Friday August 19, 2011

Nurse in ambulance-taxi collision succumbs to injuries

By R.S.N. MURALI
murali@thestar.com.my

MALACCA: A nurse who crawled out alive from an overturned ambulance on Monday has died.

Yuhana Yasin, 30, from Parit Jawa, Muar, suffered serious internal injuries in the 6.50pm accident when a taxi rammed the rear of the ambulance at the Seri Negeri/MITC junction in Ayer Keroh.

A critically-ill patient Maryam Baba, 73, who was being rushed to Hospital Kuala Lumpur in the same ambulance, also died at Malacca Hospital due to serious head injuries sustained in the accident.

Happier time: Yuhana and her fiance in a portrait shot.

Yuhana's fianc Mohd Faizal, 30, said they had planned to get married after Hari Raya.

He said Yuhana spoke to him shortly after the accident and said she would be returning home yesterday.

“I was told her condition deteriorated and she died at 1.15am in the Intensive Care Unit,” Mohd Faizal said at the hospital's mortuary yesterday.

Ambulance driver Mambang Rudy Hartono, 41, taxi driver Ali Muhammad Don, 61, and an unidentified medical officer also sustained injuries in the accident.

An eyewitness, Tan Bun Han, 40, said the ambulance was slowing down upon reaching a T-junction before the taxi rammed into it from behind.

“The impact caused the ambulance to land on its side,” he said.

Melaka Tengah Traffic and Public Order Chief Asst Supt V. Gunasegaran said the accident was being investigated.

Tailgating for a faster drive-NST Online » Local News 2008/02/10

Tailgating for a faster drive
By : Neville Spykerman
NST Online » Local News 2008/02/10

(Picture of motorist tailgating the ambulance ,removed)

A motorist tailgating an ambulance along the Federal Highway last Wednesday.

KLANG: Some Malaysians have a dirty habit: moving in behind a passing ambulance with its siren blaring so they can take advantage of the freed-up space for a faster, smoother drive.


What these people do not realise is that their bad habit could cause a problem.

An average of two Malaysian Red Crescent Society ambulances are involved in accidents every month in Selangor alone because of the actions of these motorists.

It is taking a huge toll on the resources of the charitable organisation.

Selangor Red Crescent Society deputy chairman Venukopalan Chellathurai said more than half of the organisation’s maintenance bills for the six ambulances it operates were for “body work” after being hit from behind.
“Of the RM29,000 spent on repairs last year, almost RM15,000 was used for body work. That’s a huge sum for a non-governmental organisation.”

Inconsiderate motorists who tailgate ambulances responding to emergencies were the main culprits.

“They are oblivious to the danger to themselves, the ambulance crew and patient either in the ambulance or at the scene, due to the delay any accident will cause,” said Venukopalan.

Emergency Medical Technician (EMT) Noel Silas Savarimuthu said in most instances, the culprits did not even bother to stop.

“There is little we can do if we are responding to an emergency; people’s lives are at stake and every second counts.”

He said there had been instances of EMTs being injured when their ambulance was hit from behind by other vehicles.

The society also bemoaned the fact that motorists did not follow the rules when it came to emergency lanes.

The fact that motorists used the emergency lane as “just another lane” during traffic jams, coupled with some who ignored sirens on emergency vehicles, added to the response time for EMTs.

The society believed the problem was in education and enforcement.

Venukopalan said the right response to an ambulance with its siren blaring and beacons flashing was not addressed in the syllabus of local driving tests or current road laws.

“Even the use of sirens and beacons, once reserved for the police, Fire and Rescue Department and ambulances, seems to have been extended to commercial vehicles such as hearses, trucks and buses.”

Venukopalan said the subject should be introduced to future generations of drivers while they are in school.

“The subject should be broached during primary school, reinforced while they study for driving tests and enforced strictly by the enforcement authorities.”

Lights & Sirens

Ambulances in Malaysia are in a dilemma. First of all, these life saving vehicles are mistaken to be equal to a hearse. Many think of them as the same. Both carry the deceased don’t they?

That’s incorrect!! People die while being transferred in the ambulance, yes but the ambulances does not ferry the already deceased. Hearses do. So how can an ambulance be equal to a hearse?

An ambulance is equipped with life saving tools and manned my people trained to safe life. Hearses are equipped to conduct funerals and staffed by people who are trained in bereavement. People confuse because both the vehicle as they some times look almost the same.

