemia.

Processing Tasks after point A, number 11-20 can only take place after medical delegation.
B)
Ambulance crews who have received training in paramedic with special competence in accordance with § 24 of the Ordinance on the planning of public health preparedness and pre-hospital care and the training of ambulance personnel, etc. or equivalent education should be able to make:



1) The section. A mentioned ambulance help.

2) Intravenous administration of pain medication (morphine-like substances) for pain.

3) Mitigation following intake of overdose of morphine-like substances, benzodiazepine or similar substances by intravenous administration of medicine as an antidote.

4) Mitigation of accumulation of fluid in the lungs by intravenous administration of diuretics.

5) Mitigation of nausea by intravenous administration of anti-emetic medication.

6) Intravenous administration of drugs in connection with cardiopulmonary resuscitation, see. Guidelines from the Danish Council for Resuscitation.

7) Intravenous administration of medicines.

8) Termination of certain treatments on site, for example for diabetic patients with low blood sugar.

Processing Tasks after point B, number 2-6 can only take place after medical delegation, treatment by number 7 can be done by medical delegation, provided that it is subject to specific treatment protocols and treatment by number 8 can only be done after medical prescription

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