What ails Kenya’s emergency road rescue
Every year, Kenya loses more than 3,000 people to road accidents. It is also estimated that the country loses Sh300 billion to road accidents and road crashes annually. Dr Joseph Lelo explains the need for proper emergency services in order for the country to deal with the economic burden of road accidents. He spoke to Lilian Kaivilu…
As Amref Flying Doctors, what has been your experience with road rescue in the country?
For the road rescue for road crash victims, we are called in as secondary rescue. We usually find that the patients have already been extracted from the vehicles and moved to nearby health centres. So we would move such a patient from that health centre to a higher level hospital. Our role in this case is secondary evacuation from that dispensary or clinic to a hospital in Nairobi for step-up healthcare.
From your experience, would you say that road rescue in Kenya is at its best?
What happens in Kenya is that the Good Samaritan in an accident scene will do whatever they can to save lives. In most cases you will find that the patient has been moved in whatever manner; usually less than ideal, and moved to the nearby dispensary where first aid will be given. We are quite far from having that advanced level roadside rescue. Emergency medical services are also quite expensive. We do not have a budget allocated by the government for emergency services so it is often done by well-wishers and donor funding in the marketplace.
Is it because as a country we cannot afford it?
One properly equipped ambulance costs about Sh10million. But the ambulance needs to have well equipped persons, the cost of insurance and training of the personnel. There is a huge gap between the ideal requirements and what we have now.
How about the local training for the paramedics?
It will take about four years to have a qualified paramedic. This will cost between Sh3million and Sh4million. In Kenya most of our ambulances are operated by nurses. Also, one ambulance may not be the same as another in terms of training and the equipment.
What if one is a member of the Amref Flying Doctors?
On average, it would cost about $7-$8 per mile. But if you work through The Amref Flying Doctors membership, it’s Sh2,500 per year. That entitles one to two movements to Nairobi on the air or ground. If you compare the cost, it is much cheaper and easier for most people to be members.
Even before we talk emergency rescue, what should be our priorities as a country?
The problem is in prevention. This is the first level of safety. In our setup, prevention is very poor. We have people disobeying traffic rules, un-roadworthy vehicles and poor road design. That really increases our accident burden.
Many people situated along the highways believe that establishment of rescue centres at the various blackspot will reduce the deaths on the highways. Is this a viable idea?
I do not think it is a viable investment because what we need to ask ourselves is why are these areas prone to accidents. We need to start at the basics. And the very basic is to prevent. In addition, we are still medically understaffed as a country. It is, therefore, very difficult to dedicate staff on the blackspots to wait for an accident to happen. We need the roads to be better, people to drive within the correct speed limits and to have safer cars. It is cheaper to do that way.
The first helpers on sight say that they handle the accident victims as they come, without any protection. Should this worry us as a country?
The ideal situation, anyone witnessing an accident would call for help. If you are not trained to put people out of a vehicle in the case of an accident, the best thing to do is to call people who know how to do it. There is usually a lot of damage can be done if you remove people out of vehicle sin the wrong manner. So the ideal case will be for the first responder, if well trained, to call for help and wait and warn others on the traffic. Let’s leave the rescue part to the experts.
Is there a standard on how far an ambulance or any other rescue service from an accident scene?
The standard should be an ambulance within 15 minutes to the accident. In an accident, most people would die within one hour of the road crash. But in Kenya, it can take anything between one hour 24 hours.
Although some roads within the city were initially designed with ambulance lanes, this is usually a challenge due to heavy traffic in the central business district. What would happen when your member gets involved in accident at the Westlands Museum Roundabout blackspot?
We have an ambulance parked at Agakhan hospital. And if it is a member involved, we can call upon any other ambulance service provider to respond to that. So we don’t rely on our own ambulances if the person is far.
So should hospitals own ambulances?
A hospital should focus on their core business of treating patients. In an ideal situation, you will find the ambulance providers work closely with hospitals. This way, there could be a centralised database that informs the ambulance service providers of the facilities available in each health facility. So that way, if someone has a head injury, the ambulance does not have to rush them to a dispensary or to a hospital without an ICU. A centralised system will be more effective.
So whose business it is to provide rescue services?
Ideally, it should be the government. But now it is a private sector business. Anyone who has money can buy a van, stick an ambulance label and a siren and start operating. It’s is a free-for-all market.
Is the current mapping of hospitals in proximity to accident blackspots fine?
No. For instance, there is no health facility between Mombasa in Nairobi, despite the blackspots on the 500-kilometre highway. In situation where one is bleeding, the best option is to get to a good hospital in the shortest time possible. It is really hard. So we lose so many people that way. We need to improve the hospitals along the highway to handle such emergencies.