In Malaysia ambulances and now hearses are also built on commercial van chassis and most importantly they are also installed with beacon lights. An ambulance usually uses the red or the red and blue beacon light in combination, whereas hearses use amber beacon light. But why do hearses need beacon light, in the first place?

The confusion is worsen, as hearses now, are being installed with emergency siren warning system, just like the ones in the ambulances. Now why would a hearse need siren warning system? Aren’t the uses of beacon lights and emergency siren systems regulated by the Department of Road Transport?

Can anyone use a beacon light and emergency siren accessories in any vehicle and get special treatment on the roads. Aren't they suppost to be used for emergencies only? Emergency siren system should be made exclusive to emergency vehicles such as the police, fire department, ambulances, disaster response vehicles, military and governments enforcement agencies.

The beacon light system can be used by others relevant service providers, not to gain the right of way, but to warn other road user of potential danger. The colors of the beacon lights should be regulated and enforced. For example, the of blue and red beacon lights to be used by emergency vehicles, while amber and green for others such as tow trucks and heavy vehicles.

This will eliminate the confusion and help road users give way by distinguishing emergency vehicles from the non-emergency vehicles, otherwise the emergency beacon and siren system, which is the symbol of urgency during emergencies, will loose its value.

Tailgator Grounds Ambulance

On Tuesday the 3rd of April 2007 at about 7.00pm, it had just stop raining, the roads were wet and we were rushing an accident victim with an ambulance in the after office hours traffic, to Tengku Ampuan Rahimah Hospital in Klang. The victim, a 43 year old Malay Male was involved in a motor vehicle accident earlier at Batu 3 Shah Alam, suffered serious injury to his head.

There were many vehicles on the road and we had difficulty maneuvering our way in and out of traffic. Some road users gave way early when they heard our sirens while others were practically clueless.

When we arrived at Jalan Jambatan approaching the Simpang Lima Klang Flyover Bridge , an inconsiderate road user began to dangerously tailgate the ambulance to ride the cleared road behind us. Worried about the safety of the patient and the medical staff working in the ambulance, the ambulance driver reduced speed and tried to signal the errant driver to stop tailgating the ambulance. He even used the public address system to shout out the registration number of the Proton Waja to get the drivers attention but failed.

Just after the flyover bridge, a car ahead of us stopped abruptly causing us to drop speed to avoid crashing the ambulance. We managed to stop in time but the car tailgating us crashed into the rear of the ambulance.

We were fortunate that no one was injured in the incident. But the patient was in for a rude shock from the crash and the ambulance had to be grounded as the rear end was badly damaged. Had the ambulance driver not notice the trailing car and not reduce speed, the outcome could have been fatal.

It is totally inconsiderate, of road users who tailgate behind emergency vehicles, especially an ambulance, as they distract the concentration of the driver and risk an accident. These errant road users, who knowingly risk the lives of others for a joy ride tailgating an emergency vehicle, should receive stiffer punishment from the authorities.

Tom,Dick & Harry

Do you know that any Tom, Dick and Harry can be an “Ambulance Man”? All you need is a Class D driving license. There is no regulation or special license needed to work as an ambulance personal or if there is, it has never been enforced. Besides the government hospitals and health clinics, most other ambulance personals are employed with no medical background hence they are not governed by basic laws of medicine “Do No Harm”.

Ambulance drivers are usually employed based not on their education and knowledge in pre-hospital care or ambulance work but more on the good knowledge of local roads and whereabouts. If one were to be successful in getting an ambulance job all he needs is to know the roads in the area well. There have been a high number of dispatch workers who are pulled into working as ambulance personals.

With no experience, they go through on the job training, learning the basic skill of an ambulance job. Unfortunately the core values of being a medical personal are not part of the training. Over the years these seasoned ambulance workers would then train new recruits. “The non-medical teaching the non-medical, medical” Very few are sent for official certified training as it’s usually too expensive or not readily available.

What can u expect from a commoner who have never been taught the integrity and responsibility of working as an ambulance personal. In my line of duty have met a barber, and a goreng pisang sellers, due regards to theirs previous jobs but turned instantly into an ambulance personal, does that sound right? The least that can be done is to screen all candidates for an ambulance job with the police for previous criminal records to make them understand the seriousness of their new job and send them for certified training at established institutions before they get to touch their first patient.

