EMERGENCY AND AMBULANCE SERVICES IN CHINA
DIAL 120 TO CALL AN AMBULANCE IN CHINA
- Though you may also want to have other numbers on hand, just in case
- Ambulance staff are physicians, described as both over-qualified and under-qualified
- Most larger urban centers have begun EMS systems
- Most rural areas have no EMS
- EMS models vary across country, imported from different foreign countries at different times
- Beijing EMS was planned with input from Italians
- Shanghai EMS has more influence taken from USA
% of Seriously Injured Transported by Ambulance, 2013
ROAD TRAFFIC INJURY DEATHS, 2015
(PER 100,000 POPULATION)
HOW CAN I CALL AN AMBULANCE IN CHINA?
DIAL 120 TO CALL AN AMBULANCE IN CHINA
- But don’t be convinced an ambulance will be able to find you anywhere
No, not yet. The country is too big, with too many people and an EMS system that is too young to be able to reasonably expect that calling 120 will work everywhere.
Adding to those problems are inherent flaws in the Chinese EMS designs. Most ambulances are run out of “Rescue Centers”, which are centralized bases where ambulances and staff are housed, leading to potentially very long response times in less-populated areas. In an abstract sense, the Chinese treat ambulances like Yo-Yos or boomerangs, where they are sent out from, and return to, the same place every time.
Rescue Centers are also non-uniform in their responsibilities. Some provide prehospital care only (Hangzhou), while others have their own inpatient beds and inter-facility transfer services too. In these cases, patients may be transported to a Rescue Center for resuscitation and then admitted into its intensive care unit, leading in some cases to competition between Rescue Centers and hospitals.
GROUND AMBULANCE IN CHINA
AIR AMBULANCE IN CHINA
The Sichuan Earthquake (Chengdu, 2008) provided great deal of understanding as to the country’s needs in disaster response capacity, specifically regarding prehospital emergency response and search and rescue; it was “generally observed that not enough resources have been provided for the development of disaster response” (Hung 2009):
- Disaster response command center was unable to coordinate sufficient amount of medical response in initial period
- A shortage of experienced personnel in prehospital care and disaster response led to long delays in getting critical patients care
- Communication failures with field rescue teams were frequent
- General deficiencies were apparent in medical response team training and equipment, resuscitation equipment, communication devices and personal protective equipment
“Currently there is a heavy reliance on individual hospitals which the lack the ability to rapidly deploy” (Hung 2009).
Yes. It’s very likely a physician will be staffing your ambulance in China. There are also nurses and drivers, but no paramedics or EMTs, as “the concept of transferring specialized EMS skills to nonphysician out-of-hospital personnel is not universally accepted” (Thomas 1999). Many of these physicians will be recent medical school graduates who have limited training in prehospital care or emergency medicine, though some may have postgraduate training in relevant fields. This is not common though: “Currently no specialist training or qualification in prehospital care and there is no training syllabus, professional examination or specialist registration” (Hung 2009).
Since 1993 the National Prehospital Emergency Care Training Center has conducted EMS training courses for physicians, providing courses of approximately 90 hours over 10-15 days.
An interesting note is the inherent dilemma created by building a physician-based EMS system where resources are limited: “Since all physician calls have intensive care potential, equipment needs increase further” (Thomas 1999). However, equipment supplies are often insufficient and physicians collect necessary supplies from the Rescue Center central room before each call as “oxygen, medications and monitors are not pre-stocked.”
GROUND AMBULANCE IN CHINA
AIR AMBULANCE IN CHINA
Funding of prehospital services largely relies on provincial and city bureaus of public health (Hung 2009). “Fee-for-service” is also common, where individual Rescue Centers will collect reimbursement from patients for treatment and transport, with the money being used to support operations and staffing costs. “Most ambulance centers require payment up front and patients reportedly use ambulances only for perceived emergencies… Medical insurance does not routinely cover out-of-hospital transport, although it may determine the patient destination” (Thomas 1999)
Common Emergencies in China
Vaccinations for China
According to the US Centers for Disease Control and Prevention (CDC), different groups of travelers will require different vaccinations for travel in China:
- All Travelers
- Measles-mumps-rubella (MMR) vaccine
- Diphtheria-tetanus-pertussis vaccine
- Varicella (chickenpox) vaccine
- Polio vaccine
- Your yearly flu shot
- Most Travelers
- Hepatitis A
- Some Travelers
- Hepatitis B
- Japanese Encephalitis
- Yellow Fever – “There is no risk of yellow fever in China. The government of China requires proof of yellow fever vaccination only if you are arriving from a country with risk of yellow fever. This does not include the US.” (Read full list of countries here)
Read more about travel in China at the CDC website: https://wwwnc.cdc.gov/travel/destinations/traveler/none/china (Last accessed: Aug. 7, 2017)
1980s – Development of EMS in China begins (Thomas, 151)
- Ministry of Public Health issues policy paper “Directives to Further Strengthen the Emergency Care in Urban Areas” stressing pre-hospital emergency care
- EMS planning occurs according to hierarchical administrative system
- Ministry of Public Health is lead agency, but responsibility is delegated successively to provincial bureaus (23 total), regional bureaus and then city bureaus, leading to a substantial degree of autonomy in planning and design
1987 – Society of Emergency Medicine under Chinese Medical Association for Emergency Medicine (CAEM) is established becoming the biggest proponents of EMS development
1990 – Chinese Journal of Emergency Medicine is published
Emergency medical and ambulance services are overseen by the Ministry of Public Health, though planning and regulation seem to be handled at regional and/or local levels. There are five types of EMS delivery models identified in China:
- Shanghai Model – Rescue Centers that provide only prehospital care; operated from 17 urban and 11 suburban Rescue Centers with 168 ambulances; they have no inpatient beds and tend to transport patients to the nearest hospital; in 2003 their response time was reported as 10 minutes (Hung 2009)
- Beijing Model – Rescues Centers are emergency care centers that are run independent of other hospitals; they are equipped with similar capabilities, including their own emergency departments and intensive care units, but also manage and staff their own ambulances and call centers, allowing them to provide prehospital emergency care, inter-facility transfers and home transports
- Chongqing Model – Rescue Centers run out of hospitals, operating as a single care provider within one organization; ambulances are staffed by hospital medical workers
- Guangzhou Model – Unified communication center only, handling urban calls which are forwarded to the nearest appropriate hospital for ambulance dispatch; there are no Rescue Centers
- EMS Services Integrated within Fire and Police Departments – These are few and decreasing, typically legacy services that were developed locally in absence of coordinated efforts by the government and/or health system
- Hou XY et al: “The current workforce status of prehospital care in China.” Journal of Emergency Primary Health Care 2005;3(3).
- Hung KKC, Cheung CSK, Rainer TH, Graham CA: “EMS systems in China.” Resuscitation 2009;80:732-5.
- Kou K et al: “Current pre-hospital traumatic brain injury management in China.” World Journal of Emergency Medicine. 2014;5(4):245-54.
- Man Lo S et al: “Overview of the Shenzhen emergency medical service call pattern.” World Journal for Emergency Medicine. 2012;3(4):251-6.
- Thomas TL, Clem KJ: “Emergency Medical Services in China.” Academic Emergency Medicine 1999;6:150-5.
- Yan K, Jiang Y et al: “The equity of China’s emergency medical services from 2010-2014.” International Journal for Equity in Health 2017;16(1):10
- Zhong S et al: “Progress and challenges of disaster health management in China: a scoping review.” Global Health Action. 2014;7:24986
- “Key Learning from China’s Emergency Preparedness” – Ziqitza Health Care (Apr. 2017)