Commenting on the issue of the unwarranted summoning of emergency medical services (EMS), Minister of Health and Labour Jevgeni Ossinovski said that everyone needs certainty that EMS will come when called.
EMS personnel, managers and healthcare managers all agree that a significant proportion of calls to which they respond do not involve medical emergencies and that a solution needs to be found involving family doctors, specialists or via the social system. Nonetheless, nothing has been done to address the issue in years and the number of unwarranted EMS calls continues to grow, which in turn jeopardizes their ability to respond to actual emergencies, reported ETV news broadcast "Aktuaalne kaamera."
Unwarranted calls can be broadly categorized into three groups. The first involves arguable weaknesses in the healthcare system due to which for example patients are unable to get appointments with their doctors or specialists, or their doctors do not want to order expensive testing for them, and so they hope that paramedics will complete the needed testing instead. Many people are also aware that they will be seen faster in hospital emergency rooms if brought in by ambulance.
In a related issue, according to the law, a death can only be called by a family doctor or ambulance crew leader. As family doctors in large part do not make housecalls and family nurses can only issue death certificates if and when they are working evenings on an ambulance crew, this leads to situations in which EMS are called even over long distances simply to issue death certificates.
This group also involves instances in which the family doctor helpline recommended by the Minister of Health and Labour, 1220, recommends that the caller summon emergency medical services for situations which ultimately may not require them.
"We are doing our job via telephone and we cannot assume that someone is lying to us — we cannot see the scene," explained Eva Rinne, deputy director general of the Alarm Centre. "We take it seriously — every person’s call." She added that if the doctors and nurses working on the hotline found that a caller’s situation was serious enough to warrant an emergency medical response, they were not in a position to doubt that.
The second broad group of unwarranted EMS calls involves weaknesses in the country’s social system, which include issues such as lack of awareness on certain issues and lack of adequate transport in rural areas.
The third group involves malicious callers acting according to the principle of "I pay and so I want all of this."
Regardless, Rinne noted that the Alarm Centre was of the position that people must in any case be able to receive the care they need and that the ability to call for help be ensured 24/7.
Ossinovski: It is important that people know they can rely on EMS
Speaking in the "Aktuaalne kaamera" studio, Ossinovski defended Estonia’s EMS system, noting that unlike some other countries, Estonia’s emergency medical services were fully medical and easily accessible. The average response time in Estonian towns and cities was eight minutes, with the response time stretching to 14 minutes outside of town, and he added that people were satisfied with the quality of the service overall.
"The primary cost which we pay for this service is the cost of preparedness — that the ambulance crew is there when we needed, that it would respond," explained the minister, noting that this costs approximately €1,000 per day. "Talk of each dispatching of an ambulance costing €100 — in reality it does not cost €100; the ambulance crew costs us approximately €1,000 per day — its preparedness, its being on-call — and each dispatch costs us approximately €10 on top of that. And so the cost of it responding here or there is actually rather low.
"I believe that it is very important that the people of Estonia have that certainty that if they feel that their health is in danger and they summon emergency medical services, then the EMS will respond and help them," said Ossinovski. "Yes, naturally, for the system it may become apparent upon the arrival of the EMS that this dispatch could indeed have waited until morning, but on the other hand it is in my opinion very important that people have that certainty that they can always rely on emergency medical services if they have a problem — whether they themselves or a loved one."
The minister stressed that he was not in favor of either losing the current system of fully medical ambulance crews or beginning to charge for unwarranted dispatches of emergency medical services.
"I believe that Estonia’s current EMS system, in which we have a very thoroughly and carefully considered EMS network — over 100 ambulance crews and fully medical ambulance crews — is a very great value that we have achieved," said the minister, adding that he didn’t believe it would be very sensible to dismantle such a system.
Commenting on the suggestion that patients should be charged for unwarranted EMS calls, Ossinovski said that he did not support this idea either, "…as this would result in a situation in which people in actual need of help would begin considering whether or not they had the money to pay for it before calling for help. I believe that this isn’t sensible."
Editor: Aili Vahtla