Typically, over dozen ambulances stood waiting for patients at the hospital premises. [break]
“Their presence has resulted in overcrowding and many of them have roped in hospital staffer to transfer the patients to private centers,” Dr Koirala had told Republica earlier.
According to Dr Koirala, most of the privately run ambulances are ill-equipped.
The District Administration Office (DAO), Kathmandu has stopped issuing new licenses for operating ambulance services following the revelation that many of them are involved in illicit activities.
"Illicit activities of the D class ambulances have made us alert," said Chief District Officer of Kathmandu Chudamani Sharma, adding, "It has been easy for them to engage in such activities under the cover of operating emergency vehicle.”
From now onwards, Sharma said, the whole community has to agree to run an ambulance to get the permit. CDO Sharma said that the administration office has also decided to monitor ambulance services more seriously.
The office also has formulated policies to bring ambulance services on track and has urged the District Public Health Office (DPHO), Kathmandu to take initiation.
The Kathmandu DPHO, which is responsible for regulating ambulance services, does not even have the contact number of all ambulance operators.
"We do not have contact numbers of all ambulance operators, nor do we have the exact number of ambulances operating in the district," said Sri Krishna Bhatta, chief public health administrator at Kathmandu DPHO.
The office last year had started categorizing ambulances and has distributed stickers as per the facilities they provide, but all do not comply with the DPHO directives.
“Due to the nature of the task they perform, we cannot straight away act tough against them," said Bhatta. Bhatta, however, said that the office has consulted with Nepal Red Cross Society, Metropolitan Traffic Police Division, and District Administration Office to make the operators more responsible.
“The ambulances must be well-maintained. We are also discussing to bring uniformity in the fares," Bhatta added. He said that poor quality of ambulance puts the life of serious patients at risk.
According to Indira Pandey of Kathmandu DPHO, almost all the ambulances operating in the capital are ill-equipped and do not meet the requirements set by the government. "They have been risking the lives of patients. Most ambulances do not even have life saving equipments," she said. The office said that only few ambulances operated by big hospitals like, Bir, Teaching, Gangalal and Norvic hospitals have been listed in the B category. “Most of the ambulances are in poor condition, ill-equipped and do not have trained staff to provide pre-hospital care,” said Pandey.
Doctors say that out of total deaths from accidents, about 60 percent die in lack of pre-hospital care. "We call the pre-hospital period ´golden hour´. More lives could be saved if we provide proper pre-hospital care,” said Ashok Bajracharya, director of the Trauma Center. He said that pre-hospital emergency care is a critical component of ambulance services. It is a minimum requirement regardless of the category of the ambulance. The adverse health consequences of not having pre-hospital care, even in the case of common medical emergencies, contribute to the high mortality rates.
Sanga Ratna Shakya, immediate past secretary of Nepal Red Cross Society, said that a joint survey conducted by administration office, Nepal Red Cross Society, and Kathmandu DPHO had found shoes inside the first-aid boxes of various ambulances. "Most of the ambulances do not have even oxygen cylinder and they operate without additional health workers," said Shakya.
Nepal Red Cross Society has been providing first-aid training to the ambulance drivers and so far 48 drivers have undergone the training. Nepal Red Cross Society has been operating ambulances in 56 districts and charges voluntary fee.
Shakya said that some ambulances charge exorbitant fares from the people in problem. “The government must bring uniformity in fares as many people have complained about high fares charged by ambulances,” he added.
Nepal Ambulance Service (NAS), a non-profit initiative dedicated to emergency medical response system in Kathmandu and Lalitpur, has asked the government to bring uniformity in the ambulance fares. The organization, which charges only Rs 25 per kilometer for carrying patients, has been operating five ambulances and said that it was keeping fares low despite losses in operating costs.
"We ensure the presence of trained health workers in every ambulance we operate," said Amit Shrestha of the organization, adding, "Also, they have all kinds of life saving equipments." Shrestha stressed on the need of strict regulations to bar ill-equipped ambulances from operating.
15 deliveries in ambulances
Nepal Ambulance Service (NAS) has said that so far 15 women have given birth in its ambulances while on the way to hospital. The organization said that the trained health workers in its ambulances ensured the safe delivery.
Shrestha said that the organization has several times demanded allowances from the DPHO for such deliveries, but their requests have been turned down.
The government provides allowances for safe delivery services to hospitals.
Criteria for categorization of ambulances
To qualify into ´A´ category, ambulances should have an ECG, cardio monitor, defibrillator, ventilator, nebulizer, head immobilization facility, catheterization set, length and weight-based chest for pediatrics. Along with these, the ´A´ category ambulance should also have a doctor and a staff nurse. Moreover, the ambulance should have all the facilities of B category ambulance.
Similarly, the B category ambulance should have suction machine, fracture splint, cervical collar, airway, patient restraint strap and trained paramedic.
The ´C´ category ambulance is required to have first-aid medicine, oxygen, flow meter, mask, tools required for intravenous injection, stethoscope, B P set torch light and stretcher-cum bed.
Srikrishna Bhatta
Chief Public Health Administrator DPHO, Kathmandu
Why has the DPHO failed to regulate the ambulance services?
Due to the task they perform we cannot act against them strictly. But we have been consulting other stakeholders like administration office, police, Nepal Red Cross Society to make them more responsible. Chief District Officer himself has shown interest in regulating the service. In the up coming meeting of stakeholders, we will make concrete action plan to regulate the service.
Why has the office stopped issuing licenses for new ambulances?
Due to the growing complaints of public that ambulance operators have been charging exorbitant fares, we have stopped issuing new licenses to private operators. Now, only hospitals and communities can get the permission to operate ambulances. Consent from the whole community is needed to run the service. We believe communities will be more responsible than private operators.
What is the DPHO doing to bring uniformity in the fares?
We have found that some ambulances have been serving patients freely, while others charge nominal cost. But most ambulances charge exorbitantly. In the upcoming meeting of the stakeholders, we will bring up the issue of the fares.
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