Iva Pehlivanska to FACT: In some areas, emergency care exists "on paper

What is the challenge of being a paramedic, working in Emergency Care, helping… Iva Pehlivanska, President of the Union of Paramedics in Bulgaria, speaks to FACT.

- Ms. Pehlivanska, in the Union of Paramedics you already have clear data from your analysis of what is happening with emergency care in different settlements of the country. You are talking about a critical situation because…
- The critical situation is due to years of accumulated structural, personnel and organizational problems. The data show us that in a number of regions there are not enough teams, ambulances are outdated, and the staff deficit has reached dangerous levels. In reality, in some areas, emergency care exists “on paper“, and in practice it cannot respond adequately if necessary.

– There is a shortage of over 340 doctors in ambulances, and the situation is critical in Sofia, by the sea and in Silistra. What is not being done properly in these places?
- The problem is not only in the lack of doctors – it is in the lack of sustainable solutions. In Sofia, the workload is enormous, the pay does not correspond to the risk and responsibility, and the administrative pressure repels specialists. Along the sea, the problem deepens seasonally – with the influx of tourists, without flexible support mechanisms. In Silistra, as in other border regions, there is a lack of enough young staff, and the centers cannot offer conditions that will retain them.

– According to your analysis, there are days when entire regional cities are left without a single medical team. How does this happen, why and which cities are they? What explanation do you give?
- Yes, we have cases in which for example, Vidin, Razgrad, or Kardzhali are left without a single doctor on duty in the ambulances. This happens because the schedules cannot be covered - no one wants to work, people are overloaded, there are frequent sick leaves, and there are no substitutes - no. This breakdown in teamwork really threatens the lives and health of citizens.

– And the salaries of doctors in the emergency teams have increased, right? And there are still no people, because...
- Yes, there are increases, but they are not sufficient in relation to the workload, conditions and risk. The salary, in itself, is not a sufficient motivator. When you work a 12-hour shift in stress, with a risk of aggression, with worn-out equipment and in a small team, even the higher salary does not compensate for the enormous workload and lack of career development in the system.

– Under what conditions do they work emergency teams…
- They work in difficult and often unsafe conditions – sometimes in areas with increased aggression, with insufficient equipment, with ambulances in poor technical condition. There is no psychological support, there is not enough training, there is no effective protection from the institutions when our colleagues are attacked or insulted.

– There is a written standard for the response and arrival of a team – 8-10 minutes in the city and 20 minutes in the villages. Does this correspond to reality, or is it a joke…
- In practice, in most cases these deadlines cannot be met. In large cities – because of traffic and the insufficient number of teams. In villages – because of the remoteness and lack of points. The standard is a good idea, but without resource provision it remains desirable.

– The sector needs reforms, but this is only talked about. Why is nothing being done…
- Because there is a lack of political will and long-term vision. The problems of emergency care are not a priority on the agenda of the institutions – until the next tragedy, when everyone starts looking for the guilty. There is no consistent policy, and the solutions are temporary, often piecemeal and without consultation with the specialists in the field.

– You say that the system rejects doctors on civil contracts. What is the reason?
- There are administrative and bureaucratic obstacles. In some centers, the management does not want to work with external specialists, in other cases absurd conditions are imposed on young doctors. Instead of using the flexibility of civil contracts for temporary support – we reject them.

– From the Union of Paramedics, you are demanding legislative reform, but is there anyone who will listen to you. This is not the first time you have made proposals?
- For Unfortunately, the dialogue with the institutions has been inconsistent so far. We have specific proposals for regulatory changes - from defining the role of the paramedic to creating a system for protecting the teams. We send statements, we speak publicly, but responsibility is blurred between different units. We do not stop insisting - because the system will not fix itself.