Emergency Patient Transport

Emergency Patient Transport is defined as a transport of an ill patient requiring some form of medical assistance during transport from the location the patient was found to a receiving hospital. These transports are classified as immediate or within a two-hour window depending on the condition of the patient.
Emergency Specialty Patient Transport:
Emergency Specialty Patient Transport includes any patient transport ordered by a physician for transport from one medical facility to another medical facility that requires a physician, paramedic, or nurse, or in the case of a neonatal transport, a neonatal specialist or paediatric intensive care physician to accompany the patient and provide care during transport;
While basic non-emergency patient transportation is provided by a contract ambulance company equipped with the proper level of required equipment, emergency specialized patient transport is performed by the EMS Agency’s emergency ambulances with the staffing level and equipment adequate to perform the transport. Since emergency specialized patient transport requires an emergency ambulance to be taken out of emergency service, the physician ordering the transport takes full responsibility that the transport by emergency ambulance is warranted.

Any questions or concerns regarding basic or emergency patient transport should be addressed to birhiba@mentok.hu.
The EMS Agency’s emergency and non-emergency dispatch staff will attempt to resolve all issues in a timely fashion.

In an attempt to make ordering a basic non-emergency transport as easy as possible, a physician can pre-register and then make transport requests online at https://bsz.mentok.hu

The EMS Agency would like to stress to physicians how ordering basic level non-emergency transport of patients in their care can be made conveniently, safely, and automatically over the Internet. The ordering physician must pre-register personally at the EMS Agency’s non-emergency transport coordination office and then will be granted the ability to order basic level patient transportation quickly at https://bsz.mentok.hu. The web page is easy to use, however it requires that the information provided is accurate.

SPECIAL EVENTS AND SPECIAL OCCASIONS

The Hungarian EMS Agency is legally responsible for the health and safety of patrons at special events and large gatherings. As the official agency tasked with pre-hospital care and specializing in emergency preparedness for large public events, the Hungarian EMS Agency can prepare and organize the logistics and equipment for any emergency plan for any event. The specialists at the Hungarian EMS Agency can also give expert consultation to other organizations preparing an emergency plan for a large event.

Any entity planning a large event in Hungary should turn to the EMS Agency’s specialists with confidence for consultation, planning, pricing, logistics planning and execution of any event’s prehospital emergency planning needs.

The Hungarian Health Ministry Regulations regarding special events and their emergency preparedness (Annex 2 to decree 5/2006. (II.7.) EüM) explained:

Emergency Preparedness Plans for large events:

– Events with a small number of expected attendees, under 1,000 patrons, are expected to have emergency medical coverage only if the event is specifically for a group of people with medical issues or the elderly where medical issues are expected to be common or it is a sporting event where the regulations of the event require medical staff to be on standby at the event.

– Events with 1,000 to 5,000 expected attendees require at a minimum one advanced emergency ambulance and as many basic level emergency ambulances needed to make the maximum distance between any point at the event and some form of ambulance to be no more than 10 minutes by foot. If the event takes place over water, at least one rescue boat must be available for emergency response.

– Events with 5,001 to 10,000 expected attendees require at a minimum one advanced emergency ambulance, one basic level emergency ambulance and as many basic level emergency ambulances needed to make the maximum distance between any point at the event and some form of ambulance to be no more than 10 minutes by foot.

– Events with 10,001 to 50,000 expected attendees require at least one specialist staffed Emergency Specialist Rescue Unit (ROKO), one advanced level emergency ambulance, one basic level emergency ambulance and as many basic level ambulances needed to make the maximum distance between any point at the event and some form of ambulance to be no more than ten minutes by foot.

– Events with 50,001 to 200,000 expected attendees require at least one specialist-staffed Emergency Specialist Rescue Unit (ROKO), one advanced-level emergency ambulance, one basic-level emergency ambulance; and for every 50,000 expected attendees over the first 50,000, an additional advanced-level emergency ambulance and one additional basic-level emergency ambulance. In addition, for every 100,000 expected attendees an additional Specialist Staffed Rescue Unit (ROKO) must be made available. The units must all be spaced so that the maximum distance between any point of the event and some form of ambulance is no more than ten minutes by foot.

– Events with expected attendance of over 200,000 patrons the above must be made available in addition to one Emergency Specialist Rescue Unit (ROKO) and one advanced level emergency ambulance and two basic level emergency ambulances for every 100,000 expected patrons. Resources must be positioned in such a way that the maximum distance between any point of the event and some form of ambulance is no more than ten minutes by foot. In this instance, one of the Emergency Specialist Rescue Units (ROKO) can be substituted emergency physician-staffed rendezvous cars.

