Last month when he announced government’s plan to expand our emergency medical services Minister Joe Harmon stopped short of acknowledging that the emergency response here is downright poor, and that it fails to provide timely and life-saving assistance to citizens. He chose a more nuanced description: “It is not where it should be.”
Between February 2014 and February 2015 the Government Information Agency (GINA) reported that approximately 3000 emergency calls from all parts of the country were placed to the Emergency Medical Service (EMS) team at the Georgetown Public Hospital. This number is likely to rise considerably should figures from across the country be computed for the corresponding period.
In any country, an EMS plays a critical role in delivering quality health care services to the public, as it provides the first answer in distressing situations. From the smash-ups on our roads to reports on domestic violence, an early response is one of the key factors in the successful treatment of injuries and the prevention of possible death.
It is assumed, based on anecdotal evidence gathered from newspaper reports that it takes about 25 minutes on average from the call for an ambulance to response-time of the ambulance. This time increases if the ambulance has to travel outside the city to an East Bank or East Coast location, and consequently the time could extend to a full hour or more. By medical standards, this response time is alarming. And we have the unique situation here of persons calling emergency services and being told that there is no ambulance available. This is, of course, if the call is actually picked up by the EMS.
Based on the response time of EMS services one could make a determination as to whether they will be transporting the injured to the hospital or taking a body for a confirmation of death. According to medical research, brain cells start to die after ten minutes without oxygen. Saving the lives of sick and injured citizens is a priority for any government, and upgrading the EMS component of the healthcare system in Guyana therefore should form a core focus of this government as it tackles healthcare reform across the country.
In 2013, Minister of Indigenous Peoples’ Affairs Sydney Allicock referred to the “deplorable” medical services in the hinterland during an address to the National Assembly. Specifically, he told the story of an emergency in relation to a pregnant woman, at the point of delivery, who become ill at Parishara. He recounted that there were no health workers there and the residents were forced to contact a health worker some 11 miles away.
Allicock said: “The health worker got there on motorcycle at 8.30 am and was told to take the woman to another point by motorcycle where a vehicle would have picked her up and transported her to Lethem. She arrived at Lethem at 2 pm and had to wait six hours. She delivered [some time later] but bled profusely. She was rushed to Boa Vista at midnight and by 4 am [the next day] she was no more.”
Indeed, we don’t need Minister Harmon or even the line Minister, Dr George Norton to tell us that “things are not what they should be” in the health system. What they ought to be telling us is that the government recognizes the need for an overhaul of the medical system and infrastructure in the country and will be addressing this as a priority.
Beyond the talking points, the government ought to be forthcoming with information regarding when the ambulance fleet, with drivers and attendants, with trained Emergency Medical Technicians (EMT’s or paramedics), will grow beyond its current capacity. They must also tell us what performance measurement systems are being implemented to monitor response time, the quality of service being provided, optimal locations for ambulances, strategies of integrating services with the police and fire service, and methods for disseminating all this information to the public so as to enable a better utilization of the improved services.
The daily newspapers often chronicle the trials of citizens involved in accidents who are ferried from the scene to the hospital in taxis and minibuses after someone had begged “for a lift.” It is a known medical fact that many persons who suffer physical injury can be further harmed in the process of moving them to a hospital or medical centre. Indeed, even in sport, much care is taken in moving injured players off the field of play. By comparison, it is tragic to see well-meaning good Samaritans, picking up the injured in any which way and bundling them into vehicles, possibly causing more harm than good, because of the dearth of an adequate EMS service in the City of Georgetown not to mention throughout the country.
Mr Harmon’s announcement addressed response time, and the need for additional ambulances, equipment and training. According to him, a plan which has been developed envisages that within fifteen minutes of a report being made to the emergency medical services, the patient will be picked up and taken to a medical facility.
By December 2016, the first phase of the plan should be in operation and going onwards to 2020, the other phases will capture the entire country in an emergency system, Minister Harmon reported. Perhaps the plan touched on increased collaboration between the various response agencies (for example, the police and the Civil Defence Commission) and the need for a better working relationship between them. However, there was no mention of this from Harmon.
It is true that steps have been taken to introduce an EMS team at the Georgetown hospital and training has been ongoing since 2014 with EMT technicians across the country. As such, their interventions, when performed rapidly and properly, can provide critical temporary life support until the patient is transported from the emergency scene to the hospital. To date over 100 technicians have been trained in EMS, but how many of them are posted outside the city? Where EMS is concerned, services need to be decentralized because speed is essential for an effective response. In addition, what kind of response is the public hospital providing to the public in comparison with the calls for assistance?
Finally, perhaps, and of critical importance, is the need for widespread dissemination of information pertaining to the existence and efficiency of the Emergency Medical Service, as this will lend itself to public confidence and public education in the treatment of victims of physical injuries resulting from accidents and incidents of one kind or another. The natural instinct of members of the public to take matters into their own hands and move the injured and sick without professional guidance can only be tempered by public confidence in the EMS providers.
This confidence will be fostered by information from our healthcare system, and further bolstered by the actual efficient and effective performance of our healthcare and EMS providers.
