Stella Athieno

By Stella Athieno 

The demand for emergency medical services has been aggravated by COVID-19, with rising numbers of people seeking critical care services such as expectant mothers that usually require urgent attention at night.

Developed by the Ministry of Health, the National Emergency Medical Services (EMS) Policy was timely and will guide pre-hospital care, emergency communication and dispatch systems, acute critical care in hospitals, and health response during disasters and mass gatherings.

The policy was launched last week by Dr. Jane Ruth Aceng, the health minister during the 27th Joint Annual Review Meeting themed ‘Strengthening and Emergency and Critical Care Services as a Catalyst of Improving Quality of Care in Uganda.

The EMS policy doesn't look only at ambulances but also looks holistically at how to improve emergency medical services.; personnel that are involved in providing the emergency services and other aspects.

"Our coming together to focus on this theme is to find mechanisms of improving emergency services beyond what we currently have, and beyond personnel and ambulances extending it to equipment to handle emergencies, ensuring that our theatres are ready and on standby; specialists that we need like Intensivist, anesthesiologists and among others. But also relating it to the pandemic situation and other emergencies that we face,” Dr.  Aceng remarked, during the event.

She added, “During the second wave of the pandemic, we had challenges because patients that required care were many and it (the pandemic,) tested our system. I want to appreciate our emergency medical team that despite the small number of ambulances that we have in the country, we had the opportunity to utilize these ambulances and connect the entire country to the system.”

The National EMS Policy

The formation of this policy was inspired by the fact that the response to the emergencies was found to be sub optimal. In the emergency care continuum, there's supposed to be response at the scene of the emergency, care during transportation and also care during accidents and the emergency scene at the hospitals. 

In 2016, President Museveni directed for the establishment of a functional and regionally coordinated dispatch system for ambulances and also a coordinated referral system.

In an assessment, it was found that the services provided were not optimal; lacking a first responder capacity at scene level for example if someone got an accident, there’s an absence of the very first people trained, to help and rescue them in the most immediate time, and even calling an ambulance would take a long time. Even at the hospital, the causality units would not be well prepared to save them.

Addressing the gaps in emergency care response 

Implementation of the National EMS policy will be achieved through the following priority areas;  Leadership and Governance of Emergency Medical Services, Human Resource for Emergency Medical Services, Essential Emergency Medicines and Health Supplies, Emergency Care Health Infrastructure, Essential Emergency Care Package for healthy facilities, Ambulance Service Standards, Emergency Care Data, Monitoring, Evaluation and Quality Improvement, Research, Legal and Regulatory Framework for Emergency Medical Services, Financing for Emergency Medical Services, Public-Private Partnership in Health (PPPH), Emergency Referral and Disaster Response Services and Community Health Education and Promotion on Emergency care Response.

The bystander protection is provided for in the policy, for instance, if you're at the scene of an emergency and someone collapses, and you help, the policy protects one from being prosecuted for unintentional injury. 

The recent terrorist attacks have shown that emergency medical services are crucial, such as readily available ambulances to ferry patients to health facilities.

In the 2020 Traffic and Road Safety Report by the Ugandan Police, 12,249 crashes were reported in 2020; including 3,269 fatal crashes, 5,803 serious, and 3,177 minor crashes. Such cases, therefore, require readily available services and this will help to decrease preventable deaths.

The distribution of the ambulance vehicles, and setting up the standards for the vehicles to provide the care also highlighted.

There are 120 type B ambulances; about five (5) type C ambulances (very well equipped)  and over fifteen (15) boat ambulances, out of which two (2) are specialized type C.

The policy looks at providing one type B ambulance per 100,000 people and one type c ambulance for two million population.

"By and large, the country requires over 460 ambulances which we need to provide and so far, we have 120 ambulances. Under procurement, government has planned to procure another 100 this financial year,” the Commissioner Emergency Medical Services (EMS) Dr. John Baptist Waniaye, said recently.

He added that community awareness about emergencies will prompt them to respond to them as a responsible community.  

"When an emergency occurs, instead of going in to help, sometimes people go to take away whatever the casualties have and so they leave them to even die contrary to helping them. So we would like to create that awareness so that people can become responsive,” Dr Waniaye said.

The scarcity of medical oxygen was a big problem especially in the second wave of COVID-19 and this policy looks at having well-equipped ambulances with medical oxygen and availing sites of refills on the roads to enable safer evacuation of patients from for instance West Nile to Mulago National Referral Hospital in Kampala.

"The advantage of the policy is that it brings in focused investment into the emergency care development in the country and we think between FY2020/ 2021-24/25, we should have been able to establish the national ambulance service system in the country. 

This is a 20-year policy, but in the first 10 years, the whole system will have been improved to match the international standards and in the last 10 years, it will be about filling any gaps that were observed therein,” Waniaye said.

Athieno is a communications expert