Tallinn Emergency Medical Services (EMS) experienced significant disruptions on Tuesday due to a reduced capacity at the North Estonia Medical Center (PERH), which was attributed to the simultaneous arrival of eight severe trauma cases and the overlap of the vacations period, according to the hospital's statement.

Professor Vallo Volke, a board member and medical director at West Tallinn Central Hospital (LTKH), told ERR that on Tuesday, PERH sought to redirect two patients to LTKH, both of whom matched the hospital's profile and were admitted. Volke emphasized that cooperation among regional hospitals is very strong, and LTKH has always accepted patients when beds are available.

"There are established agreements on when a patient should be redirected to another hospital. For example, LTKH collaborates with PERH and East Tallinn Central Hospital (ITK) for heart attack cases. In exceptional situations, such as hospital or department overcrowding, the transfer of a specific patient to another hospital is arranged separately," Volke added.

Inge Suder, head of communications and marketing at ITK, mentioned that PERH also redirected two EMS patients to their hospital during Tuesday's crisis, but such cases are almost daily occurrences. "It is standard practice for on-duty doctors or EMS to coordinate patient transfers," she explained, also affirming that cooperation is effective.

On Tuesday, 30 percent of Tallinn's EMS resources were tied up for five hours due to the reduced capacity at PERH. ERR inquired with the Health Board as to why more patients were not sent to other hospitals and whether this was a decision made by the major hospital itself.

Külli Friedemann, head of the health services department at the Health Board, stated that they have always cooperated with Tallinn EMS and hospitals in such situations to find solutions to alleviate the situation.

"Collaboration between hospitals is certainly important to avoid long queues, but so far, there haven't been any situations where there was a risk of a vital service being interrupted. We are currently gathering additional information on this specific incident and will only be able to draw conclusions and assess the situation afterward," Friedemann added.

According to Friedemann, several factors can contribute to such situations, including different hospital priorities and organizational arrangements.

The decision on where to take a patient is made by the EMS team leader based on the patient's condition, but in Tallinn and Harju County, there is also a regional distribution in place. For example, patients from Lasnamäe and east Tallinn are more frequently directed to ITK, while patients from Mustamäe and Nõmme are typically sent to PERH.

"In specific cases, such as severe trauma, heart or neurological conditions, patients are directed to PERH, as it has the necessary specialized departments and resources," Friedemann explained.

She also noted that hospitals do not have the right to refuse a patient in need of treatment and are obliged to accept patients arriving via EMS.

"The Health Board does not have the authority to intervene in clinical decisions made by hospitals in normal circumstances, as we do not have medical staff to assess the patient's condition and whether it is safe to transport them to another hospital. However, if a situation arises where there is a risk of an emergency or an emergency has already occurred, the Health Board can take over management and enforce measures to ensure the continuity of vital services," the Health Board representative added.

Raul Adlas, head of Tallinn EMS, mentioned at a press conference on Wednesday that the situation could improve if a coordinator were appointed to manage the distribution of patients among hospitals. Friedemann acknowledged that the idea deserves consideration, but whether it would help allocate resources most effectively while meeting patients' needs and reducing the risk of hospital overload requires further analysis.

Inge Suder from ITK noted that while it is important to draw attention to the issues, the Tuesday incident was somewhat overblown, as it was largely due to a confluence of factors.

PERH's chief of emergency medicine and center director, Vassili Novak, stated on Wednesday that PERH's capacity was not reduced on Tuesday, and everyone who needed urgent care received it. However, he acknowledged that handling eight severe trauma cases at once is exceptional, and August is also a vacation period.

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