Guidelines for Private Ambulance Services
Introduction
In Uganda,
it has increasingly become popular for politicians and other people to donate
ambulances to their people. Some health officials have been concerned of
politicians donating to their constituencies ambulances they have termed as
sometimes substandard. Ambulances are not ordinary cars. An ambulance is not
the word on top, but it's the service and content inside that vehicle, an
ambulance must have life-supporting machines, provisions for blood transfusion,
oxygen, fluids and a driver with defensive driving skills so that the life of a
patient is sustained while on transit to a health facility. Besides, even most
private health centers have been purchasing and installing ambulances in their
facilities without following the recommended guidelines for this emergency
field of medicine.
These guidelines are for implementation by any private sector
organization or institute, operating or intending to operate a private
ambulance service. The guidelines spell out the minimum requirements which the
agency must meet when operating a private ambulance service.
The
intended areas cover:
•
Ambulance owner / operator / agency
•
Ambulance vehicles & necessary equipments
•
Emergency medicine
•
Ambulance crew
Section A
deals with the Guidelines for Non-Emergency
Ambulance Services Section B deals
with the Guidelines for Emergency Ambulance Services
SECTION A
1 Definition:
1.1 A
non-emergency is a condition which does not cause immediate harm to life or endanger life and usually is a long standing problem and does
not need immediate medical attention.
A non-emergency ambulance service is one that
provides ambulances for transport non-emergency patients:
a)
Patients requesting an ambulance for regular
outpatient clinic attendance.
b)
Patients requesting for ambulance
for transport to hospital with medical conditions
c)
Intra hospital
transfers of non-critically ill patients.
d)
Patients discharged from hospital
e)
Internal Domestic transfers of
patients
f)
Routine home visits
It is noted that any non-critical/non-emergency
patient can develop any acute emergencies at any given time at any given place.
Hence, non-emergency ambulance service also should be prepared for emergency
services if required.
2. Non-Emergency Ambulance Agency
2.1
The Agency that intends to
provide the service shall be a hospital, nursing home, registered ambulance
service provides or any other voluntary or charitable organization operating a
Non-Emergency Ambulance Service.
2.2
The Agency must have the following:
a.
An acceptable place of operations with a mailing
address.
b.
A qualified person (either a
doctor or a nurse) employed by the agency who is responsible in organizing,
designing and implementing protocols of care for patients transport, training
the staff to locally accepted levels and supervision of medical care given to
the patients.
c.
A structured programme for
training and monitoring performance levels of ambulance crew and records of
such performance monitoring, acceptable scales of ambulance equipment and ambulance
medical supplies.
d.
A system for activation of the
ambulances services of the agency and mode of intra communication if more than
one ambulance is operated.
3.
Non-Emergency
Ambulance Vehicle:
3.1
The ambulance vehicle shall meet
the vehicle specifications set by Ugandan laws and regulations.
3.2
All equipments should be in good
working condition at any given time. These equipment maintenance should be
carried out by qualified persons and should be documented.
4 Non-Emergency Ambulance Crew
4.1 Each Non-Emergency Ambulance should be staffed by at least a two member crew.
a. Ambulance Officer –
a qualified Nurse or trained
paramedic.
b. Driver
4.2 The
driver should have the following minimum qualifications/experience:-
i.
Possess a valid license to drive the ambulance.
ii.
Understand the usage of ambulance stretchers and
basic ambulance equipment.
iii.
Undergone training in Standard
First Aid.
iv.
Trained in defensive training and
aware of the usage of sirens and flashing lights for conveying emergency patients
to hospital.
v.
Basic skills in handling
communication equipment and message
conveying to another party Ex: Hospitals, another care giver centers
4.3 The Ambulance Officer (a qualified Nurse or trained Paramedic) should be
able to
i.
Measure vital signs eg pulse
rate, respiratory rate, blood pressure, conscious level.
ii.
