Stopgap measures are not enough to reduce road accident fatalities, speakers said Wednesday on the concluding day of a two-day workshop on highway safety.
A system that involves the community as first responders is a must, workshop participants said, as part of their recommendations for the Health Sector Action Plan on Road Safety whose final draft is being prepared.
“Taking the right patient to the right hospital at the right time for the right kind of care” is at the heart of a good health system Amit Gupta, emergency medical service (EMS) and trauma expert at AIIMS, New Delhi, said.
“A system means the set-up right from the time the victim is injured on the road until the time he is discharged from the hospital with adequate rehabilitation,” he said.
“World-over the evidence shows that very advanced pre-hospital ambulance systems with advanced medical equipment provide no added advantage to patient outcomes over ‘scoop and run’ services with basic life-support ambulances.
“Bangladesh has to devise it's pre-hospital ambulance system in accordance with international evidence-based medicine,” he said.
Gupta said whatever type of ambulance is used, there must be an efficient call centre-based universal emergency access number common for the whole country.
He added that training first responders was a must to reduce road accident deaths.
“The call centre will then dispatch the nearest first-aid workers or community health worker or ambulance to the site to take the patient to the nearest hospital.
“This requires legislative support and an umbrella body, for instance an emergency medical service (EMS) council or authority, which lays down the rules and regulations governing EMS in Bangladesh,” he said.
The EMS expert said the next focus should be on strengthening the emergency departments of hospitals at all levels right from the upazilas to tertiary-level hospitals.
“This strengthening is not only in terms of infrastructure and equipment but also trained manpower at all levels – doctors, nurses and paramedics.”
The workshop, organised by the Directorate General of Health Services (DGHS) and supported by the World Health Organisation (WHO), was attended by representatives of the WHO, DGHS, public hospitals, public medical colleges, private hospitals, trauma centres, various NGOs and by divisional directors, civil surgeons and upazila health and family planning officers.
EMS and road safety expert Matthew Varghese said policy should be based on science and not on anecdotal guess-work.
“The science of pre-hospital care has evolved. The current understanding is that in urban areas where the transportation time is under one hour, all that is needed is to scoop and run.
“This means extricating the victim from the crash site, ensuring that the airway is clear and ensuring circulation by taking care of bleeding,” he said.
“Once this is done, any vehicle can be used to transfer the victim to a hospital which should be well-equipped with trained doctors and nurses.
“No matter whether it is a primary care or tertiary-level hospital, it should have the capacity in terms of human resources and equipment to take care of trauma victims.
“If you don't ensure this but just develop an ambulance system, then you will only shift deaths from the roadside to the bedside of the hospital,” he added.
“Getting patients safely to hospitals can be ensured by training policemen, CNG or even rickshaw drivers in first-aid. But one must ensure that hospitals are brought up to the level of providing quality trauma care,” Matthew said.
Sanjeev Bhoi, another EMS experts at AIIMS, New Delhi, said health sector problems in Bangladesh are similar to those in neighbouring countries.
He urged the reduction of road crash mortality and morbidity figures especially because they involve younger people who are economically active members of the family.
Losing a breadwinner to death or disability lays a major burden on surviving families and the economy.
“In Bangladesh 1.6% of GDP is lost every year due to road crashes. This is not affordable. A robust health sector plan is needed.
“Bystander care is a strong component of caring for a trauma patient. It involves the police, traffic police, school children as well as people living near highways who can play a key role in saving lives,” Sanjeev said.
“Training of school children in first-aid should start at the secondary level. This should include CPR, stopping of bleeding, splinting and transporting an injured victim safely to the nearest hospital,” he added.
