The Estonian Defense Forces disagrees with plans under the ambulance reform to make some ambulance crews two-person teams and reduce the number of crews.

In a response to an information request from Tartu Ambulance (Tartu Kiirabi), the Defense Forces said that, from a national defense perspective, an effectively functioning emergency medical service is a critical necessity in a crisis or wartime situation. It also noted that the ambulance development guidelines through 2035, approved by the social affairs minister, themselves cite having a personnel reserve for crises as one of the advantages of three-person crews.

The current ambulance training model, implemented in cooperation with the Defense Forces, has also been based on three-person crews.

"Experience to date, both in exercises and in real-life situations, has shown that a three-person crew is the minimum needed to effectively deal with a seriously injured patient or begin initial procedures in a mass-casualty situation. The math also weighs against two-person crews. With three-person crews, calling an additional ambulance crew to the scene increased the number of medical personnel there by three, while with two-person crews the corresponding increase is two (3+3 vs. 2+2). This, in turn, results in a shortage of personnel at the scene, which could begin to affect patient care," the Defense Forces wrote.

The Defense Forces added that three-person crews provide a personnel reserve in a crisis, noting that the war between Ukraine and Russia has shown that in a crisis or wartime situation, when the need for medical assistance increases, not all additional personnel called in will necessarily report for duty.

The Ministry of Social Affairs is planning an ambulance reform in Estonia by 2028 that would expand the existing network of ambulance bases, change the locations of physician-led crews, reduce their number, make some ambulance crews two-person teams and reduce the number of crews operating at night.

"In such a situation, three-person crews can, if necessary, be quickly reorganized into two-person crews, meaning the necessary personnel reserve is available. If there is a broad shift to two-person crews, that reserve will no longer exist," the Defense Forces said.

"In a crisis affecting the entire healthcare system — and, more broadly, society as a whole — replacing employees is difficult or may even be impossible for a certain period. The personnel reserve provided by three-person crews makes it possible, at least temporarily, to cover potential staff shortages. If two-person crews predominate, that capacity does not exist, which in turn reduces or eliminates the resilience of emergency medical services in a crisis," the letter added.

Social Affairs Minister Karmen Joller said in August, responding to criticism of the reform plan, that the reform would improve the quality of emergency medical services.

"The plan is also to change crew composition where possible and necessary, but this certainly will not have any negative impact on the quality of the care provided. On the contrary, quality will be monitored more closely than before. Ambulance bases will be located closer to people, meaning ambulances should also be able to reach people more quickly," Joller said.

According to the Ministry of Social Affairs, the reform is based on prior analysis and related modeling.

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