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Last Updated: 13 December 2024

Belgian Medical Regulation Manual

The Belgian Medical Regulation Manual (BMRM) is a guide for operators at the 112 emergency centre. The severity level of the caller’s situation is determined with the aid of flow charts specifically drawn up for each medical protocol. Based on the severity level, the most appropriate resource is then chosen (MUG/SMUR, PIT, ambulance, on-call station or general practitioner).

To find out more about the Belgian Medical Regulation Manual:
https://www.health.belgium.be

Standing orders

The actions that the paramedic is permitted perform have been regulated by law. Based on this, the Federal Council for Emergency Medical Assistance worked on a national standing order template where specific examples of procedures are given. The bundle of standing orders gives the paramedic a helping hand when they need to carry out the actions assigned them.

The standing orders also focus on working with the PIT nurse and/or the MUG/SMUR doctor.

To find out more about the standing orders for paramedics:
https://www.health.belgium.be

The nurse who is part of a PIT also works in accordance with standing orders that have been agreed upon with a doctor. These actions appear in the list of technical provisions drawn up by the Technical Commission for Nursing, known as B1, B2 and C actions.[1]

^{[1]More information about these specific actions can be found here.}

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Last Updated: 18 December 2024

Provincial Commission for Emergency Medical Services (PCDGH/COAMU)

The Provincial Commission for Emergency Medical Assistance (PCDGH/COAMU) promotes collaboration between the services and people working in emergency medical assistance. The provincial commissions are composed of several representatives from the sector and are chaired by the relevant federal health inspector. 

To find out more about this commission:
https://www.health.belgium.be

Federal Council for Emergency Medical Assistance (CFAMU)

The Federal Council for Emergency Medical Assistance[1](CFAMU) is a body that advises the Federal Minister for Public Health on the organisation and functioning of Emergency Assistance.

General operation of the CFAMU
The CFAMU advises on the functioning of the ambulance services and the training of people involved in emergency medical assistance. The Council should evaluate the quality of practice based on scientifically sound criteria. Moreover, the CFAMU has an important role in shaping the accreditation standards for ambulance services and the criteria applicable to scheduling these services.

The Council is composed of professionally active representatives from the following organisations:

For more information on this consultation body:
Federal Council for Emergency Medical Assistance | Public Health (belgique.be)

The Council sets up working groups with a well-defined remit and seeks the advice of experts of its choice. Conclusions from the working groups are sent to the Minister through the Council’s Office in the form of recommendations.

 
Four working groups to overhaul emergency medical assistance
On 22 October 2022, the Federal Minister of Public Health, Frank Vandenbroucke, asked the CFAMU for an opinion on the use of additional budgets granted to emergency medical assistance.

The total budget for emergency medical assistance would then be 239,670,000 euros in 2025.

In 2022, the CFAMU comprised four working groups designed to provide the best response to the Minister.

1. One group responsible for defining the accreditation and operational criteria of the PIT;
2. One group responsible for optimising medical regulations;
3. One group responsible for scheduling resources within emergency medical assistance;
4. One group responsible for funding.

1. PIT Working Group

The PIT working group is responsible for defining the outline for the development of the legislative framework on the Paramedical Intervention Team (PIT) as a resource for emergency medical assistance.

→ Definition of the requirements that the PIT nurse must satisfy.

→ Specification of the role of the liaison doctor for the PIT: the doctor on the PIT team must be available 24 hours a day, 7 days a week to provide remote assistance to the PIT nurse. 

→ Determination of the recognition criteria for the PIT.

• • • The PIT team must preferably be set up in a hospital with a specialist emergency care service. It is possible to deviate from this if necessary, based on the scheduling.
    • The PIT should preferably be dispatched from a hospital with a specialist emergency care service. It is also possible to deviate from this if necessary, based on the scheduling.
    • The link between the PIT team service and a hospital with a specialist emergency care service must be ensured so that the quality is standard across all PIT services.

