- The Mitsotakis experiments with military and firemen drivers failed. Guilty silence of the administration for the constant devaluation.
- The ambulance fleet was acquired in 2003 and it is a given that without the new vehicles acquired through private donations, the EKAB would not be able to operate.
- In order to operate and staff an ambulance properly, 11 people are needed on a 24-hour basis.
- The ratio of coverage of the entire country by ambulances is currently 1 per 36,000 citizens, while the European average is 1 per 27,000.
By Panos Katsahnias
“Suddenly, Last Summer”
This past summer, the National Emergency Aid Center (EKAB) was in the news, but unfortunately for all the wrong reasons.
On Sunday (4/6), a 63-year-old woman died in the back of a pickup truck as the only operational ambulance was not available to take her to Kos Hospital. The representative of the ambulance unit on the island, Konstantinos Tsampis, spoke to kathimerini.gr about the serious shortages recorded on the island. As he explained: “We are seven permanent employees and three auxiliaries. Meanwhile, in order to operate and properly staff an ambulance, 11 people are needed on a 24-hour basis. Unfortunately, there is no staff available and we have been facing this problem for several years. From time to time some people come to help, but they leave”.
He stressed that: “Since last August we have only one ambulance, Winter-Summer” and that: “All the competent bodies are aware of this situation…”.
On the same wavelength were the statements of the president of the workers’ union of the Pan Hellenic Federation of Public Hospital Workers in Kos, Garyfallia Karanasios, who had made the revelation that there is a new ambulance available on the island, but it is immobilized at the new ambulance station because there are no people to man it.
Just two days later, on Tuesday (6/6), a 19-year-old pregnant woman from Nea Makri, died, as the ambulance was delayed by 5 hours, according to a complaint by her relatives.
The next day, (7/6) a 63-year-old tourist from Romania suffered a cardiac arrest and passed away in Halkidiki. The woman lost consciousness while she was in a tavern in the area of Ouranoupoli, however, the ambulance of EKAB took 1 hour and 15 minutes to arrive. This is because according to reports at the time, there is no ambulance in the third leg of Halkidiki. So, for the incident, an ambulance started from Agios Nikolaos so it had to travel a distance of about 55 km. On the occasion of the incident, it became known that in Halkidiki there were 4 ambulances of the EKAB on standby, called to cover the needs of a million people moving in the prefecture during the summer season.
On 27/6 at Astrida beach of Thassos, a 45-year-old tourist died while waiting for the only ambulance on the island. According to the report of Thesstoday.gr, the ambulance arrived after 51 minutes, as it was at another incident 30 km from the beach. For 40 minutes, four Romanian tourists tried to revive the woman by giving her resuscitation, but without success. The president of the Association of EKAB workers of Kavala and vice-president of the Panhellenic Union of EKAB workers, Kostas Tsitsilikakis, had spoken at the time about the serious shortcomings in the EKAB. “Unfortunately, the shortages are confirmed. The only ambulance on the island was at another incident, in approximately the same area, and was returning at that time to the Health Centre.” While he said, “We are doing what we can, what we are trained to do, but unfortunately the shortages are very serious,” he stressed, underlining that of the four ambulances in Thassos, only one is actually working, due to lack of staff.
On Friday (30/6) a 52-year-old man, who suffered a heart attack in Nea Zoi Peristeri, reportedly died due to the lack of an ambulance and a critical delay in receiving the necessary medical assistance, while he was staying very close to the Attikon Hospital. The wife called for an ambulance, but the response was negative due to a lack of available vehicles. Ten minutes later – as the 52-year-old’s relatives complained – a new call was made, but again there was no ambulance available. According to the reports, his family transported him in their own vehicle -as the 52-year-old had private insurance- to the nearest private clinic in Peristeri, where it was determined by the doctors that he needed to be intubated and that he must therefore be transferred. However, neither the private clinic had an ambulance to transport him. At five minutes to two in the morning and while the patient was already in the private clinic, his wife received a call from the ambulance service asking if she still needed an ambulance. She refused, and a few hours later, the 52-year-old man passed away. The Ministry of Health stated that the 30 ambulances circulating on that particular day were all engaged in transfers, which caused the delay.