Watch Out for Unscrupulous Ambulance Suppliers

Unfortunately “What You See, Is Not What You Get” is the case with ambulances that are purchased to safe lives in Malaysia . While the Sec-Gen’s report in the The Star, on the 10th Sept mentioned about poor conditions of ambulances and its equipments already in service in the country and the Ministry of Health reported on the 11th Sept that the old ambulances will be replaced in stages, I would like to divert your attention to the process of purchasing the ambulance and how the government is cheated into accepting less than the intended purchase.

Ambulance suppliers use a show room model to introduce their products to the interested customer. The show room model has the highest vehicle specification including safety features such as Air Bags, ABS Brakes, Auxiliary Batteries and installed with the necessary medical equipment and fittings.

A basic ambulance may have many purpose built parts and medical equipments. No proper documented specification or list of equipment is made available during the preview of the vehicles. If there is any documentation, it will contain very basic details. The potential buyer only receives the complete list of specification on a later date and is not compared to the show room model. Upon confirmation of purchase the ambulances would be delivered between a minimum periods of 6 to 12 months.

By the time the intended purchase is delivered, the specs and the list of equipments would have been changed. This is not easily recognized as an ambulance comprises of many parts and equipment.

To avoid detection in the discrepancies in the vehicle specification and purchased equipment, delivery is sometimes split to two or more dates and this is done without fear as it’s a know fact that the officers involved in receiving the good will not thoroughly check the list before signing acceptance of goods supplied.

There are ambulances purchased by the Ministry of Health which were supplied with expired medications and short supplied with equipments such as the ones that were supposed to be installed with two batteries, a standard and an auxiliary in case the standard battery fails, but only one battery was supplied and yet they were accepted.

There were also ambulances supplied to the Ministry of Health which were supposed to be installed with ABS braking as a safety feature but supplied with standard braking system and again accepted without question.

In August last year a “Safety Driving” course for vehicles with ABS was organized by a automotive manufacturer for a particular model of its van which is one of the preferred ambulance conversion chassis. All the hospitals that had purchased this particular model of ambulance were invited to attend the ABS Safety Training. But only upon arriving at the training site, these ambulances were found to be supplied without ABS braking system. But the drivers were allowed to attend the training session anyway, without realizing the possible danger of wrongly applying ABS braking techniques on a vehicle installed with Non-ABS brakes. Now why wouldn’t ambulances crash? ABS braking is totally different from Non-ABS Braking.

I agree with the AG that the Health Ministry should look into these matters very seriously so that Pre-Hospital Care Ambulance services can be rendered safely and the negative image of the service improved.

EMERGENCY LANE MISUSED

Road Safety Department’s director-general Datuk Suret Singh in The Star, on the 29th December 2007 warned expressway users to refrain from stopping their vehicles at emergency lanes, to rest or carry out repair works, as it is a traffic lane for use by authorities such as the Fire and Rescue Department, the police and ambulance.

In reality the above mentioned authorities rarely get to use the emergency lane while responding to an emergency, during rush hours or in cases of road accidents.

Immediately after a road traffic accident, vehicles involved in the incident would usually block the lanes, causing traffic congestion. Within minutes traffic flow is further worsen with the arrival of many tow truck operators, flocking the accident scene and not forgetting the on-lookers on both sides of the road, slowing down to peek.

Impatient road users would then begin to misuse the emergency lane, trying to cut queue. This aggravates the bottle neck situation. The emergency lane, which should be clear and available for emergency vehicles to reach the accident site, would be clogged by irresponsible road users.

This is one main reason why, response time to the scene of an accident by the fire engine, police or ambulance is delayed. With the emergency lane clogged and not passable, emergency vehicles are forced to crawl in between lanes.

Among the road users we have the educated and alert drivers who would immediately react by moving further left or right to make way for the emergency vehicle, while the less informed and ignorant drivers, do not know how to react when an emergency vehicle approaches from the rear with its lights and sirens blaring. The most annoying road users, are the irresponsible and self-centered drivers who would disregard their own safety and the safety of others, by tailgating the emergency vehicle at a very close distance to beat the traffic jam, sometimes causing a rear end collusion.

The question is, how much is done to educate and continuously educate new and current road on this issue and at the same time enforce the law on offenders.

There are frequent emergency lane offenders who would use the emergency lane as their right of way. Just observe the Jalan Templer flyover in Petaling Jaya and the Berkeley flyover in Klang, along the federal highway during the evening rush hour when there are no traffic policemen on duty.

