International standards suggest there should be at least one life-saving, fully-equipped ambulance available for every hundred thousand people. In Karachi, considering the congestion on roads and scarcity of hospitals, experts have revised this figure to allocating at least one fully-equipped ambulance for 60-65,000 people.
Based on this aggregation, the 21 million people of Karachi need at least 350 life saving ambulances equipped with state-of-the-art medical facilities and paramedic support. Pakistan’s largest commercial hub, however, presently has only has 80 such vehicles operating. And almost all of them are provided by the private welfare organizations as the government fails to fulfill one of its very basic responsibilities: the provision of quality healthcare services.
Meanwhile, there are scores of vehicles operating as ambulances, but they are only good enough to transport patients or bodies. They even lack the basic life saving equipment or the support of any paramedic staff.
A considerable number of life-saving ambulances in the port city are run by the Aman Foundation, a private entity that maintains a fleet of 60 ambulances across Karachi, with a dozen more on backup.
According to the data shared by the operations in-charge at Aman Ambulances, they receive an average of about a thousand calls each day. A representative explains that, “of these, we are only able to cater 300 requests because of limited resources and difficult conditions. To meet the demand, we have made other arrangements where we shift less critical patients to other services so we can take responsibility of critical patients because our ambulances have life-saving equipment,” says Aman’s representative.
Trained agents work 24 hours a day at the Aman Foundation Call Center which has real-time tracking and a wireless communications network for seamless logistical coordination. These agents use the Medical Priority Dispatch System (MPDS) to manage the emergency calls. This is the same system that is used by 911, the emergency response network in the United States. While the system may be the same, the network and processes carried out to make it work here, are incredibly different.
International Best Practices
Across the globe, emergency services are state sponsored. In fact, this practice is the same in some provinces except for Sindh. Emergency services should be handled by state since the well-being of citizens is part of its responsibility. When in an emergency situation and citizens are vulnerable, it becomes the duty of the State to protect and provide for them. However the Government of Sindh has been unable to establish an emergency ambulance service and relies on private entities and charities to do this job for them.
The international protocols of emergency services suggest that civilian law enforcement should be the first respondent to any emergency. It’s for them to call assistance from all other rescue and emergency department as per the need and gravity of the incident. The real-time decision-making, logical coordination and information sharing is ideally the responsibility of civilian law enforcement agency. The police department is an example of this because they are the state representatives and in the best possible situation to accurately assess any incident that occurs on the ground. And it makes sense considering the police is the focal point for safety and security and for maintaining law and order. In case of a fire, the police are responsible for the safety of property, the same way they are responsible to arrest the suspects of road-rage in the case of a road accident.
The Emergency Ecosystem
All this highlights the need of having an emergency ecosystem where all entities are integrated into a system that is controlled and facilitated by a state-run authority.
Presently, the ambulance services working in Pakistan are unable to determine even the specific location from where distress call are being made because current laws restrict private entities to gain location-based information. This is something that is possible for state authorities to have because they have the legal and technology support to manage this.
If the emergency services ecosystem was planned in a manner that was geared to help the citizens efficiently, state authorities would be able to share specific location information from where a distress call was made, onto the ambulance driver. In an area where every second counts, such information sharing becomes a critical component within the ecosystem.
There is also a need to establish a swift and robust coordination mechanism between the city administration, police force, traffic authorities and emergency services. As part of the ecosystem, police and traffic authorities will share in advance, information about any road blocks, VIP movement, traffic congestion and diversion plans. Meanwhile, city administration could share information regarding any development work which can result in roadblock or traffic congestion. With this information in hand, emergency services will be able to better devise their route plans and avoid roadblocks while providing life-saving services.
Artificial intelligence can also come into play, making use of real-time traffic data and historical information to chart out an accurate route for each emergency vehicle.
Managing all of this requires real-time availability of relevant information in a secure environment which is only possible through the establishment a state-initiated emergency ecosystem. With technology and the workflow in place, the only roadblock seems to be the willingness of the local government to nod its head and give the system a green signal.