EMS Around the World: EU Funds Help Romania Modernize

Like several other Eastern European countries, Romania is striving to overhaul the aging ambulance fleet of its state-dominated emergency medical services. As a member of the European Union, the country benefits from access to support funds the EU provides to acquire new vehicles, with a program to acquire a total of 211 new vehicles completed in late 2020. 

The Department for Emergency Situations, a unit of the Romanian Ministry of Internal Affairs, oversees the country’s EMS, which operates in two forms: county ambulance services and the Mobile Emergency, Resuscitation, and Extrication Service (SMURD), which operates within the structures of Romania’s emergency inspectorates. 

The SMURD has its separate fleet of ambulances, uses the aviation structures of the Ministry of Internal Affairs, and collaborates with local public authorities and regional hospitals.

The SMURD was established in 1990, following Romania’s transformation into a democratic market economy, by a group centered around doctor Raed Arafat, a Syrian-born physician who moved to Romania and set up the service’s first unit in Târgu Mureș, a city in the country’s northern part, with the support of the local firefighting brigade. Arafat’s involvement in the service led to his appointment as undersecretary of state for health in 2009, and he later served as minister of health. 

Since 1990 the SMURD has expanded to cover all of Romania with its services. Depending on the region, it may solely operate ambulance services that complement the county services or also offer helicopter emergency medical services. 

Support From Friends

Over the years the SMURD has benefited from numerous donations from partners abroad. In 1991 German authorities donated its first ambulances, and a year later the service obtained an EMS laboratory from the US Open Society Foundations.

“The emergency medical service in Romania is…state-owned, but there are also private operators [including] private hospitals that also have ambulances. In Romania there are 41 stations of the county ambulance services, such as the Bucharest Ilfov Ambulance Service. [As far as] SMURD, there are 42 stations at national level,” Dan Mihai Theodor, a spokesperson for the Ministry of Internal Affairs, tells EMS World. 

Within the county ambulance services, there currently are about 800 operational type B ambulances and 90 type C ambulances, according to figures released by the department. The SMURD operates a fleet of 639 type B2 ambulances and 87 type C1 ambulances. In total this provides the state-run health care system’s ambulance fleet more than 1600 vehicles.

“The Department of Emergency Situations works constantly to improve and strengthen this integrated system,” says Theodor. “Of course, the purchase of ambulances is a necessity and an important aspect in improving the response rate to any emergency situations.”

To modernize their ambulance fleet, Romanian authorities have been carrying out a program worth €20 million (US $22 million), cofunded by the European Union’s European Regional Development Fund (ERDF). As part of the program, 6 Romanian counties obtained new vehicles in late 2020; these included specialized vehicles dedicated to births, specific biological risks, and situations and locations that are difficult to access. The majority of the program’s cost, 70%, was financed by the European Union, while Romania’s public authorities covered the remaining 30%.

Counties that benefited from the program included the country’s northern Harghita County, which obtained a total of 27 ambulances, and neighboring Mureș County, which received 46. Other counties included Alba, Brasov, Covasna, and Sibiu. 

COVID-19 Spurs Health Care Spending

The COVID-19 pandemic forced the Romanian government to allocate increased funds to the country’s health care system, resulting in a revision of the state budget for 2020. The country’s Ministry of Finance raised public spending by some RON 12.5 billion (US $2.8 billion) for 2020, of which about RON 8 billion (US $1.8 billion) was earmarked for the Health Ministry and its efforts to combat the spread of 
the coronavirus.

Antipandemic measures occurred at both the local and national levels.

“Regarding the prehospital part, the situation generated by the coronavirus led to the involvement of several forces on the ground [and] the establishment of triage points in front of all hospital units in the country, among others,” according to Theodor. “Also, the National Center for Intervention Coordination and Management was activated at the highest risk level to manage the situation.”

Global Concepts

In a presentation he prepared in 2009, titled “Emergency Medicine in Romania: System and Personnel 1990–2009,” the cofounder of the SMURD highlighted that, in the creation of Romania’s EMS system, founding institutions acted under the assumption that, as there was no perfect solution or system, the country’s EMS had to be developed based on international experiences, while taking into account local aspects and particularities. 

“There are no unique countries or cities or regions,” Arafat told a conference organized by the United Nations Economic Commission for Europe that year. “There are just local solutions based on 
global concepts.”  

Jaroslaw Adamowski is a freelance writer based in Warsaw, Poland.