This was followed by July when a new “record” was set: two deaths in 24 hours while waiting for an ambulance. In Metochi, North Evia, the victim was a pensioner who felt unwell on Wednesday afternoon (5/7). As there was no ambulance available at the Mantoudi Health Centre, he had to wait for an ambulance to come from Chalkida Hospital. After an hour of waiting and with his condition deteriorating, villagers decided to carry him in the back of a pickup truck, but unfortunately, they did not manage to reach the Health Centre in time. The second incident occurred on the beach of Gavatas on Lesvos, where according to lesvosnews, a woman suddenly lost consciousness and by the time the ambulance from Kalloni arrived, she had passed away, resulting in the Health Center where she was transferred, just to ascertain her death.
The losses that we counted this summer confirm in the worst way that the medical and nursing staff of the public hospitals have not stopped shouting with their mobilizations for many years. That is, the long-lasting and constant understaffing and devaluation of the National Health System (NHS) has brought it to such a level of degradation that it no longer serves the purpose for which it was created since people who could have been saved are constantly dying. We knew it for the hospitals that have been “brought to their knees” by the shortages of medical, nursing, and administrative staff, and we see it clearly now for EKAB, with the huge shortages of ambulances, but also of rescuers, so that at least everything that can and does work is staffed.
On the occasion of the tragic incidents of the summer the president of the EKAB Employees, George Mathiopoulos had made incredible complaints about the ambulances of Attica. As he explained to Action24, almost half of the ambulance fleet is at a standstill due to maintenance issues, he pointed out that while there is an in-house crew to solve the problems, it has been left without technical staff for years despite the union’s pleas and requests for staff appointments. “Here in Athens, there is a huge problem… We have 40-45 ambulances in Attica, while we need more than 100 to operate. Of the 90-95 ambulances we have, 35-40 are permanently stalled in the parking lots of the companies that have supplied ambulances to the EKAB. Because the excuses are too many: That there are no spare parts, they haven’t come in time and so there are ambulances that can be stalled in the parking lots for 2 and 3 months. Half of the ambulance fleet is practically immobilized in the companies’ garages. We are talking about the operational ambulances that have been donated to us by the “Stavros Niarchos Foundation”, the “Shipowners’ Association“, the “Trans Adriatic Pipeline”, the Ministry of Finance, but also private individuals, which are from 2018-2019 onwards. Although they are considered new vehicles, they have already traveled 250,000-300,000 kilometers or more, but at least they are reliable. So, there should be an immediate solution for their maintenance, because it is a very time-consuming process. We have a workshop, but we do not have technical staff. We have been asking for technical staff for years, but unfortunately, no solution has been found …‘.
| Πίνακας 1 | |||
| ΔΩΡΕΕΣ ΑΣΘΕΝΟΦΟΡΩΝ: | ΙΣΝ | ΤΑΡ | ΣΥΝΕΝΩΣΙΣ |
| 142 | 33 | 20 | |
Donations give “a breathing space”
Given that the fleet of ambulances of the EKAB was acquired in 2003, it is a given that without the acquisition of new vehicles through private donations, the EKAB would not be able to operate.
The ambulances purchased to equip EKAB – due to the cost – do not come ready-made as such from their manufacturer, rather they are purchased as professional vans and subsequently retrofitted by Greek private companies. It is not uncommon for the internal layout of the equipment and tools not to serve the rescuers in their work. The fact that there is no central planning by the EKAB for the acquisition of new ambulances, apart from the shortages due to age and long mileage, creates other problems. Each donor naturally sets the amount of his donation himself. With this in mind, the EKAB could ask for fewer ambulances, but of better quality and better equipped.
But how can it do this when its objective shortcomings are enormous? Therefore, it is forced to demand more quantity at the expense of quality. So, for example, the folding stretcher, although newer, or the transport chair, will be heavier because of their cast iron construction than the older ones which were made of aluminum. Or the immobilization boards for multi-injured patients will not be compatible with all ambulances, old and new. We are talking about an organization that until a few years ago was forced to create a huge graveyard of its ambulances in the large parking lot in front of the “Sotiria” Hospital on Mesogeion Avenue in Athens, with hundreds of vehicles immobilized for various reasons, in order to cannibalize them, offering spare parts to those that were in service.
