We started at seven in the morning and attended three cases in a row. By noon, we had already covered 200 kilometres because there was so much to do. During lunch, we got the call that we had to go to Budapest, which is 250 kilometres away. We drove up, worked there as well, then drove back 250 kilometres to our original station, arriving at quarter past four in the morning.

This depiction of a typical schedule for such a day was shared by a paramedic working in the West Transdanubian region. The paramedic requested anonymity, not even sharing his original station, due to fear of losing their job. Fortunately, as they told our paper, they were not dispatched to any more cases after returning to their station, although they could have been since their shift officially lasted until 7 a.m. – that day, they still covered nearly 800 kilometres already.

This story is not at all unique, as The National Ambulance Service orders several ambulance units from each region to Pest County and Budapest on a daily basis. There are so many cases in the capital and its suburbs that, without the help of rural units, the Budapest paramedics would not be able to manage the workload.

Another paramedic from the West Transdanubian region, whose unit has been summoned to Budapest seven times in the past one and a half months, reported that whenever they are summoned to the capital, they typically handle between 6 and 10 cases there. Such a deployment, including the 2.5–3 hours of travel, takes approximately 12–13 hours.

It’s insane

– summarised the paramedic with some indignation.

Pál Győrfi, the spokesperson for the National Ambulance Service (OMSZ), told our newspaper that 24 rural ambulance units will support Budapest’s emergency services every day. In its statement, the OMSZ did not hide the fact that the number of ambulance tasks in the capital has significantly increased in recent times, also mentioning that units from other counties are also dispatched to cases in the capital without jeopardising local emergency services, utilising surplus capacity in an organised and planned manner. We previously reported that the new on-call system, introduced in October, also relied on the help of rural ambulance staff in Budapest.

The paramedics who spoke to our newspaper anonymously emphasised that their issue is not with the planned monthly 1–2 summons but with the fact that at this point, they must practically always be ready for the call ordering them to the capital during any given 24-hour shift. “Of course you accept this, but only because you have no other choice. The leaders of the ambulance service think that you can keep whipping the horse as long as it pulls” – one of them said.

“I go to work at seven in the morning, and I have no idea what to expect.”

The healthcare service relationship law, adopted in 2020, applies not only to doctors and healthcare professionals working in public healthcare but also to ambulance workers. This service relationship replaced the public employee status in healthcare, and one of its elements is that healthcare workers can now be deployed to wherever there is a shortage of staff due to service deficiencies. For the National Ambulance Service, this means that ambulances from every region must be summoned daily to support the capital and its surrounding areas to keep up with the workload.

Several paramedics working at one of the West Transdanubian stations shared their experiences with our newspaper. All of them said they love their job — some have been doing it for decades — and while the work has always been demanding, the current deployments have made it unbearably stressful.

I go to work at seven in the morning, and I have no idea what to expect, because it might turn out that, in addition to the cases in our area, we suddenly get the order to head to Budapest

– one of them told us. The ambulance driver earns 400,000 forints at OMSZ while they also work part-time for a private ambulance service, earning between 200,000 and 300,000 HUF in a good month.

Additionally, their station is responsible for several villages surrounding the city, and they also have to head over to nearby larger towns. They have two ambulance units at the station, but if one is summoned to Budapest and the other is attending a case in the area, there are no ambulances left, and units have to be redirected from tens of kilometres away. In such situations, it is impossible for an ambulance to arrive within 20 minutes from 30–40 kilometres away – one of them explained. Of the two ambulances stationed there, one operates during the day from 7 a.m. to 7 p.m., while the other is a 24-hour unit, responding to calls from 7 a.m. to 7 a.m. the next day. It is this 24-hour ambulance that is either scheduled or unexpectedly summoned to Budapest.

The phone rings, saying an ambulance is needed in the capital. There’s no choice, we get in the car, and head to Budapest. It’s a 500-kilometre round trip.

The paramedics speaking to our newspaper said that patients are also often surprised when they learn where the ambulance has come from and how far it still needs to return.

There was a time they were released from Budapest at midnight and returned to their station by 4 a.m. This is especially problematic because the ambulance runs empty during the return journey.

Our source also revealed that decades ago, rural stations were strategically established to cover smaller settlements within their district, as ambulances from larger cities could not reach these areas in time. This well-functioning system has been disrupted by the regular need for rural units to assist with Budapest’s emergency services. When a station’s ambulances are unavailable — one being on a call and the other in the capital – it becomes impossible to reach a case within 20 minutes, even though this is the standard expectation. This is particularly critical in situations where every minute counts, such as with heart attack or stroke patients.

“Missing units are not replaced, and the Budapest dispatch centre doesn’t care that these deployments result in capacity shortages elsewhere” – our source said.

Physical and Mental Stress

Deployments to Budapest are particularly stressful for rural paramedics because they are not as familiar with the capital’s routes as their Budapest-based colleagues. Although they have GPS, it is not very useful when driving an ambulance with sirens blaring, as they could take shortcuts that the GPS cannot calculate. Those who spoke to our newspaper are convinced that their Budapest-based counterparts can reach certain cases faster due to their greater local knowledge.