The working group will focus on several issues in 2024:

• Standardisation, at federal level, of the standing orders for PITs.
• Definition of minimum requirements in terms of equipment and materials available in each Paramedical Intervention Team.
• Identification of quality requirements for all PIT services.

2. Scheduling working group

The aim of the Scheduling working group is to give opinions on the organisation of emergency medical assistance in Belgium:

• Evaluation of scheduling needs;
• Definition of the Service Level Agreement (SLA) for emergency medical assistance;
• Identification of the resources to be deployed across Belgium, their location, quantity, distribution and use.

These are just some of the issues that will be addressed using a tool to view the current Service Level Agreement in Belgium. The SLA is an agreement between the federal government and the ambulance services, whereby performance indicators and quality requirements are agreed upon based on scientific literature. Some emergency medical situations require a rapid response. It was agreed that a timespan of fifteen minutes between a call to the 112 emergency centre and the arrival of an ambulance team at the scene should be guaranteed in 90% of interventions.

In 2022, for 77% - for which it was estimated that an ambulance, a PIT and/or a MUG/SMUR team had to be called - a first emergency response team arrived on-site within 15 minutes of the call. In 92% of interventions, a emergency medical assistance resource was on site within 20 minutes and in 98% of interventions within 30 minutes.[2]

Depending on which region in Belgium, the percentage of interventions where emergency assistance is on site within 15 minutes of the call being placed varies. It can be noted that this percentage is lower in the Walloon Region.

Within the Scheduling working group, the figures above are analysed in detail and improvements that can be implemented to achieve the SLA are explored.

3. Regulation working group

The Regulation working group is responsible for reassessing the Belgian Medical Regulation Manual in line with the resources available within emergency medical assistance and the definition of the SLA.

• Evaluation of the level of pre-hospital medical care needed for each medical regulation severity level and definition of the timeframes within which this should be carried out;
• Definition of the related transport mode (ambulance, PIT, MUG/SMUR, etc.);
• Definition of the place of the intermediate ambulance and non-emergency medical and health transport in order to examine the extent to which patient transport can be a new element to be defined in the chain of unplanned treatment;
• Definition (and strengthening) of the support to be provided to the 112 operator in terms of medical regulation given the crucial role of the 112 emergency centre in the management of available emergency medical assistance resources according to the needs and the context.

4. Funding working group

The working group is responsible for evaluating the funding of emergency medical assistance. This working group has subdivided its work into three stages.

• Definition of the activation subsidy: the overhaul of the activation subsidy should have been approved by the members of the funding working group before the end of 2023. This first stage was necessary to obtain a significant increase in the budget for the emergency medical assistance subsidy in 2024.
• Evaluation of the funding system for ambulance and PIT services, as it was in force until 2023. This evaluation was carried out considering the changing emergency medical assistance landscape, as it takes shape over the coming years and the impact of the proposals of other working groups.
• Reviews of the funding of other elements of emergency medical assistance such as contingency planning, exercises to prepare for collective emergency situations, emergency centres and emergency services.

^{[1]The Federal Council for Emergency Medical Assistance was previously known as the National Emergency Assistance Council. The tasks of the National Council were set out in the Royal Decree of 4 July 2004. This body was reformed by the Royal Decree of 17 March 2024 on the Federal Council for Emergency Medical Assistance and the Emergency Medical Assistance Commissions.}

^{[2]Source: FPS Public Health and FPS Home Affairs (s.d.). SDS-records, AMBUREG, federal list of on-call rotations, data sets from 112 emergency centres. [Datasets]. Only non-occasional on-call rotation interventions were selected, excluding inter-hospital transport, interventions abroad, planned and unplanned collocations and cancelled interventions and test interventions. In addition, interventions where the time intervals were missing or unlikely were excluded, as were interventions where the contact details were missing or the distance travelled was 0 km or abnormally long.}