So when EKAB is systematically short of the number of vehicles it needs, it practically cannot afford to say “no” or to set its own strict specifications for the rolling stock it receives from donations, since the need for replenishment is always great.
Moreover, this condition creates an even bigger problem for EKAB, which is the creation of a heterogeneous fleet of vehicles, with all that this implies for their maintenance and repair. With the main parameter being increased costs. Since it cannot place bulk orders for spare parts in order to obtain better prices.
This is compounded by another technical difficulty arising from technological development. Modern vehicles carry a multitude of electronic systems, making them more demanding to repair.
“Apprenticeship” workshop
In Athens, there is a workshop at the headquarters of the Body for the repair and maintenance of the fleet of ambulances and other vehicles of EKAB. In other cities, this task is carried out by private vehicle workshops. However, because EKAB is usually late in paying them, these workshops do not have as an immediate priority the servicing of these vehicles. Moreover, because they are vehicles which, due to their increased tasks and their limited number, make many kilometers in short periods of time, visits to the workshops are inevitably frequent. It should also be borne in mind that these ambulances are driven by many different drivers in emergency situations. The wear and tear on vehicles and equipment are therefore commensurate, with the core of the ambulances – despite private donations – still being many of those purchased en masse because of the 2004 Olympic Games. A serious issue is the replacement by OAED Apprenticeship Schools of those car technicians who retire.
Army and Fire Brigade as ambulance drivers of EKAB
And this is how we arrived after the May-June double elections, to the issuance of an ALC by decision of the Prime Minister, for “the utilization of the means of the Fire Brigade and the Armed Forces in the field of ambulance services of the EKAB”, as he announced during his visit to the Ministry of Health (4/7), in order to proceed immediately with the temporary manning of ambulances with mixed crews, having characterized as “one-way” his intervention. Thus, about 200 members of the Army, local authorities, and the Fire Brigade were called to work as ambulance drivers of EKAB in 50 mountainous areas and islands of the country.
Pure communication choice “patch”, the limits of which were shown only a month later, when in a letter to the relevant ministries, the Panhellenic Federation of Military Associations, denounced the dangers for both untrained military personnel – and for patients – on the occasion of the shock suffered by a military ambulance driver of EKAB who was called to deal with a serious traffic accident in the municipality of Maroneia-Sapes in Rodopi, where a tractor had crushed a young man.
According to the president of the Panhellenic Federation of Public Hospital Employees (POEDIN), Michalis Giannakos, who spoke on this issue to Data Journalists, “Today there are serious problems in the management capacity of the EKAΒ, due to the lack of rescuers and ambulance deputies, but also due to the lack of ambulances. In Attica, in three shifts (morning, afternoon, and evening) the available ambulances are half of what we need. While 90 ambulances should be operating in the morning and afternoon and 50 at night, half of them are operating today. As a result, the response time of the ambulance service is even 4 to 5 hours. To this we must take into account that no one can assess the seriousness of the incident over the telephone, given that the citizens who call the ambulance center cannot describe with the required accuracy the seriousness of the condition of the person who needs to be transferred, since – with very few exceptions – they have no medical knowledge. Therefore, all contracted rescuers should be made permanent -as in the whole Public Health System- and at the same time, at least 1,000 should be recruited. In any case, the issue cannot be solved by the act of legislative content (ALC) involving uniformed personnel in ambulances. The ambulance services are too serious for the progression of an emergency’s disease and should be provided by qualified personnel with professional rights, such as rescuers who have graduated from the EKAB IEK after two years of study, have done their 6-month internship in an ambulance and have a license to practice their profession. If we want to attract health workers, rescuers, doctors, and nurses, we need to look again at salaries and incentives. At EUR 1,850 for doctors and EUR 800 for nurses and rescuers, no one will come to work in the NHS when food and living costs are now too high. They will prefer to go to the private sector and especially to go abroad where working conditions and pay are better”.