It is mainly the drivers on whom these 24-hour shifts with summons to Budapest take the greatest toll, both physically and mentally. One of them shared with 24.hu that there have been times when they had to stop on the way home because they were so exhausted.

You can make no mistakes, not even on your twentieth hour

– they told our paper.

When asked how things were in the past at the ambulance service, one paramedic who has worked in the field for decades explained that they had always had plenty on their hands, but the work was not as stressful or unpredictable as it is now. Previously, they were also responsible for patient transport (most of these tasks are no longer carried out by the ambulance service’s vehicles today), and while they were sometimes redeployed, it was within their county rather than to Budapest. These additional tasks were considered extra work and came with a daily allowance. Nowadays, however, there is no compensation for being sent to Budapest. “It’s just part of my standard working hours now to travel 500 kilometres in an ambulance” – they complained.

In the past, they only had to go to Budapest when they were transferring a patient from their region to the capital for hospital treatment that could only be provided there. In such cases, their only task was the transfer; they didn’t have to remain in Budapest and assist with other emergency cases.

Paramedics interviewed by our newspaper described prolonged patient handovers as a typical problem in Budapest.

One of them noted that Honvéd Hospital is the worst in this regard, with as many as 8–10 ambulances arriving with patients at the same time, creating significant delays. The situation is often not much better at Szent János Hospital.

In addition to the stress caused by redeployments, all paramedics we spoke to mentioned that unnecessary calls are also a major problem. They are frequently dispatched to cases that don’t require an ambulance because the dispatch centre is unwilling to take responsibility and sends a vehicle anyway. There have been instances where they arrived at the address only to find the patient had changed their mind and no longer wanted an ambulance or didn’t even open the door. One paramedic believes that people have been overly conditioned to call an ambulance for any issue. Often, even general practitioners in out-of-hours services unnecessarily instruct patients to do so, resulting in calls for cases like catheterisation, menstrual cramps, or cleaning catheter bags.

Number of cases up from 1000 a day to 1200 -1300

Győrfi Pál, spokesperson for the OMSZ, told our newspaper that the daily deployment of 24 rural ambulance units to Budapest is “a planned redistribution, amounting to an average of two occurrences per unit annually.” He also pointed out that the reinforcement of the capital’s ambulance capacity is necessary due to the significant increase in the number of cases in Budapest over the past few years.

Previously, the OMSZ managed to supplement the capital’s ambulance services with dynamic reallocations based on the daily situation. Now, planned reallocations are scheduled monthly in a rotating system. Additionally, in extraordinary situations such as mass accidents, ad hoc redistributions may also be required. These are carried out under strict protocols, with the head medical officer in charge of national ambulance coordination deciding how many units need to be redirected in such cases.

A few years ago, the daily number of cases in Budapest was below one thousand; now it has swelled to 1,200–1,300, stated the spokesperson, explaining the reason for deploying additional units. Another reason he mentioned is the fragmented structure of the capital’s hospital system. The institutions operate across multiple locations, which creates an increased demand for patient transport, because

if a patient is taken to one hospital and it turns out they need to be transferred elsewhere for an examination or treatment, the transport often falls under the responsibility of the National Ambulance Service.

Although ambulance services and patient transport were separated in 2008, with the latter being handled by private service providers contracted by the National Health Insurance Fund (NEAK), thereby easing the burden on OMSZ, supervised patient transport and ambulance transfers are still managed by the National Ambulance Service. For example, patients requiring oxygen during transport become the responsibility of the OMSZ, as do the cases where a patient suffers a stroke in a chronic internal medicine ward. There is no separate capacity within the ambulance service for these tasks; the same ambulance units that respond to accidents also transport patients from one hospital to another.

According to Pál Győrfi, demographic changes also contribute to the increased case numbers in Budapest: the city’s vitality is growing, and it has also become a popular tourist destination, which in turn brings more emergency response tasks.

Since the number of cases is unlikely to decrease in the foreseeable future, Győrfi considers it fortunate that a unified ambulance service operates in Hungary. One of its advantages is that resources can be flexibly relocated: “If a mass accident were to occur, say, in Lajosmizse or Balassagyarmat, and the local ambulance resources were insufficient to handle the situation, we could swiftly reallocate emergency response units from both nearby and distant locations.”

Regarding the issue of many unnecessary ambulance calls, Győrfi stated that efforts are being made to bring about change. Emergency dispatchers make decisions based on international questioning protocols to determine whether an ambulance is needed or not. The guiding principle is that “it is better to go out unnecessarily than to fail to help someone in genuine need because, for us, the patient’s welfare and human life come first” – he added.

The post “The phone rings, saying an ambulance is needed in the capital. There’s no choice, we get in the car, and head to Budapest. It’s a 500-kilometre round trip.” first appeared on 24.hu.

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