Slovenia Field Report: 2015

Published on July 16, 2015
Slovenia is now undergoing a planned transition in which primary health care emergency services will be merged with hospital emergency services.

Lake Bled, in Slovenia, set against the soaring Julian Alps. In 2014, the Mountain Rescue Association of Slovenia conducted over 400 search and rescue missions in the mountains, of which 184 involved a physician.

Slovenia is a small Central European country with only 2 million people. Emergency medicine in Slovenia is composed of primary health care emergency rooms and ambulances (prehospital emergency care), and separate emergency rooms for internal medicine, surgery, and gynecology.

At the primary health care level, physicians’ access to urgent diagnostic and invasive procedures are limited. As a result, patients often have to be referred to an internal, surgery, gynecological, or other emergency room for health problems that could be otherwise easily solved by physicians working at primary healthcare level using chest X-ray, lab work, CT scan, etc. This is a problem in that a large number of patients are referred to hospital emergency rooms for evaluation, and then many patients will also be referred between different emergency rooms within the hospital.

Traditionally, mostly general practitioners work in the primary health care emergency rooms and ambulances; anesthesiologists or specialists of other branches can be found there only on occasion. These general practitioners sometimes work in the ED and in the ambulance during the same shift.

Professor Štefek Grmec (now deceased) was a big visionary regarding EM in Slovenia. His vision was to start an EM residency as its own branch and to produce emergency physicians who would treat all urgent and acutely ill patient in the field and in one universal ED, as opposed to multiple specialty EDs. The idea was to merge primary health care emergency and hospital emergency; the emergency physician would have more competence regarding diagnostic and invasive procedures, and consultants from other specialties would come to the patient at the ED. The intended consequence would be fewer referrals to different EDs and faster treatment.

In 2006, Professor Grmec succeded in that residency of EM was accepted by the Slovenian Ministry of Health and the Medical Chamber of Slovenia. During the 5-year EM residency in Slovenia, residents complete rotations in the critical care, anesthesiology, general surgery, prehospital, cardiology, gastroenterology, endocrinology, paediatrics, obstetrics and gynecology, neurology, psychiatry, otorhinolaryngology, and ophthalmology units.

Today we have around 60 young EM specialists and residents. Many of the first generation of EM specialists and residents still work in the primary health care emergency room and ambulances. Some of the most recent EM residents are already employed within hospitals, so they have more possibilities regarding diagnostic and invasive procedures.

The Slovenian Ministry of Health has issued new regulations for emergency services for a planned merger of primary health care emergency and hospital emergency. This could be a big step in EM development in Slovenia. The transition period should last up to 3 years. During this time, young EM doctors from Slovenia will continue to work hard and provide the best emergency care for our patients.

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