Ο Μιχάλης Γιαννακός είναι πρόεδρος της Πανελλήνιας Ομοσπονδίας Εργαζομένων Δημόσιων Νοσοκομείων (ΠΟΕΔΗΝ)
Beautiful promises burn… beautifully
Despite the temporary solutions that were given, in order to cover mainly the islands due to the tourist season, the government of New Democracy, through the mouth of Kyriakos Mitsotakis, had stated regarding its pre-election announcement: “The commitment to recruit 10,000 medical personnel is in full force, of which 800 of them will be directed to EKAB, regardless of other actions”. Thus, with the increase in personnel – especially in the basin – the greater availability of ambulances moving mainly in Athens was sought, so that, as the Prime Minister himself had stated, to achieve his goal “EKAB to be able to respond in 7 to 10 minutes to emergencies.”
In the last call of the 1st Health Region for the coverage of 250 positions of auxiliary staff for the Basin, 185 people responded, and based on the audit carried out, the final number of those who met the requirements was only 142 people. Of these, however, only 120 candidates accepted their appointment, while 9 persons also resigned. Therefore, out of the much-advertised 250 recruitments announced by the government, only 111 will be recruited in the end. The few applications received for jobs in EKAB are not accidental. All indications are that no interest was shown, as the contracts are for only two years. A fact that is naturally seen as a deterrent for people who work. Finally, another reason for the limited applications is related to the reduced qualifications of many candidates. Since, in order to participate, the bar has been lowered. While the plan was for the new rescuers to commence work at EKAB at the beginning of September, however, because many of them needed training – as they are not licensed – it was estimated that they would be operationally active around mid-September…
Indicative of the regression of the profession of pre-hospital rescuer is the announcement of the 5th Health Region of Thessaly, from 28/8/23 to 6/9/23, for ambulance driver positions in Health Centers (HC). Thus, around 3,000 graduates of EKAB IEK are “invisible” to the system. At the same time, the notice for the recruitment of 270 rescuers has been frozen for 2-2 and a half years. In other words, we are heading back to the first years of the creation of EKAB. From providing specialized health services, we are ending up with simple transport.
One step forward… 10 steps back
The myth of Sisyphus in all its glory unfortunately also represents the effort that has been made for Greece to acquire a modern Emergency Response Body.
EKAB was established in 1985 (after the NHS in 1983) by Law 1579/1985 and is a Public Law Entity (PLE), but from the beginning, it did not have the form it has today. At that time there was the so-called “Regulator”, a screening point at the “Gennimata” Hospital then for Athens, where all cases went to it, and from there it was decided where each case would be transferred to be treated. A modern “Kaiadas” where those who were stronger survived the ordeal.
EKAB is under the supervision of the Ministry of Health, has its headquarters in Athens, and was established by Decree 376/1988, and amended by Decree 348/1996. The purpose of EKAB according to article 29 of Law 4633/2019 is:
- The coordination of the provision of Emergency Assistance in emergency situations
- Emergency medical care to citizens
- Transfer of these citizens to health care facilities
- The coordination of hospital and pre-hospital care in emergency and crisis situations
- Monitoring and coordination of on-call duty systems in NHS hospitals
EKAB is deployed nationwide in 12 branches (Athens, Thessaloniki, Patras, Heraklion, Larissa, Kavala, Ioannina, Lamia, Alexandroupolis, Tripoli, Kozani, and Mytilene) and each branch is developed in Sectors in the various regions of the country.
