Changes in the State Emergency Medical Service

Based on the experience gained from the operation of the State Emergency Medical Service system, hereafter referred to as "PRM," the following issues have been identified that require regulation from scratch, or changes or additions to existing solutions:

1. The presence of emergency motorcycles in the PRM system needs to be sanctioned. Although ambulance-equipped medical rescue teams, hereinafter referred to as "ZRM," are already supported by rescue motorcycles, the legal status of the latter, as well as how they are financed, remains unregulated. It is also necessary to establish a minimum number of three-person basic teams to ensure the safe provision of medical assistance to patients in a medical emergency, as well as the health and safety of team members.
2. Hospital emergency departments are the only elements of the PRM system for which, to date, no parameters have been established to guide the governor in determining their number and distribution in the provincial PRM system action plan. Therefore, it is reasonable to establish indicators based on which hospital emergency departments will be planned.
3. Medical dispensaries

Recommended solution, including planned intervention tools and expected effect

1. Motorcycle rescue units, which have so far been a component of selected ambulance-equipped medical rescue teams, will be a separate type of team, which will be one of the elements of the provincial action plan for the PRM system and a separate product to be contracted under contracts concluded by provincial branches of the National Health Fund. The motorcycle rescue unit will reach places that cannot be reached by an ambulance, during gatherings, in congestion on the road. The rescue motorcycle will be driven by a person authorized to perform medical rescue operations, and will be equipped with the necessary medicines and medical devices, as well as with equipment to operate the SWD PRM. The number of motorcycle teams will be estimated by assuming a maximum of one for each started 400,000 residents of the province, and the operating time of these units will be from May 1 to September 30, up to 12 hours per day. A minimum threshold is also being introduced below which the number of three-person core teams cannot fall, at 3 for every 10 core teams started.
2. It is assumed that a provision will be introduced in the Law on PRM, according to which one hospital emergency department will secure an area no larger than an area with a population of 200,000, allowing a medical rescue team to reach this department from the scene of an incident in no more than 45 minutes.
3. Medical dispensaries

1) Due to the establishment of the SWD PRM, the bill also provides for the addition of a definition of the SWD PRM in the PRM Act, and the provision of an obligation for its maintenance and financing by both the Minister of Health and the provincial governors. It also explicitly introduces the possibility of entrusting the dispatcher of air medical rescue teams, which is a unit supervised by the Minister of Health, with the purchase of equipment intended for the operation of the SWD PRM in specialized means of sanitary transport used by medical rescue teams, at the workstations of provincial medical rescue coordinators, the national medical rescue coordinator and at the workstations of medical dispatchers.

2) It is envisaged to amend the Act of November 22, 2013 on the emergency notification system, and consequently also the Act of September 17, 2020 on amending the Act on the emergency notification system (Journal of Laws, item 1899) and the Act of July 16, 2004. Telecommunications Law (Journal of Laws of 2024, item 34, as amended) in such a way that the possibility of directing 999 emergency calls directly to medical dispensaries, bypassing emergency notification centers, is maintained indefinitely. The maintenance of the 999 emergency call service independent of emergency notification centers is supported by the technological solutions already implemented.

3) The provisions indicating the legal basis for the Minister of Health's inspection of system unit dispatchers and medical dispensaries will be clarified. While with regard to the dispatchers of the system units, the provisions on control in medical entities will apply, in the case of medical dispensaries, the Act of July 15, 2011 on control in government administration (Journal of Laws of 2020, item 224) will be applied. The scope and manner of sharing data from the SWD PRM with professional self-government bodies, as well as with courts, prosecutors, the Police and the Patient Ombudsman will be arranged.

4) The obligation for governors to request funds from the Minister of Health for the tasks of medical dispensaries and psychological support for medical dispatchers will be abolished.

5) An additional medical dispensary will be introduced in provinces with a population of more than 3 million people (Lesser Poland, Silesia, Greater Poland) and two additional ones in the Mazovian province.

6) A special type of medical dispatch center, the CO LPR, will be introduced into the legal order. The employer for the medical dispatchers employed there will not be the provincial governor - as the PRM Act stipulates - but the Air Ambulance Service. The bill indicates the tasks to be performed by medical dispatchers and air dispatchers at the CO LPR.

7) It is also assumed that the requirements for the professional experience of psychologists, who implement psychological support for medical dispatchers, will be lowered so as to harmonize them with the requirements relating to psychologists employed in emergency notification centers, and it will be possible to employ them on the basis of a civil law contract.

1. Records

There will be a modification of the scope of data contained in the RJWPRM. Organizational units of the State Fire Service and fire protection units included in the national rescue and firefighting system will be entered in the register by the regional commander of the State Fire Service, and organizational units of the Maritime Search and Rescue Service by the director of the Maritime Search and Rescue Service. Other units will continue to be entered in the RJWPRM at their request, by the relevant provincial governor. The bill stipulates that the time for a unit's actual arrival at the scene of an incident should be no longer than 30 minutes, counting from the moment the call is received.

