Romania Field Report: 2015

Published on October 29, 2015
Twenty-one years after its first ED was delivered from Scotland, in 18 trucks, Romania’s emergency health care system enjoys strong public trust and confidence.

The Untold 2015 Music Festival was organized in Cluj-Napoca, and drew 240,000 participants over four days. The Advanced Medical Point run by SMURD Cluj treated 800 patients at the concert venue, with 43 more participants seeking help at the local ED.

With 22 years of experience in the field of emergency medicine (EM), Romania aims to meet the European standards in EM, and is therefore investing not only in technology development but also in professional skills development.

Credited with a high level of confidence by the general population, the Romanian EM systems have a rather brief history, especially “SMURD” (The Emergency Mobile Service for Resuscitation and Extrication). Romania, a southeastern European country with a population of 19.96 million, has been undergoing a continuous transition from communism to capitalism since 1989. The EM specialty was officially recognized in 1993, and Romania currently has around 400 EM specialists and 250 EM residents, and the 5-year-long training program follows the European curricula. A peculiarity of the Romanian system is the integrated prehospital-hospital structure (ER-SMURD) and its population-based development. SMURD is a complementary system of the county ambulance services (SAJ), including EM and anesthesiology physicians, nurses, paramedics, firefighters, and medical student volunteers. The effectiveness of the prehospital service is due in part to the existence of a designated emergency number (112) and to the integrated dispatch system (ambulance, firefighters, police), thus achieving shorter response times.

The first mobile intensive care team (TIM) of SMURD was founded in Târgu Mureş in 1990, beginning the transformation of the prehospital system from “scoop-and-run” to “stay-and-treat.” SMURD currently coexists with the SAJ, which includes transport ambulances and nurse/physician consult crews, along with SMURD’s firefighter paramedics (since 2000), TIM, helicopters and medical aircrafts. The vision and the translation belong to Mr. Raed Arafat, MD, a Palestinian anesthesiologist who graduated in Romania and is currently Internal Affairs State Secretary and Head of The Emergency Situations Department. According to Mr. Arafat, “the EM services need to remain state-guaranteed systems. It is a sign of civilization,” this being a governmental obligation and a social right.

The first emergency department (ED) was built in Târgu Mureş, in 1994, as an auxiliary building of the Mureş County Hospital, which is a training center today and has recently hosted EuSEM’s Refresher Course 5. In 2006–2007, the legal framework for operating the EM system was created, along with a complete modernization of 63 county EDs. Today, the 9 regional centers operate with EM physicians only and have 24-hour access to ultrasound, x-ray, and CAT scans. In order to provide better services in the lower-ranking EDs, a telemedicine system has been implemented, allowing real time transmission of medical data and videos. A similar system operates in the prehospital setting, offering support to paramedics and nurses. Several shortcomings of the present situation include the small number of polytrauma centers (except in Bucharest, the capital) and the fact that two large regional centers, Cluj-Napoca and Iaşi, still function as pavilion hospitals, where most of the departments have their own distinct buildings.

The development of the EM system included not only setting the legal framework and providing modern equipment but also developing EM professionals through numerous educational opportunities: Soros scholarships, REMSY III and IV courses, and national conferences. In 2013, the European financed project “Professionals in the Integrated Intervention for Mass Casualty Accidents and Disasters” trained more than 1,200 EM physicians, nurses, paramedics and firefighters during a program of e-learning and computer simulations. Furthermore, within the universities of medicine and pharmacy there are EM departments that provide scientific development for medical students, along with research and educational programs.

A significant contribution to this continuing process comes on behalf of The SMURD Foundation, an NGO functioning since 2006. The foundation organizes fundraising activities for the modernization of the Romanian EM system, along with training programs and humanitarian activities, as SMURD’s image has a tremendous positive endorsement among the general population.

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