Paramedics and firefighters together in the car… Iva Pehlivanska to FAKTI

What is the challenge of being a paramedic, but traveling with the fire department to help… Iva Pehlivanska, President of the Union of Paramedics in Bulgaria, speaks to FAKTI.

- Ms. Pehlivanska, paramedics and firefighters already work together in one team. How did you come to this decision?
- The idea is not new, but for a long time we lacked regulatory and organizational readiness. Analyses of serious incidents in recent years have clearly shown that the first minutes are crucial. Firefighters are often the first to arrive on site, and the presence of a paramedic in the same team allows for immediate medical assistance even before the arrival of an Emergency Medical Service team. This is a logical step towards faster and more effective response.

- What will be the role of the paramedic, given that there will certainly be an Ambulance team on site?
- The role of the paramedic is precisely at the first critical moment. He provides primary medical assessment, stabilizes the injured, performs life-saving manipulations and prepares the patient for transfer to the Emergency Care teams. The paramedic does not replace doctors, but complements them, reducing the time to the first medical intervention.

- The appointed rescue paramedics will be a key unit in the specialized ambulances of the fire department for rapid response to serious incidents. What are these ambulances?
- These are specialized emergency response vehicles designed for road accidents, mass incidents, fires and disasters, which must reach the scene of the incident quickly, including in hard-to-reach areas, and allow for rescue and medical actions to be carried out simultaneously.

- What are these ambulances equipped with?
- In terms of their equipment and functionality, these ambulances comply with the European standard EN 1789 for a type B ambulance. Which means that it is equipped with a defibrillator, an ECG, pulse and saturation monitor, an oxygen system with bottles, masks and nasal cannulas, a suction system to maintain airway patency, an ambu bag and basic airway devices (oropharyngeal and nasopharyngeal cannulas). On board there is equipment for immobilization and transport - a stretcher, a spine board, cervical collars, vacuum or standard splints, as well as kits for controlling bleeding and trauma (bandages, tourniquets). Infusion systems and basic emergency medications, basic diagnostic tools (blood pressure monitor, glucometer, thermometer), as well as communication and signaling systems for operation in all conditions are provided. This equipment allows for rapid intervention and stabilization.

- The place of paramedics in the structure of Fire Safety and Population Protection is the practice in many countries around the world. Why is it happening in our country only now?
- The problem with the introduction of paramedics into the system does not stem from a lack of qualified personnel, but rather from the absence of a consistent and clearly formulated state policy for the integration of this flexible and interdisciplinary profession into the national system for responding to emergencies, accidents and disasters. For years, the profession of “paramedic“ developed fragmentarily – with ambiguously defined functions, limited powers and unclear institutional positioning between the healthcare system and the population protection services. This led to regulatory gaps that prevented its full implementation, as well as to administrative and organizational restrictions in its integration into the structures of Fire Safety and Population Protection.
There was a lack of a unified regulatory framework that would clearly define the competencies of paramedics, link them to specific operational functions, and regulate a sustainable model of interaction with the emergency medical care system and other first response services. Only in recent years has a clearer understanding of the need for such integration been formed, based on international experience and modern concepts of complex risk management, in which early medical intervention on the spot is a key factor in reducing mortality and severe injuries.

- Will paramedics be on staff in the Fire Department or in another unit?
- Paramedics will be appointed as permanent staff in the structures of “Fire Safety and Population Protection“, as part of the Ministry of Interior system. This institutional positioning provides a clearly defined place in the organizational hierarchy, specifically regulated functions and responsibilities, as well as opportunities for professional and career development within the system. Their inclusion as permanent staff creates conditions for the sustainability of the model, better coordination with other initial response units and more effective use of paramedical capacity in incidents, accidents and disasters.

- What qualifications should paramedics have?
- To hold the position, completed specialized training for a paramedic, in accordance with national and European educational and professional standards, is required. The training includes theoretical and practical modules on emergency medical care, primary assessment and stabilization of patients with life-threatening conditions, traumatology, actions in case of mass incidents, accidents and disasters, as well as work in conditions of increased risk.
After passing the selection and approval procedure, paramedics undergo an additional six-month specialized training in the structures of “Fire Safety and Population Protection“. This training is aimed at acquiring specific skills for working in joint teams with firefighters and rescuers, tactics in case of road accidents, fires and disasters, safety at the scene of the incident and interaction within the operational procedures of “Fire Safety and Population Protection“. Practical training is of paramount importance, since the activities of paramedics are carried out in a dynamic and often extreme environment. Periodic upgrading training and certifications are also planned to ensure maintenance and updating of knowledge and skills in accordance with the development of medical standards and operational practices.

- What rights do they receive as part of the structure of the Ministry of Interior?
- As employees of the Ministry of Interior, paramedics acquire the status of civil servants and, accordingly, all the rights and obligations arising from this. They benefit from social and health insurance under the conditions provided for employees in the system, with a special work regime, consistent with the specifics of the duties and operational activities, as well as with legal and institutional protection in the performance of their official duties.