Mon | Jul 23, 2018

Dr Alfred Dawes | Emergency medical services urgently needed

Published:Wednesday | March 1, 2017 | 12:00 AM
There is no proper emergency response system in Jamaica.
In trauma surgery, we have what are called the golden hours after an injury.
Dr Alfred Dawes

Recently, I witnessed a bus in front of me collide with a motorcar that swerved into its path. A few seconds separated my vehicle from being a part of that accident.

The driver of the bus and a front-seat passenger were trapped inside but were stable enough not to warrant immediate attention. Immediately, my instincts took over, and I tried to get the badly injured occupants from the car. The young men were unconscious.

I called for an ambulance and one was quickly dispatched. We had to get those men out quickly and stabilise their injuries as best as we could, so the ambulance team would just perform a scoop and run. That would be their best chance of survival.




A crowd quickly gathered and I announced who I was and what we needed to do. But instead of helping the dying victims, the vast majority of the onlookers took out their phones and started to film the scene of the accident.

Some were very artful - zooming in and out, panning, getting close-ups of the victims, and running commentaries. Only about three or four men sprang into action to get them from the twisted metal that was the car.

It was unbelievable.

Even while removing the men, I had to be brushing phones out of the way. Luckily, a team from the Savanna-la-Mar Hospital Emergency Department, as well as the Fire Department Emergency Medical Service, quickly arrived. Even my CEO found her way at the scene, helping to coordinate the rescue efforts.

In the end, one man died on the spot and another on arrival at the hospital. The remaining victims made it out alive, some with critical injuries.




This experience drove home the stark reality of how inhumane our society has become. It matters not that people are dead or dying. What matters is posting a macabre video in order to get as many likes as possible.

It also reminded me of how backward we are as a country without an adequate emergency response system. Usually accident victims are brought in to the emergency room in private vehicles with no pre-hospital care. One can only imagine how long they were on the scene being videotaped and photographed before someone decided to be a Good Samaritan.

I strongly believe that this contributes significantly to the high mortality rate of accident victims.

In the old days, persons would fall over each other to help their brothers in need. Nowadays, you can't count on anyone to assist.

As usual, we have to turn towards the paternalistic Government, our parent, to fulfil our every need. And, as usual, because of a poorly funded health sector, we are left out in the cold. There is no proper emergency response system in Jamaica.

We have come a long way with emergency medical services now a part of the Fire Brigade. But for the average Jamaican, if you are in an accident, you will be filmed, photographed and paraded all over social media before you are brought to the hospital in the backseat of a car or in a pickup truck bed.




In trauma surgery, we have what are called the golden hours after an injury. If prompt medical attention is received in that crucial period, the chances of survival and the complication rate are improved significantly.

This is the basis of trauma systems in developed countries. No place should be out of the reach of a trained first-responder team equipped and able to stabilise a patient and safely move them as quickly as possible to a nearby trauma centre. This trauma centre may be a clinic or hospital. More invasive interventions can be done to stabilise the patient before those requiring more specialised care can be moved to a higher-level trauma centre. This scoop-and-run approach has been shown to improve trauma outcomes.

In mature trauma systems, there are different levels of trauma centres based on the services offered and the level of training of the staff. Cornwall Regional Hospital and Kingston Public Hospital would be Level I Trauma Centres and Sav-la-mar, Mandeville Regional and St Ann's Bay hospitals would be Level II. A health centre in a location such as Ulster Spring in Trelawny and Alexandria in St Ann should be able to at least stabilise patients before the nearly one-hour drive to a major hospital.

This is what we should be aiming for.

To get there requires political will to adequately fund the public health sector and prioritise its reorganisation. But political will is only shaped by public pressure. And we are now so crass and callous as a people, it is becoming more apparent that we will never come together to demand better from those who are elected to serve us.

And so we will continue to limp along while our neighbours progress. The veranda and bar talks have largely given way to posts on social media and changing of display pictures to support a cause. But there is no progress beyond outrage and the objective too often is to garner 'likes'.

If you happen to come across one of the dozens of videos of me screaming at a crowd to put down their phones and help to save some lives, before you like or share it, remember that you are massaging the ego of a despicable human whose visceral response of a fellow Jamaican in need was to jump at an opportunity to go viral.

- Dr Alfred Dawes is a general laparoscopic and weight loss surgeon at the Island Laparoscopy and Medical Care. Email:;