Ministry rejects military criticism of ambulance reform

Estonia’s Social Affairs Ministry has rejected the Defence Forces’ criticism of a planned ambulance reform, which the military says could weaken emergency response and service continuity during crises or war, ERR reported.

The reform would change the locations and staffing of ambulance teams. The ministry says it aims to increase the number of teams and cover a larger area using the existing workforce, while the total number of ambulance specialists would remain unchanged.

“We cannot significantly increase the number of ambulance specialists overnight, and in the current situation it is not possible to substantially increase the Health Insurance Fund’s ambulance budget,” said Nikita Panjuškin, head of the ministry’s healthcare department. “Within these limited resources, the only way to increase the number of teams is to review their composition.”

The Estonian Ambulance Association, the Health Board, the Health Insurance Fund and the ministry drew up ambulance development plans a year ago. The reform came as a surprise, said Lauri Kõrgvee, a board member of the association.

For serious emergencies, such as trauma or incidents involving mass casualties, “there simply aren’t enough hands,” Kõrgvee said. “Everything takes time, and that will certainly come at the cost of lives.”

Panjuškin said Latvia and Lithuania were also increasing the share of two-person teams and reducing the share of three-person teams. Their data show that the time teams spend at the scene does not increase significantly, he said.

The Defence Forces said a functioning ambulance service is critical during crises and war. They said they had not been asked to assess the reform from a national defence perspective and had not been shown an impact analysis, mathematical model or wargame results. In their view, the reform as planned would make it harder to ensure ambulance capacity during a crisis or war and would reduce continuity of service.

Panjuškin said the criticism stemmed from the Defence Forces having only a superficial understanding of the changes. A shift to some two-person teams could appear to mean staff cuts, he said, but the aim was to increase the number of teams while keeping the overall number of ambulance specialists the same.

Estonia currently has 108 three-person ambulance teams operating around the clock. The ministry plans to increase the number to 126 during the day and 113 at night by the year after next.