The
Minister of Health will distribute 224 ambulances to hospitals today, at an expensive
ceremony with fanfare at the BMICH, and a further 150 will be delivered in the
next 2 months; the latter, with the assistance of JICA, the Japanese NGO, which
has been a major donor in Sri Lanka. See link:
It
is time to take stock of the whole sordid method by which Ambulances are used
in hospitals, and how they are managed. It is my contention that Hospitals DO
NOT have the capability of managing Ambulances in the most productive manner,
and ambulance drivers are a law unto themselves, spending more time outside of
the hospital stating that they are on duty, and hence claiming overtime as part
of their entitlement when the said ambulance could actually be used to save
lives. Sometimes a hospital ambulance will not be available for over 48 hours
due to the round trip, drivers rest, and all the wasted time.
Start
with a blank page. Transfer all 2000 ambulances to one central authority, set
up 25 or up to 50 ambulance centers, near or at hospitals if need be to be
governed by a person responsible at that center for the fleet. He or she will
be responsible for ensuring the staffing and maintenance optimized. Using the
latest technology of tracking, one central authority WILL KNOW where each of
the 2000 ambulances are, which ones are available, (a color coding system will
identify – in use, free, unroadworthy and without staffing)
In
this way GPS tracking technology along with the communication system, will
direct the right ambulance to the right place to optimize patient
transportation. Let us remember, that in Sri Lanka it is NOT ambulances that
transport patients to the hospital from the accident scene. It is done without
adequate safeguards, by three wheelers and lorries etc. Ambulances are used to
transport patients from a local hospital to one that can take care of the
urgency.
When
I had my life threatening accident, when the Senior Cabinet Minister of Justice’s
security vehicle (he was at the head of his convoy and was blissfully unaware)
carelessly crashed literally into me, it was a passing truck that took me the
next 30 minutes to the hospital. Under the rules of the Polonnaruwa hospital, I
could only be transferred to the Kandy Hospital trauma unit, for surgery 140 km
away, and so opted to pay for a private ambulance service to come from Colombo
(225KM away), pick me up from the Polonnaruwa hospital 10 hours after the
accident, and then take me to the Accident Service at the National Hospital in
Colombo (another 6 hours) as I preferred to be in Colombo, to be given the best
chance of basic care. This was over two years ago and I have still not fully recovered,
taking various medications and with a painful limp, and no assistance from the perpetrators.
So
let us set up an Ambulance Service, with a billing system to all patients who
use it, which asks them to pay 5% of the cost of the Ambulance. In this way,
they will know the value of the service to them, and that their contribution is
a small one bearing in mind how beneficial it is to them. If there are multiple
patients then this billing could be divided equally amongst the users.
The
GPS system will be able to direct the right ambulance to the right place,
ensuring that response times are improved 5 fold from the present. Driver
utilization will be maximized, where it is possible that more drivers are
hired, and fewer abuse the overtime system. There will be tracking of each
movement so the on time off time will be recorded, and if unusual require
adequate explanation. In this way no one can fudge, the scarce Nation’s
precious resources, will be better deployed, one can use examples of international
best practice to develop the best framework, and in the end the patient whose
life we are talking about could be saved, and often, expensive care avoided,
due to the prompt response to the emergency.
Companies
in Sri Lanka already provide the latest GPS tracking technology at a reasonable
fee, which can be optimally used to manage the fleet. Talk to any doctor or administrator
in a rural hospital, and the frustration they face dealing with errant drivers singing
their own tune of Ambulance availability is apparent. My suggestion will save
the country millions, provide a better service, employ more drivers and
emergency technicians, and allow for quick responses to major accident scenes,
where only a trained ambulance crew will be able to reduce mortality and reduce
the level of trauma. Arguably many lives will also be saved. Snake bite deaths can
be minimized, if prompt transport is available.
I
trust the Minister will have the political will to take up a suggestion such as
this, and urgently implement a system of improvement to the existing set up.
These are examples of basic common sense suggestions, there are hundreds more,
that can improve the quality of life of all citizens of Sri Lanka, and it is
the duty of the Government of the day to consider these carefully and arrive at
a common sense approach to a practical solution. Let’s go and do it!
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