EMS Around the World: Slovakia Modernizes Ambulance Fleet Using EU Funds

By Jaroslaw Adamowski in Warsaw

The Slovak government has unveiled a program worth about €22 million ($25 million) to upgrade and expand the country’s ambulance fleet, with plans to purchase a total of 200 vehicles. As part of this initiative, the emergency services in Slovak capital Bratislava and Košice are spending about €8 million ($9.5 million) to buy some 65 ambulances under several acquisitions.

The two cities directly benefit from the funds Slovakia has secured from the European Union (EU), but they are also using their own funds to purchase the vehicles. To collect offers from local suppliers, the emergency medical services of Bratislava and Košice launched a tender earlier this year, according to the information obtained by local industry publication Zdravotnicky Denik.

“Since the vehicles [for the EMS services of the two Slovak cities] are almost identical, it is not necessary to divide the contract into two parts,” according to the tender terms.

In late July 2023, Bratislava’s emergency medical services said in a statement that they had acquired the first of the four purchased mobile intensive care unit ambulances. The delivery of the remaining three is scheduled to take place by November 2023. The ordered ambulances are Mercedes-Benz Sprinter 419CDI vehicles in a four-wheel-drive variant.

Slovakia is a country with a population of close to 5.45 million, according to data from the World Bank. With some 424,000 and 239,000 inhabitants, respectively, Bratislava and Košice represent a significant share of the nation’s urban population.

Slovakia’s healthcare system is overseen by its Ministry of Health, and there are both state and private healthcare providers active in the country.

A 2022 article by a group of Slovak researchers, comprising L’udmila Jánošíková, Peter Jankovic, Marek Kvet, Gaston Ivanov, Jukub Holod, and Imrich Berta, published in the International Journal of Environmental Research and Public Health, states the country’s EMS system operates within the Franco-German model. The paper’s authors are affiliated with the Faculty of Management Science and Informatics of Slovakia’s University of Žilina, and the EMS Command and Control Centre of the Slovak Republic.

“This means that the crew is qualified to provide medical treatment on the scene of an incident. After the initial treatment, the patient is either left at home or transported to an appropriate hospital for further treatment. There are two types of ambulances that differ in the equipment and qualification of the crew,” according to the article, entitled Reorganization of an Emergency Medical System in a Mixed Urban-Rural Area.

Slovakia’s advanced life support (ALS) units are typically staffed by a physician, a paramedic, and a driver. ALS ambulances are dispatched to handle severe incidents, such as cardiac arrests, in which a patient’s condition necessitates an immediate and specialized intervention, the researchers said.

Basic life support (BLS) ambulances in Slovakia are staffed by two paramedics and provide first aid in non-life-threatening cases. Following the completion of nursing school, EMS call-takers and paramedics are required to complete either specialized secondary education or undertake a bachelor’s degree in urgent care. EMS call-takers are also required to complete a one-year specialized command and control center course.

“Although we use the term paramedic, what the position entails falls somewhere between an emergency medical technician (EMT) and a paramedic in English-speaking countries. They undergo longer education and training than EMTs but do not have the competencies a paramedic has in, for example, the UK (e.g., invasive airway intubation). EMS physicians have a medical degree and finish their residency (usually surgical or intensive care). Drivers undergo basic medical training (not with the purpose of treating patients but to assist paramedics or physicians),” said the paper.

It is noteworthy the researchers were tasked with analyzing the system’s capacities by Slovakia’s EMS Commands and Control Centre to support the entity’s decision-making process related to the investment and reforms indicated in the Next Generation EU: Pandemic Recovery Plan to a build greener, more innovative, and stronger Europe.

As of 2022, there were 274 EMS stations located across Slovakia. Of these, some 86 stations were of the ALS type, and the remaining 188 stations accommodated a BLS ambulance.

BLS ambulances transport 71 percent of their patients to hospitals, while only about 53 percent of patients to which ALS ambulances are dispatched require to be transferred to hospitals. ALS and BLS ambulances are predominantly engaged in so-called primary interventions triggered by emergency calls. Some additional 47 ambulances carry out only secondary transfers of patients among hospitals, as indicated by the Slovak researchers.

The paper states that the performed EMS simulation with the current distribution of the stations showed “that there are big differences in service availability among [Slovakia’s] towns. The best service is provided in the district of Košice I. Here, the average response time is 6.13 min, and 80.59% of FHQ calls are responded to within 8 min. The worst availability is in Trnava, where the average response time is 13.15 min to all patients, regardless of their priority, and the percentage of FHQ calls responded to within 8 min is only 15.82%,” according to the paper.

“The situation in Banská Bystrica is only slightly better; the average response time is 11.10 min, and the 8-min coverage is 16.15%. At present, in both towns, all ambulances are housed at the same address, located outside the most populated town sections,” the researchers said.