Need of Improvement in Emergency Medical Service in Urban Cities

Abstract

Introduction: An effective Emergency Medical Service system does not exist in Nepal. For an effective EMS system to be developed the scale of the problem and the existing facilities need to be studied. Methods: Prospective observational study was carried out on 1964 patients attending Emergency Department at Patan Hospital during one month period of September 2006. The patients were specifically enquired on mode of transport used, place of origin and whether they called for an ambulance or not. Patients triage category at the time of triaging was also noted. Information on ambulance service were collected by direct interview with the service providers and the total number of patients attending Emergency Departments daily were collected from the major hospitals of the urban Lalitpur and Kathmandu. MS Excel and SPSS software were used for data entry, editing and analysis.Results: Total 9.9% patients arrived in ambulance whereas 53.6% came in a Taxi, 11.4% came in private vehicle, 13.5 % came by bus, 5.4% came by bike and the rest 6.2% came by other modes of transportation. Only 13.5% of triage category I patients took the ambulance. There were 31 service providers with 49 ambulances and 720 patients per day attend Emergency Departments in the surveyed area. Conclusions: Very less number of patients use the ambulance service for emergency services. The available ambulances are not properly equipped and do not have trained staff and as such are only a means of transportation to the hospitals of urban Lalitpur and Kathmandu.Key Words: ambulance, emergency medical service, para-medics, triage Need of Improvement in Emergency Medical Service in Urban Cities Gongal R,1Dhungana B,1Regmi S,1Nakarmi M,2Yadav B11Patan Hospital, Lalitpur, Nepal, 2Health Care Foundation, Kathmandu, NepalCorrespondence:Dr. Rajesh GongalDepartment of SurgeryPatan Hospital, Patan, Nepal.Email: rajgongal@yahoo.comORIGINAL ARTICLE J Nepal Med Assoc 2009;48(174):139-43INTRODUCTIONThe sophisticated Emergency Medical Service (EMS) is limited to developed country only. Many developing countries are now slowly developing such system although most services are localized to the urban areas.1-5 Although inadquate ambulance services are available in the capital city of Nepa

Transport and Pre-hospital Care Prior to Arrival in Tertiary Care Emergency Department of Eastern Nepal: a Cross sectional Study

“…11 Our study showed 43.2% patients arriving in ambulance which is slightly higher than the services availed by patients (13.4% and 9.4%) in previous studies done in Nepal. 4,12 Patients who arrived in ambulance with a triage score of 2 (sick patients) was 27.6% which have improved from 15.4% by Gongol et al Improvement in the proportion of using ambulance service is observed among the Nepalese population in the last decade. This study also showed an increased use of ambulance service in the eastern part of Nepal in comparison to studies done in Kathmandu.…”

“…Ambulance services availed by patients in eastern Nepal were still unreliable and not preferred even after a decade of previous studies done in Nepal. 4,10 Preference towards private vehicles to reach hospital is also prevalent. The EMS service is currently available in Kathmandu valley by Nepal ambulance services but yet to be expanded outside the valley.…”

“…Oxygen cylinders was present in 76% of ambulances which has significantly improved but absence of AED is still persisting. 4 Trainings among the ambulance drivers had been provided by some private organizations like Nepal Red Cross and NADEM (Nepal disaster and emergency medicine) but are very limited. Currently, no government regulations for attainment of license with trainings or education are required by the ambulance drivers of Nepal.…”

“…This service is provided by the nearest private or government health facility from where the patient is referred to a tertiary care centre. 4 According to a study conducted in Patan hospital by Gongol et al, only 10% of the patients arrive in emergency rooms via ambulance, and 54% arrive by a taxi. 5 The consequences may be adverse, at times serious, with delivery of patients by taxis or by make shift ambulance.…”

Multifaceted Support for a New Medical School in Nepal Devoted to Rural Health by a Canadian Faculty of Medicine and Dentistry

“…Innovations in education ( Adhikari N, 2010 ; Butterworth, 2010 ; Butterworth & Hayes, 2010 ; Butterworth, Hayes & Neupane 2008 ; Butterworth, Hayes, & Zimmerman, 2011 ; Butterworth & Pradhan, 2010 ; Upadhyay, Bhandary, & Ghimire, 2011 ) and health policy ( Allaby, 2003 ; Gongal et al, 2009 ; Gongal & Bhattarai, 2005 ; Gongol & Maharjan 2010 ; Hari, Mark, Bharati, & Khadka, 2007 ; Hayes, 2008 ) have been two other areas of publishing strength for the institution. The hospital also has been a source of telemedicine expertise for more than ten years ( Graham et al, 2003) .…”