Lagos State: How To Make Ambulance Services Work Better
LAGOS, a megacity, with a huge population, no doubt needs a lot of infrastructure to make it work. Over the years, there have been attempts in that direction, especially with the growing challenges the state is confronted with, in terms of traffic and its consequences, like road accidents. One of such efforts, aimed at ensuring that accident victims get quick response, in terms of medical care, is the introduction of ambulance services in strategic locations in the city in 2011.
When the state government introduced ambulance stations in some locations in the city, many applauded the government for thinking in that direction as some accident victims, who could have died because of lack of first and prompt medical attention could now be rescued.
When Governor Ambode was sworn in, one of the first assignments he performed, as part of fulfilling his party’s electoral promises of not leaving any member of the society behind, according to him, was the commissioning of more ambulances. It was also noticed that more ambulance stations had been built.
Some of the locations with ambulance points in Lagos at the commencement of the project were Anthony, Mile 2, Oshodi, Jibowu, Iyana-Dopemu, Mile 12, Ajara-Badagry and Third Mainland Bridge. A renewed effort led to the building of additional ambulance stations in areas like Iyana-Itire. While the state government must be commended for expanding the service, it must also be reminded that some of the old ambulance stations no longer have ambulances.
Among the old stations, except for Ajara-Badagry and Third Mainland Bridge, the others lack ambulances. Ironically too, on many occasions this reporter had passed through Iyana-Itire, the ambulance meant for the new ambulance point had never been spotted.
The state has scored itself very high on its website, where it stated, “Both services, Lagos State Emergency Medical Service (LASEMS) and Lagos State Ambulance Service (LASAMBUS), run on a 24/7 basis and have led to significant improvement in the response time and quality of care with attendant improvement in morbidity and mortality rates occasioned by medical emergencies.”
About a fortnight ago, there was a fatal accident in Mile 2 area of the city, in which a life was lost and other occupants of a commercial tricycle got critically injured. Though there was an ambulance station some meters away from the scene of the accident, there was no ambulance; the injured and the dead were taken away for medical care in a yellow Urvan commercial bus.
The Commissioner for Health, Dr Jide Idris said that though the state at present has about 24 ambulances and about 14 ambulance points, there are plans to acquire more ambulances and build more stations.
He however said that some of the ambulances may not been seen at the ambulance points because it is not all the time they are parked there, as they sometimes move around or could be called for assignment.
“In the evening, they are moved to the local government headquarter office or the nearest general hospital for security reasons,” Idris said.
He said it is strange that some of the ambulance points had been perpetually with no ambulances because according to him,“there is more than enough. It should not be.” He also said “The initial plan was to locate them around busy traffic spots and where accidents are recorded too frequently. Nonetheless, there might be need to expand to other areas of Lagos.”
A professor of Public Health at the College of Medicine, University of Lagos, Adebayo Temitayo Onajole, stated that ambulances are meant to evacuate emergency cases to the point where treatment or resuscitation can easily take place. The reason ambulances and ambulance points should have paramedics is to render first aid in the process of moving individuals from point of emergency to points of relief, where actions and treatment can take place effectively. This, to him, is why it is important to have ambulance stations and ambulances for the general public.
The professor noted that there is need to synergise between public and private institutions in the management of ambulances. “There should be a linkage between those ambulance stations and hospital settings that have ambulances. So the hospitals should be like ambulance stations. There should be a process where a resident can call on the nearest ambulance station, which could be part of a hospital setting. And a lot of hospitals, public and private, have ambulances. So we should do an integration of these ambulances in spite of ownership, to be able to work in a synergic manner for efficiency.
“In Lagos, you could have ambulances on a stand alone basis. But what is the purpose of an ambulance; it is to be able to move patient from one point to another. Most of the time, this detached ambulance stations can do little or nothing, other than first aid when available. We should rather not place too much emphasis on detached stations, but that the detached stations are linked properly.”
Onajole is also of the view that the citizens must be made to understand that ambulances are not meant only for road accident, but for all kinds of people who need emergency medical attention.
“If you suddenly develop some health challenge while working in the office that requires moving to a health facility, there is need to call an ambulance. It could also be in the house and it should not just be for road accidents. The mobile ambulances are located basically for road traffic accidents and that is not the ultimate function of an ambulance service.”
This, to him, is why there is need to reintegrate ambulance services, those at the stations and those attached to facilities, so that, whichever that is closest to the point of need should give quick attention.
“And that is why it is not about ownership, but usage and response. There is no point having an ambulance station in Ilupeju and there is an incident in Mushin, and where there is synergy, Lagos University Teaching Hospital (LUTH) could be called to send in its ambulance, rather than waiting for the ambulance coming from Ilupeju. With that, you will be having efficiency. Most of the stationed ambulances are structured to cater for accidents on the road.
“But are they the only health issues that require emergency response? No. What we are saying is that there are a lot of more health issues that require emergency response, which should not be limited to road traffic accidents.”
The professor of public health argued that, in terms of efficiency, building so many stand-alone ambulance stations is not the best. “In this age of technology, we should find a way of having inventory assessment of who has an ambulance in the state, where it is located, how they could be integrated into the state ambulance services, so that whether it is publicly owned or privately owned, it should not affect the response time.
“And there should be a protocol of where the patients are taken to, so that the patient is not compelled to be taken to the hospital that owned the ambulance, if he or she does not prefer the hospital that owned the ambulance. This is because the patient may not be able to afford the bill of the hospital that owns the ambulance. But if the state government keeps putting so many ambulance stations in the whole place, it might just be photo-trick, especially if there are no ambulances there. The question is, at the end of the day, what does the state want?
“People who have incidences should enjoy rapid response, all the time. And an ambulance service is basically to move from a point of need to point of action within the shortest possible time. If you have a protocol that tells you how to move, whether the ambulance is from Eko Hospital, it should be able to drop the patient at LASUTH, Ikeja, which is why there is need for a protocol and working arrangement for everybody concerned to know their role in this service.
“If you leave the ambulance service to the public alone, you will never have efficiency for so many reasons. There is nothing wrong if government wants to increase the number of stations, but we should not be looking at it in terms of number, but in terms of process to get a better outcome. With that, we would save more lives. There are so many ambulances in private hands lying idle, doing nothing. It may be privately owned, but private organisations also have social responsibility. Government cannot do it alone, especially if you want efficiency
“In developed clime, if anything happens and there is need to evacuate the person for better healthcare in a facility, the first thing would be to call the ambulance service, but here people would be making personal efforts to resuscitate the person, thereby compounding the issue, through pouring water and doing all sort of things. If there is better response from the ambulance service, it will reduce unnecessary death. This is more so that a lot of us try to resuscitate out of ignorance.
“The people are willing to help but we do not know what to do. And the number of ambulances in the state is more than enough, if the publicly and privately owned ambulances are put together.
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