Saturday, April 6, 2013

224 Ambulances to be distributed to Hospitals today – how many will be roadworthy in a year?

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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