A wise man once said that to be a winner, you must “plan to win, prepare to win, and expect to win”.
To see what planning to win looks like, come to lo Stivale, the boot-shaped peninsula whose other nickname means “the beautiful country”. Already famous for architecture, art, opera, literature, film, and fashion, Italy has also won: four FIFA World Cups, two UEFA European Championships, one Olympic 100 meter gold medal, the Eurovision Song Contest (three times), and in June last year Jannik Sinner became the first Italian tennis player at the top of the ATP rankings.
And if the EMS Angels Awards were a contest – which in a way they are – then put your hands together for the beautiful country, because they’re also winning that.
The most EMS awards in 2024? Italy. The most EMS awards since 2021? Italy. Most participating teams in 2024? Italy. Largest number of participating teams ever? Yes, that too. Something else that strikes you when you study the numbers is that, had Italy won the same number of EMS awards in 2024 as in 2023, they’d have ended in third place behind Spain and Brazil. Instead, they won more than twice as many awards in 2024 than in 2023 – 43 compared to the previous year’s 21. Almost one-fifth of last year’s total awards went to a country 28 times smaller than Brazil, which raises two questions – how did they do it, and what exactly happened in 2024?
‘We decided to go for it’
The answer to the first question seems to be that, as soon as the EMS Angels Awards were launched in 2021 (an occasion on which they won not a single award), Team Italy started planning for success. They launched MonitorICTUS – an acronym for ictus territorio urgenza, meaning stroke territory emergency – a twice-yearly data collection activation similar to the already successful MonitorISA that was driving quality monitoring in hospitals.
“As soon as the EMS awards were launched, we created a program with branding specially for EMS,” team leader Silvia Ripamonti says. “The EMS in Italy is complex, it differs from region to region, but we decided to go for it, so we gave it a big push.”
The Italian emergency system is indeed complex. Emergency medical services are controlled regionally under local public health authorities, and their delivery differs by location. In some places EMS is undertaken by the local hospital; elsewhere it’s driven by volunteer organizations. Ambulance services are provided by varying combinations of volunteers, doctors and nurses. On-scene medical care is usually provided by doctors and nurses who also perform advanced life support procedures.
No one understands this complexity better than Dr Matteo Rovera of 118 Novara, the award-winning operations centre that coordinates emergency resources in four neighbouring provinces in northwest Italy’s Piemonte region. In Piemonte, an emergency will activate one of three types of emergency medical vehicles (EMVs) – a rescue helicopter, an advanced EMV carrying doctors and/or nurses supported by volunteer rescuers, or a basic EMV carrying a rescue team of volunteers with basic life support skills.
In 2023, after conducting a survey of prehospital care in his region, Matteo made stroke training for volunteers a priority <link to previous story>. He created an online education course dedicated to stroke basics and local protocols and within three months trained almost 1,000 volunteers. Those who had completed the course were better at recognising stroke symptoms, more accurate when using the Cincinnatti Stroke Scale to assess stroke probability, and, most importantly, they were getting patients to hospital faster.
The fifth Angel
Matteo knew nothing about Angels when in October 2021 his director dispatched him to the inaugural EMS Angels Awards in Lisbon on the grounds that Matteo’s English was somewhat better than his own. It was year two of the pandemic and a a long battle with Covid had left him dispirited. He’d been contemplating a career change and his motivation was low. But in Lisbon things changed.
The next few days would culminate in the formation of the first international EMS steering committee, with Matteo among its ranks. This group, he observes, had a common language besides English. They spoke the language of their profession, and Matteo found himself “playing with joy in the team”.
Now established as Italy’s “fifth Angel”, Matteo is also the national EMS Angels and RES-Q coordinator, and one of the most positive factor in the winning spurt of 2024.
“What happened last year was that we launched the regional Angels strategy, which made EMS part of every conversation. There were lots of regional workshops and we were talking about the awards everywhere.”
“Everywhere” included the regional webinars where Angels consultants provide feedback twice a year on the MonitorISA and MonitorICTUS results. Seeing what others are achieving in the same region drives collaboration, friendly competition, and regional pride.
In July 2024, the EMS Angels Italy Steering Committee held its first meeting – a working group composed of regional representatives, with the aim of sharing local and regional strategies and creating a community. In September, the results of a prehospital stroke network questionnaire confirmed the disparity among regional organization models. These findings informed the agenda of the first National EMS Angels Workshop that took place in Rome on 29 November.
Future meetings of the EMS Steering Committee (in June and November) form part of an action plan for 2025, during which the emphasis will be on driving awards participation and activating a new prenotification protocol.
The steering committee’s approach is very “practical and pragmatic”, the Italian team says. Their 2024-2027 plan sets targets of at least 60 percent success and 80 percent participation. This means a minimum of gold awards status for 40 out of the 72 operations centres nationwide, and 58/72 participating centres.
The EMS community in Italy continues to “plan to win, prepare to win, and expect to win”. For countries that want to join them on the awards table, the Italian teams has three pieces of advice.
One, leverage your relationships with hospitals to drive change in EMS.
Two, create a group of people with a common goal.
Finally, it helps to know the right people, which includes finding that someone who will be your third or fourth of fifth Angel, and be right beside you from the moment you decide to “go for it” and win.
