EMS Around the World: Italy ‘Close to Catastrophe’ Amid Shortages

The Italian EMS sector faces a significant increase in pressure as the number of new COVID-19 cases in the country grows steadily amid the fourth wave of the pandemic.

The country recorded more than 15,000 new cases on December 1, bringing its seven-day average to 12,719. On November 1 that average was just 4,438. This comes despite a national vaccination rate that is among Europe’s best, with almost 80% of the population having received at least one dose; 74% having received two; and 12% having gotten boosters.

More worrying is that the number of COVID-19 cases is rapidly growing among healthcare and EMS workers, who remain at forefront of the pandemic fight. The number of such cases, according to official data, has almost tripled in the past two months.

According to the latest data from the Italian Health Ministry and National Health Institute, from September to November, the incidence of COVID cases among healthcare and EMS workers rose by more than 192%, and its growth continues.

Worker Shortages

Associated with this has been an outflow of skilled workers from the industry.

The growing threat to the health of EMS workers has already sparked serious protests. For example, on November 17 representatives of the industry, together with the members of the Italian Society of Emergency Medicine (Simeu), took to the street to raise awareness among the public and decision-makers regarding current staff shortages in emergency medicine, first aid, and 1-1-8 (the country’s emergency number) operating units throughout Italy.

An official representative of Simeu comments, “The worrying fact is that the loss of professionals has now reached the highest historical levels, and today it is very close to catastrophic. The quality of EMS in the country is worsening, which creates serious risks for patients’ health and poses a threat of collapse of the entire national health system. Today there is in fact a shortage of about 4,000 doctors and 10,000 nurses in the emergency departments of the country.”

Local authorities hope these protests will not lead to serious failures in the country’s EMS operations; they say the situation remains under control.

Bad, But Not 2020 Bad

In general, local authorities and representatives of the industry believe the current pressure of the pandemic on the Italian EMS sector is still less intense than a year ago.

Alessandro Borgonovo, a first responder and EMT-Basic instructor for the Italian Red Cross, says, “Last year the pressure on the EMS service was very high. Out of every 100 calls, at least 80 were COVID-positive patients. As for northern Italy (Lombardy), we were asked to add ambulances to active service both for new hospitalizations and for the return of those recovered from COVID.

“The same stressful situation existed throughout Italy. At the beginning the situation was heavier in northern Italy, then slowly followed the trend of virus diffusion in the other regions (center and south), and the phenomenon was accentuated. Fortunately, current pressure on the EMS system is not very high. The percentage of people vaccinated in Italy is very high, not to mention that we have an extra year of natural immunization.”

Almost the same position is shared by leading Italian clinicians. One is Dr. Giuseppe Sechi, health director of Agenzia Regionale Emergenza Urgenza–Lombardia (Lombardy Regional EMS Agency).

Sechi comments, “The current emergency department commitment to the COVID pandemic is comparable to that recorded in summer 2020 in the period between the first and second waves. Hospital emergency departments are rapidly reaching the same number of accesses as in the pre-COVID period. It can be assumed that growth will be slower and less intense than current values by the end of this year.”

According to Sechi serious work is underway to improve the quality and efficiency of EMS services.

“In the Lombardy Region—the most populous, richest, and most productive region in the country—a great impulse is being given to the reorganization of territorial services for which specific nursing skills will be required,” he says. “As regards the emergency sector, a number of bills are currently being examined by parliamentary commissions with the aim of reforming the prehospital emergency system to ensure greater organizational uniformity and constant monitoring of the quality of the services provided. The reform of the system envisages strengthening the role of the expert nurse in the field of emergency care.”

Additional measures are intended to improve the equipment used by the country’s responders. One example has been massive procurements of biohazard ambulances, useful for the safe transport of COVID patients, in some major provinces in the last several months.

As Borgonovo has also said, the pandemic led many paramedics and EMTs to be called back to service to help cope with the high number of infected people needing hospitalization.

In general, he says, in the last 15 years there has been an increase in the professionalism of paramedical and EMT staff in Italy, which has prevented an even higher number of deaths from COVID-19.

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.