Medical emergency

In my recent column on technical disruptions, I cited as an example the development of tele-medicine. Trained surgeons can now do procedures remotely from across an ocean or a continent using digital communications and robotic technology.

I wondered in my recent column if we are ready for such a development. Our laws and regulations on the practice of medicine and the mindsets of local medical practitioners need resetting. Since foreign-based specialists have not passed the local medical board exams and are not Filipinos, they cannot technically treat a patient here via tele-medicine even if the patient’s life is at stake.

A doctor in an e-group of doctors also raised the same issue in a recent posting:

 “Just three (relatively mild) questions to the medical establishment and the Philippine government –

“Why ban certified international specialists from practicing and let loose/impose on the Filipino people a whole bunch of so-called MDs who got their licenses with a grade of 50 percent?

“In a country, where a good number of people die without seeing health care personnel, why stop foreign-based medical missions (most with highly-trained specialists), which treat poor Filipinos in the hundreds in one week FOR FREE? Is it just to keep the payment-able patients in the barrio to its doctor, who in all probability passed the board with the grade of 50 percent?

“Why open/license a ‘hospital’ that does not have the facility to treat the most basic medical emergency?  Insanity, right?”

For those of us in the metro areas, we do not appreciate how badly our fellow Filipinos are served by the country’s health care system in the rural areas. Since I come from a family of doctors, I always have access to good medical services.

It is the cost of getting really sick and hospitalized that worries me, making me wish we have Obamacare or the Canadian system here. After my parents, both doctors, passed away, I also have to suffer the long lines and hours of waiting to see a specialist.

But reading the exchange of e-mails among the doctors in that e-group (I am thankful they included me, a non doctor), it seems I have more to worry about. A medical emergency such as a heart attack or a stroke will likely kill you anywhere in the country outside of Metro Manila and Metro Cebu.

But even in metro areas, the traffic situation is a serious problem for such emergencies when every minute counts. In many cases, if you are inadequately attended after 60 minutes, you are as good as dead.

And even if you get to a hospital emergency room, I now find out from this e-mail exchange of doctors that you are not home free. ER attention is not always adequate, not even in the application of such basics as artificial resuscitation. Here is one observation I caught in that e-group:

“As for CPR here, the janitors at a top hospital do an excellent job with the compressions. Some docs, I’m afraid, either lack the physical strength/stature to perform effective compressions or maybe they just don’t want to get their hands dirty. For all I know, it may even be hospital policy.”

Hmm… I know my father, a professor of medicine for most of his career, told me I should avoid a hospital if I can. But that’s to avoid hospital acquired infections because bacteria caught in hospitals are the most difficult to control with current antibiotics.  Now, I have to be ready for janitors doing artificial resuscitation?

It was not until Patrick Deakin joined the conversation that I felt reassured. Patrick runs a professional ambulance service and he said they are able to give proper stabilization procedures even while stuck in traffic on the way to the hospital.

Indeed, not only do they run an ambulance service, Patrick’s company also has “an EMS academy (essentially to train our own people because they are in huge demand overseas and are given 20x more salary than they get here). Our EMS academy takes 50 people per cycle (a cycle is nine weeks).”

Patrick said they donate 10 seats each in every class to the Army and Air Force for enlisted men to become EMTs or Emergency Medical Technicians.

“They have astounded us all! They now regularly top the class (against registered nurses) because they don’t diagnose, hypothesize, question, think of therapies or wait for MD’s instructions. They dive right in and keep the patient alive until he/she gets to definitive care. They have blown us away with their capabilities. Very few of them have completed high school and none of them have been to college.”

Here comes a good idea from Patrick. Why not “train, equip and deploy EMTs to the 18,000 barangays of the Philippines. Given that some barangays only have a thousand or so people, while some in QC have 40,000, we’re talking about 12,000 fully-trained EMT’s with online medical control, communications equipment, basic EMT equipment (sphyg, steth, first aid, splints, IV kits, emergency drugs, trauma kits, tourniquets, immobilization devices, OPAs, airbags, etc. (eventually to include AEDs if possible).

“Estimated cost per EMT = $2,000 (training and equipment – not including consumables). That would be $24 million to do the program. It would be private, but non-profit. No one gets to a scene faster than a bystander (or usisero) and the barangay network is a very fast and efficient system.

“If we can prevent further harm to come to a patient and/or commence immediate CPR whilst mobilizing other barangay assets or private help, we can indeed save a lot more lives. $24 million is not a whole lot of money when we’re thinking about first-response for a nation of 110 million people. Anyway… something to think about.” 

Maybe a public-private partnership will do here. We have rich barangays who are running out of ideas on how to use their share of local taxes. They can adopt other barangays who are less able to afford initiatives like this.

There are also a lot of corporate and family foundations running out of ideas too on how to make it look like they are spending excess wealth in the service of society. I know foundations like that of the Zuellig family are already heavily invested in health care. But there are others. 

Training barangay tanods to become emergency medical technicians will also give them an added skill they can use to work abroad and earn more for their families. Senior high school students could be trained. And in this era of natural and man-made calamities, we are better off with trained EMTs in our midst.

 Maybe I was too far ahead by worrying about tele-medicine and how inadequate our laws are in dealing with its implications. Maybe EMT training at the barangay level is an even more urgent concern.

 Hopefully, some big corporate foundation will take on this challenge because I am not sure the DOH and government in general can. And most important of all… our lives may depend on it.

 One last thing… there is a need to regulate ambulance services.  Patrick explains that in their case, “all our team leaders (one per ambulance per shift) must be trained and certified. They are also RN’s and can perform invasive procedures and deliver drugs under the standing and/or online instructions from the medical director. All parties must be in constant radio and WiFi contact with a central command which also coordinates with receiving hospitals to avoid any delays and/or secondary assessments.”

 In Patrick’s company, all their ambulances are imported from the US and are all advanced life support (ALS) ambulances. But there is still no law governing their operations. They follow global best-practices as best they can.  

Guidelines must be based on legislation. A bill needs to be passed. But no one is interested to sponsor, let alone schedule it for deliberation.

 Boo Chanco’s e-mail address is [email protected]. Follow him on Twitter @boochanco