Πίνακας 2
| Α/Α | ΠΑΡΑΡΤΗΜΑ | ΑΣΘΕΝΟΦΟΡΑ (B & C) | ΜΗΧΑΝΕΣ | ΛΟΙΠΑ ΟΧΗΜΑΤΑ |
| 1 | Κ.Υ. | 89 | 38 | 22 |
| 2 | ΘΕΣΣΑΛΟΝΙΚΗ | 85 | 8 | 17 |
| 3 | ΠΑΤΡΑ | 66 | 2 | 3 |
| 4 | ΗΡΑΚΛΕΙΟ | 52 | 3 | 7 |
| 5 | ΛΑΡΙΣΑ | 67 | 2 | 5 |
| 6 | ΚΑΒΑΛΑ | 27 | 2 | 0 |
| 7 | ΙΩΑΝΝΙΝΑ | 41 | 3 | 9 |
| 8 | ΛΑΜΙΑ | 53 | 0 | 1 |
| 9 | ΑΛΕΞΑΝΔΡΟΥΠΟΛΗ | 33 | 0 | 3 |
| 10 | ΤΡΙΠΟΛΗ | 51 | 0 | 1 |
| 11 | ΚΟΖΑΝΗ | 26 | 0 | 1 |
| 12 | ΜΥΤΙΛΗΝΗ | 83 | 1 | 0 |
| ΣΥΝΟΛΟ: | 673 | 59 | 69 | |
Athens was divided into three Sectors: The capital into two parts (with an imaginary axis from the University Campus in Zografou, the Centre, to Haidari), the northern part is Sector A and the southern part is Sector B. The third Sector, the Secondary Emergency Services, is now integrated with the Emergency Services.
All previous governments over the past few years have left the ambulance service collapsing from huge shortages, leading mathematically to the current situation. But even today’s conditions are not enough to “convince” the deep neoliberal mainstream politics to recruit by investing money in Public Health. On the contrary, the measures taken to deal with the situations are not only incapable of providing meaningful solutions but are deadly.
| Πίνακας 3 | ||
| ΜΟΝΙΜΟΙ | ΕΠΙΚΟΥΡΙΚΟΙ | |
| ΥΠΗΡΕΤΟΥΝΤΕΣ | 3.339 | 764 |
| ΔΕΣΜΕΥΜΕΝΕΣ | 294 | |
| ΚΕΝΕΣ | 461 | |
| ΣΥΝΟΛΟ ΘΕΣΕΩΝ | 4.094 |
In 2013, Adonis Georgiades took over the portfolio of the Ministry of Health for about one year (June 2013-September 2014) of the ND-PASOK coalition government (Antonis Samaras or Samaras-Venizelos government). The decision was then made for ambulances and hospital drivers to be absorbed by it, with the argument of strengthening EKAB with resources and personnel. In reality, this created more problems than it was supposed to solve.
Firstly, because secondary transports now had to be carried out by EKAB itself, by burdening its vehicles with extra mileage and employing qualified personnel (the two-man crew of the ambulances of EKAB are both professional drivers and trained rescuers after two years of training at the EKAB’s IEK and certified by the State) for cases for which this is not necessary, depriving it of the emergencies for which it is necessary.
Secondly, the ambulances of the hospitals that were granted were at least unevenly equipped – if not unequipped – compared to those of EKAB.
(The Transporters – rear-engine and air-cooled – equipped with Stretcher, Transport Chair, Oxygen, Nasal Goggles and… Cellulose wadding).
Third, because the staff added with this change, as untrained for their new role, created more problems for EKAB than it was supposed to solve, bringing down its average staffing up to that point. People of advanced age didn’t even know what a defibrillator was, let alone operate one.
So, they had to go through only some 2–3-week seminars, and those of them who wanted to learn, learned from the rescuers-trainers along the way. Since then, they have been acting on par with the rest of their colleagues. The rest, although they all came out “competent” at an absolute 100% rate from these seminars, didn’t pursue being on the “front line”. There were – and always will be – the cases of older people, close to retirement, who do not – as is natural – have the physical strength required to lift a stretcher with a patient on it.
Nevertheless, the recruitment of drivers in hospitals has not stopped after this transition. Some recruitment of drivers – usually “cronyistic” – continued in order to serve as such in the service cars of the respective hospital administrations.
It was perhaps “the first act of the drama”, in order to open the “window”, which, reaching today, ends up in the “two-speed” EKAB and its partial privatization, through the enduring devaluation.
