Tallinn to create ambulance brigade for home visits, physicians confused

Tallinn Emergency Medical Services vehicles.
Tallinn Emergency Medical Services vehicles. Source: Tallinna Kiirabi

Although home visits are traditionally conducted by family physicians, Tallinn City Government wants to hire a special emergency medical services brigade who could visit sick children. Family physicians find this idea largely incomprehensible because an ambulance worker can not write prescriptions.

Tallinn is looking for physicians which could make home visits in the daytime, starting this autumn. Making home visits currently falls under the obligations of a family physician.

Mayor of Tallinn Mihhail Kõlvart (Center) told ETV's daily affairs show "Aktuaalne kaamera": "This pilot project comes from the fact that medical assistance is not always available to children. Family physicians do not make home visits often, the service is not available on weekends and there are often long queues at emergency medicine departments (EMO)."

Kõlvart said worried parents are calling ambulances now and a home visit brigade would alleviate the workload of the ambulance service. "We are taking into account ambulance statistics and there are many calls that an ambulance should not actually have to respond to."

Initially, home visits will be conducted for children up to 12 years of age. It is not yet clear if the home visit brigade will be able to be reached by emergency number 112 or the Tallinn helpline 14410.

The city also owns Tallinn Emergency Medical Service (TEMS), which according to Kõlvart, is the perfect institution to conduct these home visits. However, TEMS would need more people and funding.

Family physicians are critical of home visit brigades

Tallinn's plan was a surprise to family physicians and they are more than critical of the idea. Le Vallikivi, head of the Family Physicians Association of Estonia, said that a clear understanding of what everyone is doing is critical in healthcare.

Vallikivi said: "We have very specific societal agreements with the Estonian Society of Emergency Physicians regarding when someone has to turn to their family physician and when they should head to an EMO or call the ambulance."

Campaigns made to raise awareness on this subject have been made for years in Estonia.

Vallikivi said society should make an effort to consider why some things are done the way they are.

She said: "I was very sorry for ambulance workers even when they were forced to conduct donated rapid tests at the airport and port. And now this. This discredits the reputation of all healthcare workers. I think it is a dangerous tendency that some politicians and populist decisions direct what healthcare workers have to do."

The head of the Family Physicians Association of Estonia added that there are also questions to be asked regarding a potential second wave of the coronavirus.

Vallikivi said: "I am not convinced that I would feel safe with a brigade who does consecutive home visits. I am not happy if these doctors have to go to their regular job the next day."

She added Tallinn's decision is even more incomprehensible because people are given specific recommendations and advice when they call 1220, the family doctor's advice line. Furthermore, even simple analyses, which take 10 minutes at a health center, can not be conducted in homes.

Vallikiv added: "It has been agreed in society since before the 21st century that an ambulance can not write out prescriptions."

Agris Koppel, head of the health system development department at the Ministry of Social Affairs, said the ability to write prescriptions depends on who is in the ambulance vehicle.

"Estonian ambulances mostly consist of nurses and they do not have the right to write prescriptions, although we have discussed that right."

Ministry of Social Affairs: The plan is to employ small brigades

Koppel said the ministry has discussed the availability of medical assistance outside of working hours with TEMS and the Health Insurance Fund (Haigekassa).

Koppel said: "The plan is to employ smaller ambulance brigades - one healthcare worker and a paramedic driver. But why not make it so the healthcare worker can make simpler visits, for example at night, without the need to send out a brigade of three."

She admitted that Tallinn City Government did not include the ministry in drawing up the home visit plans.

Koppel explained: "Like I said, we have discussed the availability of emergency medical services and the application of one-man brigades is certainly an option that we could implement wider than just Tallinn if the test goes well."

A representative of Tallinn City Government introduced the project at the Health Board (Terviseamet), who according to Pille Saar, head of the Health Board's health care service department, had many questions and proposals.

Saar said: "Our message was also that the Family Physicians Association has to be included in the project."

If the project is started in November, it would cost the city government close to €60,000. Kõlvart said, starting nex year, the service is here to stay.


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Editor: Kristjan Kallaste

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