– Events with more than 50,000 expected patrons a mobile emergency care tent, container, or trailer must also be established for primary care of the sick and injured.

– An air rescue helicopter must be made available on standby for large open space events, motorsports events, special events taking place over vast amounts of territory where ground units might have difficulty accessing emergencies at the event, events with a high probability of serious bodily injury, or events where an ambulance cannot be accessible within 10 minutes or a hospital is farther away than twenty minutes by ground.

Pedestrian ambulance crews:

– Pedestrian ambulance crews can be utilized only within confined buildings or small territories where the expected patrons are less than 1,001 in number. If the patronage is greater than 1,000, the above requirements must be met.
– Enclosed events with 300 to 1,000 expected patrons, where dancing or musical activities occur must have at least one pedestrian ambulance crew available.
– The pedestrian ambulance crew must contain a nurse specialist, paramedic, physician, emergency physician or combination of the aforementioned.
– The organizers of the event must make available permanent or temporary facilities where a patient can lie down and be properly examined.

– Landline or mobile communication equipment must be made readily available to the crews in addition to the proper medical equipment needed to adequately perform the required tasks.

Emergency transportation of patients from events:

Event organizers are responsible for the health and safety of event patrons. If sick or injured patients require transport to the nearest health facility, the event organizers are responsible to make the proper arrangements to transport the patients, except for events with Pedestrian ambulance crews. If the event organizers are incapable of transporting the patients to health facilities and utilize the EMS Agency’s ambulances, the EMS Agency has the right to bill the event organizers for any additional costs incurred to the Agency. This does not include any unforeseen catastrophic emergencies.

The Health Ministry regulation regarding ambulance rescue and event preparedness (decree 5/2006. (II.7.) Eüm) became effective on March 31, 2015 and for which the Hungarian EMS Agency has responsibility:

Section 11 (4)
a) all government events
b) European and International sporting events
c) all motorsport or equestrian sporting events
d) any event that utilizes various open spaces concurrently
e) any event where a VIP, diplomat, or any person requiring extra protection is in attendance or is involved in the event
f) any event where 10,000 or more people are simultaneously participating in the event
g) any event mentioned in the above Attachment 2 /1.6.8 where an emergency air rescue helicopter is needed
h) all national holiday events, in addition to any important event where by government decree an emergency plan is required with emergency ambulance coverage:

(4a) Any event where emergency medical coverage is requested, excluding Paragraph 4H) type of special event, but where the event organizers pay the EMS Agency a predetermined sum that was agreed upon in writing prior to the event.

(4b) Cost estimates as required in Paragraph (4a) are based upon the following criteria:
a) the amount of time units and personnel are required for the event
b) the type and number of required personnel and equipment
c) the level of competency required to fully comply to the regulations or requirements of the event
d) the distance required to travel between the base of operations of the personnel and equipment and the event
e) the distance between the event and the primary health care facility where patients are to be transported
f) the total area needed to be traversed at the sight of the event
g) the expected number of attendees
h) the type of event
i) the amount of time the event is expected to last

Preparation of Emergency Action Plans:

Paragraph 11/A. section 3 (1) requires that event organizers prepare an Emergency Action Plan of an event with an expected attendance of over 5,000, and they must consult the specialists at the Hungarian EMS Agency during the preparations of the plans if the EMS Agency has not previously prepared or approved similar plans. The Emergency Action Plan must be presented to the EMS Agency in addition to other allied emergency services agencies involved in the plans at least five business days prior to the start of the event. An Emergency Action Plan is recommended for events with an expected attendance of less than 5,000 as well.

(2) The Emergency Action Plan must take into account the type of event being organized, the expected attendance, the geographic conditions, and the weather conditions expected at the time of the event.

(3) The Emergency Action Plan must contain the following:
a) the characteristics of the event, the location of the event, and its expected time and duration b) expected attendance
c) the number, type, category, and classification of the planned number of ambulances and emergency medical staff
d) the number of emergency medical staff categorized by competency
e) a detailed map of the event containing the ingress and egress routes including emergency evacuation routes
f) the planned communication strategies and placement of the emergency medical crews and equipment
g) if necessary, the air rescue helicopter landing zone
h) the primary contact managing the Emergency Action Plan, their professional qualifications, and their emergency contact information
i) contact information and strategies for communicating with allied emergency services agencies

(4) Paragraph 37 (1) states that the creation of an Emergency Action Plan by the EMS Agency, or the consultation services of the EMS Agency (stated in (5)-(7), has a set fee that must be remitted.

