PROPOSAL FOR THE ESTABLISHMENT OF KOGI EMERGENCY SERVICE (K-EMS)

A proposal that seeks to equip and reorganize existing health facilities into an integrated emergency medical response service for Kogi State that meets globally accepted standards. 1/1/2013

INTRODUCTION

An EMS system is a comprehensive, coordinated program that delivers prompt response, appropriate care, and safe transport in medical emergencies. EMS should be designed to fulfill the needs of the local community and to provide equal access for all patients. In Kogi State, presently there is no organised emergency medical service (EMS). Some hospitals have poorly equipped ambulances. There are no water ambulances. There are very few trained first responders in Police and SSS but the ambulance drivers are not trained first responders. Usually, the doctor and nurse that accompany the ambulance on an emergency are not trained first responders. It is important to realize that a hospital cannot manage emergencies or disasters by itself. There are other pre-hospital factors, which have to be considered. Developed countries such as the USA, the UK, other European countries, Australia and Japan already have systems that integrate pre-hospital and inter-hospital facilities. In developing countries, a pre-hospital emergency service may not exist, and resources are minimal. If we can integrate all the pre-hospital and hospital resources which are available, we can make an Integrated Emergency Medical Services System which will provide the means to manage daily emergencies and disasters in an organized way, and also provide good quality emergency medical care. Such a system should have the same organizational structure at national, state and local government level so that there is uniformity even if the resources vary. It is worth emphasizing that the goals of a good IEMS plan are to be able to: Respond rapidly Assess rapidly and; Decide on the need for escalation of response

The goals are dependent upon the pre-hospital resources, the hospital resources and all elements of the integrated, mutual aid system (including other hospitals) working together.

1. The EIement of an Integrated Emergency Medical Service (IEMS)

a. Laypersons should be able to: i. Recognize and relieve an obstructed airway ii. Support respirations and apply expired air iii. iv. v. Control hemorrhage Splint fractures and bandage wounds. Know how to transport casualties safely to hospital

b. The fire brigade, security personnel, red cross volunteers, traffic wardens, scouts etc are people who are readily available on the streets and in public buildings who have been trained to help and protect people. It is logical to build on their existing skills by training them to help the injured and acutely ill. They should all be certified first responders (refer to annex 1).

c. The pre- hospital ambulance service.

The fire brigade, security

personnel etc can be organized into an integrated emergency medical service. Even hospital based ambulances (manned by nurses from the emergency departments maintained by the hospitals) and public health center/clinic ambulances can be included and organized into an emergency medical service with one system and one command but different ownership.

d. The emergency department of hospitals, public health centers and clinics. The emergency departments, public health centers and clinics in Kogi state tend to operate independently of each other, that is why the care for emergency cases and multiple casualties in disasters is of

a poor standard. Every health facility (community health center, zonal hospital, general hospital and specialist hospital) should have a well equipped emergency department that will be staffed by trained medical first responders. The departments can be organised and regionalised with each emergency department responsible for an area with a system of referrals; the community health centre would be the lowest level of the system and the specialist hospital would represent the highest level. The success of the reorganisation of the emergency departments can serve as a template for the reorganisation of the health system in Kogi state as a whole.

e. Communication. i. Access: A toll free state emergency telephone number is

required for the population to report an emergency, disaster or mass casualty incident . The toll free number will have up to five lines for incoming calls. Alternative numbers (all networks) are also required. Publicity campaigns will be embarked on so the populace can be familiar with the number. Public education programs are essential to inform the community on ways to access the EMS system properly. They also are important in preparing laypersons to render first aid while waiting for EMS They will also be educated on the disadvantages of abusing the number. Penalities for offenders can also be introduced. ii. Call center : A state wide 24 x 7 call center based in Lokoja, should be established to coordinate and rush an ambulance after receiving an emergency call. Equipped with a geographical information system, the call center will help track an ambulance near the place from where the call originated and send a message to it. The ambulance will then rush the patient to a nearby hospital, be it a public or private one. Accident victims can be transported free of charge, while other patients can be charged a nominal fee.

iii.

Pre hospital communication. a. Pager system b. Radio Communication c. Satellite and GPS Systems

iv.

Inter hospital communication:

The best inter hospital A back-up radio

communication is a Hotline telephone.

communication system can also be obtained to work in situations when the telephone lines do not work e.g during natural disasters like flooding, heavy rains, riots etc.

THIS PROPOSAL

Our company seeks to establish a Kogi state Emergency Service (K-EMS). Specifically we propose to:

Assist the state to implement a state wide Basic life support (BLS) training program for students in schools through the establishment of First Aid clubs. Implement a BLS/ First responder training program for Security personnel (e.g. vigilante), ambulance drivers etc Certify all emergency medical personnel in Advanced Cardiac Life Support (ACLS) according to international standards- (American Safety and Health institute (ASHI))

Supply equipped ambulances to K-EMS Get a toll free emergency number for the state Set up a 24-7 emergency call center Equip emergency departments in selected hospitals Set up effective pre-hospital communication and intra hospital communication networks. Supervise and Train all parties involved in K-EMS operations for one (1) year before hand-over to the state.

COST IMPLICATIONS

Cost 1 BLS training schools NGN 50,000 per day. Logistics, accomodation and feeding costs to be borne by state. 2 BLS/ CPR/AED training for ambulance NGN 17,000 per person drivers and security personnel 3 ACLS/ First responder training for medical NGN emergency personnel (ASHI cerification) 4 5 Toll free number and call center set up Ambulances- fully equipped.* -advanced life support ambulances NGN 12,000,000 person NGN 12,460,000 294,000 per

- Mercedes benz fairly used ALS ambulances NGN 5,400,000 (5000km- excellent condition. Interiors as good as new-) NGN 1,300,000 - Tricycle ambulances for rural areas 6 Pre-hospital communication and intra hospital TBA- Price depends on the number of hospitals and ambulances. 7 8 Management contract Running costs** TBA NGN annum 9 Equipping Emergency Departments- Zonal NGN hospitals emergency 10 Equipping community health centers hospital departments- NGN center 210,000 per 3,200,000 per 13,000,000 per

11 Trauma and life support center at Kogi TBA Specialist center *

kogi state requires a minimum of 30 ambulances i.e. 1 ambulance per 100,000 population. This

estimate still falls below the internationally recommended 1 ambulance per 50,000 population.

** based on estimates of 30 ambulances and 1 central dispatch center.

FUNDING
After setting up the K-EMS, the state government can introduce the K-EMS levy for all road users in the state. All road users in the state can be made to pay a token yearly to provide sustainable K-EMS funding. Non resident road users can be made to pay the levy at designated points. Transporters who ply Kogi state roads can be made to pay a yearly fee for their vehicles.

Commercial trucks are currently required to pay a produce levy in the state, it will not be out of place to introduce a levy for road users. Many states have introduced various levies on road users for mobile adverts, radio license etc.