One Year Later: Bulgarian EMS Continues to Acquire Aircrafts

Bulgaria Heli Med Service, the state-owned company established to operate the country’s airborne EMS, leased its first helicopter in March 2023. The new service was designed to provide the country’s EMS staff with access to challenging areas, such as the country’s southwestern mountainous region.

“The system of emergency medical assistance in the Republic of Bulgaria is a state structure and is financed entirely by  the state budget,” a spokesperson from the Bulgarian Ministry of Health’s Press Department told EMS World.

Acquiring Six Helicopters

As part of its responsibilities towards local patients, the Bulgarian ministry is also providing the funds for the project to acquire six aircraft for the country’s helicopter EMS (HEMS). Under the plan, the first copter is to be delivered by the end of 2023, and the last aircraft by the end of 2026.

The ministry canceled its first tender to buy the helicopters since the only bidder, Italy’s Leonardo, offered its helos to Bulgaria above the maximum price set in the tender. Local paper 24 Chasa reported that the manufacturer priced its aircraft at some BGN 123 million ($66.7 million) excluding the value-added tax (VAT).

Bulgarian Minister of Health Assen Medjidiev has told local reporters that a new public procurement will be launched, and there is enough time until the end of 2023 to acquire the first helicopter. But before up to six helicopters are purchased for the nation’s airborne EMS, Bulgaria Heli Med Service is to begin its operations by leasing one helo from a selected company.

The estimated price of the service, under which a second-hand helicopter is to be used for at least one year with an option to extend the lease by a second year, is about €1.76 million ($1.87 million) excluding the VAT, according to the tender documentation obtained by the paper. Companies that operate helicopter fleets were invited to submit their bids until December 2022.

Under the tender terms, the used aircraft can have a maximum age of 10 years, and its total flight time cannot exceed 1,500 hours.

Georgi Gvozdeikov, the chief executive of Bulgaria Heli Med Service, said that airborne EMS units have already been formed, and their staff are waiting for the first helicopter’s delivery to begin their training. Gvozdeikov hopes to have a signed contract with the selected supplier of the aircraft in early 2023 which would allow the first copter  to begin its operations by next March.

EMS Investments in Bulgaria

Bulgaria is currently the only member state of the European Union, which comprises 27 countries across the continent, which does not operate helicopter emergency medical services for its population. Local experts believe that the country should operate at least four helicopter bases, located in Bulgaria’s capital Sofia, which has a population of more than 1.24 million inhabitants, as well as in major cities such as Plovdiv, Burgas, Varna, or Pleven.

The past years have brought several major investments by the state authorities to expand and modernize the capacities of the Bulgarian EMS system. Among others, Sofia secured funds from the European Union to add new vehicles to the nation’s ambulance fleet. The project involved “the provision of 400 new, fully-equipped ambulances for the needs of emergency care centers and their subsidiaries distributed to them across the entire territory of Bulgaria,” according to the Health Ministry.

Among the 400 vehicles, 185 are type B ambulances in a standard variant; 42 type B ambulances with increased mobility and off-road capacities; 78 type B four-wheel-drive ambulances; and 95 type C ambulances for intensive medical care, as indicated by data from the ministry.

In addition to the ambulance acquisition project, Brussels also provided Sofia with funds to finance several other investments in facilities and gear that will allow Bulgaria to modernize its EMS. The financial contribution was allocated from the EU’s European Regional Development Fund (ERDF) via the Regions in Growth operational program for the years 2014 to 2020.

“The ERDF-funded project … [will enable the Health Ministry] to finance improvements in the equipment, efficiency, and accessibility of the country’s emergency health services. This will [bring] direct results in the provision of better emergency care for Bulgarian citizens. The work includes the construction of new buildings, the reconstruction, repair, and reorganization of over 230 emergency medical care sites, improvements to 34 hospital emergency departments and 27 medical centers,” the European Commission said in a statement, identifying the program as the “largest health infrastructure project of the … 2014-2020 programming period."

Ongoing Frustration with Working Conditions

Meanwhile, despite the government’s investments in the capacities of the nation’s EMS system, the service’s staff have been increasingly voicing their disappointment with their pay and working conditions.

Last November, Bulgarian EMS staff launched protests across the country, demanding salary increases and improved working conditions. In September 2022, the country’s then-caretaker government approved an additional expenditure of BGN 9.8 million for the Health Ministry’s 2022 budget.

Medjidiev was quoted by local news agency BTA as saying the funds will be spent on compensating EMS staff until the end of 2022. Doctors were allocated additional payments of about BGN 600 per month, paramedics BGN 400 monthly, nurses BGN 350 per month, and ambulance drivers about BGN 150 monthly. Meanwhile, the service’s staff are calling on the government to ensure that the extra pay is extended throughout 2023.