Ambulance care has existed for countless centuries and has developed from a simple wooden cart to a modern, state-of-the-art facility. The aim has always been to give the best possible care to the sick and wounded.
The history of ambulance care can also be described through four other timelines – for example, the development of legislation relating to ambulance care in the Netherlands.
In the 15th century, the Spanish army introduced the field hospital. The term ‘ambulance’ originally referred to this type of mobile field hospital, consisting of a horse and cart. The vehicles for transporting the wounded had a different name.
Ambulance transport has existed for a long time and initially used primitive means. Early hospitals used carrying baskets and wooden stretchers, and sick people were also transported by water, for example on the ‘plague barge’ in Amsterdam.
Wheeled stretchers – stretchers slung between two large wheels using a spring suspension system – were first used in the 19th century. Bicycle-drawn stretchers and other wheeled vehicles were also employed for the first time for transporting sick or wounded people.
Motorisation developed in the early 20th century and cars (automobiles) were put to use in transporting the wounded. These cars quickly came to be known as ‘ambulances’ and the term spread around the world during World War I.
In 1907 the first two automobiles for transporting patients took to the road in the Netherlands, quickly followed by further vehicles. These cars were the property of garages and taxi companies, which usually had a telephone. At that time, general practitioners also provided roadside medical care and used such cars for that purpose.
From the 1920s, the GGDs became active in patient transport. They staffed ambulances with nurses and sometimes sent municipal doctors to give first aid on the road. Ambulances had simple equipment: a first-aid kit, a stretcher, splints and sometimes an oxygen machine.
After World War II, the number of traffic accidents increased. New ambulance services were created especially in places where victims had to wait a long time for help. Each municipality had its own emergency telephone number, but contact between a dispatch centre and an ambulance was no simple matter.
The train crash in Harmelen, in the Province of Utrecht, showed clearly that ambulance transport was not well- organised. There was confusion in raising the alarm and the stretchers did not fit in all the ambulances.
In 1971 the Ambulance Transport Act [Wet Ambulancevervoer] (WAV) was adopted. As a result of this:
From 1971 the Ambulance Transport Act (WAV) came into force in stages:
The Minister of Health, Welfare and Sport (Els Borst) and the Minister of the Interior and Kingdom Relations (Hans Dijkstal) presented the memorandum ‘Connected with care’. The memorandum was concerned with emergency medical help in accidents and disasters, and in particular ambulance care and trauma care. Among other things, ‘Connected with care’ introduced the Regional Ambulance Service [Regionale Ambulancevoorziening] (RAV) as the desired future organisational structure.
The Minister of Health, Welfare and Sport (Hans Hoogervorst) sent the Ambulance Care bill to the House of Representatives. The legislative proposal was one of the actions resulting from the 1997 memorandum ‘Connected with care’.
In March 2006, the House of Representatives debated the Ambulance Care bill and approved it.
In late 2008, the Senate dealt with the Ambulance Care bill, which was passed on 2 December 2008. The Minister of Health, Welfare and Sport in 2008 was Ab Klink.
The Ambulance care collective agreement (cao) took effect on 1 January 2011. At the request of Klink, who was Minister of Health, Welfare and Sport until autumn 2010, the ambulance sector worked on agreeing one single cao for the sector. Until then, there had been four different collective agreements in force in the sector. This single sector cao was a major step in improving the quality of human resources policy and professionalising the ambulance sector.
At the beginning of 2011, Minister Edith Schippers of Health, Welfare and Sport announced her intention not to allow the Ambulance Care Act to enter into force. The fact that under the Ambulance Care Act, providers of ambulance care would be granted a licence for an indefinite period was undesirable. In addition, the licensing procedure was considered not to be ‘EU-proof’, which would lead to unwanted financial risks.