The random survey conducted by Road Safety Department, Datuk Suret Singh said showed that between 90% and 95% of road users did not understand the “role of emergency lanes” or were of the opinion that it was all right to use the lanes if their vehicles broke down. I remember, that when I attended the compulsory driving license course and the on-the-road driving lessons back in 1995, nothing was mentioned about the actual use of the emergency lanes or how to react to an emergency vehicle for the matter.

Driving school syllabus should be reviewed and emphasis added on these areas. Continuous promotion via educational advertisements on all TV stations and aggressive enforcement operations on emergency lane offenders, similar to other road traffic enforcement operation should be initiated, to educate our road users on the seriousness of this offence.

Auto Assistance need to be regulated

Adibah’s experience when her car broke down on the North-South Expressway and consequently cheated by a man she perceived to be “kind” and helpful but who turned out to be a runner for a workshop is a very common, unfortunate fact on our roads.

These runners or tow truck touts make a living on commission paid by workshops. They work in groups circling the highways and roads, communicating incidents of vehicle break-downs and accidents via trunk radios, which is the reason why they are always at the scene faster than the highway patrol vehicles.

In the article published in the NST dated 28th Feb 2008, Adibah mentioned that because she had her baby daughter with her at the time of the incident, her vulnerability was more significant and she accepted help from the first person that approached them. The runners and tow truck touts are well aware of this and would capitalize on such moments to dupe unlucky road users into accepting help.

In cases of road accidents and the occupants are injured, they would offer to take the injured to a hospital immediately and anyone put in this situation would decide to accept help not knowing what they are really getting into.

Injured victims would be precariously moved and rushed to a hospital without any first aid or critical medical care rendered beforehand. This is done in a hurry as they fear losing the deal to a competitor from a different workshop. They would not even wait for emergency services or the ambulance as they do not want to lose the opportunity to gain from the situation by later being able to claim ransom through means of securing the towing deal.

While it’s difficult to differentiate between a genuine offer to help from a fellow road user and those who make it their job to manipulate the unfortunate at their weakest point, road users should be made aware of the existence of such unethical people and the consequences of accepting help from them.

Authorities and organizations such as AAM and the Road Safety Department should study this matter as many road users have fallen victim to these runners and touts. A solution needs to be formulated to guarantee that when a road user is faced with difficulty, help arrives from the right place at the right time. Highway operators should increase the number of response vehicles on patrol and emergency services should ensure that response arrives promptly to take control of the situation.

Article Published in Malay Mail - Getting help in an emergency

October 15, 2007

DEAR Editor,
Balik Kampung is here again and while Malaysians prepare to travel back from the Hari Raya holidays with their family, the agencies providing emergency services are entrusted with the task of responding to emergencies, especially on our roads.

Personnel and volunteers, additional vehicles and equipment are put on standby around the clock to respond to life threatening emergencies, which depend on several factors.
The emergency hotline number is now 999.

In case of an emergency, do not waste time, calling family members or friends, and be prepared to provide vital information such as your name, telephone number, the location of the incident, the nature of the incident and number of people, among others.
Educate your children on how they to can use the number and remind them not to misuse it.
Landmarks are important information when responding to emergency situations so that help can be sent fast.

You must also be able to advise on which side of the road the accident or emergency situation has occurred, to enable emergency service personnel to take the fastest route to the site.
Motorists should not misuse the emergency lanes to park their vehicles to look at the aftermath of an accident because this will cause traffic congestion thereby blocking emergency service vehicles from reaching the site.

Try not to drive slowly to get a glimpse of what is happening because you would be slowing down other vehicles behind you and cause a traffic jam.

Traffic lights and junctions are often allocated with buffer space, marked with stripes that can be used by emergency service vehicles to pass through; unfortunately these are not spared by impatient queue-jumpers.

When an emergency service vehicle approaches with its lights flashing and sirens blaring, you should give way.
At the scene of an accident, it is common for the public to gather and watch rescue efforts.
While it is interesting to watch, many fail to realise the danger they are facing.
An accident scene can be very hazardous because of possible fuel spills.
It is sad to observe some lighting their cigarettes at the scene.

At the same time, crowding the scene only slows down the rescue efforts.
When an accident occurs, emergency services are the only hope for survival for victims.
Thus, everyone must work together to achieve a smooth rescue operation.
Give some thought to these scenarios so you do not become an obstacle to victims who need help quickly.

Noel Silas Savarimuthu
Malaysian Red Crescent Klang Chapter

Copyright 2007 The Malay Mail. Provided by ProQuest LLC. For permission to reuse this article, contact Copyright Clearance Center.

