No medical helicopters have been purchased as originally planned, since politicians do not agree to decided who pays pilot salaries and the high cost of spare parts. The health service says it needs to put on three times as many helicopter flights as it has at present, while the interior ministry prioritizes staff salaries.
A year ago, all members of the government, including the Reform Party members who are still in office, agreed that Estonia requires two additional helicopters. According to the government-discussed recovery plan, "the lack of medical helicopter capacity increases the danger of possible complications and fatality, and lowers patients' chances of recovery."
The same politicians decided against purchasing helicopters last Thursday. Currently, the PPA fleet consists of three Italian-made helicopters. These helicopters are used to search for missing people, rescue people at sea, put out forest fires and transport ministers.
"Our top goal is as always to save people's lives and health," said Egert Belitšev, Deputy Director General of the PPA.
Lilian Lääts, head of the ambulance department at the North-Estonian Medical Centre (PERH), said that it can happen that more people are in crisis situation at the same time. "When we receive two requests at the same time, whether to search for a missing person or transport a patient from Kuressaare to Tallinn, the search flight is taking precedence over the rescue flight."
On a good day, a second helicopter may be able to take off, but this is not always the case, Belitšev said, as all of these systems have scheduled maintenance periods.
"With three helicopters we can guarantee that at least one of them is ready to take off. In reality, one of the helicopters may be on short-term maintenance check, while the other is undergoing a long-term maintenance."
Occasionally, extreme weather conditions can impede flight. "Only one of the three helicopters is fitted with an anti-icing system. If there is dampness on the ground with icing conditions higher above—it is unsafe to fly the helicopter." This ice-resistant aircraft is undergoing well though-through yearly maintenance cycles, Belitšev said.
Three times as many medical flight hours are necessary
Many problems could have been solved by purchasing two new helicopters.
Tallinn and Tartu have helicopter bases planned; each city needs one helicopter at all times. The estimated air emergency reconstruction funding was €46 million.
Lääts pointed out that the same funds were intended to be used to construct landing sites, particularly in Pärnu and Narva. PERH is currently using the adjacent children's hospital backyard, from which ambulances transport patients to the hospital.
"Then, after landing, we have to transfer all of the items to the vehicle and drive to the hospital," Lääts explained. "If we could land on the hospital's roof, we'd be whisked away in less than five minutes to the intensive care unit or operating room."
The three helicopters provide around 200 hours of medical flights every year. According to the reconstruction plan approved by the current administration, our healthcare system would require 600 hours of helicopter support every year.
The Ministry of the Interior, to whom the present flying unit is subordinate via the police, led the initiative for the purchase of new helicopters. However, Kalle Laanet (Reform), who served as minister of the interior and approved the reconstruction plan a year ago, petitioned the government this week to remove millions of EU funds from the project.
Ministry of the Interior has different priorities
Deputy Secretary General of the Ministry of the Interior Piret Lilleväli said that the two helicopters, the helicopter bases, and the landing sites could have cost significantly more than anticipated.
"We don't know the exact price of the helicopters until we complete the procurement. We had no certainty whatsoever that we would be able to accumulate the necessary funds," said Lilleväli.
Counselor Triin Tomingas of the Ministry of Finance's Foreign Investment Service said that if the helicopter project would become more expensive, it would not be possible to make up the budget with the funds allocated for Tallinn Hospital, but as the European Commission rules state, the cost increase would have to be covered by the state budget instead.
"The instruction has been fairly clear that they [EU] are only willing to increase funding if we add ambition or extra obligations," Tomingas said. "Be it tied to investment success or further reconstruction commitments tied to country-specific recommendations."
Lillevali said that the fixed expenses of the new helicopters are not included in the present budget either, which means that those expenses are not covered by European money. The salaries have to be paid and the helicopters require fuel, oil, and spare components to operate. Up to 2026, around €10 million would be spent, followed by at least €6 million annually.
Lilleväli also said, an application was made to the national budget strategy for the coming years, but that there is little hope of actually getting the money. "I don't think this is realistic. The Ministry of the Interior has a number of priorities presented for the budgetary evaluation, which are even higher than the cost of maintaining helicopters," Lilleväli said. "Our top priority is the salaries of internal security staff."
Riisalo: accidents have never been that big
Signe Riisalo, the Minister of Social Protection, stated on "Vikerradio" program last Thursday that there is no reason to purchase additional helicopters similar to those currently in use by the PPA. "The planned helicopters can transport 12 people," said Riisalo. "Such a need has never occurred in Estonia, and it is highly unlikely to happen. We can successfully manage in Estonia with the existing rotorcraft, as has also been confirmed by the vice-chancellor for health."
Kersti Esnar, head of health system development department at the Ministry of Social Affairs, stated that the Ministry of Interior did not negotiate with her this move. Even more so, a working group formed to oversee the project, which has been meting on a monthly basis.
"We met with the hospitals just last week, under the leadership of the PPA, to discuss their preparations for the installation of landing strips," Esnar said. "Of course, the announcement came to us as a surprise, as big as the Tallinn hospital funding withdrawal news last week."
The last meeting of the advisory board was on Monday. After a half-hour of deliberation, it was decided that, due to a lack of money, the project would be shelved. "We will compile the work we have done so far and archive this project, and if we might need it in the future, we can reuse these materials," said Belitšev, adding that there was no need to lay people off the project or terminate contracts because it was too early in the project's development.
Belitšev said that while "costs have been made, the majority of these expenses have been in terms of work-hours, amounting not to hundreds of thousands of euros, but rather tens of thousands."
Helicopters now in service will be placed on permanent standby
Despite this, the Ministry of Social Affairs is still considering how to proceed in light of the changed circumstances. Kersti Esnar said that a new emergency health-care reconstruction plan will be developed the following year. Also, the Tartu University researchers have promised a detailed analysis by the end of the year, whereby the need for medical flights will be deal with as a separate topic.
As we are not acquiring new helicopters, the existing equipment could be put to a better use in the coming years, Belitšev said. The helicopters may be in theoretical good condition, but the crews' working hours are full, and so there is no one to fly.
With a small crew the helicopter can take off within first 15-minutes of reaction time only during the day. If help is required during the night, the pilot must be first called from his home, which extends the reaction time up to an hour.
"Our development goal for the next few years, for which we have a project underway and have recruited staff, and are still searching for more people to join our team, is to secure that we have one helicopter in take-off readiness of 15 minutes at all times," Belitšev says.
Editor: Kristina Kersa