On 8 August 2011, the Minister of Health, Welfare and Sport submitted a new legislative proposal, for the Interim Ambulance Care Act, to the House of Representatives. This was an act with a term of five years and the most important change in relation to the Ambulance Care Act was that ambulance care providers would not receive a licence, but would be appointed by the Minister of Health, Welfare and Sport for a period of five years. These five years would be dedicated to preparing a structural solution which would do justice to the principles discussed with Parliament and would also comply with European legislation.
As early as 1997, in the memorandum ‘Connected with care’, the Regional Ambulance Service (RAV) was named as the desired organisational structure for ambulance care. The ambulance dispatch centre and the ‘travelling service’ of ambulances were both made part of the RAV, so that it formed one single integrated organisation for ambulance care.
In advance of the new legislation, the ambulance organisations began to shape the RAV at the beginning of the 21st century. The formal end date of this process was 1 December 2011. The Interim Ambulance Care bill had stipulated that as of 1 December 2011, there was to be one legal entity in each RAV region that could be eligible for appointment under the Interim Ambulance Care Act. On 1 December 2011, there were 25 legal entities in 25 RAV regions, so that the establishment of the RAV was formally completed on that date.
The Interim Ambulance Care bill was debated by the House of Representatives in March 2012 and adopted by the House on 27 March 2012. On 24 April 2012, the Senate adopted the Interim Ambulance Care Act.
This meant that the existing Ambulance Transport Act and the Ambulance Care Act, which had never come into force, both lapsed when the Interim Ambulance Care Act came into force.
The Interim Ambulance Care Act took effect on 1 January 2013. The term of the Act was intended to be until 1 January 2018. After that date, there was to be new structural legislation for the ambulance sector.
With the Interim Ambulance Care Act entering into force:
In February 2016, the Minister of Health, Welfare and Sport informed the House of Representatives of her intention to extend the Interim Ambulance Care Act by two years. There were still too many uncertainties regarding the organisation of the acute care chain and the role that the health insurers could play in this, and also regarding the development of multidisciplinary cooperation and the performance of tasks at the ambulance dispatch centres. It was expected that from 2017 there would be sufficient clarity on these topics to be able to structure ambulance care definitively from 2020.
In 2017, the House of Representatives and the Senate dealt with the legislative proposal to extend and amend the Interim Ambulance Care Act. The bill was passed by the House of Representatives in May and by the Senate in October. This meant that the Interim Ambulance Care Act was extended by a maximum of three years.
A new act governing ambulance care is intended to come into force on 1 January 2021.
In 1992, the joint ambulance care organisations set up the Dutch Ambulance Platform [Nederlands Ambulance Platform] (NAP). Both public and private ambulance organisations participated in the platform, which aimed to present a common policy vision for ambulance care.
The organisations that cooperate in the platform are:
The Association of Dutch Municipalities [Vereniging van Nederlandse Gemeenten] (VNO) participates in the NAP as an observer.
The National Federation for Ambulance Care [Landelijke Federatie Ambulance Zorg] (LFAZ) was set up on 1 January 1998. The LFAZ was set up by KNV Ambulance Assistance and the National Association for Municipal Health Services (GGDs). From its establishment, the LFAZ represented the interests of private and public ambulance services and Central Posts for Ambulance Transport [Centrale Posten Ambulancevervoer] (CPA), where the requests for ambulance care were received.
In 2000 the Professional Association for Ambulance Care [BeroepsVereniging Ambulancezorg] (BVA) was established. The BVA was created through a merger of the VCHV – the association of head and senior nurses (Vereniging van Chef/Hoofdverpleegkundigen, 1959) – and the Dutch Ambulance Association (NAV, 1982). All the professional groups in the ambulance sector were brought together in the BVA.
The association Ambulancezorg Nederland (AZN) was set up in 2001.
The association V&VN Ambulancezorg has been in existence since 1 January 2007. On 20 December 2006, the BVA and the Dutch nurses’ association Verpleegkundigen en Verzorgenden Nederland (V&VN) merged.
The Dutch Association of Medical Managers Ambulance Care [Nederlandse Vereniging van Medisch Managers Ambulancezorg] (NVMMA) was set up in 2008. The NVMMA has the goal of promoting pre-hospital care.
