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There are 10 emergency centres in Belgium: one in each provincial capital, with the exception of Walloon Brabant, and one in the Brussels-Capital Region. The calls from Walloon Brabant are handled by the Hainaut emergency centre.
Via the emergency number 112, a person requesting emergency care in Belgium is referred to one of the 10 emergency centres. The centres are manned by 482 operators[1]. An operator at the emergency centre will answer the call and analyse the request for help. Using the Belgian Medical Regulation Manual, which consists of established protocols, the emergency centre classifies the request for help into a severity level. The most appropriate resource (an ambulance, a Paramedical Intervention Team (PIT) or a Mobile Emergency Group (MUG/SMUR)) is then dispatched (see the chapter entitled ‘The various emergency services for emergency assistance’).
The operators are assisted by a medical director[2], a deputy medical director[3] and nurse regulators. They are seconded from the FPS HFCSE.
- The medical director is responsible for supervising the medical quality of the emergency care. He/she must have a diploma as an emergency physician. He/she is the link with the provincial committee for emergency medical services (see ‘Quality’ section).
- The deputy medical director holds the special professional title of emergency nurse. Under the coordination of the medical director, he/she performs tasks at the emergency centre as a functional medical authority, as a project officer, and act as a link between the various partners of the 112 centre.
- The nurse regulator[4] supports and coaches the operators by offering them, among other things, adequate medical training. The nurse holds a special professional title of emergency nurse. In addition, he/she should have specific training in crisis management and contingency planning.
[1]Source: FPS Home Affairs and Firefighting and Emergency Medical Assistance service of the Brussels Capital Region
[2]The duties of the medical director are laid down in the Royal Decree defining the function, tasks and competence profile of the medical director of 112 centres
[3]The duties of the deputy medical director are laid down in the Royal Decree defining the function, tasks and competence profile of the deputy medical director of 112 centres
[4]The duties of the nurse regulator are laid down in the Royal Decree defining the function, tasks and competence profile of the nurse regulator
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In Belgium, 106 organisations concluded an ‘Ambulance service for emergency medical services’ agreement with the FPS HFCSE on 18/05/2021[1]. In this agreement, services commit to being available at agreed times.
Only services that have concluded an agreement can be dispatched by an emergency centre. Having such an agreement is also a condition for obtaining a grant from the FPS HFCSE. Non-urgent patient transport is provided by services without an agreement or their ambulances can be used as reserve vehicles.
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The following organisations are involved in providing Emergency Medical Services:
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Based on the agreement, one or more on-call rotations are manned by two paramedics, who can drive out to a patient at the emergency centre’s request. In Belgium, there were 417 on-call staff for both an ambulance (393) and a Paramedical Intervention Team (24) (see further) on 01/01/2021[2],[3].
- Most on-call rotations have an on-call service where the paramedics are on duty at the departure point. These on-call services have a rest area. This is also known as an ‘accommodated’ on-call rotation.
- A number of on-call rotations have an on-call service where the paramedics are on duty at home and go to the departure point in the event of a call. This is known as an ‘unaccommodated’ on-call rotation.
NUMBER ON-CALL ROTATIONS FOR AMBULANCES AND PIT FUNCTIONS BY TYPE (01/01/2021)
Learn more about ambulance services: www.health.belgium.be
[1]Source: Department of Urgent Aid, FPS HFCSE
[2]Source: Department of Urgent Aid, FPS HFCSE
[3] On-call rotations as discussed above are only organised for ambulances and Paramedical Intervention Teams. For this reason, no data on the MUG/SMUR functions has been incorporated here.
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In a situation where there is a need for emergency medical services, various resources can be dispatched to the location of the emergency, i.e. an ambulance, a Paramedical Intervention Team (PIT) or a Mobile Emergency Group (MUG/SMUR). On the basis of protocols established in the Belgian Medical Regulation Manual, the operator from the emergency centre determines which resource will be activated. In addition, based on the above protocols, an operator may refer the caller to an on-call general practitioner.
AMBULANCE
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An ambulance is a vehicle that has been specially adapted, furnished and equipped to provide basic life support at an intervention site on the one hand, and on the other hand to safely transport a patient to the hospital. An ambulance has the necessary equipment for monitoring and providing first aid. There are at least two paramedics in each ambulance. They are usually the first health workers to arrive at the intervention site. In Belgium, there are 393 on-call rotations for the dispatching of recognised ambulances. Of these, 31 are located in the Brussels-Capital Region, 210 in the Flemish Region and 152 in the Walloon Region. |
PARAMEDICAL INTERVENTION TEAM (PIT)
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The Paramedical Intervention Team (PIT) is a team that intervenes in more serious cases[1]. The team consists of at least one paramedic and one nurse who holds the special title of emergency nurse. A PIT can be dispatched for interventions where the care can be entrusted to a nurse. In addition, a PIT is sent in some cases when no MUG/SMUR is available. |
In addition to the basic equipment for an ambulance, a PIT ambulance must have the necessary equipment to carry out all its missions. After all, more tasks are entrusted to the nurse than to the paramedic via standing orders (see Quality chapter). This allows the nurse to perform some medical acts on the spot. Furthermore, the PIT team has the necessary communication tools to be able to contact a referring doctor if necessary. This is a doctor who remotely advises and coaches the nurse in the use of standing orders.