EMS Article on NST - Striving for fast responce to emergencies

Striving for fast response to emergencies
28 September, 2006

KUALA LUMPUR: The emergency response times of Malaysian ambulances are still slow. The average times — from the call to the time the ambulance reaches the victim — should be between 10 and 15 minutes."Anything more than 15 minutes is unacceptable," said Director-General of Health Tan Sri Dr Ismail Merican. He added that even this was slow compared with Western countries which had a benchmark of seven to eight minutes.But not all agencies in Kuala Lumpur dash to their victims within 15 minutes.

The Civil Defence Department’s (JPA3) response time is less than 30 minutes from its headquarters on Jalan Ampang. The Malaysian Red Crescent (MRCS) response time is about 20 minutes from its headquarters on Jalan Ampang, while the University Malaya Medical Centre’s is between 10 and 45 minutes from Jalan University, Petaling Jaya. St John Ambulans Malaysia (SJAM) says its response time is about 15 minutes within a five kilometre radius.SJAM, MRCS, UMMC and JPA3 blame the traffic and lack of co-operation from motorists for the delay in arriving at emergency scenes.SJAM’s regional commander for the Federal Territory Dr Lee Hoo Teong said many motorists do not move out of the way despite the sirens when it rained.

The Civil Defence Department in Kuala Lumpur plans to introduce a motorcycle squad next year to buy time until the ambulance arrives.The MRCS was the first to start a motorcycle squad service for medical emergency in 1997. The SJAM started a similar squad last year.Some agencies admitted that the delay in arriving at the emergency site was also due to poor communication and weakness in the emergency hotline (999 and 991) service. Dr Lee said there was a lack of communication among agencies and this leads to either no ambulance arriving, or too many attending to one emergency case.

The problems in the emergency hotline service could be one reason why Johor 991 calls sometimes end up in Malacca, said Johor JPA3 director Che Osman Hussin."I believe we should have one central number just for Johor so that the agencies can handle the emergency cases efficiently," he said. The thousands of ringgit needed for ambulance maintenance and rising petrol costs make it difficult for non-profit organisations, such as the SJAM and MRCS, to respond to medical emergencies. Dr Lee said SJAM spent RM2,000 a month on petrol and about RM400 to RM500 on vehicle maintenance."It is difficult for us to sustain as we receive, at most, about RM1,000 in funds monthly," he said. MRCS secretary-general Datuk Abu Hassan Salleh appealed to the public for funds to buy more ambulances to cope with the increasing number of cases.Penang general hospital physician handling the medical emergency department, Dr Teo Aik Howe said, however, that the strategic location of the agencies responding to the emergency calls was more important than the number of ambulances they had."When an emergency call comes in, the first thing we have to know is who is nearest to the victim," he said.The Penang Hospital has four ambulances, while the JPA3 also has four and the SJAM has just one.


The JPA3 handles about 30 cases daily in George Town and Butterworth on the mainland.The Penang Hospital handles about 19 cases daily in areas within a 20km radius from Jalan Residensi in George Town.It used to handle cases in Bayan Lepas on the south of Penang but recently brought in the SJAM to handle those cases under the Emas Project, a community-driven initiative.Residents in Cameron Highlands can call their Hospital Desa in Tanah Rata directly instead of calling ‘991’, said Ellangovan Nadarajah, who sits on the hospital’s advisory board.He said the hospital had three ambulances that not only responded to emergency cases but also ferried critically ill patients to the Ipoh General Hospital when the need arose.

© Copyright 2006 The New Straits Times Press (M) Berhad. All rights reserved.

Breaking Point...

The Royal Commission to Enhance the Operation and Management of the Royal Malaysian Police and the key performance indicators (KPI) are good moves by the government to improve the services to the public. Among the many public services that is in dire need of improvement is the Emergency Ambulance services.

On 16th May 2005, at about 10pm, I came upon a scene of a motor vehicle accident. The victim, a self fallen Chinese, male motorbike rider, in his 30’s was unconscious with head injuries. Members of the public had called the ambulance by the time I arrived. Being an Emergency Medical Technician I accessed the victim and found him still breathing but gasping for air, so I proceeded to provide the “Jaw Trust”, a method used to keep the victim airway open when spinal injury is suspected. Shortly an ambulance from the local hospital arrived. I briefed the responding medical assistant on the condition of the victim and requested for oxygen and a cervical collar, a device used to immobilize the neck to protect and prevent further injury to the spine. While the Medical Assistant went back to the ambulance to get the collar, the Hospital Assistant brought a folding stretcher which is a collapsible device suitable only to carry victims with no suspected history of spinal injury.

