Sri Lanka is one of the few developing countries with a completely free healthcare service for its citizens and even for foreigners who walk into any Government Hospital. The Government spends billions of rupees on the health service every year, but more can be done to make it even better.
One major lacuna was the lack of an islandwide ambulance service. Individual hospitals, both Government and private, do have ambulances but they are mostly used for transferring patients to and from hospitals.
There are a few private ambulance services that do make house calls for a fee, but these are restricted to the Colombo District. Thus, most patients, especially, in the outstations, have to rely on private vehicles to get to the nearest hospital in a health emergency. This is complicated by the fact that even three wheelers are a rare commodity in some of the remotest parts of the country.
It is not unusual for these villagers to carry a patient on a makeshift stretcher for miles on foot to reach the nearest Government Hospital.
In this regard, the introduction of the free 1990 Ambulance Service in collaboration with the Indian Government was a revolutionary step. The completely free service has become a true life saver for residents of Western and Southern Provinces where it is currently operational. The ambulance reaches the caller’s home within 10 minutes in most instances. It has so far saved the lives of 21 critically ill children, not to mention hundreds of adults. The service will be expanded islandwide next year.
However, there are certain critical instances and geographical regions where even an ambulance cannot reach fast enough. Even a minute can mean the difference between life and death for a critical patient at home or at a traffic/industrial accident site.
Most countries have an Air Ambulance (Flying Doctor) service to serve such patients in remote areas. The Sri Lanka Air Force provides this service at the moment, but given its own operational requirements and other constraints it cannot offer a full-time or dedicated Air Ambulance service.
Reality
There have been calls for an Air Ambulance service, formally called Helicopter Emergency Medical Service (HEMS), in Sri Lanka for many years, but it never became a reality due to cost constraints.
There are many advantages of having a HEMS system. Only an emergency medical helicopter can provide the flexibility to deliver medical care where no ground vehicle can possibly go.
In addition, a helicopter can cover greater distances three-to-five-times faster than a road ambulance (with speeds exceeding 200 km/hour) and can land as close as possible to an accident site even when unreachable by a ground vehicle. It can fly over obstacles and avoid the hassle of winding roads. It never gets caught in traffic and could fly uninterrupted for up to four hours.
Thanks to a wide range of medical equipment on board the helicopter, the medical crew is able to make an initial diagnosis and start treatment.
They also have access to in-flight resuscitation (CPR) and endotracheal intubation capabilities. The stabilized patient can be transported by the helicopter to the nearest or most appropriate hospital quickly and safely.
The Health Ministry now plans to procure eight Airbus helicopters (a leader in HEMS helicopters) for this purpose with German assistance, in addition to 28 state-of-the-art emergency vehicles.
This is a major investment, given that an entry level single engine brand new helicopter for passenger use (not modified for air medical services) costs around US$ 2 million. Airbus and other manufacturers currently offer a range of HEMS helicopters with the bigger models being able to transport two patients on stretchers along with several medical professionals. Since HEMS helicopters are equipped with Night Vision and Instrument Flight Rules (IFR) systems, they can be operated day or night. They can even be operated in adverse weather. Moreover, an air medical ambulance program also decreases the number of ground ambulances needed for long-distance patient transport, freeing more ambulances for short distance patient transport.
This will be a revolution not only in Sri Lanka, but also in South Asia. However, upgrading hospitals is equally important to cope with an influx of patients from an expanded ambulance service. With this aim in mind the Government hopes to establish European standard hospitals in Hambantota, Panadura, Dambulla, Matale and Embilipitiya with German, Netherlands and French aid.
Complement
The 28 all-new emergency vehicles, which will be in addition to the 1990 Ambulance Service, will complement the Air Ambulance and Medical Evacuation Service and the new hospitals. It goes without saying that all major hospitals in the country should be equipped with helipads to accommodate the Air Ambulances. There are many details which are yet to be revealed on the proposed Air Ambulance service, such as the recruitment and training of crew and medical professionals, maintenance costs and operational costs.
We can expect the SLAF to play some sort of role in this regard at least in the initial stages, but this will be essentially a civilian operation in the long term. The Government should also obtain foreign expertise for crew training.
Apart from medical emergencies, we hope the helicopters will be used in search and rescue efforts, both, inland and within our maritime boundaries.
They will essentially have a dual role of patient evacuation and rescue of persons in distress, the latter in collaboration with the Coast Guard if a sea rescue is called for. Again, the SLAF has been rendering a yeoman service in this area, but it alone cannot cope in an emergency situation such as a major flood.
In the future, there could even be autonomous drones that can pick up patients from remote areas and bring them to the nearest hospital.
This sounds farfetched, but plans are already underway to start autonomous flying taxi services by 2025 in several countries. Patient evacuation takes it a few steps further, along with other plans such as robotic surgery.
But the ambulance will remain the most critical component of patient care for decades to come and the Air Ambulance Service will reinforce this status.