The Russian emergency medical services industry is on the verge of big changes, thanks to ongoing reform recently initiated by the national government. The goal of these efforts is to improve the quality and accessibility of EMS provided to the local population, according to recent statements made by senior officials with the Russian Ministry of Health and local EMS experts.
Currently the EMS industry is the most affordable rescue service in Russia (and likely the only one that’s free). However, the service’s current structure is still mostly based on Soviet standards and thus significantly outdated.
The planned reform mainly involves its separation into two independent services that will focus on the provision of EMS itself as well as ambulatory medical support. That means the emergency physicians who ride in Russian ambulances will deal only with emergency or life-threatening calls, such as heart attacks, childbirths, knife and gunshot wounds, road accidents, heavy bleeding, etc.
At the same time paramedics from special ambulance stations that will be organized at the district health centers and healthcare facilities in each city will be responsible for calls from patients suffering simpler health problems (fever, high blood pressure, etc.). According to the latest data from the Russian Ministry of Health, such calls currently account for up to 25% of emergency calls. This is one of the major reasons for the planned separation.
Moreover, as part of the reform, the government plans to include paramedic-drivers in the emergency crews (ambulance drivers currently have no medical training) and allow them to conduct medical procedures. This will provide an opportunity to eventually replace doctors, who will go on calls only with resuscitation teams.
Currently each Russian emergency crew consists of five people, among whom are a doctor, two paramedics, a male nurse, and a driver. In recent years state spending on EMS operations has significantly increased, which prompted the government to start considering reform. Training paramedics is much cheaper than training doctors and provides significant cost savings for the state budget. It is planned that future Russian emergency crews will include only two paramedics, who will also work in hospitals.
The reform also involves the establishment of special units organized in each Russian hospital where patients will receive treatment from paramedics and emergency physicians. The main function of such units will be to conduct diagnostics, including referral of patients to the appropriate department of a particular healthcare facility. All the units will operate around the clock and have all necessary medical equipment. They will also have operating rooms, along with registration posts and waiting rooms for relatives.
As part of the reform, the government also plans to introduce a new principle for triage that will be applied to patients delivered to hospitals by emergency teams. In addition to the existing triage of surgical, therapeutic, traumatological, and gynecological departments, all patients will be classified in accordance with special zones, depending on the severity of their condition.
As part of these plans, special areas at hospitals will be reserved for alcohol and drug addicts, the homeless, and people with mental issues. They will be equipped with bulletproof windows and vandalproof equipment, as well as a security posts and mandatory surveillance equipment.
According to the health ministry, the reform will help provide emergency medical assistance faster and more appropriately, increasing the efficiency of the system.
Historically Russian emergency medical services were designed to provide medical treatment and assistance primarily in public places. However, in recent years the share of such calls has declined to only 10%–20%—the remaining 80%–90% come from households. This has changed the way Russian emergency crews work. According to Ministry of Health data, only 20%–30% of the overall volume of calls to Russian emergency medical services are completely justified, meaning the existence of a real life threat.
The Soviet Era & Aftermath
Ministry analysts believe successful implementation of the reform will greatly improve the quality of emergency medical services provided in Russia, which significantly deteriorated after the collapse of the USSR in 1991.
During Soviet times the EMS industry was part of the Soviet healthcare system. By 1974 the number of emergency stations and centers in the USSR was estimated at 3,887, including 180 air-ambulance stations. However, after the collapse of the country and series of economic and political crises that followed, the number of such operating units has declined by several times.
According to Sergei Bagnenko, one of the main initiators of the reform and head of Pavlov State Medical University, Russia’s leading medical university, the situation had become close to catastrophic by the beginning of the 1990s, due to a shortage of doctors and extremely low funding from the state.
The situation began to improve during the 2000s, however, thanks to a series of state projects in the field of national public healthcare. These included the Zdorovye project, which helped to attract new doctors and other personnel to the industry by increasing their salaries and the provision of social guarantees and other benefits.
According to Bagnenko the reform, which is scheduled for completion by 2021–22, will improve both the quality and efficiency of EMS in Russia.
“One of the main problems of the Russian EMS industry is lack of integration of the prehospital and hospital emergency phases,” Bagnenko says. “At present admission zones of Russian hospitals are not designed for emergency treatments. This poses a threat to patients with serious diseases. The reason for this is the wrong organization and lack of triage practice in the majority of Russian hospitals and healthcare facilities.”
In the meantime the government believes the ongoing reform will contribute to the reduction of waiting time for emergency crews, including in remote districts; reduce the number of unnecessary and hoax calls; and create conditions for the renewal of the vehicle fleet used by Russian EMS.
The volume of investments in the reform has not been officially disclosed, but according to some state sources, they are estimated at about 33 billion rubles (USD $500 million).
Still, despite the expected benefits and advantages of the reform, some Russian analysts remain skeptical of its prospects, considering it a blind imitation of the models in some Western countries.
Alexander Saversky, head of an organization dedicated to protecting patients’ rights, says, “The conduction of the reform of the national EMS industry in accordance with some Western standards, as proposed by the Russian Ministry of Health, looks nice in theory. However, in reality it may finally ruin the whole industry of primary medical care in the country. We do not have information about how this will be done and what kind of costs it would require. I think the final volume of investments will be significantly higher than those initially planned by the state.”
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 firstname.lastname@example.org.