IF WE BUILD IT, WILL THEY CALL?
Meeting Demand with Supply in Tanzania
By Scott Campbell, EMT
Tanzania Program Coordinator
December 7, 2015
Here at Trek Medics, we’ve always known that demand for the services and assistance would be high – few communities would argue the need for emergency medical services, and particularly in low- and middle-income countries where more than 90% of all traffic-related injuries worldwide occur. The bigger questions we’ve been trying to answer, however, are more concerned with public outreach – that’s to say, “If we build it, will they call?” After three months of hard work recruiting partners and training responders in Mwanza with the Tanzania Rural Health Movement (TRHM), and thanks to a generous seed grant from Google.org, we found that the answer to this question was a booming “Yes” – and it came quicker than any of us had expected.
Included below are some excerpts from a recent field report sent back to us from Scott Campbell, Trek Medics’ Program Coordinator in Mwanza, Tanzania, who’s been working with TRHM to implement the city’s first coordinated emergency medical service.
A HINT OF THINGS TO COME
“Early in the morning of the third day after we launched the service, one of the firefighters from Mwanza fire department was on his way to work when it was still dark out, an early riser, and he came across the scene of a recent accident. The patient was a young motorcycle driver who had collided with a car and was visibly hurt with fractures to both of his lower extremities. Thanks to the intensive training we’ve been giving the fire department, the firefighter knew exactly what to do: he controlled the scene and made sure there were no other victims, controlled the patient’s hemorrhaging and then wrapped the patient in his jacket. And because he felt confident enough in his own skills, he made the decision to transport the patient without calling for more assistance, taking him to the Bugando hospital emergency department (ED) by taxi.”
It was an early win that got everyone talking at the station, and though it all happened incidentally, and independently of using Beacon to dispatch, it wouldn’t take long for that to change, either.
STEP 1: KNOWING WHEN AND WHERE THE HELP IS NEEDED
“The second patient, and arguably the first real patient of the Tanzanian project, happened when a member of the public called the fire department around lunchtime to report a motor vehicle collision with an entrapped driver.
“After taking the location and information, the dispatcher created an incident using Beacon, which then relayed an Alert to all of the active responders with the location.
“The lads were on scene in under five minutes and when we arrived a large crowd had gathered, with the odd film crew moving throughout. The patient had a right-side open tib/fib [tibia/fibula] fracture, which was easy to see when they opened the door of the truck, but he was entrapped, so the firefighters had to extricate him first, which took no small amount of teamwork with their limited tools.
“Once freed, they provided care to the patient, controlling hemorrhage and splinting the fracture with great care (and with the medical supplies donated by Msua Pharmacy). In any formal service, with an injury like that, the patient would’ve had a needle in his arm with morphine almost immediately, so I was really proud to see how much effort the lads took to handle him with care, and not let the adrenaline take over.”
(View tib/fib fracture photo here. Warning: graphic)
“After that, they tasked the Police with transport of the patient to Bugando ED in the back of their pickup. This was probably the most satisfying part of the call for me personally as I have spent months instilling in them the need to put their pride aside and avoid any ‘turf wars’ so they can do what’s best for their patient – treating the patient as if he/she were a member of their own family. Letting the Police transport probably wasn’t very easy for them to do given the enthusiasm they had on the call, but it was definitely the correct decision, and the Police played their part well, too, agreeing to take two firefighters in the back of the pickup to monitor the patient en route.
“From the time the call was placed to the time the patient arrived in the ED was under 45 minutes, so they met the ‘Golden Hour’ standard for critical traumatic injuries, which is awesome considering the patient had to be freed from the vehicle and the extrication tools they have at their disposal make a western fire service look like NASA.
“Once at the ED I followed up with the patient who was happy with the care he received and was surprised with how fast he was treated and transported. He also noted his level of pain decreased after the splint was applied, which was another win for them.
“After this, Marko [Dr. Marko Hingi, TRHM’s Executive Director] and I headed back to the fire station where we conducted a debrief of events, coming up with some Fixes, Improves and Maintains related to their performance. They outlined some of their frustrations with ED staff and delays in handing over the patient.”
“The initial alert they sent using Beacon was the first and last use of the software for the duration of that incident, but I’d mark that up to them just being super excited to get the alert when it happened, and so were focused on getting to the patient. But they are getting there. As we continue training and running simulations, and this all becomes more routine, it won’t be any different than the MDTs [mobile data terminals] we’re using back home.”