Our current project will train Ambulance workers toward a modern EMS system Share the Health Cambodia Emergency Responder Mission Outline
Share the Health Cambodia (STHC) is a US based NGO performing medical missions in rural Cambodia. At the request of their government, we have agreed to assist the Ministry of Health (MOH) in the creation and implementation of a basic Emergency Medical System (EMS). STHC has assembled a team of over 70 medical and public health specialists for this project, including Doctors, Nurses, Paramedics and other Public Safety providers, many with prior experience in Cambodia. We are collaborating with several other NGOs in the region with similar experience. We will be functioning under the MOU of The Cambodian Road Safety Project (CAMSAFE), through the Ministry of the Interior. We are also collaborating on this project with the Cambodian Red Cross, Side-by-Side International, Surgeons For Cambodia, Vimean’s Kids, and other local and international NGOs. We have drafted the framework for a complete, ongoing and functional EMS service, first as a pilot project in Kampong Thom, and expandable to reach the entire country. STHC will coordinate with Kampong Thom local medical system and national medical community to produce a simplified emergency medical care provider course, adapted to reflect resources actually available in remote areas. This will be a slightly modified version of previous training provided by Medical Teams International (MTI) and was previously approved by the MOH. We would prefer this initial year of training will be a “Train the Trainers” scenario, where we will bring a team of 10 Master Trainers, and conduct classes that the graduates can then take back to their local service to improve the basic level of care. The students selected for this training should be advanced and capable of conducting training classes with the material. Once trained, we will assist them in conducting the responder classes in their geographical region. The medical training classes are the core of the mission, but there is no possibility an EMS system will function without mandatory changes to the infrastructure. EMS must be a coordinated program, and function as a vital member of the Emergency Department. The ED must provide funding, support and supplies for EMS services. A dispatch system must be created to answer and log calls, send appropriate resources, and obtain data. Cambodia should develop and promote a dedicated Emergency Number (119/911). For an EMS service to function, there must be an Emergency Physician with trauma skills in the position of Medical Control Officer (MCO). All EMS workers operate under the protocols and license of a dedicated MCO, who oversees all aspects of training and performance. This person is generally an ER Physician. It is critical that an MCO be selected, authorized, and funded by the Ministry of Health. I am currently seeking to establish contact with the Ministry of Health, Department of International Cooperation, to begin the approval process and ask for their collaboration in the project. This position must be created and supported by the Ministry, and the MCO must be devoted to this position. There are other positions such as Public Health Director and Training Officer that would be helpful, but a MCO is mandatory and the service cannot function without this. Mass Casualty Triage and Interagency Coordination between the various public service agencies is a critical factor in public safety. We would like to include at least one member of the local police service, fire service, Public Health Dept, a Midwife, and one ER doctor in our training program to teach the role and capabilities of EMS, especially during mass casualty and triage situations. We will work closely with the MOH to give this technical advice to help them create this system. It must be stressed that our NGO will act in a technical capacity as trainers, evaluators and advisors. We may assist in the medical care of patients in a training or evaluating capacity only. We will train workers and develop the infrastructure to create an EMS service, but we will not be acting as an EMS service. All of our medical trainers will restrict their actions to their currently certified skills. In Cambodia there is currently no “Good Samaritan” law. This is a law in nearly every country, and is required for an EMS system to function properly. In Cambodia there are still randomly enforced laws that can cause a medical worker to be legally charged for the death of a patient, even if their care was perfect. Even if this may not be frequently enforced, it is a major obstacle because it creates fear, and can prevent qualified workers from a career in EMS. I would like to be put In contact with a legislator who is willing to submit this law, and assist them in its creation. We can also discuss other laws common to EMS and Public Safety, and provide technical assistance with those as well. We will arrive in January for a weeklong visit to meet with our collaborators and obtain any documents we will need to proceed. We will visit the medical facilities at Baray-Santouk Referral Hospital, Kampong Thom Provincial Hospital, and the Bileg School to determine any logistical needs for this training. We must also study the capacity for creating a dispatch call center and the establishment of a dedicated Emergency Number. This trip would be a good opportunity to meet with the Ministry Officials so we can discuss details and support for our mission. Between January and June, we will be finalizing our customized training program, called MAT (Medical Attendant Training). It is based on a previously approved MTI program, and is meant as a simplified medical response program that is more focused on simple immediate lifesaving techniques, rapid intervention and public safety interaction. When we return in June, we will begin conducting “Train the Trainer” classes on Saturday and Sunday. Mondays we will be off, and Tuesday through Friday we will be working with the local medical services to help create a Mass Casualty and Triage system, a dispatch system, a medical protocol system, a training and recertification system, interfacility transfer protocols, and a medical equipment supply provider. Each of these systems is imperative for a properly functioning EMS service. We will not be providing these services- we will be assisting the MOH in their creation of a sustainable and functioning service. This initial class will be for 6-7 weeks, and the graduates should be able to provide this training to their local providers. After the class, I will remain for some time and assist these graduates in conducting further classes in their community. I understand projects frequently fall apart without a foreign presence. We will try to rotate staff to maintain an ongoing presence in Cambodia, and have a 3 year timeline of providing this assistance. After that, if we are successful and cooperation is sustained, we will consider teaching higher skill levels such as EMT or Paramedic. Finally I must stress- it is vital that the Ministry of Health has a role in this project. Unnecessary death and injury from road accidents costs Cambodia $400 million dollars a year in lost productivity. Ministers have been calling for this service for years, and several prior attempts have failed. We have studied those successes and failures closely. We believe that, with support, Cambodia can rapidly have a reliable and functioning EMS service. The Cambodian government must be willing to cooperate in this plan and improve their current infrastructure to achieve this service.
