Ambulance Design/Specification

RMA Vehicle Solutions – outline of our position and plans:

IN CONFIDENCE

BACKGROUND:

There were a number of calls to Dan and his colleague relating to the possibility of your company supporting our initial development into Ambulance Operations in North East Thailand (Khonkaen city). This contact was facilitated by Mike Morrison (who is based in the UK and has had professional dealings with Dan and others previously relating to NGO work globally).

We are a new(ish) ‘Foundation’ with approximately 30 volunteers of varying skills and a number of overseas volunteers too (ambulance professionals across Europe). We set up the Foundation in response to the desire to change the way in which pre-hospital care is delivered and are working with an ‘open mind‘ approach to the adoption of new training and skills sets, utilising a blend of Thai and European practice adapting to suit the local needs and requirements.

In so far as supporting organisations are concerned, we have had equipment donated by an NHS Ambulance Service in the UK (South West Ambulance Service NHS Trust) and also my employers, St John Ambulance (London Region). We are currently in detailed discussions with St John Ambulance Western Australia, who are presently setting up operations in Vietnam (based in Hanoi). They have taken on the project of developing an entire community reliance based approach to ambulance services – ie in the first instance, training school children in the basic of first aid, developing this knowledge and the desire to learn, so that in time, as they enter adulthood, these said same children will have a desire to enter into pre-hospital care as a career. We will be supporting their work in Hanoi in a variety of ways over then next 18 months. They have a considerable background in supporting pre-hospital care across SE Asia, supporting a number of developing organisations and guiding them through their developmental stages.

DEVELOPMENT OF AMBULANCE SERVICES:

In association with SJA Western Australia, we are looking at the potential for how ambulance services can and should be developed in Thailand and have watched with interest the announcement from the NRSA regarding Emergency Medical Service Reform, as announced in early June 2016 where it was agreed that 4000 ambulances would be provided in order to deliver a 5 minute, 5km response to 1669 calls. Both of us agree that this is cannot be achieved with the current staffing and logistics structure and there will almost certainly be a need to call upon a number of the foundations in order to assist with the roll out of this plan.

This is where we are hoping to make our presence felt!

In a recent report by ASEAN entitled ‘The Survey on the Current Situation of Disaster/Emergency Medicine System in the ASEA Region – Final Report’ dated August 2015 jointly published by the Japan International Cooperation Agency, KRI International Corp. & Nippon Koei Co. Ltd., a number of findings were presented which pointed out that while there had been significant inroads made towards developing and running and Emergency Medical Service across Thailand (and also other countries) there was the defined need for Thailand (among other countries) to develop a ‘relevant curriculum in pre-service education, career development system, and in-service training programs’.

In the country specific recommendations, table 11-8 ‘National Health Development Plan (2012-2016)’ Strategy 3 states:

‘Focus on health promotion, disease prevention, and consumer protection in health for Thais to be physically, mentally and spiritually healthy’

Strategy 4 states:

‘Strengthen health-care systems with quality and standards at all levels in response to health needs of all age groups and improve seamless referral systems’

This is where we see our future and are building our ‘strategic development plan’ around these and several other key points.

Pre-hospital care in Thailand (ie the service provided when you call the Emergency Medical Number 1669 or the local variants) is lacking. There is no consistency in the standard of service, care or treatment a patient will receive. With a few provincial exceptions (Khonkaen being one of these) there will be an uncoordinated response led by a number of voluntary organisations and Foundations, all of whom are, in all honesty, hoping to get to the patient first so they can convey to hospital and receive the agreed payment for services rendered from the provincial MoPH. The training these volunteers receive will vary from organisation to organisation. There is no mandate for on-going continuation training ensuring skills are up to date and correct, the equipment that they will have will vary from vehicle to vehicle and in many cases, is not fit for purpose (out of date or more worryingly, completely lacking appropriate items needed for a Basic Life Support (BLS) ambulance), enthusiasm is in more abundance than ability and in the case of a major incident, there is no ‘management structure’ that falls into place to ensure a correct response is initiated.

Ambulances, as such, will be generally funded by the organisation or by the volunteers themselves. Don’t read this as a criticism in their enthusiasm and support for the organisation they volunteer for (in fact, it is creditable that they do this) however when looking at the overall delivery of ambulance services, glaring omissions and risk areas are patently evident. We are only too aware of the number of accidents involving volunteer ambulances (only within the past couple of days ago there was a significant one which led to the total write off of the vehicle) which in general terms, will be a direct result of ‘lower than expected driving standards’ by the person driving the ambulance. The expected safety and restraint equipment which we would expect in an ambulance are lacking. Why? Many of the ‘ambulances’ are no more than a 10 year old van with a stretcher in the back with a plywood interior conversion.

So, I have highlighted the systemic failings (training and development), the lack of qualified MoPH EMT’s to deliver the NRSA planned expansion, the poor standards of training and the dangers the actual vehicles present.

WHAT DO WE PROPOSE?

We are doing the entire delivery of pre-hospital care differently. Instead of relying on ‘redundant’ vehicles from cheap motor dealers which are not fit for purpose, we want to start with a small number of specific designed adaptable vehicles which will be safe, clean, kitted and stocked correctly and will represent a professional service.

Our volunteers are going through an initial retraining period. Starting with the basics and working forward with skills development. Included in this training will be a mandatory driver training course modeled on the UK Ambulance driving course.

We are plan to expand by collaborative partnership with a number of other foundations, who will in turn whilst retaining their ‘name or identity’ work under our direct governance.

I have initiated contact with the MoPH expressing our interest in participating in the development of the Emergency Medical Services proposal. It is likely that we can make a real difference to the delivery of this plan.

This is where you guys come in:

We are a relatively new organisation but one with a wealth of experience supporting it. With the early stage conversations I had, we were looking at how your company could support the conversion and supply of perhaps 1 or 2 ambulances for us as part of a community support initiative. Our plans for development include expansion into the more rural areas surrounding Khonkaen City where there is an identified need for ambulance provision, as well as community lead schemes where local people can provide the immediate life saving skills until an ambulance arrives.

However, before we do this, we need to achieve the ‘gold standard’ and set measurable goals in Khonkane itself – proving to not only the regional MoPH and the Trauma Unit that we can deliver as promised, but also to other Foundations so they can see we are credible, capable and professional.

We are to some degree, reliant on support from ‘key stakeholders’ and I would be interested in discussing in more detail with you what role you could play in this relationship, how you could support us and in turn, how we could support yourselves.

I realise that this is somewhat of a ‘big ask’ however, it is something that I am sure is of interest to yourselves and one that we can discuss in more detail.

My contact details are below should you wish to speak to me. We will be in Bangkok in October (dates to be confirmed) and I am planning a visit to your plant to see the build process, so perhaps we could meet up then and I would be happy to deal with any questions you have.

Kind regards

Chris Hall
Emergency Medical Technician
CATS Retrieval Service
St John Ambulance
London Region
m: +44 7739 072 491
e: christopher.hall@sja.org.uk
SKYPE: ChrisHallNW1
w: www.khamnakornrescue.org/wordpress
Facebook: @Khamnakornrescue