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PROTOCOL OF AMENDMENT
OF THE AGREEMENT BETWEEN THE GOVERNMENT OF THE REPUBLIC OF LATVIA AND THE GOVERNMENT OF THE REPUBLIC OF LITHUANIA ON THE CROSS-BORDER COOPERATION IN THE PROVISION OF AMBULANCE SERVICES IN THE BORDER AREA BETWEEN THE REPUBLIC OF LATVIA AND THE REPUBLIC OF LITHUANIA,
SIGNED ON 3 OCTOBER 2018

the Government of the Republic of Latvia and the Government of the Republic of Lithuania (hereinafter referred to as "the Contracting Parties"),

pursuant to Article 12 of the Agreement between the Government of the Republic of Latvia and the Government of the Republic of Lithuania on the cross-border cooperation in the provision of ambulance services in the border area between the Republic of Latvia and the Republic of Lithuania, signed in Bauska on 3 October 2018 (hereinafter referred to as "the Agreement"),

have decided to amend this Agreement as follows:

Article 1

Articles 2, 3 and 10 of the Agreement shall be worded as follows:

"Article 2
Definitions

For the purposes of this Agreement, the following terms shall have the following meanings:

'ambulance crew' means a team consisting of persons authorised to provide outpatient ambulance services, equipped with a specialised ambulance vehicle meeting European Union harmonised technical and quality requirements, including medicines, medical devices, personal protective equipment, rescue and safety equipment, as well as communication equipment;

'ambulance services' mean the provision of emergency medical services by an ambulance crew for the purpose of the initial diagnosis and care in life-threatening critical conditions, including the processing of emergency calls and the dispatch of ambulance crews as well as the transport of patients to the nearest institution capable of providing the necessary inpatient care in the territory of the State of the aid-requesting Contracting Party;

'state border' shall mean the state border between Latvia and Lithuania in accordance with the Treaty concerning the restoration of the State border between the Republic of Latvia and the Republic of Lithuania, done at Biržai on 29 June 1993;

'border area' shall mean municipalities of the Republic of Latvia and the Republic of Lithuania bordering the state border, where the ambulance crew operates and provides services;

'competent authority' shall mean the institution to which the Contracting Party concerned has delegated the right to establish direct contacts and to conclude Sub-agreements under this Agreement;

'case of emergency' shall mean an event that requires the immediate provision of emergency medical services to the person(s) in life-threatening situation;

'ambulance service providers' shall mean legal entities having an ambulance crew and responsibility for provision of ambulance services.

Article 3
Competent authorities

1. The public institution of the Republic of Lithuania, the Ambulance Service shall act as the competent authority of the Republic of Lithuania, which shall be authorised to establish direct contacts and conclude the Sub-agreements in accordance with the terms of this Agreement, as well as to implement and supervise them. The public institution of the Republic of Lithuania, the Ambulance Service shall have the right to:

1.1. register calls for an ambulance crew, or not to register them, and dispatch an ambulance crew;

1.2. complete performance of actions related to ambulance services at the scene;

1.3. define the operational area of individual ambulance crews;

1.4. ensure and coordinate the technical fluency of messages;

1.5. record detailed medical information on ambulance services provided;

1.6. strengthen and improve liaison, organise and deliver cross-border ambulance services, as well as provide joint training;

1.7. assess and monitor the quality and safety of ambulance services provided.

2. The State Emergency Medical Service of the Republic of Latvia shall act as the competent authority of the Republic of Latvia, which shall be authorised to establish direct contacts and conclude the Sub-agreements in accordance with the terms of this Agreement, as well as to implement and supervise them. The State Emergency Medical Service of the Republic of Latvia shall have the right to:

2.1. register calls for an ambulance crew, or not to register them, and dispatch an ambulance crew;

2.2. complete performance of actions related to ambulance services at the scene;

2.3. define the operational area of individual ambulance crews;

2.4. ensure and coordinate the technical fluency of messages;

2.5. record detailed medical information on ambulance services provided;

2.6. strengthen and improve liaison, organise and deliver cross-border ambulance services, as well as provide joint training;

2.7. assess and monitor the quality and safety of ambulance services provided.

3. The competent authorities shall conclude a Sub-agreement specifying the exact procedures for requesting and providing aid. This Sub-agreement shall enter into force on the date of its signature.

Article 10
Obligation to Exchange Information

The competent authorities shall immediately inform each other through diplomatic channels of all organisational and legal changes that may influence the implementation of this Agreement".

Article 2
Final Provisions

1. This Protocol shall form an integral part of the Agreement and shall enter into force on the date of receipt of the last written notification by the Contracting Parties about the fulfillment of the necessary internal procedures required for this Protocol to enter into force.

2. This Protocol shall cease to have effect upon termination of the Agreement.

3. The Sub-agreement referred to in paragraph 3 of Article 3 of the Agreement shall be signed no later than three months after the date of entry into force of this Protocol.

Done at Joniškis on the 11 of July 2024, in duplicate in Latvian, Lithuanian and English languages, all texts being equally authentic. In the event of any divergence in the interpretation of the provisions of this Protocol, the English text shall prevail.

ON BEHALF OF THE GOVERNMENT OF THE REPUBLIC OF LATVIA	ON BEHALF OF THE GOVERNMENT OF THE REPUBLIC OF LITHUANIA
Hosams Abu Meri Minister for Health	Arūnas Dulkys Minister of Health