The Estonian Health Insurance Fund (Tervisekassa) recently completed a comprehensive study on the response capacity of ambulances. According to the results, the average ambulance brigade arrives on the scene in ten minutes in response to a priority "C" ("Charlie") call, and, in nearly eight minutes for D ("Delta") calls, or those in the highest priority category. At the same time, there were several regions in Estonia where it took over 30 minutes for an ambulance to arrive in more than half the cases studied.

"There are indeed some areas, such as around Tõstamaa, Nõva and Avinurme, as well as on the islands, the southern and western coast of Hiiumaa and the northern part of Saaremaa, where it can really be the case that an ambulance arrives later than expected for Charlie or Delta calls, which are the highest priority calls," said Kristiina Vaas, the Health Insurance Fund's emergency medical services manager.

Both the Health Insurance Fund and the Health Board (Terviseamet), which runs Estonia's ambulance services, say the introduction additional brigades or base stations ought to be considered in certain areas. According to the analysis, Tapa and Märjamaa require additional units, while in Saaremaa a new base should be established in the Leisi area. The same goes for Tõstamaa in Pärnu County in and the Mõniste area in Võru County.

According to the Estonian Ministry of Social Affairs, the creation of new brigades will depend on the size of the Health Insurance Fund's budget.

"The ministry sets the minimum number of brigades by decree, we do not limit the maximum number. But we certainly have no plans to reduce the minimum number," said Nikita Panjuškin, head of the health services department at the Ministry of Social Affairs.

According to Panjuškin, the biggest issue facing the ambulance service at the moment is a shortage of staff. One way to reduce this is to cut the number of three-person brigades.

"It is certainly not option number one , but it is one of the development options we are looking at. If, for example, the population on the outskirts of Tallinn continues to increase and we are in a situation where we cannot hire more ambulance staff, one measure could be to reduce the size of some brigades to two people," said Panjuškin.

For a number of years, the majority of medics involved in ambulance work have been nurses, with only Tartu having dedicated brigades. However, the study showed there is not much difference between the two.

"When we looked at hospitalization, the hospitalization rates of nurses and doctors' brigades were the same overall. Yes, the medical brigades hospitalized a little less and had the courage and competence to discharge more people. But if we look at it over a period of three days, the patient still ended up going to the hospital. On balance, nurses can do ambulance work very well and this has been proven for 10-plus years," said Ragnar Vaiknemets, deputy director general of the Health Board.

A new set of ambulance development guidelines are due to be approved in the summer.

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