Dr. Tornev, has anything changed in emergency care after the declarations of the new minister and the reform plan?
- The deadline is very short to make many changes already. But I see a real desire on the part of the minister and his team to change the pre-hospital emergency medical care built by centers like ours. For this, we need financial resources and changes in the outdated legislation. I hope it will come true, because I have been leading CSMP - Sofia region for 11 years. During this time, there were many concepts, but none of them were realized in practice. There are ambitious people in the team of the Ministry of He alth. I know Dr. Sharkov, who also managed hospitals, and before me he was the director of this center. He is aware of the emergency system. Therefore, I hope that the ambitions will not remain just words.
Where do you think it should start?
- The main problem here is the lack of specialists - doctors, nurses and paramedics. The average age of medics is quite high - over 45 years, which does not speak well for the system, because it is not renewed. The crisis started in 2010. The number of doctors decreased more and more. We had not appointed newly graduated doctors for 3-4 years. To boast that I now have the good fortune to employ a fresh graduate. The situation is the same with the sisters. I can't remember when we haven't hired a new graduate nurse. The profession of paramedics is disappearing because since 2000 there has been no such training. And we are still waiting for the paramedics. So much time has passed, by now it could have been an established profession. There are many unemployed people in Bulgaria who would like to practice it. With this shortage of medical professionals in paramedics is the way out. There is no other salvation.
We can buy ambulances, equip them according to modern standards. But if we don't have trained people, nothing works. They say they will come from abroad. But with these wages -
who will come to work for 300-400 euros
Vietnamese and Chinese go to Arab countries and get ten times more than in Bulgaria.
Is there really a salary increase in emergency care?
- Yes there is. In mid-January, at a meeting in the ministry with Deputy Minister Sharkov on the occasion of this 20 percent salary increase, we prepared preliminary estimates. Good salaries are obtained for doctors and other medical specialists against the background of salaries in Bulgaria. The basic salary for a doctor without a speci alty is BGN 1,100. With one speci alty it is BGN 1,200, with two - BGN 1,300. Adding the additional remunerations - for internship, night work, overtime work, etc., it is possible to get decent pay. The increase is due to take effect on January 1 and people are already waiting for their money. With this misery in Bulgaria, everyone has made their personal plans for the year and every penny has been counted.
There is another big issue that hasn't been given much thought, although I have brought it up in various forums. It is a question of disparity between the remuneration of the employees in the different centers, although they perform the same work. It has been historically established since the 1990s, when emergency centers separated from hospitals. Since then, everyone has started with a different salary, and the increase is proportional and the disparity persists. We discussed with Dr. Sharkov to gradually work towards the unification of the basic salaries, somewhere to give more. I even wrote that the clothing in all CSMPs should be the same. Because we work in one system. Another issue is the different workload. There will already be a difference with the additional rewards. The workload of the teams in Sofia cannot be compared to that in any other city. The population is 2 million people, and a million come and go every day.
Is the equipment issue resolved? In Romania, ambulances are equipped to a standard and every emergency medic knows how to work in them
- That's right. Not only medical standards for emergency care, but also a standard for medical equipment and ambulances should be drawn up. I have been to Romania twice on a working visit. These days I'm going to Bucharest again. I will have a meeting with Dr. Raed Arafat - the "father" of the emergency aid system there, which includes, in addition to medical, police and firefighting teams. They all go to the scene together. They have built a very lean system. They do not deal with all kinds of calls and medical assistance like we do here. The rest of the activity is carried out by private and state medical centers and hospitals. They also have cars for that. It struck me that the he alth insurance fund also pays for the transport of patients from their homes to the medical facility, because there are many elderly and disabled people. We were at a private medical center that had bought 30 cars and was driving the patients in them. This is a dream for us.
We talked about standards for medical equipment in ambulances and for the cars themselves…
- There are no such standards in Bulgaria. We have had ambulances here since the last century. It's not right and
trucks to be adapted for ambulances
and this was the practice until now. It is good that at the end of 2014 funds were allocated to the centers and to the regional he alth inspectorates for sanitary vehicles and equipment for them. Fortunately, I was able to find a purpose-built ambulance car with the special suspension. Here we have retrofitted it so that it can be raised and lowered depending on the terrain. In Europe, there are several types of standard for ambulances according to the team that uses them. Level A is the lowest equipped car, and in level C minor interventions can be made. We equipped ours at level B.
What will be achieved with the three equipment levels of the ambulances?
- This means that there will be actual triage of cases and which team and level of ambulance should go to the address. Things should start at the 112 dispatch centers. But even there the remuneration is not high, they do not have medical specialists in their teams. There, the training must be very serious, they must know the symptoms to determine exactly what disease or condition it is, whether it is urgent or can wait and send an ambulance to a truly urgent patient. Our teams are spread out for all kinds of cases, and at the same moment there may be a patient who really needs emergency care, and every minute counts. In Germany, patients who call a non-emergency team are fined. I think that in order not to make too much noise, to avoid public dissatisfaction, our centers are left as buffers of the system. If they are not to serve everything, imagine the resentment that will arise.
People complain again because the ambulances are late…
- That's right. I'll give you an example from Kostinbrod, where we have one team. When he goes to an address or the scene of an accident and then has to hospitalize the patient somewhere, that area is without a team for minutes to half an hour.
This in other countries is compensated by people with all kinds of professions and volunteers who are trained to maintain breathing and heart activity until the team arrives. And with us, everything is left to its own devices. We need political will to change all this.