HERE are some of the things that make the Latvian capital Riga different from capital cities elsewhere in the world.
- It has the highest density of Art Nouveau buildings in the world.
- It has an enormous market located in five former World War I Zeppelin hangars.
- It has the tallest tower in the European Union – at least on hot days, when the metal expands and it beats its German rival by 3 cm.
And, cue drumroll – because Riga recently became the world’s first capital city to be recognized as an Angels Region.
This Latvian first isn’t all that surprising when you consider that Riga is the home of Pauls Stradins Clinical University Hospital, a diamond hospital 28 times over. Having more awards than any other hospital in Europe doesn’t mean they got there ahead of the others – the hospital only won its first award in 2018, one year after the ESO Angels Awards were launched. But since becoming a diamond hospital they have demonstrated the same level of excellence an unbeaten 28 times.
The secret is consistency, says neurologist Dr Kristaps Jurjāns, a 2025 recipient of the Spirit of Excellence award. Under his larger-than-life leadership, Pauls Stradins CUH has become so synonymous with stroke care excellence that one risks forgetting that Riga has another superstar – Riga East Clinical University Hospital, with the same number of awards certificates (including seven diamonds) on their trophy wall.
These hospitals are located on opposite sides of the Daugava river, and serve different referral networks, so it’s fair to say that the city more than meets the first criterion for Angels Region status – access to a high standard of stroke care for all its citizens.
But as Dr Jurjāns always tells members of the national ambulance service (NMPD) in training workshops, there’s no point in the hospital having record-breaking door-to-needle times if patients don’t arrive in time for treatment.
“I always say to them the hospital can work like a factory. But if you don’t bring us the patient or provide us with the information we need, there’s no point in being a super factory. We can have a door-to- needle time of six or seven minutes but there’s no point if the patient came too late or not at all.”
The significance of a seamless and immediate connection between EMS and hospital is of course the precise foundation for the Angels Regions strategy, coupled with the need to educate the community so people can recognize the signs of stroke and the importance of calling 112 without delay.
So with two hospitals at the top of their game, when Angels team leader Rita Rodrigues introduced the goal of converting Riga into an Angels Region early last year, it was understood that their focus would be twofold – a first EMS Angels Award for the ambulance service, and rolling out the FAST Heroes stroke education campaign in the city’s elementary schools.
An auspicious beginning
Rita began working with Riga hospitals in 2018 and led simulations with Riga East Clinical University Hospital in April, and at Pauls Stradins CUH in September. By then, neurologists from the hospital had already attended an Angels Train the Trainer program in Wiesbaden, Germany, and before the simulation commenced, a younger Dr Jurjāns proudly pointed out their first gold certificate outside the stroke unit door.
In the first round of simulation, the team resolved the first case in a fleeting 20 minutes, then found a way to improve on it. What if the hypothetical ambulance team, having pre-notified the hospital, delivered the patient directly to the CT scanner? It was a case of small change, massive impact. By employing these two key priority actions, the second dummy patient was treated within 9 lightning-quick minutes.
Prenotification of suspected strokes is one of five criteria for the EMS Angels Awards that were launched in 2021. For Riga to obtain Angels Region status, the NMPD would have to submit patient data for at least 30 patients to RES-Q in order to demonstrate that hospital excellence was matched by prehospital excellence, and that stroke patients in Riga reached the “factory” in time to be given a second chance at life.
Data extraction and filtering and getting the appropriate permissions from national coordinators took time, but in March 2025, the project got a boost when, at Dr Jurjāns's suggestion, the first joint hospital and EMS Train the Trainer event was held in Mainz, Germany. Twenty pairs of attendees from 10 countries were nominated for the event, each pair consisting of a neurologist and EMS professional from the same region. The expectation was that this would positively impact regional performance, and in Latvia, that was exactly what happened.
At the end of July, Rita announced to the Angels team that Latvia had won an EMS Angels platinum award, having submitted data for 1,231 patients in a single quarter. Three months later, they earned a diamond award.
Everyone can be a hero
FAST Heroes implementation targets are population-based. In Riga it was estimated that 48 class rooms would have to join the campaign to keep grandparents in the capital safe. That in the end with a great effort from the Center for Disease Prevention and Control, Riga sailed over the finish line with 63 classes under its belt owes a great deal to Dr Jurjāns, who, as campaign ambassador, became something of a cheerleader and Pied Piper.
Several things fell in place almost at once. The education department in the mayor’s office agreed to encourage participation in schools. The Center for Disease Prevention and Control set aside some money to support the project, and, as is fitting in a city with a thriving cultural scene, a play based on the FAST Heroes campaign was performed for an audience of aspirant superheroes from four schools – Incukalns Elementary School, Džukte Elementary School, Jurmala Pumpuru High School and Valmiera Pārgauja Primary School.
The play was created in collaboration with independent theatre group Kvadrifons, and the script underwent expert scrutiny from Dr Jurjāns himself, who also made an on-stage appearance to answer questions from the audience.
“By educating children at an early age, we are creating a society where everyone can become a real hero,” Dr Kristaps says. In Latvia, where basic health education is no longer part of the curriculum, teaching children how to prevent stroke will certainly benefit the overall health of the community.
With close to one million people living in the Riga metropolitan area, Angels Region status for the capital means well over a third of Latvians are now living in safe city for stroke and can expect standardized care no matter where they are.
Now, here are some of the things that make Latvia different from countries elsewhere in the world.
- It has the widest waterfall in Europe.
- It has one of the world’s oldest flags – the red background with a white stripe dates back to the 13th century.
- Its national animal is a ladybird.
- In 1510, it was the location of the world’s first decorated Christmas tree.
By 2027, will it be the world’s first Angels country? You’ll hear it here first.
