Slovenia Field Report: 2016

Published on October 6, 2016
After building 10 new EDs with EU grants, Slovenia is slowly adopting a more standardized emergency care system, and a new organization, SEMA, is focused on streamlining EM training.

In Slovenia today, emergency medicine is in the midst of great flux and transition. Historically, emergency care in Slovenia was divided between primary care health centers, located in almost every town, and a secondary level of emergency care in hospitals, where it was further divided between different specialties. The system basically follows the Franco-Germanic model of EMS, with doctors on board ambulances, and division between different specialties at hospital entry.

For the last 30 years, until today, prehospital care has been provided by community health centers in 50 towns across the country, comprising 20,000 square kilometers with a population of 2 million. In most of these smaller towns, family doctors join ambulances and provide emergency care in the field, usually during their regular GP working hours. Only in about a dozen towns, comprising roughly 30,000 people, are there dedicated EMS units with their own doctors. Such prehospital emergency care is provided 24/7, and doctors are present on board the ambulances in the vast majority of all interventions.

One of the reasons for such micro-organization is the absence of a unified nationwide dispatch system. As of today, all of these 50 smallest EMS units perform their own dispatching, and follow their own procedures to gauge the needs of interventions in the field.

On the secondary level, until the end of 2015 there were no emergency departments per se. Basically, each hospital had numerous receiving wards, divided both by location and concept. As there were no universal EDs that could be accessed “straight from the street” without a referral letter from a GP, there were no simple and defined entry points into hospital emergency care.

Fortunately, this has started to change. In 2006, a decision was made to begin building EDs in every hospital, and European Union “cohesion funds” were granted. As per contracts, all EDs had to be built and operational by December 31, 2015, and that was actually achieved! Today, we have ten brand new EDs — half a year old — into which Slovenia now is trying to breathe life. Since there aren’t enough emergency physicians, the core concept for getting EDs to start functioning is combining former surgical and medical receiving wards (and their staff), thus quite literally assembling an “Accident & Emergency” department. Along with that, a nationwide dispatch system is being built, which will rely on the concepts of the Norwegian Index for Emergency Medical Dispatch. Prehospital systems are being reshaped concurrently, decreasing the number of physician-led EMS ambulances and expanding the net of paramedic-staffed EMS vehicles, and creating a dense network of civilian first-responders to cover rural areas.

EM Specialty and Training

EM was established as an independent specialty in 2006. In the coming years, as more and more EM specialists graduate from residency programs, they will slowly take over the workload and expand the concept of emergency care practiced in the newly devised A&E departments. This transition will take years, so the main burden of future EM development in Slovenia rests on the shoulders of the trickle of EM specialists and the slowly expanding stream of EM residents. Thus, the entire present generation of EM doctors and residents will have to take charge of their own professional growth and establish the field of EM outright in Slovenia.

To achieve that while concurrently providing quality medical care, we also have to put great emphasis on efficient and quality education—focusing on our training residents! This will be particularly challenging, as in Slovenia, similarly to continental Europe, there is a very weak tradition of effective clinical teaching.

The Slovenian Emergency Medicine Association (SEMA) was recently founded to aid in these efforts—to help coordinate efforts in establishing clinical pathways and standards of care, in helping to improve and standardize residents’ education, and in helping to establish the proper institutional position and remuneration of emergency physicians.

The EM community in Slovenia will need, and will gladly accept, all the help it can get. One of the key agendas of SEMA is forging connections with other world organizations in order to help us adopt the best clinical and educational practices.

Final Word: From Slovenian EM Residents

The establishment of SEMA was made possible by a group of enthusiastic specialists and EM residents aiming for a better future. EM residents were especially interested and supportive throughout the way, and a great number of them are now part of the SEMA board, proving the point.

With the current residency education system being outdated and ineffective, clinical education therefore suffers gravely. The resident’s training has mainly consisted of observer-styled or secretary-like work outside their designated working posts, unwillingly bringing up the paradox of rotations versus ED work, or “from zero to hero.” Great efforts have been made by current EM residents so far to try and change the educational system and training conditions, without a “bigger brother” looking after us—without much success. Thankfully with the rise of FOAMed resources, some of the obstacles, like running simulation training or incorporation of new ideas, seem manageable, although implemented in a rough, guerilla-style way. As word of SEMA began to spread, residents quickly embraced the organization in hope of effecting our visions and changes through it. As SEMA becomes more operational, hope continues to grow of finally establishing a functioning and sustainable EM system in Slovenia.

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