EMS Around the World: COVID-19 Roils Swedish EMS System

Sweden’s turbulent COVID-19 experience—marked by a laissez-faire approach unique in Europe that yielded results experts consider mixed—may help lead to a massive reform of the nation’s domestic healthcare system and national system of EMS. 

From the outset the nation’s hands-off reaction to the virus, resisting lockdowns and aimed at achieving herd immunity, produced worse results than its Scandinavian neighbors: By July 2, 2020, Sweden had 69,692 cases of the new COVID-19 virus with 5370 dead, compared to 7200 and 328 in Finland and 8800 and 251 in Norway. Today, while it’s among the better nations in Europe in terms of COVID-19 deaths per capita (1513.91 per million, per Statista), it fares significantly worse than its regional neighbors who implemented more vigorous restrictions (Denmark 531.19, Finland 342.79, Norway 263.25, Iceland 120.83).  

The drive for herd immunity, spearheaded by state epidemiologist Anders Tegnell, led some local opposition parties in Sweden to accuse the national government of being unable to organize the work of the special services responsible for dealing with COVID-19 patients, including EMS, in a proper way. These accusations resulted in the creation of a special commission that will investigate the activities of Swedish healthcare authorities during the pandemic. 

Reforms Planned

While the number of doctors in the Swedish healthcare sector, including those involved with EMS, is one of the highest in Europe, the efficiency of Sweden’s healthcare services has always been a subject of criticism. 

According to some analysts, the pandemic revealed serious weaknesses in the country’s EMS sector and how it’s structured. One example has been the inability of local EMS to deal with a significant increase in the number of emergency calls to the country’s universal 1-1-2 number for medical emergencies since the pandemic began. 

According to data from the Swedish Ministry of Health and Social Affairs, the number of such calls increased by almost 40% in the early days of the pandemic, which led to serious increases in waiting times for ambulance teams in most of the country’s largest cities. Swedish television channel SVT recently reported waiting times for response by SOS Alarm Sverige AB, which operates 1-1-2, had increased by 12–15 seconds, falling out of compliance with state regulations. 

While Swedish standards of living are among the world’s highest, in recent years its local EMS has faced significant obsolescence among its ambulance fleet and infrastructure. 

One reason is a lack of coordination for the activities of Swedish EMS: There is currently no centralized state body responsible for the implementation of such control. This is also reflected in extremely limited data, as no government department is responsible for analyzing the overall results of prehospital care, monitoring outcomes, and initiating improvements.

Swedish regulators have spoken of plans to initiate domestic EMS reforms; Lena Tellvik, a senior supervisor of the Swedish Civil Contingencies Agency (MSB; a state agency that implements some oversight functions of EMS), in an interview with Göteborgs-Posten newspaper, said MSB is seriously concerned regarding the current situation in the Swedish EMS sector and would propose measures for its improvement. However, no concrete proposals have followed. 

Retention Troubles

Other concerns surround large numbers of providers leaving healthcare fields, driven by pandemic-related burnout. The disease’s rapid early spread led to infections among doctors and paramedics that left emergency responses shorthanded, and by the end of 2020 media were reporting mass resignations of ICU nurses and other key professionals. 

In an attempt to preserve workers, the Dagens Juridik news outlet reported, some leading hospitals and medical institutions issued special orders that employees with confirmed COVID would no longer be considered contagious if they’d been without symptoms for two days. The World Health Organization’s standard is 14 days. 

One such order was issued by the management of the Karolinska Institutet, a research-led medical university in the Stockholm urban area. The move sparked serious criticism from its personnel, primarily those working with ambulance teams. They maintained the order forced them to work while ill. Some refused to come to work even as local authorities significantly increased their wages (by 120% in some cases) for the duration of the pandemic. 

Most Swedish paramedics and local healthcare analysts agree on the need for reform of domestic EMS. According to them such improvements will have a particular importance considering that since the beginning of 2000s, the number of elderly persons in the country has almost doubled, making Sweden one of the most mature nations in Europe.   

Sidebar: Did the Swedish COVID-19 Policy Work?

As much of the world locked down in response to COVID-19 in March 2020, Sweden took a different approach: Rather than trying to stifle its spread, the country chose to stay relatively open and pursue herd immunity instead. Two years later Sweden has fared better than some of Europe but worse than its Scandinavian neighbors in terms of cases and deaths. Its numbers as of February 1, 2022:

While Sweden benefited from a young, healthy population and remote-capable workforce, many experts regard its approach as unsuccessful. Researchers from Imperial College London determined the country could have reduced its 2020 first-wave deaths by three-quarters with a U.K.-style lockdown and 78% with a stricter model like Denmark used.¹ 

By the end of 2021 authorities were permitting some business restrictions when herd immunity hadn’t produced the anticipated benefits.² “Criticism arose within the country,” noted one analysis, “with many Swedes opposing the authorities’ laissez-faire public health policies,” in particular their lack of clear guidance. 

A Bloomberg analysis from October 2021 was more ambivalent but noted, “Given how much more successful its Nordic neighbors have been and the fact that it entered 2020 with such built-in advantages…[Sweden’s result] has to be seen as something of a disappointment.” But it may have worked better, columnist Justin Fox wrote, than “the U.K.’s careening back and forth between strict lockdowns and paying people to eat in restaurants, or the cacophony of different policies followed by state and local governments in the U.S.”³ 

References

1. van der Merwe B. Weekly data: No, Sweden’s Covid-19 strategy hasn’t worked. Investment Monitor. Accessed Feb 1, 2022.

2. Jonsdottir V. Sweden’s Unconventional Approach to Covid-19: What went wrong? Chicago Policy Review. Accessed Feb 1, 2022.

3. Fox J. So Was Sweden a COVID Success or Failure? Washington Post. Accessed Feb 1, 2022. 

Eugene Gerden is an international freelance writer who specializes in coverage of the global firefighting, EMS, and rescue industries. He has worked for several industry titles and can be reached at gerden.eug@gmail.com.