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February 2012, Volume 62, Issue 2

Letter to the Editor

Ambulance Service: A call unheard

Madam, I am writing in reference to the Editorial titled "Role of pre-hospital care and ambulance services in Karachi" published Dec, 2011. The author presents a well-balanced argument in regards to the role of ambulance and Emergency Medical Services (EMS) in a city densely populated as Karachi. Being a city with population of over 20 million and government\'s obvious lack of adequate understanding of EMS it seems only just that the void be filled by private volunteer organizations like the AMAN, EDHI, CHIPA and KKF. Many hospitals have their own ambulance services but their numbers are actually too diminutive to be of any significance to the masses on a whole. Hence people are at the mercy of private foundations for whatever facilities they may be providing. With the exception of the very recently introduced Aman Foundation ambulances, most Bolan-converted ambulances just have a driver with no basic insight on BLS/ACLS, negligible first aid skills, a stretcher and an oxygen tank. Is it enough one may ask? Beside the need for better equipped ambulance and trained staff the use of technology can be pivotal. Literature search suggest that an Emergency Medical Service system be established that integrates the use of technology like WiMAX in order to create a system that will link the healthcare service center, Emergency Medical Service hospitals and emergency ambulances.1 Through this system (audio/video) the patient\'s condition can be accessed by the ER doctors and necessary arrangements and criteria based dispatchments made so the time lag between the arrival of the patient and the provision of treatment is minimized. But this I believe is too much to ask where the affordably of basic lifesaving drugs and ambulances alone seems more like a luxury to economically poor. Statistics show survival increase as much as sevenfold with paramedics reaching prior to an out of hospital cardiac arrest.2 In Pakistan where EMS is in its infancy and due to the lack of awareness considerable amount of the patients report to the emergency come by different modes of transport. It takes an average over 30mins within a maximum distance of 10km to reach one of the 3 Tertiary Care Hospitals located in Karachi.3 Future establishment of alternate route for ambulances can be crucial, as ambulance with license to speed through the traffic infested roads of Karachi may seem nothing short of a miracle.
Disclosures: There were no competing financial interests for this manuscript nor does the author recommend any particular ambulance service.

M. D. Saleem,1 Amin Ahmed Kapadia2
Dow Medical College,1 Civil Hospital Karachi2


1.Li SH, Cheng KA, Lu WH, Lin TC. Developing an Active Emergency Medical Service System Based on WiMAX Technology. J Med Syst 2011; Nov 23.
2.Colin O\'Keeffe, Jon Nicholl, Janette Turner, Steve Goodacre. Role of ambulance response times in the survival of patients with out-of-hospital cardiac arrest. Emerg Med J 2011; 28: 703-6.
3.Roomasa Channa, Hira Altaf Jaffrani, Aamir Javed Khan, Talal Hasan, Junaid Abdul Razzak. Transport time to trauma facilities in Karachi: an exploratory study. Int J Emerg Med 2008; 1: 201-4.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: