Estonia to shift to mostly two

Estonia to shift to mostly two-person ambulance crews by 2028 Estonia's ambulance service is to be overhauled and a more streamlined structure will enter work from 2028, mostly using two-person crews and aimed at regional standardization. Two state bodies, the Health Board (Tervisamet) and the Health Insurance Fund (Tervisekassa) are developing the new model, which they said in a joint statement will position ambulance crews more closely in line with actual demand, and will bring emergency care closer to people. Regional disparities will be reduced, the authorities said. As well as mostly two-person crews staffing ambulances, there will be fewer ambulance teams working nights, under the 2028 new plan. "This is a more flexible deployment and operating model, allowing ambulance crews to be positioned closer to people and providing better coverage in areas where the current network does not ensure sufficiently even access," the Health Insurance Fund and the Health Board said in a joint statement. For more serious cases, resuscitation units are planned to support ambulance crews, while physician support teams will be added in every region. The two authorities said that adding physician support teams to regional Estonia will help standardize service quality and improve the handling of more complex cases throughout Estonia. "Medical expertise will no longer be concentrated solely in the larger centers, but will become more flexibly available across the regions. In addition, development of telemedicine support and the e-ambulance system for ambulance crews will continue, helping ensure the provision of a uniform ambulance service throughout Estonia," the statement went on. Specialized capabilities will be important under the new model. Field supervisors, first response teams, physician support teams and resuscitation units will be available across Estonia to assist ambulance crews treating critically ill patients, during peak demand and at complex incidents. "First response teams have an important role on the smaller islands, where maintaining a permanent full-scale ambulance crew is not practical given population distribution and call volumes. A local team can begin providing care before additional ambulance resources arrive or before the patient is transported," the statement continued. Areas where weather conditions, geography or transport connections may affect response times are to be particularly in focus. Under the 2028 network model, new ambulance bases will be added in four regions of Estonia. Healthcare authorities will select locations based on where they most improve emergency care access, considering distances, population distribution, call volumes and response times. The Health Board and Health Insurance Fund note ambulance workload varies by time of day. In 2025, 64 percent of call-outs occurred during daytime and 36 percent at night. Therefore, the new model expands the daytime network, while reducing night crews but maintaining emergency care readiness across Estonia, authorities emphasized, with emergency coverage preserved throughout the country despite fewer overnight units. Estonia will retain medical ambulance services, with nurse- or doctor-led crews and healthcare status maintained. The new network model will primarily use two-person ambulance crews, while three-person crews will remain in areas and situations requiring them. Health Board deputy director general: New ambulance stations planned Taavet Reimers, deputy director general of the Health Board, told ERR later on Tuesday that a new base is to be added in the Hiiu-Pääsküla of Tallinn, and in either the Muraste or Tabasalu areas of Harju County, both of them just outside Tallinn. In Ida-Viru County, Narva-Jõesuu will be getting additional resources, while a base is planned for either the Rõuge or Mõniste areas of South Estonia. while western Estonia will see new centers in Sindi and either Audru or Tõstamaa, all in Pärnu County; on the island of Hiiumaa, stations will be set up in either the Nurste or Emmaste areas, both in the southern end of Estonia's second-largest island. "These are locations where it is clear that additional ambulance resources are needed specifically to ensure timely access to emergency care for people in those areas," Reimers said. Board: Transition from 3- to 2-person crews will be gradual The Health Board later also clarified that three-person crews will still remain in significant numbers under the network model introduced in 2028, though the transition toward a predominantly two-person crew network will begin by then. "Under the current plan, there will be 63 three-person crews and 43 two-person crews during the day, with 63 three-person crews and 30 two-person crews at nights. This means that in the initial 2028 model, all three-person crews will remain in operation at night, with the nighttime reduction affecting only two-person crews," Reimers said. All additional crews introduced from 2028 onward are planned as two-person teams, with the long-term direction being a gradual increase in the proportion of two-person teams. Smaller islands' services to remain largely unchanged The current arrangements on Estonia's smaller islands will remain unchanged, Reimers added, meaning that Prangli, Vormsi, Kihnu and Ruhnu will continue to have two-person first-response teams, equipped with full emergency equipment, responding to calls within their areas. "The difference here is that there will not be a crew leader on site making clinical decisions. Instead, those decisions will be made via telemedicine by a crew leader on the other side of the screen, who will receive all of the patient's vital signs and direct the patient's treatment through telemedicine tools," he explained. Reimers added one of the most important effects of the reforms are that access to physician support currently varies region by region within the ambulance network. "With the changes planned for 2028, every region will have physician support teams whose task will be to assist ambulance crews in their service areas when they are dealing with more serious cases." The Health Insurance Fund plans to announce a public tender for new ambulance service funding contracts no later than September 30 this year, to replace the current ambulance service contracts, which expire on the last day of next year. Ambulance provision is organized on a regional basis. Editor's note: This article was updated to include comment from Taavet Reimers. -- Follow ERR News on Facebook and Twitter and never miss an update! Editor: Andrew Whyte, Mirjam Mäekivi