It is envisaged to reduce from 30 to 7 days the time in which the director of the provincial branch of the National Health Fund provides the governor with information on the conclusion or termination of contracts covered by the RPRM. The scope of the data processed in this register will be adjusted to the actual state of affairs.

1. Medical personnel

It is also planned to change the definition of a system physician by expanding it to include intensive care specialists. This is a medical field that is useful in the units of the State Emergency Medical Service system. In turn, the change in the definition of a system nurse involves adjusting the names of the fields of nursing in which specialization and qualification courses may be conducted to the Regulation of the Minister of Health of December 12, 2013 on the list of fields of nursing and fields applicable to health care in which specialization and qualification courses may be conducted (Journal of Laws, item 1562). An obligation to complete emergency management courses is being introduced for those providing health care services in system units, i.e. in the Emergency Medical Service and hospital emergency departments. Doctors specializing in emergency medicine, intensive care, anesthesiology and intensive care, as well as nurses with a degree in emergency nursing or in anesthesiology and intensive care nursing, as well as those undergoing specialization in these fields, will be exempted from this obligation. Failure to complete the aforementioned courses will result in the inability to provide health services in system units. Control of the implementation of this obligation is entrusted to the dispatchers of the system units.

1. First aid

The definition of first aid will be expanded to include the possibility of administering prescription medication in an emergency situation. Such medication will be able to be administered to the injured person by a witness to the incident.

1. Courses to qualify for the position of medical dispatcher and provincial emergency medical coordinator.

It is planned to abolish the obligation to complete courses authorizing work in the position of medical dispatcher and provincial rescue coordinator for persons already employed in these positions. This obligation will apply only to persons employed in these positions after January 1, 2024. Persons who will be employed in these positions in 2024 will be required to provide the employer with a certificate of completion of the course by March 31, 2025, while persons who will be employed from January 1, 2025 and onward - within 3 months from the date of employment.

1. The rules for the implementation of the obligation of in-service training for persons employed as medical dispatchers who began their educational period before January 1, 2024 will also be regulated. It is envisaged that medical dispatchers who began their educational period before January 1, 2024 will continue it, however, already realizing courses that are organized by the NMCMRM, and not, as before, by entities accredited by the Medical Center for Postgraduate Education. The continuing education course for medical dispatchers completed under earlier regulations, before January 1, 2024, is valid until the end of the three-year educational period.
2. The provision in the PRM Law for calculating the third quartile of arrival times has also been dropped, as it has not been useful to date.
3. It is planned to introduce (clarify) sanctions for failure to implement the decision of the national emergency coordinator or provincial emergency coordinator in situations of disputes over the admission of a person with a medical emergency to the hospital. The maximum time for admitting a patient to the emergency room or hospital emergency department from the emergency medical team will be 15 minutes. The maintenance of this parameter will be one of the conditions for the provision of health services that can be objectively assessed and verified.
4. It is envisaged to clarify the handling of the cor pses of persons who died in a specialized means of sanitary transport. It is envisaged that the corpses of such persons will be transported to a forensic medical institution of a medical university or to the prosectorium of a hospital designated by the medical dispatcher or the provincial coordinator of emergency medical services.
5. There is also an obligation to pay allowances for work at night and on Sundays and holidays and non-working days resulting from an accepted five-day work week for members of emergency medical teams practicing a medical profession, analogous to the case of employees practicing a medical profession employed in a shift work system in a medical entity performing medical activity in the type of stationary and round-the-clock health services (Article 99 of the Act of April 15, 2011 on medical activity (Journal of Laws of 2024, item 799)). Due to the fact that the obligation to pay allowances to members of emergency medical teams practicing in the medical profession implemented under the provision of Article 47a of the Law of December 5, 2008 on Prevention and Control of Infections and Infectious Diseases in Humans (Journal of Laws of 2023, item 1284, as amended) ended with the abolition of the state of epidemic emergency on July 1, 2023, it is proposed to specify in the Law that the provision will enter into force with effect from July 2023. A provision will also be introduced to exclude the obligation to pay allowances for the period from July 1, 2023 to the effective date of the regulation to those medical entities that paid allowances during the period under regulations introduced pursuant to intra-company labor acts.
6. In order to remove doubts of interpretation, a provision is being introduced that explicitly indicates that a paramedic may practice in a medical entity as an entrepreneur who is not a medical entity, on the basis of a civil law contract concluded with the medical entity.
7. In order to make the provisions of the current law more coherent and appropriate, it is reasonable to introduce regulations to amend the catalog of entities exempt from the need to obtain an opinion on the advisability of the investment. The catalog of entities listed in Article 95d(2) of the Act on health care services financed from public funds will be supplemented with emergency medical teams. This provision specifies the entities for which an opinion on the advisability of investments is not issued.

Source: RCL