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21 March 2025 | Country Update
Greece modernizes its emergency medical response capacity through the reform of the National Trauma System
5.5. Emergency care
Emergency care is provided free of charge at the point of use through the emergency departments of public hospitals and the facilities of EKAV (Papaspyrou et al., 2004). A person with a life-threatening problem can choose either to go directly to an emergency department of a public hospital or to call EKAV.
EKAV was established in 1985 and is responsible for the provision of first aid and emergency medical care to all citizens, as well as transportation to health care units, free of charge at the time of use. It also provides training to doctors, nurses and other health care personnel in all aspects of emergency medicine and health care. Its central service centre is located in Athens, with 11 regional stations in major cities and substations in smaller cities, serving about 600 000 patients annually. Box5.6 outlines the method by which patients access emergency care.
Box5.6
Although the Athens Olympic Games in 2004 was a major factor contributing to the modernization of EKAV (Zygoura, Syndos & Kekeris, 2007), the economic crisis and austerity measures implemented after 2010 have had a negative impact on the adequacy and quality of its services. Horizontal cuts in health expenditure, nonrenewal of fixed-term contracts for temporary staff and a reduction in the replacement of retiring staff have resulted in approximately one fifth of the nationwide ambulance fleet being off the road through shortages in ambulance crews, as well as repair requirements and delays in the procurement of new ambulances.
In addition to EKAV, all public hospitals with a capacity of more than 300 beds operate 24-hour independent emergency departments staffed with physicians from the following specialties: surgery, anaesthesia, internal medicine, cardiology, pulmonology, orthopaedics and general practice with proven experience and knowledge of emergency medicine or specialization in intensive care medicine. Emergency departments undertake admission, triage and immediate treatment in life-threatening situations.
The proper functioning of emergency departments is impeded by several factors. First, emergency medicine has not yet been institutionalized as a specialty in Greece. Second, the absence of gatekeeping results in a large number of unnecessary visits to these departments, increasing their workload. Third, budget cuts have resulted in a lack of personnel to triage patients. Shortages of paramedic personnel in emergency departments often results in ambulance crews having to take on the role of paramedic personnel by transferring patients from one hospital department to another, delaying them from performing their core duties.
Law 5173/2025 (published 30 January 2025) sets out the reform of the National Trauma System. The legislation foresees the establishment of 17 trauma centres for adults and two paediatric trauma centres in public hospitals, and trauma stations in health centres and rural clinics. A trauma centre is a specialized hospital or unit equipped and staffed to provide care for patients suffering from major traumatic injuries such as falls, motor vehicle collisions, or gunshot wounds.
The centres are categorized into four levels based on their capacity to handle different types of injuries, ensuring that patients receive the most appropriate level of care. Level I trauma centres will be equipped to handle the most severe and complex cases, with specialized medical teams and advanced facilities available around the clock. The tiered system aims to ensure that critically injured patients are quickly transported to the most appropriate facility for their needs.
The new law also provides for the establishment of a National Trauma Committee to evaluate trauma centres and trauma stations nationwide and oversee the National Trauma System.
Furthermore, the training of specialized and trainee medical and nursing staff participating in trauma centre teams will also be initiated.
Authors
References
Law 5173/2025, “Reform of the National Trauma System”. Official Government Gazette, Issue A’/Number 11/30-1-2025 (in Greek), available at: https://search.et.gr/el/fek/?fekId=776750
https://www.iefimerida.gr/english/greece-establish-national-trauma-care-system