EMS Around the World: Lithuania Boosts Ambo Fleet, Int'l. Cooperation

Lithuania’s emergency medical services are decentralized, and both privately owned and public stations operate without a central dispatch system. However, the ongoing COVID-19 pandemic has shown that the provision of EMS in Lithuania should be centralized, according to senior Health Ministry representatives, and ensured to the Baltic state’s inhabitants without concern for “turf.”

Viktorija Buzytė, an adviser for the Primary Health Care and Nursing Division of the Lithuanian Ministry of Health, says Lithuania’s EMS system consists of 49 stations located across the country. Of these, two are privately owned, and 47 are operated by the state.

Adding Ambulances

As the pandemic has highlighted the importance of investing in national EMS capacities, Lithuania’s authorities are planning to buy 225 additional ambulances for the state-owned EMS stations, Buzytė said.

The Health Ministry only has data on ambulances owned by entities that have signed contracts with the country’s state-run National Health Insurance Fund, an agency overseen by the Ministry of Health. “At this moment, in this network there are 260 ambulances. Of these, 239 are main vehicles, and 21 reserve vehicles,” she says, adding the government could not provide figures on privately owned ambulances outside the ministry’s purview.

A presentation by Nerijus Mikelionis, chair of the board of the Emergency Medical Services Association of Lithuania, cites eight emergency dispatch centers that cover the country’s territory. These provide services to a population of about 2.8 million inhabitants across some 25,200 square miles. The decentralized dispatch system means each Lithuanian municipality or city has its own center, and there is no coordination at the regional or national level. 

Lithuania’s 215 on-duty EMS units ensure a relatively equal provision of EMS in the country’s urban areas, with some 18,000 inhabitants per unit, and rural areas, with about 16,000 inhabitants per unit, according to data from Mikelionis, who in addition to his role at the association is also director of the EMS station in Kaunas, in Lithuania’s south. Under the country’s regulations, the required response time is 15 minutes in urban areas and 25 minutes in rural areas for Category 1 calls—those that are life-threatening and require immediate intervention.

System Design

The design of the Lithuanian EMS system dates back to when the country was part of the Soviet Union, from which Lithuania separated in 1991. The service was created based on the Franco-German EMS model, which relies on the “stay and stabilize” philosophy.

Today there are two types of EMS units in Lithuania: basic life support (BLS) units, which consist of a paramedic and a paramedic/driver, and advanced life support (ALS) units, which consist of a doctor/nurse and a paramedic/driver. ALS units dominate the service’s structure, representing about 90% percent of the total.

In his presentation Mikelionis identifies a number of issues faced by the country’s EMS system. These include an unequal level of medical care provided by particular EMS stations, as demonstrated by mortality rates varying between 0.2% and 2.2%; a lack of development and integration of standard operating protocols across the system; and a lack of well-funded trauma care programs that could increase the quality of trauma care, among others.

Trauma Care Overhaul

The inefficiency of Lithuania’s trauma care service was highlighted in a 2012 paper by researchers Raimundas Lunevicius and M. Hafizur Rahman published in the European Journal of Public Health.

“The Lithuanian whole-trauma sector does not substantially contribute to improving the health of the population. The legitimate expectations of the community—respect of persons in terms of dignity, autonomy, confidentiality, client orientation—do not correspond with the responsiveness of the trauma service. Financing of the trauma sector does not correspond with the magnitude of the injury problem,” they wrote. 

Lithuania’s trauma service is decentralized, and “there is no national policy for unintentional injury prevention and control, no specialized injury research institute, no system of trauma centers, and no injury surveillance system,” the paper says.

The researchers conclude the performance of Lithuania’s trauma sector “does not…correspond to the needs of country’s public. The Lithuanian trauma service has to be conceptualized and changed to an inclusive system.”

Other issues faced by Lithuania’s EMS are raised in a December 2017 study by Rimantas Stašys and Gintautas Virketis of Klaipeda University. Their paper identifies several shortcomings of the country’s EMS system: a lack of approved protocols, algorithms, and performance standards; a lack of quantitative and qualitative performance measures; a lack of regulation related to patient transportation between hospitals; and insufficient funding, among others.

Another challenge that hampers EMS operations is a lack of airborne support. Despite this shortcoming, Buzytė says that the country’s authorities are not planning to buy medical helicopters.

In his presentation’s conclusion Mikelionis calls on the Lithuanian Health Ministry to introduce several changes to the system’s design, and, like Buzytė, he argues Lithuania’s EMS requires more centralization.

Cross-Border Cooperation

In recent years Lithuania has worked to add EMS to the scope of cross-border projects it implements with its Baltic neighbor Latvia. In 2018 the two countries signed a cooperation agreement under which their respective EMS systems are to complement each other in areas along their land border of about 365 miles. This is facilitated by the fact that both Lithuania and Latvia are members of the European Union and part of the Schengen Area in which passports and other types of border control have been scrapped.

The 2018 deal allows ambulances from each of the countries to attend to patients if they are closer to the scene than ambulances from the patients’ country of origin. Moreover, Lithuanian and Latvian EMS stations were enabled to contact each other for enhanced cooperation and increased interoperability.

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.