[Problems with organization and operation of emergency medical services in the post-war period in districts with a population of up to 60,000 inhabitants].

Demographic characteristics of Gracanica municipality:--Organization of the municipality on 15 local communities that are 5-20 km away from the centre of municipality.--Road conditions--Starting of industry within Gracanica municipality and social status of the employed population.--There are two main roads that are passing through the territory of municipality--These highways are passing through densely inhabited areas and traffic is heavy. Distance of Tuzla Clinical centre. Services of Gracanica Outpatient Department organize their work although lacking professional staff and equipment. Significance of Emergency Medical Service (EMS) for the municipality and broader community under these circumstances. Present EMCS organization in Gracanica is the following: EMS in Gracanica is organized as a separate service with three permanent teams and temporary engagement of 2 doctors who are on specialization in pediatrics and lungs diseases. A team comrising of a specialist of emergency medicine, three medical technicians and one driver works from 7.00 to 15.00 on regular working days and other doctors work at EMCS from 15.00 to 7.00 and on weekend as well. EMS doesn't examine patients outside the EMS rooms. EMS equipment consists of one ECG, one defibrillator, two aspirators, one oxygen concentrator and a resuscitation set. The Japanese Government donated equipment. Lack of intravenous solutions, drugs and other material for the emergency treatment is notified as permanent problem in emergency care service. Next problem is unsuitable and non-functional space with difficult access and lack of ambulances because the whole rolling stock was destroyed by shelling in 1992. In any case, all these circumstances diminish a team efficiency in providing emergency care. Even under these circumstances EMS had 10,415 examinations during the first sixth months in 2000, provided 45,265 services and treated 912 injuries out of which 64 were traffic injuries. Concerning the complicity of work in EMS Gracanica, standards and norms related to emergency medical care, which have been proposed by the Federal Ministry of Health couldn't be met. By these standards one team covers 20,000 inhabitants and EMS from 19.00 one day until 7.00 the next day and Saturdays and Sundays as well. The question is what to do between 15.00 and 19.00, when every Outpatient Department is closed? For normal functioning of EMS in Gracanica municipality we should do more work on the prevention and work organization in the surgeries of General Medicine in a distant local communities. In that way, EMS wouldn't be a surgery of General Medicine after 15.00. It's necessary to ensure an adequate space, professional staff (at least 4 teams with their leaders) new equipment, ambulances, medicaments, disposable material and furniture. It is necessary:--to develop a system of communication tha could cover municipality and Clinical Centre area,--make educational plan and to respect it,--to establish a cooperation with EMS in neighboring municipalities,--to discuss EMS role in relation to family medicine organization within General hospital in Gracanica.