(5) Paragraph 38 states that if a site inspection is required by the EMS Agency during the preparation of the Emergency Action Plan, the following fees must be remitted:
a) 1,000-5,000 expected attendance of a one-time event is 15,000 HUF
b) 5,001-10,000 expected attendance of a one-time event is 17,000 HUF
c) 10,001-50,000 expected attendance of a one-time event is 22,000 HUF
d) 50,001 expected attendance of a one-time event is 43,000 HUF

(6) Paragraph 39 states that if a site inspection has already occurred of a prior event and a similar event Emergency Action Plan is being generated that does not require a new site inspection, the following fees must be remitted:
a) 1,000-5,000 expected attendance of a one-time event is 9,000 HUF
b) 5,001-10,000 expected attendance of a one-time event is 10,000 HUF
c) 10,001-50,000 expected attendance of a one-time event is 11,000 HUF
d) 50,001 expected attendance of a one event is 16,000 HUF

(7) Paragraph 40 (1) requires the following fees to be remitted if the EMS Agency must be consulted on the Emergency Action Plan but is not the operative agency providing emergency medical services:
a) 12,000 HUF, if a site inspection must be performed
b) 7,000 HUF, if the event has already had a site inspection and a new site inspection is not required
Paragraph 11/B. section 41 A 11 section (4h) states that these events require no fee to be remitted to the EMS Agency for providing an Emergency Action Plan as well as emergency medical equipment and personnel to implement the plan. This regulation is governed by Contract 107 (1) with the European Union and is regarded as a public service extended through contract and the funding for the services is considered a public service of the government.

For any event where additional resources are required to implement an Emergency Action Plan, the Hungarian EMS Agency will hire subcontractors who meet the stringent requirements set forth by the EMS Agency whereby the EMS Agency must be assured that the set standards shall be met.

The Hungarian EMS Agency strives to establish a pool of professional, efficient, and economic partners who adhere to the transparency and high standards set forth by the EMS Agency. Our partners must meet the following standards, in addition to the stringent equipment and personnel standards set forth by Hungarian regulations:

• Adherence to the medical standards and protocols set forth by the EMS Agency, or other protocols that have been reviewed and permitted by the EMS Agency, or international standards of care or Hungarian standards of care that have been reviewed and permitted.
• Submission of a copy of all patient care documentation.
• Proof of regular training and education of Emergency Medical Staff.
• Agreement to follow all orders given by the EMS Agency’s operations supervisors
• Agreement to follow all EMS Agency dispatch protocols.
• Sharing of emergency response statistical information from the event with the EMS Agency.
• Agreement to possible inspection by the EMS Agency’s Operations Inspection Team
• Agreement to adhere to the EMS Agency’s Press Protocols (includes news agencies, Internet portals and social media). Agreement to share only information with the press that has been authorized by the EMS Agency’s Public Information Office.
• Immediate reporting of problem recognition and solutions to the EMS Agency.
• Adherence to all conditions of the completed contract. Full responsibility for the medical care it administers.
• Submission of a copy of its liability insurance policy to the EMS Agency.
• Provision of the quantity and quality of emergency equipment, ambulances, and personnel agreed upon in the contract for the full extent of the contract.
• The contractual agreement is for a fixed term.  Either side can cancel the contract without reason as long it is done at least ninety days before the termination date. The contract can also be cancelled immediately should either party not live up to its contractual agreements.
• The subcontracting entity must sign a declaration of transparency that meets the Hungarian law (Act CXCV of 2011, section 41. 6) which includes:
• There is no delinquent account with the EMS Agency.
• There is no legal action being taken by the entity against the EMS Agency.
• In the event that the subcontracting entity is required to pay an outstanding balance, it can submit evidence that it has paid this balance in full.
• The subcontracting entity must demonstrate that it can provide the contracted services without relying on other subcontractors.
• Advance payment is not required. Payment in full to the subcontracting entity will be made within thirty days of submission of an invoice to the EMS Agency.

The EMS Agency has the authority to cancel a contract with a subcontractor in the following circumstances:

• The agreed upon quantity or quality of the ambulance provided does not meet the contract requirements, is not available for the full extent of the contract, or the medical personnel staffing the ambulance or the ambulance equipment do not meet the specifications of the contract.
• The subcontracting entity is repeatedly cited for failing to conform to the EMS Agency’s Operative Team’s instructions, or the entity is repeatedly cited for failing to conform to the EMS Agency’s Standard Operating Procedures.
• The business license of the subcontracting entity is repealed for any reason.

We hope that the above rules and regulations for conditional cooperation with the EMS Agency will allow interested entities the ability to meet the expectations of those depending on our work and our high standards of excellence.

Hungarian Emergency Medical Services Agency