It is disparaged in order to allocate the field of Secondary Transports to private individuals, which does not have technical requirements and offers an opportunity for substantial profits. As was the case with private hospitals and clinics during the coronavirus pandemic. Even if you had private insurance, you ended up in a public hospital. In about 35,000 cases, literally… Even so, there are parts of the country, such as the small islands, e.g., the Cyclades and the Dodecanese, where even if a Greek or tourist has private insurance coverage, there are no other ambulances (private) apart from EKAB to serve them.
The change in EKAB (Emergency Medical Services) through the privatization of secondary healthcare services, just like the entire National Health System, was something the governors wanted to implement much earlier. However, the COVID-19 pandemic came and delayed their plans. Today, many public hospitals have already entered into contracts with private individuals for the discharges, which has the consequence of putting a strain on the insurance funds, the state budget, and the budgets of the hospitals.
Devaluation through shortcomings
The shortage of ambulances is dramatic, since in Attica only 65-70 ambulances are operational every day. The result is that there are no spare ambulances in case of breakdowns. Many of them are 20 years old, since the last purchase of ambulances was in the distant 2003, due to the Athens Olympics. In February 2023, a contract was signed for the supply of 52 ambulances through RAL, but they have yet to be delivered. A large number of ambulances have been stranded for many months with breakdowns, with many of them having traveled a large number of kilometers. The main cause of low availability, however, is the long delays in private car workshops, which can exceed seven months. It should be noted that the EKAΒ of Attica has a workshop at its Central Service, which until 2017 took care exclusively of the repair and maintenance of ambulances, responding promptly and adequately to the needs of EKAΒ. However, the chronological understaffing of the -mainly in mechanics- has resulted in its inability to cope.
Regarding staff, from 1/1/2016 to date, the departures/retirements of permanent employees in the field of ambulance crews amount to 600, while recruitments from 2017 to date amount to 750, of which only 50 permanent staff and 700 auxiliary staff.
Of the 700, about 240 auxiliary rescuers are working in Attica, and most of them have contracts expiring on 12/31/23. A large number of auxiliary staff members of the paramedic crews were recruited with auxiliary qualifications in several cases without even having completed the theoretical training. 2.5 years ago there was a commitment to advertise 270 ambulance crew posts. To date, it has not been done. The last major recruitment that took place was in 2016. Massive recruitment of rescuers and all necessary personnel of all necessary specialties is required. Finally, there is a need to upgrade the level of the rescuer by creating a tertiary education specialty, as is the case with nurses, in order to create a scientific background in the specialty.
Facts and Figures
The strength of ambulances for the Emergency (simple and Mobile Medical Units) in Attica was 55 morning-afternoon and 35 at night for the three-year period 2019-2021, while in 2022-2023 (first half of the year) 50 ambulances morning-afternoon and 30-35 at night. In September 2023 the force went up to 60 morning-afternoon and 35 at night.
For Attica, at least 100 emergency ambulances are needed in the morning-afternoon and 50 at night, based on the population, but also because of the non-existent Primary Care, as well as the limited number of hospitals on duty, due to the many shortages in medical specialties, especially in the province.
In addition, the number of EKAB motorcycles in the same month was more than 10, and up to mid-summer 2023, they did not exceed 6 morning-afternoon. However, no matter how much their number increases, if there are no ambulances to transport patients to hospitals, they do not contribute substantially to the outcome of the patient’s course.
Response times
In Attica in 2021 we had dramatic delays. According to the EKAB data at that time, the average waiting time for an ambulance was:
- For an emergency 1 hour and 15 minutes
- For cardiac arrest 24 minutes (while resuscitation should start in the next few minutes)
- In an urgent traffic accident, it took 24 minutes (while rescue operations should commence within the immediate minutes)
- In cardiac emergency 54 minutes
It is worth noting here that for less serious incidents the waiting time can last… hours
The situation is similar for the previous years 2019 and 2020, to reach the peak of this summer with fatalities.
