Thursday, July 24, 2008

Pakistan First Trained Emergency Service

Pakistan’s First Trained Emergency Service

Punjab Emergency & Ambulance Services

Directorate Of Punjab Emergency & Ambulance Services
Health Department, Government Of Punjab

Punjab Emergency & Ambulance Services
The Government of the Punjab has established the Punjab Emergency & Ambulance Services (Rescue 1122) keeping in view the dismal state of pre-hospital emergency management in the country. This is the first trained Emergency Service established in Pakistan according to the International standards. The Service provides efficient and effective response, rescue, emergency medical treatment and safe transportation to the helpless victims of Accidents, Emergencies and Disasters whom earlier people were afraid to help due to medico-legal reasons.
The Service, initially established in Lahore has been evaluated to be a great success by providing a sense of safety to the citizens of Lahore and it is serving as a model for other governmental and non-governmental organizations. Based on the success of the Service, its expansion to all the major cities of Punjab is underway.

The pre-hospital emergency management of accidents, emergencies and disasters has been long neglected in Pakistan, which was evident from the fact that there are over 95% chances that in case of any emergency, the victims will not get an ambulance for transportation, let alone any timely emergency care by trained professionals. The hospital emergency management does exist but requires significant improvement. Provision of timely help during emergencies is a basic human right and can significantly reduce the morbidity and mortality. This issue becomes even more important when injuries (mostly resulting from road traffic accidents) are the leading cause of death amongst the young, able, earning bread-winners and results in significant socio-economic impact on the society.
Futile efforts were made to improve the disaster management infrastructure by several governments and in this regard many disaster management plans were drafted but never implemented or tested. Learning from the past experience the Government of Punjab decided not to reinforce failures or avoid making haphazard interventions to improve the emergency services. Finally it was decided to launch a new model Emergency Rescue Medical Service, Punjab Emergency & Ambulance Services (Rescue 1122).
• To establish a system for providing comprehensive emergency response, rescue and management of all accidents, emergencies and disasters.
• Development of Safer Communities through proactive approach towards Emergency Management and Community Awareness & Training.
• To have positive socio-economic impact on the society by reducing morbidity and mortality due to injuries (mostly resulting from road traffic accidents) amongst the young able breadwinners.
Service Established in Record Period of Time:
This model Emergency Service was established in a record period of six months after successfully completing a number of activities listed below:-
• Transparent recruitment of two hundred rescuers
• Curriculum development
• Training of trainers workshop
• Rigorous training of the first batch of Emergency Rescue Paramedics
• International Monitoring of Training
• Acquisition of most appropriate sites for stations
• Construction of Six Emergency Rescue Stations
• Procurement of Wireless Frequencies and Emergency Number 1122 from Pakistan Telecommunication Authority
• Establishment of effective Wireless Communication System
• Establishment of Emergency Control & Command Room and Emergency Response System
• Indigenous designing of state of art Emergency Ambulances and Rescue Vehicles according to International standards
• Development of Software for Call Recording, Emergency Data compilation and Analysis for research and preventive purposes

Structure of the Rescue 1122 Service
The Service has been initially established in Lahore as a pilot project. The Service comprises of six stations located at most appropriate sites to provide swift response to emergencies. The stations are located at Ferozepur Road, Chowk Niaz Baig, Walton, Mughalpura, Yadgar & Shahdara.
The Service started with a staff of around two hundred rigorously trained rescuers working in three shifts. The staff comprises of Emergency Medical Technicians, Rescue Drivers, Computer-Wireless and Telephone Operators, Station Coordinators, Emergency Officers, Emergency Control Officer, Deputy Project Director and is headed by the most experienced and dynamic Project Director. There are fourteen state-of-art indigenously designed Emergency Ambulances and two Rescue Vehicles.
Perfect Location of Stations
Due to strategic selection of sites for Stations the response time of less than seven minutes has been achieved, which is comparable to any international standards. The provision of this kind of a response time with only six stations and fourteen Vehicles for a population of over seven million is a record accomplishment even internationally.
Recruitment of Appropriate Staff
Most appropriate staff of two hundred was recruited for the first batch after scrutiny of over 800 applications. The recruitment process was completed in a record period of seven weeks. The recruits had to go through physical fitness tests, pre-selection screening interviews and then final interviews carried out by a board constituted by the competent authority. The recruitment was subject to successful completion of training. During training a significant number of over ten percent recruits dropped out and the vacant seats were filled by waiting candidates. This transparent recruitment of best possible candidates and rigorous training provided to the recruits has resulted in the success of this exemplary emergency service(Rescue 1122).