Since the victim was suspected to have spinal injury, I requested that we use the much appropriate scoop stretcher in which he agreed and retrieved the stretcher from the ambulance. At this point the Medical Assistant returned and said that there was no cervical collar in the ambulance. The victim was precariously scooped up only with manual cervical immobilization (which is an absolute no-no in a suspected spinal injury), transferred to the ambulance and rushed to the hospital.

I feel sad that despite the much advancement in the Medical industry in our country the Ambulance Services are still very poor. One can be easily be fooled by the impressive looks of the new, well designed ambulances we have in our hospitals but most of the time they are ill equipped and the standard of care provided by the crew remains poor. The confidences in our ambulance services have long been lost. Public resort to use their own vehicles or taxis to transport injured victims to the hospital. The awareness that this action is dangerous and does not necessarily help the victim is ignored. On arrival at the hospital, the Emergency Department staff is faced with a patient whose condition has worsened. Improving the standard of care would be imperative to strengthen the Emergency Medical Services in order to help lower mortality rates in road accidents.

Back in the late 90’s an article was published in the local daily titled “Scoop and Run” or “Stay and Play”, explaining the future development of the emergency medical services in Malaysia. Scoop and Run describes a philosophy in which the patient is transported as fast as possible to the hospital without spending much time at the scene of the accident. The stay and play on the other hand is a strategy based on providing maximum care before transportation which includes basic life support, immobilization and intravenous drip. But from my experiences for many years as a volunteer and the recent incident on the 16th May 2005, I find that there has been no improvement on the standard of care at the scene of the accident. Large amount of fund is being spent to acquire modern ambulances and equipments but they not properly maintained or even put to the necessary use, sighting the missing cervical collar and scoop stretcher as appose to folding stretcher as an example in this incident. Poor guidelines and monitoring system, I believe is cause that the ambulance services in Malaysian fail to improve and are unable provide even the basic care needed by the unfortunate victim.

Crowding the Accident Scene

Crowding around an accident scene is a common sight in Malaysia , as ignorant member of the public gather to watch the drama, live at close range paying no heed to potential danger lurking the accident site . It is understandable, if one was first on scene or was there when the accident happened and decides to approach the accident scene to render help but crowding around even after emergency services and police have arrived on scene hinders rescue efforts and more importantly puts the life’s of the injured, the rescuers and the public themselves in greater danger.

The scene of accident is a dangerous area. Debris from damaged vehicle sharp in nature, hot engine parts, slippery lubricants and inflammable leaked fuel usually fill the hazardous accident scenes and sometimes damaged power lines and structures on the road adds on to make the situation more dangerous. Crowding also causes congestion to traffic as onlookers slow down to take a peek causing a chain reaction of a bumper to bumper situation and later misuse of the emergency lane causing a clog by irresponsible road users which in the end causes a delay in emergency vehicles reaching the accident scene.

An emergency worker is trained to always begin any rescue effort with the capital “D”. i.e. Danger. “Survey the scene & Check for DANGER” is the first thought that flashes in a rescuers mind as they activate themselves on arrival at the scene. This also helps to look out for and identify possible “Mechanism of Injury” to the victims in the accident. A damaged front windshield on the driver side or damaged steering wheel for instant indicates that the driver may not have had the seat belt secured therefore possibly sustaining injuries to the head and chest. Rescuers too need to take the necessary precaution to not get injured themselves. Crowding at the scene hinders this very first step from being carried out as the view on the accident scene become very much complicated. It takes the rescuers some time to even identify who is involved and injured and who is not.

Access to the injured is also difficult as the rescuers will have to walk past scores of on-looking crowd to get the injured victim. In an ideal situation all necessary tools and rescue equipments should be brought out from the rescue vehicle and placed near the scene for a swift rescue operation. Unfortunately as the scene is filled with crowd, it is not safe to leave too many tools unattended at the scene. Rescues are forced to run back and forth to pick up what they need to use hence slowing the rescue process. Small but crucial tools such as a flash lights can go missing in an instant if left unattended.

Work space at the accident scene becomes very limited with all the crowding and rescuers now have to work in that little space rubbing shoulders with the on-looking crowd. Rescue work becomes very slow as the rescuers need make sure no public is injured when work is carried out or when tools, equipments and damaged vehicle parts are moved about.

