Improving Emergency Medical Services in Cambodia
Every day, an average of four people are killed on the roads of Cambodia-- one of the highest fatality rates compared to other Southeast Asian countries. Many others are injured. Traffic accidents have an enormous impact on the social and economic welfare of the country, with an estimated annual cost of $116 million.
Medical Teams International is working in Kampong Cham province, in northeast Cambodia, since 2008. At the completion of our first three years of work, we have realized the following accomplished:
- Trained more than 300 health care professionals in EMS doctors and nurses, ambulance staff and drivers, health center staff, and village health support groups.
- Compiled in Khmer and distributed an EMS textbook based on the U.S. Dept. of Transportation National Highway and Safety Admin. First Aid, First Responder and EMT Training Program Manual.
- Created a supporting multi-lingual EMS training DVD.
- Conducted EMS courses at Calmette Hospital in Phnom Penh for leading physicians.
- 10% of Kampong Cham population now knows how to access and activate EMS locally (up from 0%).
- In fiscal year 2013 ("FY13" which is July, 2012-June 2013) more than 200 community members will receive focused community emergency responder training.
- A quality improvement process for a provincial wide pre-hospital patient care report will be in place by the end of FY13.
- Equipped 11 hospitals and their ambulances to internationally accepted minimum standards.
See the Kampong Cham Province summary report [PDF] for more information about our EMS work in Cambodia.
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Critical situations resolved through EMS program training
Mother saved at childbirth
Dilanga Manuweera is an emergency medical services specialist working with us in Cambodia. He has witnessed the impact of our EMS program training. Here is a recent story of his:
“In the U.S., we all take for granted that in an emergency situation we can call 911 and get care immediately. But imagine living in a place where the nearest hospital is hours away, you have no reliable or quick transportation available to get there and no one close by knows how to help.
"For the past two years, Medical Teams International has been developing an EMS system in Cambodia. A year and a half ago, I came to Cambodia to teach and train first responders, medical providers in rural clinics, police and community health volunteers in emergency care. Creating emergency medical services in a rural part of a developing country is challenging, but empowering local first responders with the knowledge and skills to provide care is crucial in order to help save lives.
"Like the life of a young mother named Sophol. Her little baby was delivered far from any hospital by a rural clinic nurse, but following the birth Sophol continued to bleed profusely—a major cause of maternal mortality. Without immediate and knowledgeable intervention, Sophol could die. But earlier that year, this nurse had attended our EMS training. Using the emergency childbirth skills learned through MTI, she was able to not only stop the bleeding, but treat Sophol for shock and ensure that mother and baby could be safely transported to the closest hospital.”
On 24th October 2011 in the district of Chamkar Leu there was a mass casualty incident (MCI) involving 113 students who fainted at a local high school. Most of their ages were around 16-17 years old. The students were gathered for school assembly at 7:30am and had been standing for an extended period of time at which point the students started to faint. The Kampong Cham Provincial Health Department and the Ministry of Health concluded that the cause for the fainting’s were from pesticide fumes that the students were exposed to and inhaled which was being used by farmers in nearby fields.
Initial triaging and treatment was performed by the local Village Health Support Group (VHSG) who employed MCI protocols taught to them by Medical Teams International during First Responder classes. The personnel in the VHSG utilized colored paper to distinguish severity of patients and employed and directed the school staff and police in their efforts. The police officers present were of more assistance to the VHSG since they were also knowledgeable of such MCI protocols after having gone through the Medical Teams International
First Responder course earlier in the year.
Chamkar Leu hospital was first to respond with two ambulances from the hospital. Upon assessment of the MCI, these ambulances called for additional ambulances from Kampong Cham Provincial Hospital. Both hospital ambulances had accompanying Doctors and Nurses for the additional human resources needed for this scale of MCI. Students were transported from both the high school as well as the adjacent Health Center based on determination of severity. Students who were determined to be minor were not transported and remained under care at the Health Center or treated and released.
Twenty of the students were immediately taken to a Health Center located close by prior to EMS arrival. 93 students were transferred to Chamkar Leu hospital and Kampong Cham hospital via ambulances. Chamkar Leu hospital ambulance made a total of 13 trips from on-scene to both Chamkar Leu and Kampong Cham hospitals. (/p>
The chief complaint of the majority of the students was difficulty breathing and these students were transported while being placed on Oxygen. The ambulance personnel stated that the training received from Medical Teams International in the assessment and treatment of respiratory ailments was highly valuable for them to care for these students. In addition, treatment such as Oxygen would not have been possible if it were not for the donated Oxygen tanks by Medical Teams International. Other equipment Medical Teams International donated to the Kampong Cham Provincial Health Department and in turn, distributed to all the hospital ambulances in the province to be stocked in the ambulance, such as BVM’s, pocket masks, C-collars, backboards, straps, penlights, suction machine, and related equipment were also used during this incident.
On November 4, 2011, there was one incident at O Pi Village, Dong Kdar Commune, Chamkar Leu District. Four farmers went to work on a rubber plantation and were exposed to chemical spray that is used to ward off bats. They began to have difficulty breathing and the Chakar Leu ambulance was called by the village leader.
The village is about 20km in from the main National Road and access is over very rough and uneven terrain on a road filled with potholes and ruts. The ambulance arrived with two ambulance personnel and a nurse. The team started assessing and treating the farmers using equipment and training that was given by Medical Teams International (BVM’s, Oxygen, backboards, etc) and subsequently began transport back to the hospital. They stated they used their knowledge gained from the Medical Teams International EMT-B level class on assessment and treatment of respiratory ailments along with the various lifting and moving techniques also taught in the class to treat and move all four patients and begin transport.
The Ambulance crew had to face a further challenge in route to the hospital—the ambulance broke down while going over the rough terrain and had to be pulled by a small tractor. The ambulance, after being pulled out, restarted and resumed transport to the hospital.
All patients were successfully treated and released after arrival at the hospital.
International Justice Mission treats fractured leg
In October, 2011, during a rescue operation, a woman sustained a lower leg fracture. International Justice Mission (IJM) responded to this situation effectively and appropriately. Following the Medical Teams International training and advice, IJM had assigned one member of the response team to be in charge of the first aid kit and to make decisions related to medical care. In this manner, the IJM team was able to act both decisively and calmly, eliminating responses guided by confusion or panic.
In caring for the woman, the team put into practice skills directly learned from the training the previous fall, including cleaning and dressing cuts and splinting fractures. The practical exercise that the team had been given during the training not only enabled IJM staff members to work effectively, but also guaranteed that IJM possessed all the necessary equipment in their first aid kit.
Overall, the training helped the IJM team address the medical issue at hand with confidence and competence. In doing so, the IJM team was able to provide the best care possible for their client, reassuring her that IJM was there to help and protect her—a crucial part of building a relationship of trust with the patient.