The subsequent advertisement for the expansion of the Service, received over 3700 applications for 116 posts, which shows the popularity and success of the Service. The recruitment of Trainers for the Emergency Service Academy is underway.
Curriculum Development
The curriculum and training material was developed and written by Dr. Rizwan Naseer in Urdu so that the recruits could easily understand it. This training material/ book on principles of first aid and emergency management is very simple and easy to understand. The Health Ministry of Pakistan and World Health Organization also accredit this book. These books are also a part of the curriculum of Police all over Pakistan, motorway police, fire services, civil defence and other organizations, so that they can also be trained to manage emergencies in a better way and without causing further harm to the victims.
First Training Course for Emergency Rescue Paramedics
The training of newly recruited staff was a great challenge as there were no trained Emergency Paramedics even in the Emergency departments of teaching hospitals in Pakistan. Therefore, new rescuers had to be recruited and trained to manage emergencies, rescue victims and provide emergency medical treatment to the victims of accidents, emergencies and disasters. Considering the fact that this was the first course for emergency rescue paramedics in Pakistan, international monitoring was important to ensure quality. As a result of the appropriate selection of training institute, rigorous training and international monitoring the rescuers were imparted the best possible quality training in Pakistan to become first trained Emergency Rescue Paramedics in Pakistan. Thus this Project has resulted in the historic beginning of human resource development in the most vital area of emergency management.
After extensive search the Elite Police Training School, Lahore was used for training of the recruits. The instructors of this training institute ensured the physical fitness and discipline amongst the rescuers. The theoretical training and simulations were designed and executed by Dr. Rizwan Naseer (Project Director). In order to ensure the quality of training Dr. Rizwan through personal contacts and efforts arranged for international monitoring by the trainer and monitor from the Asian Disaster Preparedness Centre. He also arranged trainers on honorary basis from Austria, Australia and U.S.A. to come and train rescuers.
Finally the rescuers were also sent to the emergency departments of teaching hospitals in Lahore to obtain hands on experience in managing emergency patients and establishing a rapport with the staff of emergency departments and understand the protocol for smooth delivery of emergency patients.
On Job Specialized Training of Staff
A process from the very start of the Service has been initiated to train specialized teams to deal with special emergencies like Urban Search & Rescue, hazardous material incidents etc. In this regard teams of the staff members has attended specialized hands on training courses arranged and conducted by a special team of instructors from the United States. This provides the staff with the opportunity to learn the latest techniques and skills being used to manage emergencies by the other advanced services in the developed countries.
Emergency Service Academy
For the establishment of a sustainable, efficient and effective training infrastructure, The Government has approved the Emergency Service Academy. In this regard recruitment of Instructors has started and the construction work is underway. WHO-EMRO is positive to provide International Trainers / consultants for training of the faculty of the Emergency Service Academy as trained trainers who could impart this specialized training are deficient in the country. This academy is going to be the first training institute of its kind in Pakistan.
Importance of 1122 Universal Emergency Number
1122, Universal Emergency Number is a Toll Free Number, which is the best possible and shortest emergency number that could be obtained from Pakistan Telecommunication Authority. The reason why 1122 was selected is that it is easy to remember and being the first two digits of the dial pad, the number can be easily dialled even in darkness.
Establishment of Wireless Communication System
An efficient and effective wireless communication system has been set-up after obtaining six frequencies from Pakistan Telecommunication Authority. The system comprises of six towers of appropriate heights and locations, base stations, mobiles and handsets. This system ensures smooth and cost effective method of communication between the emergency stations, vehicles and personnel.

Indigenous Vehicle Fabrication of International Standards
The emergency ambulances have been specially fabricated in Pakistan for the first time. They meet with the international standards and have helped in significant financial saving for the government. An ambulance of similar standards imported from abroad would have cost around five times more. This indigenous fabrication of emergency vehicles also helped in developing this industry in Pakistan and setting the standards for emergency management in Pakistan.

Rescue System

1122, toll free rescue number is accessible round the clock. On receiving emergency call through a software programme, staff at Rescue Control & Command Room activates immediately to help the victims. Speedy communication between computer operator, wireless operator and personnel in Ambulances (Emergency Medical Technician and driver), helps Emergency Service to respond swiftly.
Monitoring of Emergency Calls
Software for the computerized recording of emergency calls has been developed locally at very economical rates. This ensures the quality and for maintaining the records for research and legal purposes. The system has the capability to display the number and address of the caller on the monitor screen and the necessary data about the emergency and disaster can also be entered into the system.

Monitoring of Emergency Vehicles
No organization can work efficiently unless there is an excellent system of supervision and monitoring, especially when the span of management is spread over a wider area. Therefore, in order to effectively monitor and prevent misuse of emergency vehicles they are monitored through a satellite tracking system. The information regarding position, speed, direction, ignition status of any vehicle can be checked through a satellite map. Moreover, the data of any emergency/ incident can be retrieved as and when required.
Quality Assurance of Service
A strict monitoring system has been put in place to ensure the quality of the services provided by Rescue 1122 staff. In order to minimize the chances of error in handling the patients, the SOPs have been defined and practiced. This is the first public service health and emergency organization to aim for quality care certification in Pakistan.
Voluntary Risk Coverage of Staff
The job of Rescuers is a high-risk job since they have to rescue people from collapsed buildings, fires, train accidents, conflict situations and other hazardous emergencies. Considering the risk involved in the job, a system of insurance of all rescuers has been initiated after consultation with the rescuers with a government insurance agency. As a result of this Salary Saving Scheme, the rescuers will also be able to get an amount four times their original saving near their retirement.
Data Compilation and Analysis
A software programme has been developed so that regular compilation of data regarding the number of emergencies, locations and type of emergencies is recorded. Details about road traffic accidents, injuries and other emergencies is regularly recorded on call recording register and forms available in the control room and details about the nature and cause of emergencies is recorded on specially developed Emergency Response Forms during transportation by the field staff. Cluster mapping of all emergencies is also done to identify high-risk areas. Daily, weekly and monthly reports are generated so that the data could be analysed for preventive purposes and for improving the quality of the service. This information will help Rescue 1122 in making Punjab a Safer Province by reducing the disability and deaths due to injuries, which is the leading cause of death amongst the young earning breadwinners of the society.

