Editorial | One number for ambulances
It is more than a quarter of a century since Peter Phillips, then the health minister, launched what he promoted as the start of a modern emergency medical service (EMS), built around the Jamaica Fire Brigade (JFB).
Fire stations across the island were to be provided with ambulances and emergency medical technicians. They would be among the first responders in cases of medical and related emergencies.
There was supposed to be a regulatory environment that ensured that the government’s system and private providers of emergency medical services operated under the same rules and with equivalent standards.
Yet, as this newspaper reported last week, 27 years later, draft legislation for the service is gathering dust in files somewhere, and calling an ambulance in a medical emergency is mostly an excruciating experience for private citizens – except maybe in cases of traffic crashes.
Short of ambulances and trained staff, the fire brigade-centred EMS system merely limps along. And calling a private ambulance company is often like entering a lottery. It is hit or miss whether one will be available – assuming the firm’s advertised number is answered, or if the company is still in operation – or if the ambulance attendant is trained in medical emergencies.
“There has been no advancement of the 1996 draft EMS Bill to date,” Dunstan Bryan, permanent secretary in the Ministry of Health and Wellness, conceded last week.
But the ministry, Mr Bryan said, has developed operational guidelines for medical emergency technicians, as well as specifications for ambulances seeking registration. Mr Bryan expects that an external review of Jamaica’s emergency response arrangements this year will help advance the EMS system.
Largely, the whole thing is a rehash of two years ago when The Gleaner asked similar questions about the EMS system and its regulation.
While there is no empirical data to prove the point, it is widely accepted that the island’s shambolic emergency medical response system costs lives. People wait for long periods for ambulances to turn up, uncertain that they will. And if they do, there is a little certainty about the quality of assistance that can be provided by the attendant. Or the ride to the hospital is, the anecdotal evidence suggests, often an organ-rattling experience. And that’s not only because of the bad state of Jamaica’s roads.
Twenty-seven years is more than a generation ago. Many of the people who were young when Peter Phillips launched the EMS service are now well into middle age. It is past time that the service gets serious attention as part of the health infrastructure initiatives that are being touted by the current minister, Dr Christopher Tufton.
Indeed, early knowledgeable assistance at medical emergencies lead to better outcomes for patients, which, in the end, is cheaper than the cost of longer-term rehabilitation and care that may be required when such intervention is unduly delayed.
Even as we wait for Dr Tufton to take the EMS law to Parliament, to eke out the money to buy additional ambulances and recruit and train medical technicians, things can be done to better coordinate and improve the EMS service.
For instance, while it is possible to dial the 911 number for an ambulance in medical emergencies, that usually is a link to the public system – and it is not necessarily the surest bet. Calling a hospital or fire station directly – on the off-chance that an ambulance is available – is likely to yield a better result.
Indeed, the health ministry lists on its website six fire stations with which its EMS Unit collaborates to provide “pre-hospital care”. The ministry posts separate telephone numbers for each of the stations – not 911. Further, private ambulance providers are not linked into the Government’s or any formal network.
It is possible, and would make sense, to have all of the island’s EMS services – public and private – linked to the single medical emergency telephone, but allowing the caller to determine whether he wants to be routed to the state or private provider. The backbone of the system would operate something like that for the automated banking network, made compulsory by the Government but paid for by the participants. It would likely save time and lives.