Emergency care on the move, ambulance teams are largely recognized for rushing into life-threatening emergencies, saving lives in people’s homes, by the side of the road or on route to the hospital; but also for driving the dead, in silence and respectfully, only its flashing lights on.
In some parts of the world, however, quality and timely emergency medical care is neither accessible nor available to all. In light of this, the World Health Organization (WHO) is advocating to strengthening emergency care systems that serve as the first point of contact with critically ill or injured patients which include first aid, prehospital care, facility-based emergency unit care, and early critical and operative care as needed.
In the Rohingya refugee camps in Cox’s Bazar, WHO and partners have established - and further strengthened - a referral pathway to allow for the safe transfer of critically ill CoVID-19 patients to the newly established Intensive Care Unit (ICU) at the Cox’s Bazar District Sadar Hospital. Comprising 32 ambulances for a population of over 860 000 refugees, the ambulance fleet teams are working around the clock to meet the overwhelming need.
Together, the World Health Organization (WHO) and the International Committee of the Red Cross (ICRC) are building on the capacity of frontline ambulance teams to ensure skilled prehospital emergency medical care in the world’s largest refugee camp.
Under the overall supervision and coordination from WHO, camp-wise Rapid Investigation and Response Teams (RIRT) have been responding to alerts within 24 hours and referring CoVID-19 patients to SARI ITCs with the help of the Dispatch and Referral Unit (DRU), under the coordination of IOM. WHO Bangladesh/Tatiana Almeida
More than helping moving patients to Severe Acute Respiratory Infection (SARI) Isolation and Treatment Centers (ITCs), when equipped with the necessary skills to provide patient assessment and emergency care, ambulance teams can stabilize acutely ill and injured patients thus minimizing disability, ill-health and even death.
“My father is an ambulance driver and a compelling storyteller. One of the stories that inspired me to join the emergency workforce care was the day he rushed a severely injured baby to the hospital and the doctors said that my father was the one who had saved the child by driving so fast”, recalls nurse Sizar Sultana.
An experienced nurse in the Rohingya refugee camps, six months ago Sizar Sultana joined the Bangladesh Red Crescent Society (BDRCS) as a frontline responder to CoVID-19 pandemic. WHO Bangladesh/Tatiana Almeida
To enhance prehospital emergency medical care in Cox’s Bazar, the World Health Organization (WHO) and the International Committee of the Red Cross (ICRC) organized four batches of Basic First Aid (BFA) trainings to build capacity among ambulance teams.
“The benefits of this training go far beyond the best available options for the mobility of critically ill CoVID-19 patients in the refugee camps as it promotes standardized case management practices and emergency referral of patients”, explains WHO National Consultant Dr Tasnova Sadneen. “Participants are oriented to work as a team while developing important skills about scene management and patient handling”, she adds.
“Designed for out-of-hospital emergency care in fragile and low resource settings, the basic first aid training represents ICRC’s foundational prehospital care training covering key first aid principles and various lifesaving skills in addition to the basics of wound care, fracture management, resuscitation, etc. We are proud of bringing this very hands-on job training opportunity to CoVID-19 frontline responders in Cox’s Bazar”, says ICRC First Aid and Prehospital Care Delegate, Matthew Earl.
Participants of the Basic First Aid (BFA) training learning how to apply pressure and use a tourniquet to stop massive bleeding with the guidance provided by Dr Tasnova Sadneen. WHO Bangladesh/Tatiana Almeida
Building on team work, Basic First Aid (BFA) participants responding to a simulated car accident. WHO Bangladesh/Tatiana Almeida
“The four Basic First Aid (BFA) trainings that took place in November having reached a total of 64 staffs of various SARI ITCs including drivers, nurses and doctors, were a first step towards building the capacity of health staff to safely accompany critical patients during transport. Further steps have now been taken to ensure that ambulances are being upgraded with technical equipment and supplies”, tells WHO Case Management Consultant, Ina Bluemel.
A few days after successfully completing the WHO/ ICRC training, a call came for ambulance driver Md Alam from DRU informing that a CoVID-19 positive patient who had delivered her child five days earlier and whose respiratory condition had deteriorated, was in dire need of transport to Sadar Hospital at the Hope Foundation SARI ITC in the Rohingya camps.
“It was the most complex case I have ever witnessed in my life. They asked me to drive as fast as I could, and while I was battling the traffic jam and pleading to other drivers to give us way, at the back of the ambulance a doctor and two nurses were kept busy”, recalls Md Alam.
“It took me one hour to reach Sadar Hospital, which is nearly impossible given the distance and condition of the road. But unfortunately, CoVID-19 was faster. This pandemic really is a battle, but in the end we will win”, he adds hopeful.
As an ambulance driver at the Bangladesh Red Crescent Society (BDRCS), often times Md Alam is one of the first responders reaching an emergency. WHO Bangladesh/Tatiana Almeida
The second step to build critical care capacity among health care providers within the SARI ITC network in Cox’s Bazar, WHO and ICRC are currently providing Basic Emergency Care (BEC) trainings for 29 SARI ITC nurses and clinicians. This will enhance safe transfer of critically ill CoVID-19 patients to the ICU at Sadar Hospital.
A number of dedicated SARI ITC network partners and other critical stakeholders such as the ICU team at Sadar Hospital, are currently involved in developing a critical patient transfer system between the SARI ITCs which includes a strengthened health workforce, upgraded 24/7 ambulance availability and revised standard operating procedures that incorporate lessons learned from the past six months of referral of critically ill patients to Sadar Hospital ICU.