Performance / Achievements
Punjab Emergency & Ambulance Services is playing pivotal role in saving human lives and reducing the rate of morbidity and mortality. Ten-month performance can be viewed as under.
Performance During the Test Run (from 10-10-2004 to 30-08-2005)
Road Traffic Accidents 5987
Fire 339
Building Collapse 61
Explosions 09
Others (Mostly Medical Emergencies) 5856
Average Responded calls per day 36
Average Response Time 5.9 min
Patients Rescued & Hospitalized 10996
o Dead at Incident Site 194
o Expired 29

Cost Effectiveness of the Project

It is one of the most cost effective projects. A significant saving was made by indigenous fabrication of vehicles within Pakistan. The expenditure of providing first trained efficient and effective Emergency Service, which is a basic right of every citizen and also provides a sense of safety to the citizens of Lahore, is one-fifth the annual budget of the smallest teaching hospital of Punjab.
Exemplary Project for other Services

As a result of the exemplary performance of this model service the other governmental and non-governmental organizations like Edhi, patient transport service and Fire Brigade have been inspired to improve their standards for patient care. The Rescue 1122 Service has been exemplary in motivating such organizations, which in itself shows the success of the project.
International Recognition
The Service has already gained significant recognition and was highly appreciated by the Indian, English and American delegations. The US State Department has also donated specialized rescue equipment worth over 140,000 US dollars, on the basis of excellent performance of Rescue 1122.
This is one of the few projects of the Health Sector to undergo third party evaluation prior to its expansion. The results of the evaluation ordered by the Planning and Development Board of Punjab reveal this Service/ Project to be “a well conceived and excellently implemented project. It is an exemplary project in terms of training, quality care, response and professionalism. It has provided a sense of safety to citizens of Lahore. Its beneficiaries are primarily breadwinners hence it has favorable socio-economic impact.”

Reasons for the Success of Service

• Transparent recruitment of appropriate staff
• Rigorous training according to international standards.
• Procurement of quality equipment and ambulances
• Good Management
• Proper defining of SOPs for operations
• Strict Monitoring
• High level of coordination between different agencies
• Data compilation for Research and Analysis
Future Vision of the Service
• This Emergency Service apart from expanding to all the major cities, would develop a proactive approach towards emergency management, so that the leading cause of death and disability due to injuries amongst the young, able and earning male members of the society could be reduced. This proactive approach towards Emergency Management through proper data collection and taking preventive measures through the Emergency Council will help in establishing safer communities.
• The sustainability of the Service is being ensured by establishing a model Emergency Service Academy for continuous supply of trained human resource required for expansion and refresher courses of the Rescuers to ensure the quality of the Service.
• The model Emergency Service Legislation is also in the final stages of enactment.
• Rescue 1122 aims to be a model Emergency Services for developing countries.

Our Beneficiaries say

 The response time and professionalism of Rescue 1122 is excellent. Mr. Rizwan Naseer, the project Director of the Punjab Emergency & Ambulance Services is the most experienced person in emergency management in the country.

(Mr. Mushtaq Kiayni Provincial Minister for Public Health Administration)
 It is a worth praising achievement of the Government of Punjab to establish Rescue 1122 Service in Pakistan. My mother was seriously sick when I called Rescue 1122 and its personnel rushed my house within no time. They shifted my mother to Shalimar Hospital efficiently.

(Mr. Mohammed Anwar from Mehmod Boti Lahore.)
 Rescue 1122 is playing important role in saving lives by providing efficient and effective management of injuries (mostly resulting from Road traffic accidents).

(Dr. Abduljabbar from Mumtaz Bakhtawar Hospital)
 Rescue 1122 is a model Emergency Service. Its response time and efficiency in managing accidents and disasters is remarkable

(Dr. M.A Sufi)
 The Rescue 1122 personnel were the first ones to rush to the scene of bomb explosion at Ichhra and shifted the injured to the Services Hospital.

(Mr. Shamsuddin, victim of Bomb explosion at Ichhra, Bhandara Center. Quoted by DAWN 23 September, 2005.)

 Rescue 1122 personnel performed very well in Cylinder blasts incidents at Allama Iqbal Town, Lahore. Their response time was five minutes in the middle of night.

(Daily Pakistan,4 May,2005.)
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