Health Services in Spain are devolved to the seventeen Regional Governments. Ours, in Valencia, is called the Generalitat Valenciana. Hence the logo on the ambulance. But I wondered about that name of the private firm. Obviously there are private ambulances to move people to and from private clinics and to deal with patients who are paying through their insurance companies or health plans. Mutual societies, which work with the Social Security Department to cover work place health, might also use private ambulances. But that wouldn't be the case for an ambulance with the Generalitat logo. Google of course knew. It seems that, in the modern world, the Health Authorities usually outsource their ambulance services. So there's a tendering and contracting process for outsourced fleets of ambulances. Staff can also be outsourced though it seems that the doctors and nurses aboard the ambulances are, usually, Health Authority Staff whilst the drivers and paramedics come with the ambulance.
I know there are Red Cross, Civil Protection and yellow DYA ambulances. I'd also read a story recently, in the local press, about our Town Hall buying a new ambulance. So how did this all fit together?
I think the Red Cross ambulances are, much like the Red Cross or St John in the UK. I saw a Red Cross ambulance crew in action only a few weeks ago in Aspe. They were covering a fiesta and somebody was taken badly ill. I presume that event organisers have to cover emergency first aid and one of the potential options is the Red Cross. The DYA is another example of a charitable organisation that raises money in any number of ways, including selling its services. The DYA was originally set up to cover the shortage of ambulances to deal with road traffic accidents in Spain but, I think, it now generally operates through arrangements with Regional Health Authorities. Obviously when push comes to shove, in a train crash or terrorist attack, all the ambulances from everywhere become available. So then, what about our Town Hall ambulance? Checking back in the local press the ambulance was described as a TNA. Google said TNA is Ambulancia de Transporte no Asistido. The penny dropped.
There are two basic types of ambulances. Emergency Response Ambulances and Transfer Ambulances. Emergency Response Ambulances come in two types and with three crewing levels. Transfer ambulances come in two variations with two crewing levels. There are plenty of other sorts too, like rapid response vehicles, but I'll just stick to the principal types.
Generally, when someone calls 112 (there are other numbers too but 112 is foolproof), the ambulance that turns up will be an SVB - Basic Life Support ambulance. It will be crewed by two TES, técnicos en emergencias sanitarias, or emergency health specialists which are probably equivalent to UK paramedics. They will have spent a couple of years at college getting their qualification and they will probably have done lots of short ancillary courses. The SVB vehicles are kitted out with defibrillators, all those immobilising braces, oxygen, drips and a long etcétera.
The next step up is an SVA - Advanced Life Support ambulance. These SVA vehicles carry more medication on board than the SVBs and more sophisticated kit. The real difference though is not in the vehicles, it's that SVAs come with more qualified staff. The SVA Sanitarizada (the lowest level of SVA) comes with an Emergency Health Specialists (TES) and an Emergency Nurse. The course to become a nurse in Spain is a four year university degree course. Most SVA nurses also do a further two years masters in nursing.
The most sophisticated vehicles and crew is also an SVA but, this time, it's called Medicalizada. These ambulances are sometimes referred to as Mobile Intensive Care Units. The on board equipment doesn't usually vary much from the Sanitizada but this time the TES and the Nurse have a Doctor with them. A Spanish SVA Doctor will have done six years at university, a couple of years on a Masters in Emergency Medicine and another four years or so on a specialism like cardiology or intensive care medicine.
Away from the full blown, nobody dies on my watch, vehicles there are the two types of transport or transfer ambulance. The first of these is what my dad and his mum would have recognised as ambulances. The patient will probably be on a wheeled stretcher. Their lives are probably not in danger but they are not well. It's possible, though not likely, that the transfer could become an emergency so the vehicles are equipped with horns and lights. The patient will be accompanied by one TES paramedic and a driver. The driver may just have first aid type knowledge from a couple of months course or they might be a TES as well.
The last and simplest type, the TNA, the sort of ambulance that our Town Hall just leased, may have a first aider or a TES type driver but there is no expectation that the run will become an emergency. Often these vehicles are minibuses.
In re-reading various articles about transfer ambulances it looks as though there are often arrangements between local Town Halls to share access to the SVB ambulances. I was talking to one of my students about this and she said that before Pinoso sorted out its own local arrangements people could die whilst they waited for an ambulance to arrive from Elda, which is where our hospital is, some 28 kilometres away.
There is all sorts of legislation about how a vehicle qualifies to be an ambulance, from simple things like having the word ambulance painted back to front so that any driver looking in their rear view mirror will be able to read that they have an ambulance on their tail through to what it needs to carry, how it can operate and how long it can take to get such and such a distance.
Just one last thing. Spanish ambulances have traditionally had amber flashing lights, they've only just started to use blues and twos. Ambulances could have blue lights from August 2018 and all of them will have to carry blue lights by August 2020.
