The death of a man in the mountains has once again put on the agenda the question of why the air ambulance system in Bulgaria is not working effectively almost two years after its launch. The case has opened a number of questions - why medical helicopters are rarely used in road accidents, why primary rescue missions are few and why the project to build the system remains stalled.
In theory, air ambulances should reach the scene of an accident and quickly transport victims to a medical facility. In practice, however, the system mainly performs rescue operations in the mountains or transports patients between hospitals, as is clear from a NOVA report. The statistics show a serious difference with other European countries. In nearly two years, about 200 missions have been carried out in Bulgaria, while in just one year in Austria they have been over 21,000.
One of the main problems is the small number of so-called primary missions - cases in which the helicopter is sent directly to the scene of the incident to transport a victim to hospital. Another serious problem is the construction of helicopter bases. Currently, only bases in Sofia and Sliven are operating, although the initial plan envisaged six.
The air medical assistance system declined to comment.
According to Dimitar Dimitrov from the Bulgarian Avalanche Association, the problem is the lack of a well-established system. “The air emergency assistance system was a long-standing battle. For a long time, the state opposed it because of funding. When we received European support, it was created, but most importantly - the system itself - is missing“, he commented.
According to him, the country currently has several helicopters, but in reality it has “one and a half bases“, which makes effective work almost impossible. Dimitrov also points out that over the past two years, primary missions have been carried out mainly at the request of the Mountain Rescue Service, which he believes is a result of the way the system was introduced.
According to Dr. Blagomir Zdravkov, a member of the expert council on aviation medicine, the most serious question remains why the main function of the system – rapid response within the so-called “golden hour” – is still not being performed. “Two years after the launch of the air ambulance, there are still no real primary missions on the necessary scale, and this should be its main task“, he pointed out.
Minister of Health Assoc. Prof. Mihail Okoliyski stated that Bulgaria has a relatively even distribution of medical facilities, which in many cases makes air transportation unnecessary. “It is not necessary to activate the medical helicopter every time, because the patient can be transported by ambulance to a hospital“, he explained.
According to him, the system is new and is still being developed. Greater experience of the teams and pilots is also needed in order to avoid risks for patients.
Regarding the tragic incident in the Malyovitsa region, the minister pointed out that the helicopter took off about 45 minutes after the signal was sent. The reason for the delay was the need to specify the coordinates and take into account the difficult terrain. According to the available medical information, the victim's condition was so serious that even a faster arrival of the helicopter would probably not have changed the outcome.
There are currently four medical helicopters in Bulgaria, with a fifth recently arriving. The minister pointed out that when the caretaker cabinet took office, unfulfilled commitments were identified for the construction of bases for them. At present, none of the planned investments has been fully completed, and the country faces the risk of losing funds under the Recovery and Resilience Plan.
According to Dr. Blagomir Zdravkov, however, only two helicopters are actually operating, and some of them have technical limitations - for example, they cannot transport children under five kilograms.