Perform Basic Cardiac Life
Support (BCLS) and be certified by a qualified agency registered with the Ministry of Health. Those have to be
revalidated every 2 years.
iii.
Use air way adjuncts such as
oro-pharyngeal, naso-pharyngeal airways, suction devices and basic oxygen
devices such as bag valve mask.
iv.
Use various types of stretchers
and body immobilization devices.
v.
Perform basic emergency
procedures such as:
·
Control of external bleeding
·
Application of dressings, bandages, slings and
splints.
vii.
Transfer and maintain patients with nasogastric
tubes and urinary catheters.
viii.
Establish contact with a nearest
receiving hospital if need arises.
SECTION B
Guidelines for Emergency Ambulance Service
1 Definition
1.1
Emergency
patient:
A patient through sickness,
injury or other circumstances is in immediate danger of life unless emergency
treatment is given and a patient who needs monitoring and suitable transport to
a facility were necessary treatment is provided.
• Emergency ambulance service:
Ambulance service which can
provide services, necessary ambulance to respond to a scene of a medical or
surgical or other mass casualty emergency, stabilize the victims by providing
emergency care at the scene and transport with necessary monitoring facilities
for a definitive treatment to a suitable facility or to provide necessary
transport for critically ill patients been transferred from one facility to
another facility.
1.2
An Emergency Ambulance Service
may, in addition also, at its own choosing, attend to Non-Emergency patients or
else refer these patients to any Non-emergency Ambulance Service.
2 Emergency Ambulance Agency
2.1
The Agency that intends to
provide the service must be a hospital, nursing home, registered ambulance
service provider or any other voluntary/charitable organization operating an
Emergency Ambulance Service.
2.2
The Agency must have the following:
a) An Agency
place of operations with a mailing address.
b) The
capacity to provide uninterrupted services for 24 hours, 365 days or a standard agreement with another ambulance service provider as a
backup in the event of unavailability.
c)
A qualified person (a doctor)
employed by the agency, who is responsible in organizing, designing and
implementing protocols of care for patients transport, training the staff to
locally accepted levels and supervision of medical care given to the patients.
d)
A structured programme for
training and monitoring performance levels of ambulance crew and records of
such performance monitoring.
e)
Acceptable scales of ambulance equipment and
ambulance medical supplies.
f)
A system for activation of the
ambulance services of the agency and mode of intra communication if more than
one ambulance is operated.
3 Emergency Ambulance Vehicles
3.1
Emergency Ambulance vehicles
managed by the agency may be one or more of the following types:
a. Standard
ambulance vehicles
b.
Bus ambulances
c. Air ambulances
3.2
The ambulance shall meet the
vehicle/vessel specifications for emergency ambulances set by the Government of
Uganda.
3.3
The minimum equipment in each
emergency ambulance should be serviceable at all times when the ambulance is in
operation.
3.4.
Maintenance of emergency
equipment should be as of supplier specification and all maintenance should be
documented.
4 Emergency Ambulance Crew
4.1
Each Emergency Ambulance should
be staffed by 4 crew-members, including an ambulance driver and an ambulance
assistant. The Ambulance Officer should be a Medical Officer and the Assistant
Ambulance Officer should be a Nurse or trained Para-medic.
4.2
The Emergency Ambulance should
have ambulance crew whom are competent in providing simultaneous air way and
circulatory management during transportation of critically ill patients.
4.3
The driver of the Emergency Ambulance should have
the following minimum qualifications/ experience: -
ii.
Undergone training in Standard
First Aid certified by relevant District
Director of Health Services or registered agency with Health Ministry.
iii.
Exhibit proficiency in the use of
ambulance stretchers and basic equipment.
iv.
Trained in defensive driving and
be well aware of the use of sirens and flashing lights
v.
for conveying emergency patients to hospital.
