Ambulance interior

Simple and Reliable: 5 Myths That Prevent Ambulance Services From Expanding in Developing Countries

Jason Friesen is the Founder and Executive Director for Trek Medics International, a non-governmental organization that builds emergency medical systems in countries that don’t have them. Friesen is also an OnFrontiers expert.

During a decade of helping develop ambulance services in more than 10 countries, he’s encountered multiple situations, ranging from hospitals with one ambulance to governments with 150. He’s also repeatedly faced obstacles regarding perceptions about how complex ambulance services should be in order to effectively aid local communities. He addresses those obstacles and counters them in this post:

 

In the case of acute medical conditions where time is a critical determinant of outcomes – like Ebola, cholera and injuries – improvements to prehospital emergency response systems are crucial in reducing premature death and disability at the local level. Yet within the international health community there are comparatively few organizations with a proven track record of implementing effective prehospital systems. Just think of the last time you were in a developing country and needed to call an ambulance and you’ll get the idea; outside of the wealthiest nations, emergency medical care and transport is usually limited, unreliable and generally restricted to the wealthiest communities or international organizations.

The reason for this lack of access to prehospital emergency services is pretty straightforward: Without lots of public funding and well-maintained roads throughout the area, it’s difficult to replicate the 24/7, door-to-door, on-demand emergency medical services (EMS) system that are found in wealthier countries. Nonetheless, the need for more ambulances and community health workers is becoming more pronounced; as public health scares resulting from disease outbreaks, natural disasters and terrorism continue to threaten large populations, communities will want to be better prepared and budgeting decisions will need to be made.

This is an attempt to counter several recurring myths regarding emergency medical response systems. The hope here is to shed some light for health-care managers and policy makers who have been tasked with designing and building ambulance services in communities that have never had 24/7 emergency medical response before.

Myth 1 – A good EMS system is defined by its ambulances

A good EMS system is defined by speed, quality and reliability. While the core purpose of an ambulance is to quickly retrieve and transport the sick and injured to the nearest and most appropriate healthcare facility, the shape and contents of those ambulances are an entirely different story. Ambulances typically grow in size (and expense) as the equipment that is stored in them increases; few ambulances were designed to safely transport more than one patients on their back.

Myth 2 – Advanced training for prehospital personnel will ensure the best outcomes

The best emergency response training is basic first aid – everything beyond that increases cost and ambiguity in outcomes. The best example of this is cardiopulmonary resuscitation (CPR), universally recognized as a life-saving intervention that can be taught cheaply to just about anyone. What they don’t tell you is that CPR has a very low probability of positive outcomes – around 7-8% of persons undergoing CPR will survive, assuming you live in cities with the most advanced (and costly) EMS systems in the world. If there’s no EMS system to speak of in your community, you won’t need advanced training for some time.

Myth 3 – Public ambulance services need to be provided free of charge

Not true. Ambulances, fuel and repairs are expensive. It is true that ambulances are ripe for price gouging, but requesting reimbursement for services provided is just smart and responsible management. All countries do it differently: Some ambulance services are covered entirely by government insurance, others are covered by a mix of public and private insurers, and in the US there’s also plenty of out-of-pocket payers, which is by no means ideal. Whatever the case, the ambulance services that thrive are able to cover their costs through reimbursements, subsidies or a mix of the two; without a plan to subsidize costs from other revenue sources, the best cost plan is to keep overhead low.

Myth 4 -Helicopter ambulances save lives and are sustainable

If you don’t yet have a basic EMS system with ground ambulances that reliably provide emergency care and transport to the majority of the targeted population, then a helicopter ambulance is going to be a distraction and a large drain on financial resources. New helicopters are sure to grab headlines, but their ability to drastically improve patients outcomes, from a public health perspective, is anecdotal. Based on the history of air ambulances in the United States, the takeaway is pretty simple: don’t put the helicopter before the truck. For the private citizens and organizations who can afford them, helicopter ambulances are a great item to have, but they shouldn’t be much of a consideration for public emergency systems if the average citizen can’t call for a regular ambulance.

Myth 5 – Emergency dispatch systems require lots of resources because of their complexity

It’s easy to imagine what an emergency communications center would look like: Platoons of dispatchers wearing headsets sitting in front of a theatre of computer screens filled from top to bottom with live feed cameras, multi-color maps, scrolling lists, and endless news tickers. For NASA, the military and unified command centers, this may be the case. For your run-of-the-mill dispatch center responding to car wrecks, pregnant women and other ‘routine emergencies’, a simple laptop or even smartphone would do.

The communications systems built for Western countries were originally developed in the 1950s and 1960s with landline-based infrastructure in mind. Now that mobile phone towers have overtaken copper telephone wires, these same countries are struggling to accommodate all of the different technologies. In countries and communities that went from limited phone access to widespread mobile phone coverage, emergency communications systems can be managed through basic mobile phone technologies.

An effective emergency medical system, at its core, does four things very well:

  • It makes it easy for the public to call for help from anywhere in the community at any time;
  • It quickly alerts and dispatches appropriate and available resources with minimal delay;
  • It ensures that trained responders will locate and transport the patient without making the patient’s condition worse;
  • It provides these services reliably

Whatever can help communities to achieve and maintain those standards should be considered fair game to establish an effective emergency medical response system. Those that can meet those standards with existing resources are far more apt to get the new resources they need for proving their commitment to the community, not to fancy equipment with bells and whistles.

 

* Views expressed in this article are those of the author and not of OnFrontiers *