An intense job…
In emergency cases (car accidents, cardiac arrests), rescuers have to act quickly, they have to have the physical strength required, not only for the transport of the patient on the stretcher, but also for everything that has to be done in the ambulance compartment during the transfer to the hospital. The application of CPR, for example, is an arduous procedure that quite often requires several repetitions and a long time. That is why in many countries in Europe and the developed world, crews are three-man crews. So in the ambulance compartment, there are always two rescuers – if not a rescuer and a doctor – who alternate the tasks required at any given time. Or when the mileage is long. This is ensured in Greece, in the event of a major emergency, by both rescuers being crew members and drivers, so that they can take turns. A condition that becomes even more problematic when, since the summer of this year, an ambulance of the EKAB on an Aegean Island can operate with only one driver as crew and that driver must be a soldier or fireman.
With the human and his rescue as the object, as one of the first rescuers and later instructor confides, “the volume of work in Athens is not comparable to that in the provinces. So, to have a heart attack, or an autoimmune disease – whatever anyone can do – to get off the front line and into an office is a tactic that is practiced. Particularly in those cases where one is not prepared from the outset to study hard.” He continues: “It all starts with whether or not someone is adequate in the job they are doing. The prerequisite is a love for the subject of the work so that by learning it, one can do it properly and with zest. And if there is a need, to make an extra living at a second job. But not the opposite… Like a colleague who I happened to find working in a building materials yard and in an imperative way forbade me to talk about the emergency services so that if something ever happened where he worked, they would not ask for his help as an expert…”
“Any progression in the hierarchy requires registration and activity in trade union factions. This even affects the employee’s unhindered work (in a good car and in a good Sector), or even taking the days off that are due to him. It is also found in this Public Service that many workers feel that they have to bring it up to their standards, while for some of them, either out of necessity or because they can, it is just their steady second job. The first is somewhere else: Taxi, kiosk, construction, tourist business (rentals).”
Another serious problem, as in the entire Public Sector, is the constant movement of the staff of the ambulance service within the country. Because it is normal for someone who has been appointed far away from his place of residence to do whatever he can to return to it. A matter that should be dealt with centrally, so that the real shortages in each place can be seen, and to eliminate practices of bargaining to ensure that the person concerned is transferred. This does not take into account the fact that during the summer months, ambulance rescuers from the mainland of Greece – except Attica – mainly support the islands where, due to tourism, the needs increase dramatically.
…and difficult requirements
“After 40 years since its establishment, EKAB is being modernized and adapted to the needs of citizens and the demands of the new era,” Health Minister Michael Chrysochoidis said during his intervention at the Council of Ministers (1/9). He stressed at the time that with the planned changes Greece will close the gap in the operation of EKAB compared to the international average.
The ratio of coverage of the entire country by ambulances is currently 1 per 36,000 citizens, while the European average is 1 per 27,000. The new political leadership of the Ministry of Health announced that this will reach 1 ambulance per 20,000 citizens.
According to European protocols, the transfer of a multi-injured person after a car accident requires the crew of rescuers who will pick him up from the scene, after taking him to the hospital, to remain there until the multi-injured person has undergone an imaging examination, the injuries are determined and only then, he is allowed to be transferred from the ambulance immobilization board to another means of the hospital. This is to prevent the injuries from multiplying. Such a procedure, however, requires time and therefore personnel, i.e. funds. When hospitals today lack even paramedics, resulting in queues forming on call because patients cannot be transferred to the various departments in time and this task is often taken over by their guardians, how can we talk about more ambulances and rescuers’ crews?
As an experienced rescuer working in a large provincial town explains, “The value in the ambulance transport of an incident is not in the driving position and the acceleration, but in what happens back in the chamber and to the patient.”
For this reason, it is very sad that the ambulances of ΕΚΑΒ are overwhelmingly used as taxis. This is because people, who are aware of the long waiting time in the emergency rooms of hospitals on duty, choose to call ΕΚΑΒ to pick them up so that when they arrive at the hospital, they do not have to wait because of the priority of those who go by ambulance. As a result, someone who has gone to the ER alone – because he has chest pain – sees the person with the abdominal pain go through first because he arrived by ambulance.
But there are also cases of people who literally use ambulances of ΕΚΑΒ instead of taxis. They call the Centre with a report of a heart problem and when they arrive at the hospital, they claim that their back hurts!
