EMS Around the World: War, Sanctions Push Russian EMS Toward Crisis

The Russian EMS sector faces its deepest crisis in the modern history of the country as the ongoing war in Ukraine and unprecedented sanctions squeeze the industry, which had been rapidly growing in the post-Soviet era.

Since the second half of the 2010s, the Russian EMS sector has developed at a rapid rate due to funds and attention from both regional and federal authorities. Probably the biggest progress was observed in Moscow, where the EMS system was recognized in 2019 by accounting giant PwC (PricewaterhouseCoopers) as the second-most efficient among the world’s megacities. PwC’s international study “Analysis of EMS Efficiency in Megacities of the World” considered indicators such as response times, crew equipment, number of units per capita, and patient feedback. (Berlin took its top spot; New York was third.)

Now most analysts believe the war will set back the progress of both the city’s and the nation’s emergency care systems by decades. Despite the official optimism of authorities, the current situation in the Russian health care sector overall is steadily deteriorating, hastened by broad international sanctions.

Imports and Reserves

Traditionally the Russian EMS sector has depended heavily on imports from abroad as a significant part of its necessary medical technology and equipment, expendables, etc. Most of those supplies were suspended after February 24. While the country has some reserves, most analysts expect they will be exhausted for most important items within 6–12 months. Meanwhile, a significant portion of the equipment and technologies used in Russian EMS remains outdated and in acute need of renewal. One way to solve the problem could be through establishing domestic production of the needed equipment and materials, although actual implementation of such plans may take several years, and the country lacks financial resources to implement them.

Similarly, underfunding of EMS needs, a problem even with recent progress, seems more likely to worsen than improve. A sharp devaluation of the ruble and its current inconvertibility in the global market has already led to significant wage reductions for most of the industry’s personnel. This poses the threat of the massive exodus of all levels of providers, including paramedics, and longer response times due to personnel shortages.

Under current Russian regulations ambulance arrival to patients under ordinary conditions should not exceed 20 minutes. The ability to comply with this will be especially threatened in rural areas, which account for almost 30% of the country’s overall population.

“In order to ensure stable work in emergency medical settings, especially in rural areas of the country, it is important to have at least 2 ambulances and staff that can work 2–3 [shifts] a day,” Artemiy Okhotin, a well-known Russian cardiologist, told the independent news outlet Novaya Gazeta of the current situation. “There are simply no people and no ambulances for this in Russia at present.”

Aging Hospitals

Complicating the situation is that most hospital emergency departments and other emergency settings throughout the Russian health care system need modernization and overhaul. In the last 20 years the number of such settings has declined by 30%.

This was largely a consequence of a failed reform that began in 2010 with the adoption of a new law on medical insurance. At the heart of the reform was liquidation of ineffective hospitals and their emergency departments and reallocation of funds into other, more modern medical facilities.

In 2019 Russia’s first deputy prime minister, Tatiana Golikova, acknowledged the failure of the reform, which she said did not achieve the anticipated renewal and modernization of medical infrastructure, some of which dated as far back as the 1950s.

Most experts believe the war will put a final end to these plans for the foreseeable future. They also expect a continued negative effect on the financial position of personnel in the EMS and health care sectors.

Prior to the war the average monthly salary of an emergency doctor in Russia was about US $450. This dropped significantly after February 24.

This has had a predictable effect on the workforce, and many regions of the country are experiencing shortages. On average in Russia there are 0.85 emergency doctors per 10,000 people, but in some regions this figure is as low as 0.2.

According to the World Health Organization, Russia ranks 121st in the world in terms of spending on health care (5.3% of GDP). The per capita state funding of the healthcare and EMS sectors is estimated at only US $879 per year, compared to $1898 in Israel, $2560 in Spain, and $3495 in Australia.

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.