PosterPDF Available

Implementation of a de-novo ambulance service in the United Arab Emirates

Authors:
  • National ambulance UAE

Abstract

Poster describing the implementation of National Ambulance LLC services in Northern Emirates, UAE.
Background
National Ambulance is the leading pre-hospital emergency care provider in the
UAE.
It was established to serve government and private clients, and commenced
operations in 2010.
National Ambulance is majority owned by the Government of the UAE, and its
commercial strategic partner is Aspen Medical Pty Ltd, an Australian company
with international experience in providing clinical services.
Provision of ambulance services to the emirates of Ajman, Al Fujairah, Al Sharjah,
Umm al-Quwain and Ras al-Khaimah began in February 2014. This service area is
collectively known as Northern Emirates (NE).
Summary
The National Ambulance NE service has responded to 31,786 calls in its first
year of service
Interim figures for 2015 to date suggest this will increase, and expansion of
the service is planned with further vehicles and additional clinical staff
References
1. Hardeland C, Olasveengen TM, Lawrence R, Garrison D, Lorem T, Farstad G,
Wik L. Comparison of Medical Priority Dispatch (MPD) and Criteria Based
Dispatch (CBD) relating to cardiac arrest calls. Resuscitation. 2014
May;85(5):612-6
2. Al-Hajeri A, Batt A, Minton M, Haskins B and Cummins F. (2015) National
Ambulance Northern Emirates PAROS Study Annual Report 2014-2015. Abu
Dhabi: National Ambulance LLC.
Acknowledgements
National Ambulance Northern Emirates, ACC & Clinical Education Dept. staff
Implementation of a de-novo ambulance service
in the United Arab Emirates
Al Hajeri A1, Batt A1,2, Haskins B1,4, Cummins F1,3,4
1Clinical Education & Research, National Ambulance LLC, Abu Dhabi, UAE.
2 Centre for Prehospital Research, University of Limerick, Ireland
3Graduate Entry Medical School, University of Limerick, Ireland. 4Charles Sturt University, NSW, Australia.
Results
Average of 664 dispatches per week in the Northern Emirates service area.
From February 2014 to March 2015, a total of 31,786 emergency calls were
responded to, with 33,467 patients transported.
Of these 33,467 patients, a total of 384 cardiac arrests were treated.
National Ambulance staff achieved a ROSC rate of 2.3% for the first year of
operations, and that is expected to increase.
National Ambulance has achieved ISO 9001,14001 and OHSAS 18001
accreditation.
National Ambulance is also accredited by the Joint Commission International.
Clinical Governance
Clinical oversight of all patient care activities is provided by the Office of the
Chief Medical Advisor (CMA).
The CMA is supported by a clinical governance team who execute clinical
directives at a service level and provide field-based training and evaluation of all
clinical staff.
Clinical staff in the NE service area are guided by a suite of clinical governance
documents issued by the CMA, including
Patient Care and Treatment Protocols
Medication Formulary
Clinical Practice Guidelines 2014 Edition
National Ambulance policies and procedures
These documents are based on the latest available evidence, international best
practice and are customized to meet the needs of the UAE population.
Guidelines are reviewed and updated regularly as new evidence emerges.
Operational Delivery
International ambulance services were studied, and various modes of
deployment and dispatching were investigated.
The service is led by the Director of Operations Northern Emirates, who is
supported by five area managers, each responsible for service delivery in one
of the emirates.
Currently there are 269 Emergency Medical Technicians assigned to the NE
service area.
The service is delivered with 24 ambulances based at 14 stations throughout
the service area.
Ambulances are custom designed, van-conversion Mercedes Sprinters.
These ambulances rotate through 25 standby points based on dynamic
dispatch concept at differing times throughout the day.
Clinical Staff
Clinical staff (Emergency Medical Technicians) man a total of 24 ambulances,
and are supported by five area managers equipped with first responder vehicles.
EMTs are currently authorized and trained to perform a wide range of basic and
intermediate life support interventions, including:
Defibrillation
Application of mechanical CPR device
Insertion of advanced airway devices
Administration of symptom relief medications for pain, asthma attacks,
cardiac chest pain, diabetic emergencies, and anaphylaxis
Intranasal and intramuscular medication delivery
Naloxone for opioid overdose management
Communications
All calls received from the NE service area are received in the Ambulance
Communications Centre (ACC) in Abu Dhabi.
National Ambulance ACC uses King County Criteria Based Dispatch (CBD)
under licence, and has two on-site licenced CBD Trainers. CBD ensures early
pre-arrival information is provided to the caller.
The communications centre is staffed by 25 call takers and dispatchers, with
support from five team leaders, operating 24-hours a day.
A backup communications centre based off-site is also located in Abu Dhabi.
Members of the public ring 998 in an emergency which is answered directly by
National Ambulance ACC staff. Call takers speak Arabic and other languages
to aid callers.
ResearchGate has not been able to resolve any citations for this publication.
Article
Background Prompt emergency medical service (EMS) system activation with rapid delivery of pre-hospital treatment is essential for patients suffering out-of-hospital cardiac arrest (OHCA). The two most commonly used dispatch tools are medical priority dispatch (MPD) and criteria based dispatch (CBD). We compared cardiac arrest call processing using these two dispatch tools in two different dispatch centres. Methods Observational study of adult EMS confirmed (non-EMS witnessed) OHCA calls during one year in Richmond, USA (MPD) and Oslo, Norway (CBD). Patients receiving CPR prior to call, interrupted calls or calls where the caller did not have access to the patients were excluded from analysis. Dispatch logs, ambulance records and digitalized dispatcher and caller voice recordings were compared. Results The MPDS-site processed 182 cardiac arrest calls and the CBD-site 232, of which 100 and 140 calls met the inclusion criteria, respectively. The recognition of cardiac arrest was not different in the MPD and CBD systems; 82% vs. 77% (p = 0.42), and pre-EMS arrival CPR instructions were offered to 81% vs. 74% (p = 0.22) of callers, respectively. Time to ambulance dispatch was median (95% confidence interval) 15 (13, 17) vs. 33 (29, 36) seconds (p < 0.001) and time to chest compression delivery; 4.3 (3.7, 4.9) vs. 3.7 (3.0, 4.1) minutes for the MPD and CBD systems, respectively (p = 0.05) Conclusion Pre-arrival CPR instructions were offered faster and more frequently in the CBD system, but in both systems chest compressions were delayed 3-4 minutes. Earlier recognition of cardiac arrest and improved CPR instructions may facilitate earlier lay rescuer CPR.