MTI Cambodia EMS Project Phnom Penh Neurosurgery Conference

MTI Cambodia EMS Project Phnom Penh Neurosurgery Conference Preah Kossamak Hospital March 28 to 31

Brief Statistical Overview • The Global status report on road safety 2013 estimates that more than 2, 400 people are killed in road traffic crashes in Cambodia every year. • Motorcyclists make up 70% of all these. • Pedestrians are the second most vulnerable group, representing 12% of all road fatalities. Photo: Phnom Penh Post Statistics: who. int/violence_injury_prevention/road_traffic/countrywork/khm/en /

Notable Healthcare Statistics 2013 to 2014. • 15 -to-30 -year olds represented the majority of the head injuries (66 percent). • Males outnumbered females by 4 - to-1. • Fifty-six percent of the cases involved motorbike accidents, and of these motorbike accidents, 91 percent of riders did not wear helmets and 42 percent admitted to using alcohol at the time of the accident. www. cambodiadaily. com, December 9, 2014

History of EMS in Cambodia 1974 to late 1980’s Total distruction of the Healthcare infrastructure Late 1980’s ambulances for community response started at some major Hospitals in Cambodia Khmer Soviet Friendship Hospital Calmette hospital Preah Kossamak Hospital Some private clinics started single ambulance initatives

Growth of EMS in Cambodia • 1990 to 2010 primarily provided by Private clinics • 1990’s Several Short lived NGO ambulance projects • 1997 to 2003 SAMU Ambulance in PP (ECHO project) • Nov 2008 Private Ambulance Response banned by MOH • Overall, slow growth until 2015 • Gift of 200 Ambulances to MOH from China May 2015

UN Sustainable Development Goals EMS programs are directly impacted by the Sustainable Development goals of the United Nations EMS Program falls directly under Goal three (3): Ensure healthy lives and promote well-being for all at all ages 3. 6 reduce impact of Road Traffic Accidents 3. 8 Achieve access to Quality Health Care Services 3. 12 Recruitment, Development and training and retention of the Health workforce

OVERALL IMPACT ON SDG’s • EMS Programs play a part in the overall strategy to achieve the Strategic Development goals. • 3. 1 Reduce Maternal Morbidity – Provides direct training – Provides referral method – Provides equal access – Provides universal access

SDG Role In Care for Children • Goal 3. 2 End preventable deaths for under age 5 children. – EMS Education focuses skills of Healthcare workers on identifying and correctly treating pediatric emergencies – EMS capacity building provides a mechanism to transport children to appropriate Hospital – EMS programs provide direct support to prevention programs such as helmet, car seat, other pediatric safety programs

SDG Role In Epidemics • Goal 3. 3 end the epidemics of … communicable diseases • EMS PCR reports are a real time tool for use in epidemics and pandemics in the US. • Digital data is used in real time (in the US) to focus efforts in disease mitigation • EMS programs assist directly in establishing a program of disease and injury surveillance.

Medical Teams International’s EMS Development work • EMS Development projects started in 2000 • Initial projects in South Western Europe • Moldova, Albania, Uzbekistan • EMS projects started in Asia • Vietnam, Sri Lanka, Cambodia, Nepal, Myanmar Photo: MTI Hattaway 205

MTI’s Cambodia EMS Project • Started in 2009, EMT & First Responder Textbook approved by MOH • EMT Education Classes in Kampong Cham (initially( • Provided EMT education to every Emergency Department and most Health Centers • Expanded EMT Education under USAID Grant to 9 Provinces in 2014 to 2016 MOH Master Trainer Dr. Yav. Yan Photo: MTI Hattaway 2015

Highlights of the MTI EMS development Project • More than 1, 100 EMT’s trained in nine (9) provinces • 76 EMT Master trainers trained with classrom experience • Equipped Ambulances in Prey Veng, Tbong Khmum , and Kampong Cham with minimum level of supplies on ambulances • Worked to streghten PHD’s, OD’s and the Ministry of Health • Currently providing First Responder training to Village Health Workers and the Traffic Police

Significant Accomplishments • Translated, approved EMT Textbook as basis for Education • Translated Curriculum / Lesson plans for consistent Training • Patient Care Report Introduced and approved by MOH National use (for improved Quality of care, Statistics and Documentation) • MOH Trainers that have actually taught the curriculum • 9 provinces given initial training (50+% of population)

Visible Results of the MTI EMS Development Project • Many ambulances in the provinces now staffed with both EMT and Driver • Many ambulances now starting to acquire & maintain supplies and equipment (But need is still acute) • Ambulances are now being used to transport patients between Referral Hospitals • Ambulances are starting to Document Care rendered With the PCR Photo: MTI, Hattaway -2016

Road traffic Accident Statistics in Cambodia • Road Traffic Accidents account for More deaths than 9 times the number from Malaria, Dengue fever, HIV / Aids combined • In Cambodia, motorcycles are the primary mode of transportation. Their drivers and passenger make up the highest portion of all road fatalities. • In 2013, 62 percent of these victims perished from traumatic head injury. “Often surviving is worse, ” says Mirjam Sidik, CEO of AIP Foundation. “Many injuries cause life-long disabilities creating a sudden need for permanent care source: AIP foundation. org

TRAUMA / DISEASE COMPARISON • Death by trauma greater than Communicable and noncommunicable disease deaths combined under age 47 http: //www. cdc. gov/injury/overview/leading_cod. html

Primary Cause Of Death Age 1 to 47 • Trauma as cause of death • #1 for age group 1 -46, or 47% of all deaths in this age range • #3 as leading cause of death overall, across all age groups • It is the most likely cause of death during your working career • Death of young working age Adults 16 to 40 is a primary cause of poverty in developing world http: //nationaltraumainstitute. org/home/trauma_statistics. html

Preventable Deaths from Road Traffic Accidents • Bleeding, both exsangunation and Internal • Head Injury - Most are low speed Motocycle crashes • Cervical spine and Multiple long bone fractures Photo: WHO. org; MTI Hattaway, 2016

EMS System Improvements needed Now to continue the growth of EMS More EMT Education – Increase from 74 to 120+ hours ALL Provinces need EMT education (only 9 thus far) Strengthened Referral system Connecting Major Centers in Phnom Penh with referral hospitals Computer Aided Dispatch (CAD) System for statistical gathering Increased Surveilence and Statistical information system for PHD’s and MOH to make informed decisions

Specific Training needed in Provinces for timely recognition and referral • Advanced Airway skills • Cervice Spine injuries • Bleeding and Shock control • Epi and Subdural Hematoma Recognition and treatment • Critical Care maternal and Pediatric Care • Transport Protocols to the Appropriate Facility

EMS Project Development Continium

Good progress made in past many years • Focus has been on Capacity Building /Systems strengthen Training (MTI) and vehicles (other groups) • Need to begin to develop all areas • Improvements have been rapid in the past 5 years • Data collection is primary

EMS System Improvement Needs • More EMT Education • Advanced Education for Level 3 hospitals • Equipment and supplies on Ambulances • Adequate staffing on Ambulances • Referral and Dispatch Coordination • Public Service Announcements (PSA) development for Use and respect

Ambulances Today in Cambodia • MOH has adequate ambulance vehicles because of China donation • Most ambulances have no equipment • Many ambulances still staffed with only one driver • No notification system to coordinate ambulances • Many Patients still transported to Private clinics instead of MOH facilities Photo: MTI Training class 2015 – MTI Hattaway 2015

Conclusions • Considering complete destruction of Healthcare in 1990 EMS has made significant gains • Progress CAN be more rapid (IF funded) because of international experience in systems design • Ministry of Health and PHD’s , OD’s are supportive of EMS development Photo: Siem Reap EMT Graduates 2015 MTI Hattaway 2015