Estonian ambulances too swamped with calls

  • 2004-09-22
  • By Aleksei Gunter
TALLINN - Frankly speaking, the Estonian medical system is dangerously inefficient. One of the biggest problems, Estonians will readily admit, is the inaccessibility of regular doctors, which leads to multiple ambulance calls that disrupt the system as a whole, according to experts from the state audit office.

News Analysis

Granted, residents are prone to call for an ambulance even during nonemergency situations, which naturally leads to a system overload. However, considering the relatively poor availability of doctors, patients have no other choice than to dial an ambulance for help in some cases.

These and other conclusions were highlighted in a state audit office report released Sept. 20. The report states that about 27 percent of emergency calls answered by ambulance teams have nothing to do with the service's core function of responding to life-threatening diseases, injuries or intoxication.

Among such nonthreatening cases, approximately 70 percent belong to the low-priority A and B categories. Audit experts have therefore recommended that the government create a basic ambulance team made up of nurse-level medical specialists, thereby saving on the number of employed doctors.

Ambulance teams in many countries offer basic medical help and then transport the patient to a hospital where qualified doctors provide further care. Such a scheme requires a relatively lower level of training for ambulance teams. According to Social Affairs Minister Marko Pomerants, Estonia is on its way toward replacing doctor-run ambulance teams with nurse teams. However, this is only possible with the overall development of the medical system.

In addition, Pomerants added that should a situation arise when the ambulance team could not treat a patient on the spot, it could lead to higher treatment expenses since the patient would have to stay in the hospital for a minimum of four days.

The minister, however, agreed that although the creation of two-member ambulance teams instead of the current three-member teams could lead to an increase in hospitalization cases, the government may have to consider this measure should the money shortage continue. Practicing ambulance personnel have criticized the idea of a two-person team, arguing that certain medical procedures, such as resuscitation, would be difficult to perform with just two people.

As part of its investigation, the state audit office also found that low-income patients call ambulances in order to avoid the 50 kroon (3.2 euro) fee required while visiting the emergency service center. The ambulance service, by comparison, is free. (Even if the patient must be transported to the hospital for further treatment, there is no extra cost.)

Experts concluded that should family doctors 's therapists who deal with general diagnosis and serve a number of particular residents 's become more accessible outside office hours by, for example, a medical aid hotline, ambulances' workload could subside.

According to the Estonian National Health Insurance Fund, such a hotline would not be possible before 2005, and larger towns may have to consider the creation of a family doctor night-watch if the emergency phone system continues to remain insufficient.

Estonia currently has 26 ambulance service providers with a total of 90 teams that include 235 doctors, 535 nurses and 428 technician-drivers. The ambulance service, funded by the government, received about 170 million kroons in 2003. Although the Social Affairs Ministry asked for 215 million kroons to cover ambulance costs in 2005, the government has so far agreed to provide only 183 million kroons for the service next year.