Apr 04 2014
Ashley Brown, MD
While working in the Accident & Emergency Department in Georgetown, Guyana, I noticed one thing that was very different from what I’m used to back in Nashville: few to no ambulance arrivals. That is because there is essentially no EMS system in Guyana.
There are a few ambulances that are a part of the hospital system. These are used mainly for transport between outlying hospitals and GPHC, where I was working. They are also used to transport patients in our hospital to the CT scanner, located in another building, or to transport laboring mothers from the L&D ward to the main hospital, where the operating rooms are located. When used for transport from an outlying facility, they are staffed with a driver, sometimes a nurse, and an “attendant”, who might be able to assist the nurse. In addition, multiple family members will usually ride with the patient.
I happened to glance in the back of one of these ambulances to see what sort of equipment they carry. Not much, I found out. There is room for a stretcher along one wall, and along the other wall is a long bench for other passengers. There was an oxygen tank under the stretcher, although I could not tell how much, if any, oxygen was present. Having worked in EMS, I am used to seeing a bag full of airway equipment, some suction equipment, and some basic medications and IV start supplies; none of this was present on this ambulance.
While working in the A&E I received a few patients who had been transferred via this ambulance service. Occasionally, they came with a nurse who could give a patient report, as well as some papers with labwork and a history, but often we had little to no information about these patients. Notably, I never treated a patient brought in by an EMS crew from any sort of scene (i.e. an automobile accident or a medical emergency from home). Guyana does have a 911 equivalent for calling for an ambulance, but this number is not staffed at all times. Even when you can get through to someone, there is no telling how long it will be before an ambulance is available to pick you up, or what sort of personnel and equipment will come with it. Most people who are the victims of some sort of trauma will either take a taxi or have a family member drive them to the hospital.
The problems with this are many. First, for trauma patients, there is no spinal immobilization. There are occasional attempts to stop bleeding by family members or bystanders, but often these were unsuccessful. At home, our fully trained paramedics will often pick up a patient with heart failure and severe respiratory distress and by providing treatment in the field and in the ambulance will have them almost asymptomatic by the time they arrive in the Emergency Department.
As an Emergency Physician and former EMT, I have read about the start of EMS in my country, when there was little to no actual medical care provided and was more just transportation. I was continually reminded of that while in Guyana.
The week I left, the Rotary Club had returned for the second part of a series of paramedic classes for the nurses in the hospital. While I think it is wonderful to provide this additional training, there is still much do be done in terms of infrastructure to create a functional, though needed, EMS system. More ambulances will need to be obtained, and a minimal level of equipment will need to be stocked and maintained on the ambulances. There must be a more cohesive system for dispatching the ambulances, as well as some sort of base at which the ambulance and crew is quartered. There will also need to be qualified personnel to work on the ambulances.
There is tremendous potential in creating a transport system that can respond to emergencies, provide some minimal, life saving care, transport patients to the hospital rapidly, and communicate with the receiving hospital to give basic patient information and acuity, particularly for the trauma population.