
Appointing paramedics in schools will help solve the nursing shortage crisis. An analysis conducted by the Paramedics Union on medical assistance in schools showed that these are mainly incidents, injuries, and emergency conditions. Paramedics are specifically trained in first aid. However, the regulation for school health offices limits school administrations to hiring only nurses and feldshers. In Bulgaria, there is a shortage of 30,000 nurses, and the profession of „feldsher“ no longer exists – it has been replaced by „health care practitioner“. As a result, some schools cannot provide the required „medical personnel.“
The Paramedics Union in Bulgaria suggests to the Ministry of Health that the strategy to increase the number of nurses should consider changing the regulation, allowing paramedics to be appointed in schools. This would reduce the shortage of medical professionals in school healthcare, ease their workload, and allow the nursing qualifications to be utilized where they are especially valuable – in hospital and pre-hospital care. Paramedics in schools would save the state a significant financial resource, as their training is shorter and more specialized.
„We’ve had many discussions with colleagues from school healthcare. Our goal is definitely not to replace nurses with paramedics, but to establish a model of cooperation and lighten their workload, as there are practices in a number of European countries,“, lawyer Iva Pehlivanska, president of the Paramedics Union, commented.
The Union prepared an analysis of the activities of medical professionals in schools. Under the Access to Public Information Act, inquiries were sent to all regions in the country regarding the most common cases handled by medical professionals in schools during the previous two academic years – 2022/2023 and 2023/2024.
In an average school with 700-1000 students, between 100 and 300 visits are registered in the health office annually. 10% of the cases are related to incidents requiring wound treatment. Another 10% concern the worsening of chronic diseases. The remaining 80% are cases such as fever, stomach pain, headaches, toothache, nosebleeds, insect bites, rashes, tick removal, etc. A team from the Emergency Medical Center is called in 1% of all cases – no more than three times a year for a single school. In Sofia, for example, in 174 schools, emergency medical teams were called to 100 cases during one academic year, averaging twice per school per year. During one academic year, Sofia schools recorded 32,924 visits to the health office, which averages to 190 visits per school – about one per day.
“A qualified nurse is irreplaceable in hospital care. But in schools, she bandages wounds once a week, and the rest of the time she is called for all sorts of tasks. She fills out logs, writes reports, prepares health education and hygiene plans, and even participates in students’ career orientation. Some of these tasks can be taken over by a paramedic. The regulation for health offices in kindergartens and schools states that emergency medical care is provided for children and students until the emergency medical team arrives. Neither the nurse nor the paramedic can make diagnoses or prescribe treatment. This is done by the doctor, and there is no doctor in the school. Therefore, the medical professional in the school is authorized only to provide first aid, notify the parents and the child’s general practitioner, and call the emergency medical service,”, Iva Pehlivanska argued. She argued that many paramedics are already working in children’s camps and accompanying sports teams at competitions.
Some of the nurses, for example, shared that teachers often send children, especially first-graders, to their offices simply because they are „crying“ or „upset“, and the teacher wants to make sure „nothing hurts.“
„The nurse cannot prescribe treatment even for a headache because she does not have that right. She ends up acting as a psychologist and social worker,“, Iva Pehlivanska commented.
In cases of toothache, ear pain, fever, a foreign object in the eye, or pain during menstruation, the only thing the nurse can do is send the child home and notify the parent.
„A nurse from a vocational high school shared that she had a fainting student from hunger. She bought him breakfast, and he told her that this often happened—his grandmother took care of him, his mother was abroad, and his father had abandoned them. The boy needed someone to listen to him. These are very human stories, but they are far from the professional qualifications of a healthcare specialist,“, Iva Pehlivanska pointed as an example.
In several European countries, it is also not common to appoint nurses in schools, as their work is highly specialized and expensive. European practices demonstrate a significant commitment to providing health services to students by applying flexible and integrated solutions. In Germany, schools cooperate with local health services, and regular check-ups are conducted by doctors. In Austria, schools also do not hire their own medical staff, and teachers are trained to handle chronic conditions, such as diabetes in children. A similar approach is used in Switzerland.
Countries where nurses work in educational institutions, but are also responsible for vaccinations, contraception, and promoting a healthy lifestyle, include Finland, Sweden, Norway, France, and Denmark. There, each school has a medical team that includes a nurse, social worker, and psychologist.
In the United Kingdom, several schools share a single nurse, and emergency cases are handled by paramedics. Social workers are also assigned to take care of mental health. For sports events and major gatherings, schools across Europe additionally provide paramedics.
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