Text by Sajeet M. Rajbhandari
Ambulances are the first line of help during a medical emergency. The crucial help that emergency services such as ambulances have given to people have immense value as a quick response medical facility when it comes to saving lives and helping masses. Calamities such as the April 2015 earthquake and multiple landslides only emphasise the necessity of good ambulance services. However, while there are a decent number of ambulances registered, it is questionable whether or not these resources have been maintained and put to good use. A lot of the ambulances that operate within the country often lack basic equipment, trained emergency medical technicians, and in some instances even a proper 24/7 operation schedule.
For an ambulance service to function properly, there are a few different parties involved who are required to work as a team in order for the service to efficiently benefit a significant demographic. The institution organising and operating the ambulances must work with emergency dispatchers who are to communicate with patients, relay the information to the closest ambulances, and then have the drivers connect to the closest health facility available. The organisation should also maintain at least three different teams of drivers and EMTs (Emergency Medical Technicians) in order to make sure that an ambulance is operational at all hours of the day.
This interlinked system if implemented properly should work towards saving as many lives as efficiently as possible. While personal vehicles and taxi cabs seem like an immediate solution during a medical emergency, they might not always be the best solution.
Ranjit Acharya, President of Nepal Ambulance Service (NAS), an NGO, explains, “While an ambulance may take 10 to 15 minutes to arrive on the scene, the medical procedure starts immediately after it gets there. A taxi cab will lack trained EMTs and equipment you would find in a well-equipped ambulance.” Acharya adds, “The rest of the traffic won’t be able to tell if your vehicle has a patient inside and you might get caught up in traffic. On the other hand, in an ambulance you can bypass this traffic.” Unfortunately, this knowledge is often sidelined by a large chunk of Nepalis. As a matter of fact, a study conducted by Patan Hospital concluded that only 10% of patients arriving at emergency room were transported via ambulance while over 50% patients admitted arrived in taxi cabs. What’s worse is that this 50% even included patients in life threatening triage categories and approximately 18% of these patients were dying on the way because they didn’t have access to emergency health care. Furthermore, another 18% of the patients suffered from partial paralysis because they were not properly handled during the transfer.
According to Acharya, an ambulance run by NAS has an average response time of 10 to 15 minutes. These ambulances are strategically stationed at different areas across the valley in order to minimise response time. The ambulances are also fully equipped and operate around the clock. Given the numbers that respond to medical emergencies inside the capital, Acharya claims that five life support ambulances and over 10 basic support ambulances equipped with well trained EMTs should be enough for Kathmandu to sustain itself under one emergency service. At the time of writing this article, the NAS can succeed in providing emergency healthcare service to about 250 patients in a day with each ambulance capable of treating up to 7 to 8 patients.
Even so, NAS is only one of the few cases where emergency health care is provided as coherently as possible. Nepal still witnesses tons of registered ambulance services, both privately run or under governmental operation that have been out of service, unmanaged or in some cases used for purposes other than providing immediate health assistance. While ambulances have been operating in Nepal for a long time, most ambulances run on their own without provisions of any dispatch centers.
As the health sector gradually developed so did the number of ambulances. But we have constantly failed to get ambulances that are actually needed. On paper, the number of ambulances in operation show a healthy number, but most of these ambulances are very poorly run and most people lack faith in them. While some ambulances barely qualify as ambulances, with some just being small vans with a stretcher inside, others come from privately run, for-profit institutions that have alliances with specific hospitals or are simply too costly for the common citizen to afford.
While the government has made plans to use 102 as a common toll-free number that connects to all ambulances services and manage the existing chaos, little has been done by policymakers to make this plan concrete. Currently, NAS is the sole facility that makes use of this number. Even those ambulances which have been donated to the nation for various philanthropic causes have failed to see optimum use and many a times they have been lost in a blur of medical facilities competing with one another. The Indian government has gifted 722 ambulances to Nepal since 1994, but a lot of these resources have failed to witness appropriate usage.
The ambulance service in Nepal still has a considerable journey to accomplish, however slow yet steady some progress is being made. In case of a medical emergency, it is still vital action to call 102 in order to seek medical help. Rather than rushing patients in a personal or public vehicle, the existing ambulance service can still provide patients with better immediate care.