EKAB Centre on the other hand cannot “cut off” any incident. Because once in a while, if leg pain invoked by someone calling in develops into a heart attack, for example, there will be legal implications if they underestimate it and don’t respond. It can only prioritize the incidents it is called upon to manage at the time, responding more immediately to some of them so that the rest can follow. But it cannot refuse to send an ambulance. Which for a portion of rescuers should be done. In the past, in areas where resources and staff were scarce (and to which we have unfortunately returned), local centers could refuse to send an ambulance in those cases where they could take a taxi to the hospitals. Such as, for example, in cases where someone had broken their arm without the bone coming out of the skin.
This situation results in rescuers and vehicles being employed in cases for which they are not needed (from simple pains to hysteria and other psychiatric incidents) and missing or delayed for this reason, from incidents where they are needed. Additionally, the vehicles accumulate mileage, with all the implications this has for their availability and utilization.
A “two-speed” but not private EKAB
In order to overcome its current crisis – apart from the necessary recruitment – EKAB should be structured in such a way that its main section serves the Emergency Department and a second one the Discharges. In other words, a “two-speed” EKAB will be able to handle both categories of cases without any charge to those served by it or the insurance funds. In other words, the opposite of a permanently understaffed EKAB, with a shortage of means and equipment, which, in order to exist, relies on private donations for their renewal and replacement.
Today, there are very few ambulances in Athens in order to meet the needs of secondary transport, this task is practically given to private companies. Mr. Georgiades, who as Minister of Health had imposed the payment of 5 euros by those who visited the public-hospital outpatient care and 25 euros for admission to them, could, in order to share the costs, charge a sum of 10 euros, for example to those who are discharged from public hospitals in order to go home or wherever else they want, without having to wait for hours for an ambulance to be available to pick them up or to pay for a private ambulance out of their own pockets so as not to be inconvenienced by the long wait. Nowadays, more and more hospitals in the country are contracting with private ambulance companies in order to serve their secondary transport needs. As a result, of course, these charges are borne by the Insurance Funds. Charges that are not only small. If a private person approaches these companies in order to be served, he will find that their price list of charges for the services offered, “hides many devils in its details”… The charge from the private persons starts depending on the mileage, continues with the kilograms of the customer, the floor of his house (another charge on the ground floor, another on the 3rd floor), whether there is an elevator or not (and the dimensions required).
The silence of the EKAB management
In their attempt to understand who and what is to blame for the level of services offered by EKAB to the community it was created to serve – as was natural in the context of a journalistic investigation – Data Journalists addressed first by phone and then by e-mail to the management, in order to get the information, they needed. Since this could not be found on the official website of the Organization. We never received a response to anything we asked for. To our repeated telephone pestering over a period of about a month, the answers from the Administration Secretariat were more or less the same. That is, after we first requested the information we wanted, it was sent from the relevant departments of EKAB to them, and then they collected it from them so that finally, it would be compiled and approved by the Commander, to be handed over to us. To our question “When will this happen?” we never received an answer. Only that “we will call you” when this has not happened once in all this time.
Towards the end of last month, we visited the Central Office as a last attempt to find a solution. Leaving the personal details at the entrance and taking the visitor’s badge, we went up to the 2nd floor. In-person, however, the answer remained the same, again accompanied by “nothing else could be done”. On leaving, we visited the workshop hosted right next door in order to take some photos for the needs of the reportage. On the way out, however, we were informed that permission from the management was needed for this. Permission that we had made sure to ask for in the e-mail we had sent on 4/9, without ever receiving a reply. To our argument that we needed some photos for the recording, we were asked to delete them! Abuse of journalistic work to the utmost degree and without any justification whatsoever. By simply putting forward the premise that “these are our orders as a Secretariat” and sealing this argument with a statement of “incompetence” as a last line of defense. All we received (exactly one month after sending the e-mail, on 4/10) are the three Tables we published with the numbers of means, personnel, and ambulances coming from donations.
We are still waiting for the answers from EKAB to all the requests we have made. Especially now that the Press Office has been staffed with two members.
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