There are few things worse than being rushed to a Russian hospital. Not being rushed is definitely one of them.


"I do this job as well as I can," said Valery, who for the past three years has worked as a driver of one of Moscow's 980 skoraya pomoshch, or quick help ambulances. "And so do the doctors. But look at the conditions we're working under. This car breaks down on a regular basis. I couldn't even get somewhere in a hurry if I needed to."


Russia's notorious red-and-white ambulances have long been a major player in the country's endless saga of medical horror stories. In addition to regular breakdowns, Valery's clattering van suffers from a complete lack of shock absorbers and, aside from a no-frills stretcher, is virtually empty.


Sheer mechanics are only part of the emergency service problem. Sluggish response times, incompetent attendants, and drivers -- like Valery, who declined to give his last name -- who sometimes use their vans to pick up passengers for cab fare are all common complaints, and can add up to fatally low odds for anyone in need of emergency care.


"The cars are not the worst of the problem," said Igor Elkis, the head of Moscow Ambulance Service, which comprises 44 dispatching stations and a squad of roughly 980 ambulances, 250 of which are new and comparatively sterling Mercedes models purchased by the city and the state gas monopoly Gazprom. "The new cars have helped a lot. The biggest problems are the slow arrival time, the low salaries and having the money to rent the ambulances."


The service, however, may soon be getting a much-needed overhaul. A two-month study of the service, sponsored by USAID, has pronounced the situation flawed but fixable, and has laid the groundwork for helping Russia's capital city make the move to Western-standard emergency service.


The results of the study, conducted by Andersen Consulting and members of the Moscow Ambulance Service, were concluded last week after 145 observation hours of the '03' emergency service. The conclusions were worrisome, if not necessarily unexpected: According to a project executive summary, crews at local ambulance stations were effective during only 45 percent of the observation time.


Response time to calls incoming to the emergency service are slow -- according to a project proposal, only 30 percent of calls are currently fielded within the first six rings -- and operators often fail to get adequate information from callers, or lose information during the dispatching process, according to the summary. Once dispatched, urgent calls are not always responded to in time, and after the ambulance has arrived, the medical care provided by its staff is "sometimes inadequate."


Surprisingly, the study also concluded that in certain areas, staff levels were 50 percent higher than ideal requirements for maximum efficiency. Problems with rapid turnover rates, "nonexistent" performance monitoring and inadequate salaries -- ambulance doctors earn the ruble equivalent of $80 a month -- were also listed as probable cause for the flagging service.


But in as little as two years, most '03' calls could be answered before the fourth ring, ambulances could reach their destinations within 25 minutes and the salaries of employees could double. And according to the project results, the ambulance service could finance these changes with only a 5 percent increase in its yearly budget -- currently $48 million -- for 1995-97.


The hard part is convincing the Moscow city government that it has the resources on its own to make the proposal a reality without any boosts from foreign aid.


The ultimate success of the emergency service enterprise depends on the success of the Municipal Finance and Management project, a two-year cooperative venture between Moscow and Research Triangle Institute, a USAID contractor, aimed at teaching the city the finer points in money management.


"This is clearly a pilot. The management intervention study is being used to show how this information could be used by the Moscow government," said A. R. Sharp, RTI's chief municipal advisor in Moscow, who added that the project results will be presented to the mayor's office later this week. "This isn't about the American government coming in with bucketfuls of money."


Elkis said he was pleased with how the project had been handled to date and that city health officials familiar with the results had so far been supportive. Igor Nadezhdin, head of the press center for city health services, declined to comment on how the city planned to utilize the proposal, saying only that it had received the project results.


"It would be nice if it worked," said Valery, who hadn't heard of the MAS enterprise. "But there are lots of ways for the city to spend its money. The way they see it, problems with the ambulance service probably aren't as urgent as some other things."