Trung Vuong Emergency Conference Transportation of traffic accident victims by taxis in Ho Chi Minh city Dr David TRAN Afravietmur Trung Vuong Emergency Conference November 10th 2011

Particular context of HCM Megalopolis with about 10 millions inhabitants About 5 millions of motorbikes and a growing number of cars. Un-adapted road corridors with trunks crossing the center city A lack of traffic control with a lot of traffic jams Regular traffic rule violations (red lights, priority, one way traffic etc…)

Problem of traffic jam in HCM city A lot of motorbikes More and more cars

Traffic Accidents in Vietnam & HCM city Traffic accident are the first cause of trauma in Vietnam (11.499 people were killed in 2010 = 30/day) Motorbike are involved in more than ½ of non-fatal accidents (734/100.000 inhabitants) From september, traffic police punished more than 88,200 people for traffic rules violations In HCM, about 100 serious accidents/month are officially registered (probably much more) In HCM, 788 deaths due to traffic accidents in 2010 (more than 2 deaths/day)

Organization of 115 system Trung Vuong Emergency Hospital (tel 115) 24h/24 call center A fleet of about 10 ambulances (but only 4 ambulances can operate in the same time) About 16 calls/ day (6000 per year)

Trung Vuong Emergency Ambulances

115 HCM call center A nurse from 115 alarm center waiting for a call

Knowledge of prehospital service 115 by HCM inhabitants 16% are aware of pre-hospital emergency service in HCM 32% are aware that 115 is the emergency response number 46% of people will transport relatives by themselves and 67% think it will be faster (than ambulance service) The main complain is the waiting time before the arrival of the ambulance

Number of ambulances in HCM About 60 ambulances available in HCM (?) 4 to 6 medicalized ambulance in Trung Vuong Emergency Hospital 1 ambulance for 140.000 inhabitants (?) 1 medicalized ambulance (SMUR) for more than 1.000.000 inhabitants

Transport of victims by taxis or private cars In 2009, a survey about pre-hospital cardiac arrest arrived in FVHospital showed that only 17% arrived by ambulances 83% arrived at the back of a car (most of them at the back of a taxi) The average of time to send the patient to the hospital was 35 minutes

Taxi’s company in HCM Ex. ML taxis: 2000 cars in the city (5000 drivers) The fleet is well distributed in all districts Time of intervention on site very short Possibility to communicate by radio

Problems of transportation of victims by non professionals Risk of aggravation of lesions during installation in the taxi or on the way to the hospital (ex: spine injuries, obstruction of airways, inhalation etc.) Cannot be applicable for cardiac arrest… Responsibility in case of problem on the way to the hospital Problem of money: who will pay the transportation?

How to solve those problems? Train the taxi drivers in first-aid (short training program) Equip each taxi with minimum equipment (first aid kit)

Train the taxi drivers in first aid How to protect a victim How to take care of a wound / a fracture / stop an hemorrhage How to put a splint, a neck collar How to carry a victim into the back of a taxi How to open the airway of a victim and insure efficient respiration. How to put a victim in recovery position waiting for help.

Minimum equipment required Compresses, bandages Splint (forearm & leg) Neck collar Oral canula Disposable gloves

Problems: organization & cost-effective Who will organize training courses ? (Hospitals, NGO, Training centers ?) Who will pay the expenses for training & materiel ? Who will replace the materiel after use? How to train so many taxi-drivers (ML taxi: 5000 drivers) Necessity to organize refresh courses every year, every 2 years?

Advantage of this solution Based on an existing organization (Taxi’s network) ➔ Could be effective quickly (< 1 year) Represents an original solution waiting for an efficient professional system of pre-hospital cares (SMUR, Paramedics etc.) Cost effective solution (training, basic equipment) Could avoid a lot of complications and maybe a few deaths.

Other aspects of the problem Education of population (115, first aid) Improve the pre-hospital system with generalization of ambulance services with a central decision center (intervention in less than 20 min. all over HCM) Improve the capacity of 115 call center to be able to give a quick and adapted answer

Vietnam has to invent original solutions to improve road safety Even if this “taxi-ambulance” solution seems to be interesting, it is not the ideal solution…

Thank you for your attention