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Operations

EMS Around the World: Seventy Years of Innovation

The National Ambulance Service (NAS) is the largest health and ambulance organization in Hungary. Founded by the Hungarian government in 1948, it's been performing rescue and patient transport for 70 years.  

The roots of ambulance service in Hungary date back to the last third of the 19th century. The predecessors of NAS were the Budapest Volunteer Ambulance Association (1887) and the Counties and Cities Ambulance Association (1926). The latter operated a nationwide network of ambulance stations.

NAS was founded after World War II through nationalization of its predecessors, becoming a national state-run organization. It absorbed more than 130 years of existing services. The Counties and Cities Ambulance Association provided almost all infrastructure and personnel for the new organization, while the Budapest Volunteer Ambulance Association ensured the medical background.

Today the NAS has more than tripled the number of ambulance stations, while its manpower has grown more than 20-fold and number of cars has increased sevenfold.

NAS’ Structure

To ensure efficient operation, the NAS established ambulance organizations based in county seats around the mid-1960s. These were headed by the director-general and his professional administrative departments, with their directors deciding on technical and organizational matters. Counties had jurisdiction in other cases. In 2005 this structure changed when the NAS formed regional ambulance organizations (RAOs), which have taken over the role of the early county ambulance systems. 

These seven regional ambulance organizations are parts of the NAS today. Each RAO has a local director with a chief paramedic and economic-technical department. All RAOs are supervised by the director-general and his colleagues and their departments from the Budapest headquarters. NAS is a standardized organization with a unified vehicle fleet, equipment, drugs, uniforms, education, and medical treatment guidelines. Its local stations are commanded by ambulance doctors or paramedics, the smallest stations sometimes by EMTs.

In the year of its founding, the NAS’s network included 76 stations. Today it has 254, which are independent from hospitals and other health organizations. The aim is that any scene in Hungary be reached within 15 minutes after alerting. We distinguish three categories of ambulance stations: Type C stations are the biggest, with eight or more vehicles, and are led by ambulance doctors or paramedics. Type B stations have 4–7 vehicles, type A stations 2–3, and both are commanded by paramedics or EMTs. 

Countrywide, ambulance units travel nearly 40 million kilometers on the roads in Hungary each year, and the 7,500 ambulance employees work on more than a million tasks. The NAS has an annual average budget of nearly $146 million. 

Dispatch and Coordination

Dispatch and coordination of resources are integral parts of ambulance work. NAS manages its entire vehicle fleet along unified professional principles through 19 call centers utilizing telecommunications apparatus with nationwide coverage. Each county has a coordination-dispatch center. The Budapest-based Central Coordination-Dispatch Center (CCDC) is the largest. In case of need, the CCDC is permitted to command the other centers. 

In recent years the European Union and Hungarian government supported the development of this dispatch and coordination system with considerable financial resources. The total budget of the ambulance call and coordination project was $14.5 million. Meanwhile the NAS’s previous ambulance call number (1-0-4) changed (except the central RAO, Budapest with Pest County) to 1-1-2, the common European emergency telephone number. NAS accepts 3,000 first aid calls a day nationwide, out of which the CCDC receives 1,000. Ambulance doctors or paramedics send the appropriate units from regional stations to the scene. 

Education

From the mid-1950s to the mid-1970s, the NAS launched training courses for paramedics and ambulance personnel (EMTs). Under a 1975 provision of the Health Ministry, the training has continued within the framework of higher education. In recent years interested young people have had the opportunity to participate in graduate courses for paramedic education at universities. Paramedic education requires four years of study. 

Graduated paramedics can provide ALS-level care, including defibrillation, use of an esophageal transthoracic pacemaker, cricothyrotomy, endotracheal intubation, controlled ventilation with respirator, vein puncture (peripheral and central) and venous access with crystalloid and colloid solutions, and ALS CPR for adult, children, and infants. Additionally, they may apply intravenous injections with accepted substances. Furthermore paramedics can perform bleeding control, provide medicaments with Perfusor, treat thrombolysis, and fix damaged limbs and articulations. 

Ambulance provider qualifications at NAS could previously be obtained only through informal education. Today their education lasts two years (1,080–1,320 hours), with an additional half-year-long (360–440 hours) specialization. All trained EMTs can provide BLS-level care.

In 1979 the Ministry of Health recognized a new medical science discipline, oxyology. Since 1983 the teaching of this discipline has been integrated with the medical universities’ basic graduate training. The training time for ambulance doctor certification is five years on top of the six years of basic physician training. 

The Hungarian ambulance system is based on the Franco-German model, in which ambulance doctors and graduated paramedics are present on scene. It has far-reaching historical roots. The NAS formed the first special experimental ambulance unit with doctors in 1954. This unit was the first in the world at that time; it used vein techniques for scene treatment, drugs, defibrillators, pacemakers, and other formerly unknown procedures. 

Field and Air Ambulances

The development of the NAS’s vehicle fleet correlates closely with that of the ambulance station network. In 1948 the Hungarian ambulance system operated 134 cars of 19 types. Now it has more than 1,000 vehicles, most of them Mercedes-Benz. The NAS fulfills its first aid obligation (rescue and emergency patient transport) 24 hours per day. 

The most common rescue units are paramedic (paramedic, EMT, and driver); ambulance doctor (doctor, EMT, and driver); and EMT (EMT and driver) teams. Special units are adult paramedic (paramedic, EMT, driver) and ambulance doctor (doctor, EMT, driver) passenger cars; pediatric doctor passenger cars (pediatric doctor, EMT, driver); pediatric ambulance doctor (pediatric doctor, EMT, driver) units; ambulance motorcycles (doctors or paramedics) and scooters (EMT); and mass-accident (EMT, driver) and mobile intensive care (paramedic/doctor, EMT, driver) units.

The NAS’s rescue system uses standardized medical and technical equipment along with the appropriate competencies of doctors, paramedics, and EMTs. The vehicle fleet has its own service background in all RAOs. The NAS is not only a field ambulance organization; it founded its own Air Transporting Group (ATG) in 1958. During the early years it used the rescue airplanes for secondary transport, but they were not able to provide first aid on scene. This changed in 1980 when NAS activated its rescue helicopters, the first of which was a Mil Mi-2 model. The fleet has been modernized from the early 1990s, and today only EC135s are used.

The ATG was reestablished by NAS during the last decade and continued as the Hungarian Air Ambulance Nonprofit Ltd. with seven bases throughout Hungary. All helicopter crews have similar composition (ambulance doctor, paramedic, pilot). These special units are alarmed and coordinated by NAS’s centers.

With a long history of innovation and professionalism, the National Ambulance Service is leading the way in prehospital care for the people of Hungary. 

References 

Debrődi G. Seven Decades from the History of the Hungarian Ambulance. Budapest: National Ambulance Service, 2018.

Debrődi G. History of the Hungarian Ambulance System (1769–2012). Budapest: Hungarian Oxyology Association, 2012.

Felkai T. Hungarian Ambulance History. In: Cselkó L, ed., Jubilee Album for the Centenary of the Organized Ambulance’s History. Budapest: National Ambulance Service, 1987, p. 7–59. 

Pap Z. Jubilee Album for the Fiftieth Anniversary of the Hungarian National Ambulance Service. Budapest: National Ambulance Service, 1998.

Gábor Debrődi is director of the Kresz Géza Ambulance Museum in Budapest, Hungary.

 

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