In the mid-1960s, ambulances were equipped with radio telephones.
At the end of the 1980s, a national training programme for Emergency Medical Technicians (EMTs) and ambulance drivers was established.
In 1992 EMTs and ambulance drivers began working according to a national protocol, creating uniformity of care. From that time on, patients with the same symptoms were assisted in the same way throughout the Netherlands.
In addition to the introduction of the protocol, the 1990s saw a major increase in the amount of equipment kept in ambulances, for example cardiac care equipment and a ventilator.
National agreements were reached on the clothing of ambulance staff, with the aim of enhancing recognisability.
The sector worked towards creating larger organisations, consisting of one or more ambulance services and an ambulance dispatch centre (previously CPA). In 1976 there were 236 organisations and in 1995 the total was down to 129.
Two basic documents for the ambulance sector are the Policy Document on Responsible Ambulance Care [Nota Verantwoorde Ambulancezorg] and the Uniform Glossary of Ambulance Care Terms [Uniform Begrippenkader Ambulancezorg] (UBK). Both documents were revised in 2007 and approved by the AZN Board. The documents contained, for the first time, a clear and uniform description of the ambulance care process.
The Healthcare Quality, Disputes and Complaints Act [Wet kwaliteit, klachten en geschillen in de zorg] (Wkkgz) regulates two important matters: quality and the right of complaint. The Wkkgz partially replaced existing legislation, but also contained new provisions and obligations. The Act came into force on 1 January 2016, with a six-month transition period for the quality section and a one-year transition period for the complaints section.
In 1971, the Ambulance Transport Act [Wet Ambulancevervoer] (WAV) was adopted. As a result of this:
There was a need for a nationwide system for reporting emergencies and in 1986 the 06-11 emergency number was introduced.
Since 1997, there has been a single European emergency number: 112.
Minister of the Interior and Kingdom Relations, Guusje ter Horst, announced in a letter to the Safety Consultative Body that she wanted to change the existing dispatch centre structure. Her aim was to form a single national dispatch centre organisation with at most three locations. The situation at that time – with more than 20 dispatch centres with their own facilities, which were not sufficiently interchangeable or standardised – was no longer considered sustainable.
The Security Regions Act [Wet veiligheidsregio’s] (WVR) came into force on 1 October 2010. In accordance with the Ambulance Care Act, the RAV regions are aligned with the Security Regions. Section 35 of the WVR states that the Security Region is responsible for setting up the regional ambulance dispatch centre. The director of an RAV is responsible for maintaining the Ambulance Dispatch Centre.
Before the signing of the Transition Agreement on the Dispatch Centre of the Future on 16 October 2013, Ivo Opstelten, the Minister of Security and Justice (VenJ), announced where the 10 future dispatch centres would be established.
In 2010 the formation of a national dispatch centre organisation was announced. On 16 October 2013, the parties concerned signed the Transition Agreement on the Dispatch Centre of the Future. These parties were the ministers of Security and Justice; Health, Welfare and Sport; and Defence (on behalf of the Royal Netherlands Constabulary); the Safety Consultative Body and all the chairs of the Security Regions; Ambulancezorg Nederland and all the chairs of the RAV boards; and the National Police Board.
On 1 January, the quartermasters’ organisation, the National Dispatch Centre Organisation [Landelijke Meldkamerorganisatie] (KLMO) began its work. The KLMO prepared the ground for the new national dispatch centre organisation.
The National Dispatch Centre Organisation had what is called a multi-governance management board, in which all the parties that signed the transition agreement were represented. The ‘highest’ administrative body was the administrative coordination group LMO. The coordination group was concerned about the progress being made in forming the LMO and decided in January 2016 on a reorientation of the process.
The reorientation of the LMO was set out in the decision memorandum on the reorientation of the LMO. The administrative coordination group LMO began to deal with the decision memorandum on the reorientation of the LMO in autumn 2016.
From 2020:
