Brunei has, since 2010, had a three year diploma course for Paramedics. 18 months nursing training followed by 18 months paramedic training. There are 60 trained paramedics in the country. CPD and in-service training is conducted from time to time and will include the following subjects:
ACLS, ATLS, Rescue Skills and Defensive Driving Techniques
Cambodia has emergency services available in urban and tourist areas, however most of the country is not service by emergency personnel. There us no Urban Search and Rescue agency established. Ambulances dispatched from Calmette Hospital have a doctor and a nurse, and are fee based, although in the case of an RTC, there is no charge. In the provincial areas, ambulances are attached to hospitals but there is no central emergency number outside the Phnom Penh area. These ambulances will have a driver and a nurse who has learned the required skills by ‘working on the ambulance’. Fees are unregulated. There are no paramedics and no training in situ as such for EMT grades.
Indonesia has had an ambulance service since the early 1990’s in response to the recognition of the importance of pre-hospital care by the Indonesian Surgeons Association. However there is no national standard as to ambulance training and crewing. A majority of patients will be conveyed by other means to hospital.
Lao has no agency responsible directly for emergency response however there are informal arrangements in place ranging from NGO’s, local police and military and local youth organisations. In the 2005-2007 period, trainees were sent to Thailand to learn pre-hospital care, however this was not developed or continued due to lack of resources. Mittaphab Hospital is the model hospital for EMS with four ambulances available. There is one ambulance center responsible for the entire country and there are three organisations providing ambulances across the country, however there is no co-ordination across these organisations. Ambulances from Mittaphab Hospital are fee based and there are three differing levels of response: Volunteer and Driver, Nurse and Driver and finally, Doctor, Nurse and Driver. The Lao Red Cross started piloting an ambulance service in 2012 and has 2 ambulances, funded by donations from private sector. The vehicle is crewed with 4 volunteers and a driver, and they have currently 65 volunteers within their service. There is a clear need to develop the EMS provision within the country.
Malaysia has had an ambulance service since 2004 which was set up in response to the tsunami disaster. There is no law or regulation governing EMS in Malaysia however all emergency and trauma departments work within a set of guidelines. There is a well structured provision for disaster response. Ambulance provision has been modeled on the UK/US model. There are 21 medical dispatch centers across the country dealing with primary and secondary ambulance services and transfers. A BLS crewed ambulance is sent to all calls, and a secondary ALS vehicle will follow as a secondary response.
Myanmar has a developing EMS model. In late 2013, Nay Pyi Taw 1000 Bedded Hospital was opened and eventually, 75 ambulances were distributed to district hospitals by the Ministry of Health. in early 2013, MIMMS training was provided to 42 participants from a range of organisations. There is no co-ordinated ambulance system in the country and there is no national training program in pre-hospital care, therefore the range of skills will vary from provider to provider. As with Lao, there is a clear need for development of an EMS model.
The Philippines, Malaysia and Singapore had established EMS in place and provide the opportunity to learn from their experiences.
Thailand has an EMS model based on the French SAMU system, with training modeled loosely on the Australian EMT program. According to NIEMS there are approximately 13,000 ambulances in Thailand (2015) and 77% of these are volunteer based and run. There were in 2014, over 83,000 First Responders (EMT-FR), 4,500+ EMT-B and just over 1000 EMT-I personnel (EMT-P figures were not available). Whilst there is still a lot of work required to achieve the standards aspired by the NIEMS and MoPH, Thailand is in an ideal position to start sharing knowledge with countries such as Myanmar and Lao (and this is being done in Myanmar by a number of Thai foundations who are working in close co-operation with local and national government agencies and officials).
Vietnam has an EMS based on the SAMU model and are fee based. The coverage is low and vehicles limited by staffing issues. St John Ambulance, Western Australia is now working in Hanoi and are planning the development of the EMS model. There is a lot of work required to bring the standard of EMS up to the expected level.
From a personal perspective, the way forward is going to entail co-operation between countries in development of their EMS models.