Rescue service in Europe: Belgium
Legal basis In Belgium there are currently two different systems responsible for rescue services in the country: on the one hand, the public medical rescue service (aide médicale urgente), regulated by the Belgian rescue service law of 8 July 1964, amended by the law of 22 March 1971 and the relevant directives; and on the other hand the private, generally unregulated emergency and ambulance services (services d’ambulances), which are only subject to regulation statutes on vehicles and personnel.
Organisation The public rescue service is responsible exclusively for emergencies and is carried out by teams of first-aid physicians. The primary task of these doctors is to look after persons who, due to acute illnesses or accidents, require urgent medical care, as well as the care of the sick and those injured in domestic accidents, or in cases where no private emergency service is available. The public service is moreover also responsible for transporting patients between hospitals. These duties are generally performed according to the rendezvous system, i.e. a first-aid vehicle stationed at the clinic is driven with a team of first-aid doctors to the scene of the emergency and there meets up with the emergency ambulance. The team of first-aid doctors consists of a nurse specially trained to deal with emergency cases and a doctor. The basic principle is the “nearest-vehicle” strategy, i.e. the central control station will deploy the service team that is the shortest distance away from the scene of the emergency. The waiting time for emergency services is 5 to 10 minutes and targets are considered fulfilled when this time achieved in 90% of the cases.
Control Stations The public emergency service has since 1997 been directed by 10 control stations, i.e. the number of provinces in Belgium, all of which can be reached through the same emergency number “100”. All control stations, referred to as “centre 100” due to the emergency phone number, are linked to the fire service and are generally staffed by two members of that service with no special medical training. Control stations have authorisation to direct the services, institutions and doctors linked to the “centre 100” system.
Medical participation Physicians are mostly assistant doctors in the fields of surgery, anaesthesia or inner medicine, for whom a 120-hour course in emergency/intensive medicine and practical experience is recommended.
Air rescue At the moment the Belgian air force has provided one or two helicopters for emergency sea rescue, as well as a helicopter rented by the St. Jan hospital in Brügge for several months each year for use in further rescue operations. Discussions are currently under way on how an air rescue service could be integrated in the existing emergency system, although this is not considered to be particularly urgent by the Belgian government due to the good distribution of the hospitals linked to the centre-100 system and the relative small size of the country.
Personnel/ Training A training course as “Ambulancier DGH” is required for all personnel active in the public emergency service. This course comprises 60 hours of theoretical and practical instruction, often supplemented by 40 hours of hands-on training in an emergency clinic and in an ambulance. Moreover, a 60-hour course of further training is mandatory at five year intervals. Training of personnel in the private emergency service varies greatly due to the lack of statutory requirements, and ranges from no training at all, through a 40-hour course of first aid to a 60 to 100-hours training course as rescue assistant.
Funding The system is financed through a public-utility foundation which is funded in equal parts by the health ministry and a mandatory contribution from insurance companies. Concrete expenses incurred in transport and treatment are generally borne by the health insurance companies. | 
