December 4, 2022

Fatteh Hamid

Ambulance delays have been a major concern in attending to emergencies in some countries. The increase in deaths caused by the situation has raised concerns among stakeholders.

Deaths recorded over lateness in the arrival of ambulances for emergencies have been on the rise in the United Kingdom leading to the deaths of nearly 30,000 patients since the emergence of COVID-19.

Though gridlocks, lack of priority for ambulances, bad roads, and insufficient ambulances, among others, have been identified as the major reasons for ambulance delays, it is noteworthy that inadequate laws to support ambulances were an issue.

Germany, Austria, Switzerland and some other advanced countries adopted what was called ‘Rettungsgasse’ connoting a rescue alley/lane in English. The system makes it a law to move to the farthest side of the road when high traffic is experienced on autobahns or highways.

The rescue lane is created so that emergency service vehicles such as ambulances, fire trucks, etc can move through traffic with ease. If anyone disobeys the law, deliberately blocks emergency vehicles in any way, or uses the rescue lane, the offender will pay a fine.

In a research by Agnes Utoro et al titled, “Perspectives on the current state of Nigeria’s emergency care system among participants of an emergency medicine symposium: a qualitative appraisal,’’ it was estimated that of the 1.6 million deaths recorded annually in Nigeria, between 10 and 15 per cent occur in emergency departments. It stated that Lagos is one of the few states in Nigeria with a public ambulance transporting system, many of which are non-functional. The research stated, “And for those that are, the ability of the ambulances to get to the scene is difficult with the current road traffic system. Commentaries published by healthcare professionals have characterised deficiencies in the Nigerian emergency care system and offered potential solutions.”

In May 2022, reports noted that ambulance drivers in Lagos State lamented motorists’ refusal to give way and make them lose patients. Lagos State is not the only place where this situation happens, it is commonplace in Nigeria.

Commenting on the issue, pioneer Vice Chancellor of Ondo State University of Medical Sciences and professor of Gynaecology and Obstetrics, Friday Okonofua, stated that ambulances in Nigeria were not properly managed.

He said, “Ambulances all over the world are important for emergency services. But without being adequately managed, with the government willing and having the commitment to purchase the right and sufficient ambulances and to put up a management system, it won’t work.”

He noted that the management service often set up around ambulances in Nigeria wasn’t adequate, stating it was the reason why the inefficiency became apparent.

Okonofua stated, “The system in Nigeria is cumbersome. All over the world, we have countries who use helicopters as ambulances. It’s because they have a quality management system that works. It shouldn’t be an expensive business for us in Nigeria; local governments can afford to purchase ambulances. After all, they buy vehicles of all types. When they purchase ambulances and respond to them, they will be made use of by those who need it.”

He also noted that the few ambulances available in the country were not used for their primary assignments, noting that they were deployed for other secondary uses.

He said, “Imagine people taking ambulances to weddings; that’s ridiculous. Management is what is wrong and where we need to actively work on.”

On the need for Nigerians to give ambulances priority, he stated that if ambulances were not regularly available, people would forget what they were meant for.

He said, “When growing up and we heard the sirens of an ambulance, we knew that someone was being carried for an emergency. But these days, how will an ambulance be prioritised when we do not even know if someone sick was inside? That is the truth. People have forgotten the concept of emergency treatment or ambulances because of how badly managed it has been in recent years. When the government starts managing ambulances properly, then we’ll know they are serious.”

Okonofua added that people die because they were not given adequate care at the time they were meant to receive it.

On his part, another professor at the University of Benin Teaching Hospital, Michael Aziken, noted that the government had a major role to play in ensuring ambulances’ efficiency.

He said, “There are road networks in most cities in Nigeria, however, they are not motorable. The few ones which are motorable are congested. However, ambulances are supposed to ferry the sick, but how many of these ambulances are actually carrying sick people when blaring sirens? How many of them are on errands to carry sick people? At times, the drivers take advantage of their status to get to their own destinations. However, with time, the citizens have realised that they aren’t going anywhere.”

Aziken noted that it was important to give the right of way to ambulances, stating that drivers needed appropriate education in order not to abuse the power they have.

He noted, “In a civilised society when ambulances are coming, every vehicle moves to a side of the road to allow the ambulance right of way. Also, we need to ask ourselves if our ambulances are well equipped. People are dying inside ambulances because the patients are not getting the needed treatment they needed before getting to the hospital.

“The problem is multi-factorial and we need the Federal Road Safety Corps to be active in the enlightenment of the public, which will be continued in order for people to know what attention ambulances deserve, especially on the road.”

Commenting on the German ‘Rettungsgasse,’ Aziken stated, “We must understand that these are civilised societies where everybody has a responsibility to maintain law and order. However, in a country like Nigeria, do people respect the law? From the top to the lowest person in society, who respects the law? Take the Federal Government, for example, they have abused court orders severally and people are watching them. These are the issues. The police who are meant to charge people who abuse such rules in Nigeria take bribes and free the offender even if the law is adopted. We have a long way to go.”

He added that nothing works in societies where people are not punished for crimes.

Also, a doctor at the University College Hospital, Ibadan, Oyo State, Uthman Adedeji, noted that the challenges were multifaceted in the area of emergency service.

He said, “One of the major challenges ambulance services has is that the rescuers, those at the forefront when incidents happen such as the FRSC, onlookers, Red Cross, first raiders, etc are not properly trained. Sometimes, we have patients who sustained a certain injury and require a certain means of transport. For instance, for a spinal cord injury patient, there’s a log of wood and other material in the vehicle which the patient is meant to lay flat. Training of these front-liners is important for resuscitative care.”

Adedeji explained that the Federal Government needs to also look into peripheral hospitals and health centres to cut the long-distances ambulances have to pass during emergencies.

He noted, “Look at the country’s primary and secondary health care, if they are able to offer immediate response to emergencies, the issue of a delayed arrival, and traffic might not be a major concern. Because most of the time, around the region where accidents happen, there are either primary or secondary healthcare facilities. If that is properly taken care of, then a proper referral will help patients for survival.”

Adedeji also noted that due diligence was needed for first responders or primary centres to intimate the hospital the victims would be transferred to for them to give adequate care.

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