site.btaRomania's Emergency Care System Founder Dr. Arafat: Bulgaria Should Adapt Our Model, Not Copy-Paste It

Romania will share experience with Bulgaria as it is trying to improve its emergency care system, Dr. Raed Arafat, the head and founder of the Romanian Department of Emergency Situations, said in a BTA interview. A cooperation plan is to be drawn up between the two countries regarding the work of the firefighters, paramedics and rescue aviation.

Born in Damascus, Syria in 1989, he graduated Iuliu Hatieganu University of Medicine and Pharmacy in Cluj-Napoca, the oldest medical education institution in Transylvania. Two years later Arafat built the foundations of the Emergency Care System in Targu Mures. Initially, the unit known as the Mobile Emergency and Resuscitation Service (SMUR), operated on a voluntary basis and had a single vehicle. It was driven by students from the Faculty of Medicine, doctors and Red Cross volunteers in the city. The system was based on the principle of a medical team helping on the spot rather than transporting the patient to hospital.

A year later SMUR received its first ambulance, a donation from Germany, and gradually established contacts with like organizations in the UK, Norway, Germany, the Netherlands and the USA who helped with instructions, training and equipment. Other Romanian districts began to implement the same model. Only then did Romania's Ministry of Health declare SMUR a national operational centre.

In 1993 SMUR turned into SMURD – the added letter comes from the Romanian "descarcerare" meaning extraction of victims from cars smashed beyond recognition in crashes. SMURD has three staff categories: medical (from the intensive care hospitals), firefighters and pilots from special departments of the Interior Ministry. The teams receive alerts via the single emergency number 112.

The Romanian emergency system serves the entire population, including citizens without health insurance. The medical team travels to the patient and helps them on the spot. In Bucharest, they respond within eighth minutes of the call.

The SMURD is funded by the state budget through the Ministries of the Interior and of Health, but also receives private donations. One of its planes was bought with donations.

In 2023, Romania operates 8 air ambulances, including two planes and six Black Hawk helicopters.

"Our concept is to cover the whole country - a helicopter to be able arrive on site in a maximum of 20 minutes," Dr. Arafat said.

Here is what else the head of the Romanian Department of Emergency Situations told BTA:

Q: Mr. Arafat, you recently received in Bucharest a Bulgarian delegation led by senior commissioner Alexander Dzhartov, the head of the Fire Safety and Civil Protection Directorate. What was the purpose of the visit? 

A: Exchange of experience. We mainly commented on how we will cooperate in the next period. The Bulgarian delegation showed great interest in the alert system. We also commented on the possibilities for cooperation on the firefighters' side. We showed the equipment we use. We also visited the aviation inspectorate, where we explained how the air rescue unit operates. In Romania, it works in close coordination with the Ministry of the Interior and the health institutions in the counties where the helicopters are.

Q: How did Romania resolve the situation with the medical helicopters? I'm asking you this because Bulgaria is the only EU member state that does not yet have air ambulances.

A: The helicopter pilots, the helicopters themselves, the fuel, the maintenance, all the technical aspects are paid for out of the Interior Ministry budget. The guiding principle of our concept of air rescue is that it should be affordable for all. It should be a public service that fulfils a mission of the state. We do not perform a commercial service, we do not exist on the basis of trust between commercial companies. Helicopters are dispatched by the dispatcher upon request, without further approval. It's all very simplistic. When we receive a 112 call, we assess whether there is a need for a helicopter or an ambulance team. The dispatcher sends the helicopter from the appropriate base. At the moment, we have ten functioning air bases in Romania. We are going to open the eleventh one this year.

The total number of flying hours we do per year is approximately 6,000. I am only talking about the emergency medical unit. But we also have other air rescue missions for which we use larger helicopters in case of emergency, flooding, forest fires. We have also managed, with European funds, to purchase two very modern, new Learjet 75 aircraft, which will arrive by the middle of the year. We have also purchased six emergency Sikorsky Black Hawk helicopters. They will be delivered at the end of the year. The machines will also be used in maritime search and rescue operations. There will be an airborne command post in the Constanta area, which will operate continuously. Two special maritime search-and-rescue vessels are also to be delivered for incidents at sea, so that we can intervene if there are stranded ships or problems with oil platforms, for example. We expect the ships by the end of this year. Each ship will have medical equipment and a place for patients if people need to be rescued from the water.

Q: What can we adopt from your experience to improve our system?

A: Each country can borrow from the experience of other countries, but must adapt it. Usually copy-paste does not work. Many systems are based on commercial services or a commercial model of operation. A model that we, in Romania, have avoided for many reasons. We can fly at much lower prices unlike most of our counterparts in Europe who use the same helicopters because we control the price. We have neither profit nor so-called depreciation. We work and pay the maintenance costs, the flying costs, the doctors' salaries, the pilots' compensations. But we pay much less per flight hour than other countries.

Q: You say it is not a good idea to copy-paste a system. But could the Romanian model be applied in Bulgaria? There was a similar idea in the past for Ukraine.

A: The copy-paste approach is not a good idea if the systems in the two countries are different. You just have to adapt. We borrowed working models from France, the United States, Germany and adapted them. In terms of pre-hospital care, for example, we are very close to the experience of the European countries. In the field of emergency care, we are following the model of the United States and Great Britain.

Q: How did you manage to integrate firefighters, police and ambulances into one system?

A: It was hard. Very hard. We have brought everything together. We have involved the firefighters from the beginning. Now SMURD is mainly made up of firefighters.

I started with a pilot project and we developed it little by little. Other areas started copying it, then I was invited to the Ministry of Health and the State Secretariat for Emergencies was established. I started to develop the system from the top down at the national level. Funds were set up for this. Important funds to acquire ambulances, equipment, helicopters - everything. We started using European funds, we used a lot of them. At the same time we were working on legislation. In 2006, we made legislation that would be comprehensive, that would establish how the emergency care system works in Romania, what are its methods of operation, its methods of financing. All this was established by a law that was passed by the politicians and voted on in Parliament. And then we started implementing the system. My opinion is that there are never perfect systems, but there are functioning systems.