Publicatie datum

Ambulance care in Europe: organization and practices of ambulance services in 14 European countries.

Bos, N., Krol, M., Veenvliet, C., Plass, A.M. Ambulance care in Europe: organization and practices of ambulance services in 14 European countries. NIVEL, 2015. 46 p.
Download de PDF
Ambulancezorg Nederland (AZN) is the national sector organization for ambulance care in The Netherlands. AZN is interested in the organization and practice of ambulance care in the Netherlands and other European countries. Therefore it initiated and funded an investigation among ambulance care services in Europe. The investigation was partly a repetition of a previous study in 2010. The fourteen countries that participated in this survey were Belgium, Croatia, Czech Republic, Estonia, Germany, Hungary, Ireland, Latvia, Lithuania, the Netherlands, Norway, Spain, Turkey, the UK.
The questionnaire addressed nine important topics in ambulance care such as organization and personnel, legislation and regulations, quality and safety and the patients’ perspective on quality of ambulance care. The results provide an overview of the organization of ambulance care in fourteen European countries and are presented in this report.
In general, the organization of ambulance care in countries is much alike. Most countries regulate ambulance care at a national level. All countries have separate ambulance care for emergency and non-emergency ambulance transportations. Response times can differ between countries from five to twenty minutes for life-threatening events. Ambulance services collaborate with various other service-types, e.g. hospitals, general practices, mental healthcare institutions, fire brigades, and police departments. Ambulance crews vary with type of transport and can include a range of medical staff, such as emergency care assistants and paramedics. In the case of life-threating events usually a physician is part of the crew.
Patient safety is considered an important topic in ambulance care all over Europe. The survey results show that patient safety programs and national regulations regarding quality of ambulance care exist in the majority of the participating countries (9). In eight of these countries official quality ratification is required. Quality indicators of ambulance care are being defined and recognized in ten countries. Further, patient complaints about the care received or about adverse events are registered in most countries. However, only few countries have national regulations on adverse events. In eight countries patients’ experiences are measured. In three countries these measurements are part of a national survey program. Still, patient involvement is only limited in ambulance care.
It appears that the organization of ambulance care is broadly stable over time (e.g. emergency levels, response times). The national budgets increased over the past five years. Due to extended budgets ambulance care services were able to respond to the growing number of emergency calls and other types of transportation. Consequently, ambulance staff increased in volume and functions. New positions such as nurse assistant, care ambulance assistant or care ambulance driver are introduced.
Healthcare professionals in ambulance care would welcome and join an international platform or forum to discuss and exchange information about ambulance care. An international forum could eventually lead to an international research agenda, comparable to the recently developed research agenda in the Netherlands. The development of a research strategy in the European Union strategic paper was one of the long-term conditions for quality of emergency care in the AWHO report (2008).
The initiative of AZN for this investigation among 14 European countries resulted in an overview of the organization and practice of ambulance care. Further in-depth exploration of ambulance care could occur by setting up an international discussion platform, and building an international network of healthcare professionals. Sharing knowledge can be useful in anticipating to changes and challenges in ambulance care. (aut. ref.)