4.4
The Ambulance Officer and the
Ambulance Assistant must be able to,
a)
Evaluate the ill and injured.
b)
Render Basic life
support/Advanced life support/Pediatric Life support and first-aid to patients
with trauma Emergencies.
c)
Measure vital signs such as temperature,
blood pressure, pulse and respiratory rates, SO2 levels, level of consciousness
and pupil status.
d)
Perform Cardio Pulmonary Resuscitation
(CPR) including the use of mechanical adjunctive aids such as oropharyngeal
nasopharyngeal airway, suction devices, and basic oxygen delivery systems.
e)
Use various types of stretchers and body
immobilization devices.
f)
Carry out emergency basic
procedures to control external haemorrhage, apply dressings, sling bandages and splints. Provide immediate medical
care to casualties during the process of extrication and disentanglement from
entrapments.
g)
Perform basic field triage, insertion and
monitoring of peripheral IV lines and monitoring of central lines.
h)
Transfer patients with
endo-trachial tubes, intercostals drainage tubes, nasogastric tubes, orfoley
catheters.
i)
Administer intravenous injections
and fluids, sublingual. Subcutaneous, oral,
intramuscular as prescribed by appropriate protocols.
j)
Perform defibrillation and
synchronized cardio-version.
k)
Obtain venous samples.
l)
Monitor ECG.
4.5
The other Supportive crew-members
should be able to assist:
a. Render Basic Life support and first-aid to patients with trauma
emergencies.
b. Perform CPR including the use of mechanical adjunctive aids such as
oropharyngeal nasopharyngeal airways, suction devices and basic oxygen delivery
devices.
Carry out emergency basic procedures to control external haemorrhage,
apply dressings, slings bandages and splints. Provide immediate medical care to
casualties during the process of extrication, disentanglement from entrapments.
5. Emergency Ambulance Drugs
This type of ambulance is one that
transports highly critical patients , so we need to give a list of life saving
drugs needed examples
§ Adrenaline
§ Diazepam
§ Prednisolone
§ Inhalers
for asthma patients
§ Analgesics
( common and restricted)
§ Disinfection
substances like formalin, jik, gutarlyhyde
§ Misoprosol and oxytocin ( for
expectant mothers in transit)
5. 1 Emergency Ambulance Drugs and Supplies
To avoid ambiguity its important to
set the bare minimum equipment for all emergency ambulance owners and the
investment required must be in some of the following equipments
§ Resuscitator
§ Blood
pressure machine
§ Digital
and non-digital thermometers
§ Defibrillator
§ Ambu bags
§ Cannulas
§ Manual and electric suction tubes
5.2 Other Skills Required
in addition to First aid
§ Medical
sample handling
§ Bleeding
of patients
§ Skills in
managing basic bleeding
§ X-ray interpretation
5.3 Communication
systems, we need to be clear on the following
§ Telephone
system, mobile airtime enabled, and satellite enabled
§ Multi-network toll free line
A complete referral system with two
way feedback from the point of referral to the receiving facility and back from
the receiving facility upon discharge, this helps to track lost patients and
complete referrals
Non-emergency medical transportation can be a great option for long distance travel for several reasons:
ReplyDeleteComfort and convenience: Non-emergency medical transportation providers offer vehicles that are equipped with comfortable seating and ample space for medical equipment and luggage. This makes the journey comfortable and convenient, especially for people with medical conditions that require additional support during travel.
Expertise and specialized care: Non-emergency medical transportation providers are equipped with trained professionals who are experienced in providing specialized care to patients during transportation. They have the necessary knowledge and expertise to manage various medical conditions during the journey.
Safety and reliability: Non-emergency medical transportation providers follow strict safety protocols and regulations to ensure the safety of their passengers. They also have reliable and well-maintained vehicles to ensure a smooth and hassle-free journey.
Cost-effective: Non-emergency medical transportation can be a cost-effective option compared to other modes of travel for long distances, especially when considering the costs associated with medical emergencies that can occur during regular travel.
Overall, non-emergency medical transportation offers a safe, comfortable, and cost-effective solution for long distance travel for individuals with medical conditions or mobility challenges.