ACCIDENTS | GOVERNMENT | EMS

KAMPALA - Infrastructure is being put in place so that, in the near future, nobody dies stranded after a traffic accident. 

According to the new National Emergency Medical Service Policy (EMS), anybody who gets an accident on Uganda’s major roads, will just dial a dispatch code 912, and the system will send an ambulance depending on his location, severity and time of accident.

Specific ambulances, with accident specific gadgets, and a doctor on board, will deliver victims to the nearest hospital or Health Centre, Government or private, without regard to the treatment costs. 

While infrastructure for this is being laid in incremental stages, the training of staff is ongoing and the specific ambulances are expected to start by the end of the year. 

The EMS policy was lauded by Health experts as a positive step in mitigating the high number of fatalities from road accidents.

Accident statistics

Uganda currently falls under countries with high fatalities of 27 per 100,000 persons mainly in the global South compared to 8 per 100,000 in the high-income countries. 

This is according to the Global Status Report on Road Safety (GSRRS) 2018, a publication of the World Health Organization (WHO). 

In 2020, Uganda lost 3,663 people to road crashes according to the Uganda Police Annual Crime Report. 

The WHO estimates in the GSRRS give a higher figure as it includes deaths in hospital facilities as well.

This means a big failure for Uganda to achieve targets set in the ambitious UN Decade of Action for Road Safety which intended to reduce road accidents by half in 2020. 

The majority of death occurs among the youth, the most productive group. 

Globally 1.35 million people die from road accidents, which ranked 8th in 2016 WHO figures of causes of deaths. 

However, in Uganda while they are third in causes of death in Uganda, according to Dr John Baptist Waniaye Nambohe, Commissioner Emergency Medical Services, of the Ministry of Health.

The EMS infrastructure

The EMS is a call to address these high death rates. The WHO has been calling for the scaling of emergency care to reduce the number of deaths. 

The policy was launched last week by the Health Minister, Dr. Jane Ruth Aceng. 

It provides for the creation of a standardized ambulance system, funding for emergencies, leaderships, and development of a dispatch code 901 among others.

It also caters for on-scene accident management, transportation, and care at the hospital. 

Aceng said at the launch said the process was already going on with some success.

“We have almost doubled the number of ambulances, but also increased the number of first responders,” she said 

 Nambohe, who is the architect of the policy, argues that the gear to address critical emergency care is set. 

“It is the biggest achievement for the government to take the decision to approve the policy,” he boasts. 

The policy address training of emergency personnel, recruitment, ambulances service management, funding, equipment supplies, and community engagement.

On training, he said Mbarara University of Science and Technology and Makerere University College of Health Science are already training emergency doctors at masters’ level. 

Those at a lower level are being trained at Rubaga. He said the goal was to have two professional emergencies at Health III that would beef the community-trained first responders. 

Ambulances

Nambohe says, government is developing guidelines and standards for the different types of ambulances from vehicles, motor tricycles, and boat and helicopter ambulances. 

These will be responding according to the severity of the victim and location. 

There is type A for patient transport vehicle, Type B for basic life support /emergency ambulance, and Type C advanced life support and Intensive Care Ambulance.  

He said the government was adopting type B for universal coverage and Type C for regional referral hospitals and super-specialized medical centers like the Uganda Heart Institute.

For this, 120 ambulances including 14 boat ambulances have already been procured and distributed. 

The plan is to have between 20-30 ambulances in each region. Some other current 300 considered substandard will be phased out. 

He said the regional ambulance call and dispatch centres with the code 912 would be running by end of the year at all the 14 regional referral hospitals. 

Once activated, hospitals will be informed in advance of the accident victims. 

He adds, that the reception and casualty centers in the referral hospitals have been improved and others are being improved across the country to improve on emergency care.

Training

Nambohe said they already have 20 running scholarships for Masters Emergency Medical specialists at MUST and Makerere University College of Health Sciences.

He said the lower-level specialists are being trained at Rubaga Hospital. He said the goal was to have two professional emergencies at Health Centre III who would beef the community trained first responders in case of an emergency.  

The policy recommends access to care at the nearest health facility, private or public, without thinking of who will pay.

The policy also talks of strengthening first aid in the communities like the training of boda boda riders

Christine Kasirye, secretary-general of St John Ambulance, a stakeholder in ambulance services lauds the policy saying it will wind out the unprofessional in the emergency services.  

“These are scientific operations that require professionals,” she said. “It gives borders. Who should be in the ambulance and who should touch the patient? For us, we are modifying all our ambulances to the right standards.

Dr Emmanuel Tugeineyo, the director Mbale Regional Referral Hospital, welcomes the policy and says Mbale has already received a multi-purpose ambulance which is very helpful in moving victims from the scene to the hospital. 

“The key in saving lives is the fact that there will have a doctor onboard will help save lives,” he says.

He is happy that the abrupt dumping of victims at reception centres will end with the development of a robust communication system with call centres.

“I will be ready to receive the patients as I have already been informed through the communication system. The ambulance will have GPS that can locate the victims and also be monitored and deployed according to need,” Tugeineyo said. 

Dr Celestine Barigye, director Mbarara Regional Referral hospital says the guidelines are very helpful in the procurement of ambulances as well as the recruitment of competent staff. 

The GSRRS argues that effective care for the injured requires timely care at the scene, prompt transportation to appropriate emergency and surgical care at the hospital, and care to rehabilitation services.

WHO says rehabilitation is important as it helps in ensuring recovery of mobility, communication, and cognition. 

This will also reduce the economic burden.  

The report also mentions the role of bystanders in activating the dispatch code for the hospital to be aware of the accident, and also providing first aid until the professional arrives.