The PIT function is currently a pilot project whose added value is being evaluated. On 01/01/2021, 24 recognised pilot projects in the framework of a PIT function were started in Belgium, 12 of which in the Flemish Region, 9 in the Walloon Region and 3 in the Brussels-Capital Region[2]. However, when we look at the number of PIT functions per 100,000 residents, we see that there are as many PIT functions in the Walloon Region and the Brussels-Capital Region per 100,000 inhabitants, namely 0.25, and that there are 0.18 PIT functions per 100,000 residents in the Flemish Region.
Currently, no new services are being started up within the pilot project, but several hospitals are taking the initiative to upgrade an existing, recognised ambulance service to a PIT function themselves. Their number is limited, but is slowly increasing.
NUMBER ON-CALL ROTATIONS FOR RECOGNISED AMBULANCES, PIT FUNCTIONS AND MUG/SMUR FUNCTIONS PER 100,000 RESIDENTS
MOBILE EMERGENCY GROUP (MUG/SMUR)
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A Mobile Emergency Group (MUG/SMUR) is a mobile medical team that provides advanced life support during an intervention in the context of an emergency situation[3]. The team consists of at least one emergency doctor and one nurse who holds the special title of emergency nurse. The MUG/SMUR station is located near a hospital. |
The MUG/SMUR team is always accompanied by an ambulance at the intervention site and can be dispatched at the request of the operator at the 112 emergency centres or at the request of the on-site ambulance crews if they feel that a doctor is required.
On 01/01/2021, there were 84 MUG/SMUR functions in Belgium, 44 of which in the Flemish Region, 33 in the Walloon Region and 8 in the Brussels-Capital Region[4]. Two of these 84 MUG/SMUR functions concern MUG/SMUR helicopters based in Liège and Bruges, which are currently being evaluated as a pilot project. Looking at the number of MUG/SMUR functions per 100,000 residents, there is a greater presence of MUG/SMUR functions in the Walloon Region (0.91 per 100,000 residents), compared to 0.66 and 0.65 per 100,000 residents in the Flemish and Brussels-Capital Regions respectively. The greater presence in the Walloon Region can be explained by the more sparsely populated areas, which require a greater presence of MUG/SMUR functions to ensure rapid care. The aim is to achieve equal access to emergency assistance in the various regions of the country. To this end, the number of MUG/SMURs is determined by programming criteria based on population density and the population of each province, among other things. These were defined in a Royal Decree[5].
Learn more about the location of the recognised MUG/SMUR and PIT functions: www.health.belgium.be
[1]https://www.health.belgium.be/fr/pit-paramedical-intervention-team
[2]Source: Data and Policy Information Service, FPS HFCSE
[3]https://www.health.belgium.be/fr/smur
[4]Source: CIC, Data and Policy Information Service, FPS HFCSE
[5]RD 20 September 2002. - Royal Decree determining the details of the maximum number and the programming criteria applicable to the “Mobile Emergency Group” function
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Typically, an ambulance will transport the patient to the nearest hospital with a specialist emergency care service, as determined by the 112 emergency call centre.
| The nearest hospital is calculated in line with the journey time and not in line with the number of kilometres: e.g. the distance from Egenhoven via N264 to UZ Leuven campus Gasthuisberg is 5km, but the journey time is 9 minutes. The distance from Egenhoven to Heilig Hart Regional Hospital is 4.2km, but the journey time is 10 minutes. In this case, then, the patient will be taken to UZ Leuven campus Gasthuisberg even though the Heilig Hart Regional Hospital is closer, because the journey time is shorter. When a MUG/SMUR intervenes, it is also possible to deviate from the fastest journey time based on diagnosis or need for a therapeutic platform. |
In Belgium, we have two types of emergency services:
- A service for specialist emergency care: this service must be permanently staffed by an emergency doctor and a minimum of 2 nurses, at least one of whom must have obtained the special professional title in intensive care and emergency care. This service must be able to stabilise and restore a patient’s vital signs.
- An emergency first responder service: each critical hospital that does not have a specialist emergency care service must have an emergency first responder service. One nurse and one doctor on duty for the entire hospital are sufficient.
On 01/01/2021, there were 126 emergency departments in Belgium, spread across several hospital campuses[1]. Of these, 3 campuses in the Flemish Region and 1 in the Brussels-Capital Region only have an emergency first responder service. The others are specialist emergency care services.
NUMBER OF EMERGENCY SERVICES PER REGION (01/01/2021)
To find out more about the criteria that a specialist emergency care service or an emergency first responder service must meet.
[1]Source: CIC, Data & Policy Information Service, FPS HFCSE
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Nurses and paramedics need a badge to identify them when they go out in a regular ambulance or a PIT ambulance. This allows them to be easily identified in the performance of their duties. The badge can be obtained by holding a valid licence.
- Paramedics can obtain this licence by taking training at the provincial training centres, passing the exams and having a positive internship report.
- Nurses can also obtain a licence, but are exempted from part of the training at the provincial training centres. Nurses with a special professional title of emergency and intensive care don’t need to take any additional training in order to obtain a badge.
- No badge and therefore no licence are required to perform the MUG/SMUR function.
NUMBER OF CARE WORKERS BY TYPE WITH LICENCE AND BADGE (31/12/2020)[1]
[1]Source: E-CAD, Department of Health Care Professions, FPS HFCSE