Another dreaded sight at the accident scene is to see someone smoking, totally ignorant that their act, risk a great danger or a hazy discomfort to say the least. Leaked fuel and flammable gas if present at the accident site might ignite causing another accident. An injured victim is already in an uncomfortable situation and it is made worse by the presence of cigarette smoke polluting the air. I personally experienced an incident that almost blinded me recently when an ignorant smoker standing next to me watching, almost burned my left eye when he lowered his hand after taking a puff while I was kneeling down, attending to an injured motorcyclist.

While there are laws in the “Akta Bomba Dan Penyelamat” to prevent crowding at accident scenes to stop the public from causing further danger or obstructing rescuer from carrying out their job promptly, we have yet to see it being enforced. Even when barricading plastic lines are put up to stop public from entering the accident scene, usually it is ignored. The police need to be more aggressive in accident scene management to clear the area off non-rescue personal including tow-truck operator and touts hence eliminating the risk of a second accident and to facilitate a swift and successful rescue effort. Public on the other hand, need to understand that their uninvited presence crowding the accident scene merely causes grave disadvantage to the rescue process and could contribute to loss of lives, maybe even their own.

Pre-Hospital Care Dilemma

The ambulance agenda in Malaysia has been postponed for too many years and I am glad that major steps have been taken to finally rectify it. But a few questions still remain unanswered. From my observations, the previous attention brought forth by the local print media on the ambulance issues did not bring much change. However each time there will be a new catch word, Improve Ambulance Service, Trauma Care, “Stay and Play” or “Scoop and Run”, Healthcare Quality, Empty Ambulance and the latest catch word is “Pre-Hospital Care”

I have learned that, one of the main reasons this issue was not able to take off, is the lack of key people in the industry. *The Emergency Physician*. The Head of Traumatology in Malaysian was a General without soldiers; there were practically no emergency physician in the country back then. The Accident and Emergency departments were headed by physicians from other discipline such as Orthopedics, Anesthetics and even Medical Officers. Today this scenario is changing; I salute all who were involved in producing our own Emergency Physicians. The “Accident and Emergency Departments” which used to be “No Mans Land” have been given a new name “Department of Emergency” (Jabatan Kecemasan) and are currently being headed dedicated emergency physicians.

Another issue involves the supporting allied health personal. These can be divided into two categories. Emergency Nurses and Medical Assistant fall under the Trained, Certified and Licensed to practice category, where as the First Aiders, First Responder and EMS Enthusiast who fall in the Trained & Certified but unlicensed category. The emergency nurses and Medical Assistants are very highly trained but unfortunately their trainings are focused on in-hospital care. When it comes to practicing out of hospital, in the fields, very few of them are able to perform as well as they do in the hospital.

For many first aiders and first responders in Malaysia who are mostly volunteers, the trainings are not a straight forward issue. Anyone who has interest in the paramedical field would have started with Basic First Aid and progressed to Advance First Aid which was the highest levels of training offered by the St Johns Ambulance and the Red Crescent Society. Thanks to Sukom 1998, the First Responder Life Support course was introduced in Malaysia by MASTEM and is on going. HUKM in 2001, collaborating with St Johns Ambulance and the Rotary Club initiated the Emergency Medical Technician – Basic course, which is the first level of three level EMT – Intermediate and EMT- Paramedic in the American Paramedic Syllabus. Some 50 odd EMS enthusiasts who were mostly volunteers, graduated from this course before it was temporarily discontinued after 2002.

There were also short term certificate courses such as, Basic Life Support, Advance Life Support, Advance Cardiac Life Support, Aquatic Rescue, and Malaysian Trauma Life Support conducted for small groups. Unfortunately there were no clear academic pathway for Pre-Hospital Care training in Malaysia, unlike in developed countries with clear academic pathways, an EMS enthusiast could earn a PHD in paramedical sciences or management. These volunteers represent the largest number of ambulance crew in Malaysia, which for the past one month have been described as “Inadequately Trained Ambulance Crew”. Are they to be blamed for their lack of knowledge?



EMS hardware, the ambulances and pre-hospital care equipments is another orphan issue that has no clear guideline. In Malaysia the definition of an ambulance starts with a marked van with beacon lights, siren system, a stretcher and first aid kits box, to purpose build emergency vehicles with paramedical ergonomic design, equipped to handle high dependency patients.

