Recently, I have read a chain of stories about a health care crisis that, until I moved to Sweden, was barely on my radar. And coming from the US, a country mired in health care woes, I thought I had heard it all.
In recent months, newspapers around Sweden have reported a slow trickle of deaths connected to the slow or lack of response from ambulances.
On March 27, The Local reported that a young woman in Timrå died after being denied ambulance services even after her third call begging for help. And just two weeks earlier, on March 14th, The Local ran a story about a man in Stockholm for whom, after three calls and thirteen hours, the ambulance arrived too late. There are two similar articles from the month of February as well. And these are just the deaths.
While an emergency operator undoubtedly has a tough job, one piece of it sounds fairly straightforward: if someone asks for an ambulance, in most cases, they probably need it.
So why are these people being denied?
I wondered this to myself when I first moved here, and the question stayed in the back of my mind until we ourselves had to call an ambulance. After that, it was clear to me where things can go wrong.
Our son Erik has the unfortunate distinction of breaking his arm in two countries. And in neither of these cases was there any doubt that his arm was really, horribly broken.
About a year ago, Erik was playing on top of a built-in bunk bed (a piece of furniture we never would have chosen ourselves) when his friend accidently knocked down the curtain covering a skylight. This skylight sits about a foot away from the bed, and Erik reached up to fix it. He then returned to what he thought would be the side of the bed, but his guess was a little off; he fell straight down, directly on his arm.
From across the house, we could hear these were no ordinary screams. One look at him confirmed my suspicion—the bottom half of Erik's forearm was pointing the wrong way. Anyone who had ever seen the sight of a limb so clearly broken will never forget just how terribly wrong it looks—the image is forever imprinted in my mind.
It was at this point, as I was standing over my son writhing in pain and fear, that I realized I had never bothered to find out what the Swedish emergency number was. I'm sure I had seen it somewhere before, but it hadn't registered. Luckily, I wasn't the only one at home.
My husband tried to comfort Erik while holding his own fright at bay. Meanwhile, I dialed 112. The conversation went something like this:
“My son fell off our bunk bed and broke his arm. We need an ambulance.”
“Is he conscious?”
“Does he have any other injuries?”
“I'm not sure. We haven't really checked.”
Did he break his back or neck as well? I hadn't considered this possibility. This thought is not calming me down.
“How high is the bunk bed?”
In my panic, the question stumps me. This sounds ridiculous now, in the quiet of my now-peaceful home, but I blanked. After less than a year in Sweden, I hadn't entirely gotten used to the metric system, so in the panic of the moment, I couldn't come up with an instant estimate.
“Um… one meter? Two meters?”
“Well, which one is it? There's a big difference,” she snaps at me.
“I'm not sure. The regular bunk bed size?”
She is silent.
As Erik's screams carry through the house, a new thought dawns on me.
“You haven't asked for my address yet. Aren't you going to send an ambulance?”
“No,” the operator patiently explains—that's not how this works. First, she needs to decide if we need an ambulance. Then, she needs to decide how to prioritize our call if someone else in our area happens to call when the ambulance is on its way.
I can hear my Swedish is getting worse by the minute, but experience tells me that switching over to English isn't going to make things better.
“My son's arm is pointing the wrong way, and it's possible he had other injuries we didn't notice immediately. I'm sure he needs an ambulance. And it's really hard to concentrate on your questions when he is in so much pain and I know the ambulance is not coming.”
But she continues.
Even in the midst of this crisis, I'm incredulous.
Do I have to convince this woman that I need an ambulance? Is the burden of proof on me? That is to say, is my son's care resting on my persuasive abilities…in a foreign language?
Now, there are a lot of things wrong with the US health care system. After lengthy wait lists, coverage denials and nurse strikes (including on the day of my daughter's birth), I wasn't sorry to say goodbye to that system.
But here's one thing that, for the most part, I could rely on: if I call an ambulance, it will come. In fact, if I call them by mistake and hang up, they'll call me back just to make sure I don't need help. No convincing necessary. This was true when I lived in suburban Michigan, rural New Hampshire, and New York City (not the nicest part), and it was true in San Francisco.
Here's the beginning my conversation with the US emergency medical services for Erik's identical arm injury, two years before:
“My son fell off the monkey bars and broke his arm. I need an ambulance.”
“Where are you?”
“Golden Gate Park, the playground by Fulton Street.”
“An ambulance is on its way. Please stay on the line.”
No convincing involved.
Don't get me wrong; I'm not making any broader suggestions that Sweden's health care system should look more like the US's. My point is just the opposite: if a country with such a fractured health care system can make ambulance services work, shouldn't Sweden be able to as well?
After experiencing the same injury in both countries, it seem as though a system which provides more ambulances, more often would benefit the health of all people living in Sweden. Yes, this solution costs more, but isn't this particular cost worth it?
By the end of our ten-minute-long conversation, the Swedish operator couldn't promise me an ambulance any time soon. And in this case, there was no doubt that Erik needed a hospital, not even in the operator's mind—she just wasn't sure about our ambulance status. I hope I never have to find out what happens when the symptoms are more fuzzy.
The intentions behind the Swedish process are good: a more careful screening of emergency victims is intended to cut down on wait times and guarantee care… and possibly save money. But in a twist of irony, instead of feeling as though the care I need is guaranteed, the current model has undermined my confidence that I will get that care at all.
As an immigrant with imperfect Swedish, I felt especially vulnerable. After Erik broke his arm, my conversation left me with the feeling that our emergency care rests on a decision made by one bureaucrat behind a desk, not a group of people concerned with my son's safety. In a new country that I'm still figuring out, I don't want to be concerned that an ambulance might not come, despite my protests.
The Swedish model of care gets so many things right. Having experienced both systems with kids, overall, Sweden's has been a huge relief for us.
I hope that, with all the recent publicity, Sweden can re-think the current emergency care model so it can get this right, too.
Rebecca Ahlfeldt is an American ex-pat writer, translator and editor currently based in Stockholm.