Hong Kong

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General

Capital – None (special administrative region of China)

Land Size – 1,104 sq km

Population – 7,089,705

Language(s) – Chinese (Cantonese) 89.2% (official), other Chinese dialects 6.4%, English 3.2% (official), other 1.2%


Prehospital Care


Overview

  • Hong Kong service divided into 2 regions
    • Each region has 4 subdivisions
    • Each division has “approximately 300-400 staff in 4-7 ambulance depots” (Graham, 737)
  • 2006 – Average of 1,577 calls/24hrs
  • Response Time Goals – 12mins
    • 2004 – 91.1%
    • 2005 – 89.6%
    • 2006 – 92.5%
  • Ambulance Command
    • Primary provider – Government funded
    • Began with 17 ambulances serving approx. population of 1,000,000
    • Present day:
      • 30+ ambulance depots
      • 250+ ambulances
      • 35 motorcycles
    • 4 Mobile Casualty Treatment Centers (MCTC)
  • Volunteer organizations
  • St. John Ambulance
    • Independent volunteer organization
    • Medical services during disasters, major public events (civic and sporting)
      • 2008 Beijing Olympic Games equestrian events in Hong Kong
  • Auxiliary Medical Service
    • Volunteer government organization
    • Back-up and on-call medical services for disasters and major public events
    • SARS outbreak (2003) – augmented infection surveillance programs at airports and ports


History

  • 1868 – Hong Kong Fire Brigade established
  • 1914 – Ambulance Service becomes part of Fire Brigade
    • Originally provided by Medical Department (non-emergency)
    • 1919 – First motorized ambulance acquired
  • 1941-45 – Japanese occupation: development of Ambulance Service stopped d/t manpower and equipment shortages
  • 1953 – all ambulance resources and ambulance medical personnel put under control of Fire Brigade
    • Forerunner of present Ambulance Command
  • “The Trench Report” (1960-65)
    • Government paper which further developed ambulance service
      • Later became service independent from Fire Brigade, renamed to Ambulance Command
  • 1960s-80s – provided Basic emergency care
  • 1990s – Exposure to other international prehospital services led to consensus to upgrade services to advanced provider skills “so as to maintain world standards” (Graham, 736)
  • 1992 – Officers from Ambulance Command sent to Canada for Emergency Medical Assistant (EMA) II training; also became instructors to provide courses in Hong Kong
  • 1997 – First part-time Medical Director appoint “to provide expert input into [advanced provider] development and the overall direction of training” (Graham, 736)
    • Second part-time Medical Director appointed in 2002
  • 2000 – “An independent consultancy, after a large-scale study, recommended that extended provision of [advanced provider] services with extra 400 EMA II staff would be necessary” (Graham, 736)
    • 2002 – Official EMA program started with funding from Hong Kong gov’t


EMS System Model

  • Anglo-American
    • Modeled after Canadien Emergency Medical Assistant program in conjunction with Paramedic Academy of Justice Institute of British Columbia (JIBC)


Lead Agency


Funding


Levels of Care

  • Ambulance Fleet
    • “Fully equipped and manned at [advanced provider] service level since March 2005” (Graham, 737)
    • All are equipped with AED
  • Ambulance Personnel
    • 3 Staff
      • 2 providers, 1 driver
      • At least 1 EMA II-level provider on each ambulance
  • Ambulance-Aid Motorcycle (AAMC)
    • Key component to provide rapid care in Hong Kong’s notoriously narrow, crowded streets
    • First introduced in 1982
  • Mobile Casualty Treatment Centers (MCTC)
    • Mobilized for incidents requiring more than four ambulances
    • Stocked with “more sophisticated equipment in larger quantities than a standard ambulance” (Graham, 738)
    • Small clinical area which can also function as operating theater
    • Respond to calls “limited to life threatening ‘ABC’ conditions, when an ambulance is unlikely to reach the scene within the 12 min target response time” (Graham, 738)


Education & Training

  • EMA I
    • 760h (26 weeks) lecture and practical instruction
    • Basic medical aid
    • “Respiratory … nitroglycerine protocol”
  • EMA II
    • Certified by JIBC (CAN)
    • 20 weeks instruction
      • 10 weeks self-study
      • 8 weeks (234h) labs and classroom lecture
      • 2 weeks clinical
    • AED use; IV cannulation; Infusion of Normal Saline, 10% Dextrose; IM injection of thiamine, glucagons and naloxone; SL nitro; nebulized salbutamol and ipratropium;
    • Some have received training in: LMA and Combitube®; Direct laryngoscopy/Magill’s for FBAO; rectal diazepam, IM midazolam and chlorpheniramine; SC adrenaline
    • Periodic re-certification
  • EMA III
    • “Seven senior ambulance officers have gone to Canada for EMA III training in recent years”
  • Chinese University of Hong Kong
    • Provides independent postgraduate diploma and Master of Science degree in Prehospital and Emergency Care since 2005.
  • First Responder Program
    • Launched in 2003
    • Trains firemen to BLS level for care prior to ambulance arrival


Medical Direction

  • QA program
    • Paramedic Service Quality Assurance Program
      • Includes field audit, documentation review and remediation


Specialty Services

  • Government Flying Service
    • HEMS Search and Rescue – fixed-wing and rotor
      • Hong Kong and surrounding waters
      • 200 staff – medical personnel trained to BLS level
      • Works in coordination with Ambulance Command, though independent
    • Air Medical Officer (AMO) program
      • Volunteer specialist emergency physicians working on holidays and weekends
      • 2002 – began to recruit volunteer RNs


Dispatch & National Emergency Telephone #

  • 999 – like UK, as Hong Kong was British colony until 1997
    • Linked to all emergency services (EMS, Police, Fire)
    • Fire Services Communication Center responsible for mobilizing all ambulance resources
      • Also acts as EOC for complex emergencies
    • June 2005 – Center was upgraded with advanced telecommunications, “Third Generation Mobilization System” similar to enhanced 911


Emergency Medicine & Emergency Care


Disaster


References


Links

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