But its very sad the better ambulances are totally not affordable, ambulance builders and importer in Malaysia are taking advantage on the lack of governance in ambulance specification, standard and pricing to practically reap the industry of the little budget they have, to survive and operate. Even with tax exemption, medical equipments for EMS are extremely costly. Most organisation wanting to start an ambulance service are taken in to purchase what they don’t need at a high cost. At times, to cut cost, ambulance vendors compromise vital safety features in the ambulance vehicle by removing ABS breaking system, airbags or auxiliary batteries.

Testing and Commissioning, product familiarization training are not done, hence the dilemma of ambulances breaking down due to improper use, highlighted by our health minister. Pre-Hospital Care vendors, should be identified and regulated. Unethical vendors should be investigated and
publicized to disallow them from cheating the industry, especially now as pre-hospital care vehicles and equipments are in demand inline with the governments move to improve services.

In summary, the Malaysian Pre-Hospital Care Dilemma, needs a collective effort if we want to see any improvement in the near future. No single entity will be able to provide a complete solution. The Ministry of Health, Ministry of Education, the current pre-hospital care providers such
as the St Johns Ambulance, Malaysian Red Crescent Society, the Fire and Rescue Department, JPA3 and most importantly, the Malaysian community need to be involved. *Pre-Hospital care is not a business; it’s a service to humanity.*

Paid Samaritan

Paid Good Samaritans

The article “RM10 fine for staying too long on expressway” published on Friday 21, January 2005 brought me to write about my concern on our roads being infested by tow truck operators and their “Call Man”. They can be frequently seen with their vehicles parked along the road sides waiting for cars to stall or an accident to occur. Though the tow truck operator would be able to provide immediate mechanical or towing assistance, it wasn’t until I attended a first aid course I realized that their presence and actions sometimes may be detrimental. The first aid instructor started the session with a slide showing an accident Scene. He then asked us if we were to call the Police, the Fire Department and the Ambulance, which one of these agencies would arrive first, on scene. The opinions of the participants were divided between the three. He then asked for a show of hands starting with the Police. There were quite a large number of hands in the air when the next slide showed the word police being striked through indicating the police are not the first ones that would reach the scene. To my surprise, those who chose the remaining two options, the fire department and the ambulance were also wrong as they were striked through as well. For a second we were left wondering what the answer would be and then the next slide showed a picture of a tow truck that caused everyone to burst into laughter, applauding and agreeing with the instructor.

He then went on to explain that competition among tow truck companies has increased the number of “call man” on our roads. This range from dedicated call mans who usually drive modified vehicles with yellow and red beacon lights at the back of their cars to taxi or lorry drivers or sometimes even the odd traffic police men. They are linked with trunk radios and hand phones to immediately relay the news of a stalled car or an accident in the area of their coverage. This is the reason why even if it was a single vehicle accident crashing into the divider, there would be at least five to six cars parked along the stretch within the first five minutes. The first operator that reaches the scene would use all means to secure the towing deal which includes sending the victim to the hospital in their own vehicles.

Though this can be viewed as a Good Samaritan act, it is also important to note that the first rule in first aid indicates that an injured victim should not be moved unnecessarily unless there are pending hazards, i.e risk of explosions. A trauma patient, if moved improperly may result in paralysis, if not death. How many tow truckers are certified first aiders? Usually little or no proper first aid is given on scene or on the ways to the medical facility.

The awareness on first aid is very low here among the general public and professional pre-hospital care is almost non-existent in Malaysia. The public blames the ambulance for arriving late on scene to justify their decision to move and self transport the victim, ignorant of conditions of when this would cause more harm than good.




On the other hand the agencies involved in providing ambulance services tend to blame the public for being irresponsible on the road; not giving way to ambulances or clogging up the emergency lane; to justify their poor service. Hence failing to take actions to improve the current low standards of emergency medical services in the country.

The losers in this scenario are the victims. Nobody wakes up in the morning and chooses to be a victim of road traffic accident. You may have access to the best trauma surgeon in the country, known for bringing people back from the bringe of death. But what are the chances of getting to such facilities in good shape if you were to crash your vehicle on Malaysian roads? Does it not defeat the purpose when the first to arrive and render assistance is most likely an untrained person, whose primary objective is a financial commission from towing your vehicle? I can only hope and pray that I’ll not be a road traffic accident victim one day, but if I was on scene for one, at least I would know what to do. Do you?