EMS Around the World: Helicopters to Bolster Croatian EMS

As with a number of other countries in Europe, the COVID-19 pandemic provided additional incentive to authorities in Croatia to develop the nation’s EMS. With this in mind, the Croatian Ministry of Health is pursuing plans to launch helicopter-based EMS next year, with four bases to be established at state-owned airports. 

Croatia’s EMS system is organized at the county level, and 21 counties operate a growing ambulance fleet that currently comprises 446 vehicles, serving the country’s population of about four million, according to data provided by the Croatian Institute of Emergency Medicine (CIEM), a state-owned entity that oversees the country’s EMS.

“Each of the 21 counties has its county institute of emergency medicine, with several substations located within each county depending on their population density and distance from healthcare facilities,” a spokesperson for the CIEM says. “Emergency calls are dispatched through counties’ medical dispatch units, which allocate them to EMS teams.”

Compared with other countries in the Eastern Europe, Croatia’s ambulance fleet is large for its population, with a ratio of about 9,000 inhabitants per vehicle. In comparison, the ambulance fleet operated by Romania’s Mobile Emergency, Resuscitation and Release Service (SMURD) and county ambulance services totals roughly 1,620 vehicles, according to 2020 data. With a national population of about 19.5 million, this amounts to a ratio of about 12,000 inhabitants per vehicle. 

In Poland, data from the state-run Central Vehicles Register (CEPiK) indicates that close to 1,400 ambulances are registered under different categories. Given Poland’s population of close to 38 million, this translates into a ratio of one ambulance per roughly 27,100 inhabitants.

Booming Tourism

Croatia’s geographic features suggest expansion of the country’s EMS with helicopter-based units is long overdue. The Croatian Adriatic coast consists of some 1,185 islands, rocks, and reefs, populated by some 122,000 residents, according to figures from the Croatian Bureau of Statistics. While these attractive features are one reason why Croatia attracts large numbers of tourists and seafarers from Europe and beyond, it is also why the country is currently working to expand its EMS capacities. 

In 2019, the last year before the pandemic broke out, Croatia was visited by a record 21 million tourists—more than four times the country’s population—as indicated by figures from the Croatian National Tourist Board.

New HEMS Bases Next Year

Starting on July 1, 2022, EMS helicopters are to be deployed to four bases, located in Zagreb, Osijek, Rijeka, and Split. At the same time, the Ministry of Health is preparing to launch a tender worth some 135 million kunas (U.S. $21 million) to establish the bases in March, before the summer season starts. Following this, the ministry will sign three-year contracts with selected operators for each base.

However, local observers remain skeptical whether the project will allow the ministry to comply with its promises of covering the country’s entire territory with air-medical resources. 

“We believe the optimal number of bases is eight,” Mladen Tureček, president of a local association called HELP, which focuses on issues related to medical helicopter services, told local daily Večernji List.

Zagreb, Split, Rijeka, and Osijek are Croatia’s four largest municipalities, with a combined population of more than 1.2 million. This said, a study of the Croatian territory shows that such a deployment could leave some of country’s regions with insufficient helicopter coverage.

Tureček is also critical of the idea to locate the four bases at existing airports, saying this would delay their response times.

“There are two basic principles on which such systems are set up,” he said. “One of these principles relates to population density, to cover 90% of the population and more, and the other one is to cover the entire territory. The base in Osijek would also cover part of Serbia but not a big part of the Croatian territory.”

Some experts have suggested the Health Ministry should establish a fifth base in Ston, at the tip of Croatia’s Pelješac Peninsula. Some industry observers also suggest that instead of establishing a base in Osijek, located in the country’s eastern part, it could be more useful in Požega, a city more to the west.

While the Health Ministry’s helicopter-related plans have been communicated to the public, the CIEM did not confirm whether the ministry was planning to acquire new ground ambulances for the country’s EMS in the coming months. 

The institute’s spokesperson said that “new ambulances are continuously procured according to the valid ordinance and ambulance standard, replacing the old ones and assuring fast and safe patient transportation.”

Regional Trend

Croatia’s efforts to add helicopters to the country’s EMS capacities are part of a larger regional trend, with other countries in the region launching similar initiatives. In late June Bulgarian Health Minister Stoycho Katsarov announced at a press conference that his ministry was initiating a project to buy six and establish helicopter landing sites at 15–20 medical facilities across the country. 

The Bulgarian program will be supported by funds from the European Union, which Bulgaria joined in 2007, and the helicopters are expected to be deployed by the end of 2024, according to Katsarov. Each of the six vehicles is expected to come with a price tag of between 50 million (U.S. $30.5 million) and 60 million levs (U.S. $36.5 million).

Jaroslaw Adamowski is a freelance journalist based in Warsaw. Among other subjects he covers the EMS industry and related developments in Central and Eastern Europe.