Ecuador Intercultural

Although there is a single emergency access telephone number (1-1-2) and legislation that requires fixed and mobile telephone carriers to provide free connection to the emergency access telephone number, connection is not always free and there are substantial geographic coverage gaps. Further, it is estimated that less than 25% of the population knows and can properly use the emergency access number by memory. Note that the NAS has intentionally controlled promotion of the emergency access telephone number to avoid not being able to respond promptly given existing resources, which might result in a loss of confidence in NAS services.

There is an organised national prehospital care system with certified prehospital care providers (i.e., NAS) and a number of private ambulance services; however, the majority of the population in both urban and rural areas does not have access to prehospital care services due to inadequate numbers of ambulances, staff and stations. If the emergency access telephone number is called, callers are connected to the appropriate service (e.g., NAS, NPS, NFS). If the call pertains to a condition that requires emergency care, providers can be dispatched to the scene or facility. There are no nationally agreed upon response times used by all ambulances services for responding to the highest priority calls.

Currently, dispatch services do not routinely provide standardised basic clinical advice to bystanders. Once prehospital care providers arrive, their care is often governed by protocols, particularly if they are NAS providers; however, they lack real-time medical direction, a backup advisory mechanism to provide extra clinical support, and a communication system to do so, if needed. There are no destination triage protocols for prehospital care providers; decisions on where to transfer a patient with a given emergency condition are made based on provider and/or patient preference.

Information about the patient, care provided during transport, and immediate clinical care needs is rarely given to the receiving facility prior to arrival. There is no system-wide automated tracking of caller location via telephone or other methods; however, there is a pilot program evaluating this technology in Greater Accra Region. The NAS performs regular audit of prehospital care data for quality assurance and improvement purposes.

To augment existing prehospital care capacity, GRCS and St. Johns Ambulance Service train laypersons in first aid using validated courses, provide trainees with basic emergency care provider kits, and use a credentialing system. GRCS has trained more than 40,000 laypersons; however, layperson first responders are not widely available when needed, and they are not integrated into the formal prehospital care system administrative or credentialing structures. Recently, GRCS began piloting a tricycle ambulance programme in Upper East Region to extend prehospital care service to those currently without access to the NAS when needed. Despite these significant efforts, there is not a centrally regulated layperson first responder training programme with overall coordination or quality control mechanisms.

Strictly speaking, there is not a ‘Good Samaritan’ law in Ghana to protect laypersons who provide first aid; however, according to Common law and legal precedent, if a layperson offers help within their means, they could seek protection from harm caused to a victim.

Prior to formation of the NAS, NFS training included basic emergency care that was supported by the GRCS. As the NAS developed, the NFS has abridged first aid training and is now unable to act in the capacity of a first responder, even during disasters.

ACTION PRIORITIES

Advocate for 1-1-2 being toll-free on all carriers in function and accessible across the country 24 hours per day.

Restart real-time medical direction of prehospital care providers by utilising the new cadre of emergency medicine specialists; propose volunteer medical direction posts in each region.

Re-introduce basic emergency care training into the NFS curriculum to extend population-level access to prehospital care services in areas without NAS coverage, and to improve emergency and disaster preparedness.

• Support the NAS by assisting in community-based initiatives to teach 1-1-2 and its use to the population when NAS is ready to expand services.

• Work with the NAS to pilot a medical priority dispatch system that offers bystander instructions when needed, which can be either electronically based or a card system.

• Ensure that there is a single designated telephone or radio at each facility that functions and with a staff member assigned to answer incoming calls 24 hours per day; prehospital providers should have access to the telephone numbers or radio frequencies of each facility so that they can communicate with the receiving facility prior to arrival.

• Develop destination triage protocols for all prehospital care providers so that patients can be cared for in the most safe and timely manner possible by facilities with the necessary capacity; destination triage protocols for injury can be piloted along roadways with a high incidence of road traffic crashes, and be monitored and evaluated in coordination with the NRSC.

• Incorporate GRCS-trained laypersons into the formal prehospital care system to expand population-level access to prehospital care services.