HELP OR HURT? - Unregulated ambulance services, uncertified emergency technicians could be putting public in danger

Three weeks after a probe revealed that most local private hospitals were unregistered, The Sunday Gleaner has learnt that the island’s private ambulance service is operating without oversight, putting members of the public at risk.

When contacted last Wednesday, Dunstan Bryan, permanent secretary in the Ministry of Health and Wellness, said he needed to run some checks.

He later reported that he was “not aware of any legislative framework that supervises their (private ambulances) operations”.

Basil Ferguson, an emergency medical technician (EMT) based at The University of the West Indies (UWI), Mona, told The Sunday Gleaner that apart from the initial application process, there are no accountability checks.

“There’s a form that will tell you what needs to be on the vehicle. They will come in, do the inspection, and based on that, you will get an approval letter. You can take that to the insurance company to say, ‘All right, this is no longer a bus. This is now an ambulance’,” explained Ferguson, a private operator.

After that, he said, there’s “nothing” from the ministry, it is all up to the provider at this point.

Another private operator, who has a 10-vehicle fleet, said the oldest unit is 12 years old, but it has never been inspected by the authorities since it was approved for service over a decade ago.

Responsibility for emergency medical services (EMS) falls under the health ministry’s emergency disaster management and special services unit. However, repeated requests for information on the ambulance registry and oversight systems have not been answered. It’s also not clear how many certified EMTs are in the country.

Nonetheless, a crude search, using the word ‘ambulance’, turned up 14 active, registered or renewed entities on the Companies Office of Jamaica’s registry.

EMS is a critical part of the pre-hospital care with many medical doctors emphasising its importance to improving a patient’s chances of survival after injury or trauma. Most EMS response here is at the basic life-saving stage, which includes stabilisation and oxygen care.

Garth Richards, former president of the now dormant Jamaica Association of Emergency Medical Technicians, said that the society faces “a lot of danger” without guaranteed standards for the ambulance service.

“Most life-threatening injuries have been done pre-hospital. If you can catch those injuries and stabilise patients prior to taking them to the hospital, it saves lives,” he stressed.

Richards further lamented that “Jamaica doesn’t have any formalised system for EMT service.

“We’re just putting out ambulances,” he said, adding, “It robs the Jamaican people of a service that is essential and that’s something very critical.”

Many gaps in regulations

For Professor Winston Davidson, head of the School of Public Health and Health Technology at the University of Technology, Jamaica (UTech), the current lack of oversight of private ambulances highlights a bigger problem confronting the health sector, which recently came under the microscope after The Sunday Gleaner revealed that of the more than a dozen private hospitals recognised by the Government, only four were legally registered to operate.

That probe, triggered by the controversial circumstances surrounding the death of first-time mom Jodian Fearon, prompted Health Minister Dr Christopher Tufton to order the immediate inspection of the facilities as well as to dust off draft legislation to properly capture private hospitals.

“There are many gaps in relation to regulations, and these regulations are not in place, not only because of the lack of the institutional capacity to put these regulations in force, but also the standards are not in place,” Davidson said.

“So, the universities that have to give certification are usually the source of the development of these standards, but these standards ought to be promulgated through the Bureau of Standards in order for them to be globally accepted.”

EMT certification here is granted by The UWI, which uses the US curriculum, and UTech. It runs for two years, with no mandatory requirement for renewal.

Emeleo Ebanks, public relations officer for the Jamaica Fire Brigade, where the public EMS is based, said technicians there were “current” with their certifications.

However, one evaluator said “what you have is a large number of EMTs in that space who do not return for recertification”. That’s referring to emergency personnel based in public institutions such as hospitals.

The situation is even more concerning since, unlike many of its Caribbean neighbours, Jamaica does not have a national emergency ambulance service.

A partial EMS service was started here in 1996, but to date, it only operates out of five parishes, four of which make up the country’s tourism heartland – St James, Westmoreland, Hanover, Trelawny and St Catherine.

The rest of the country is serviced by private operators whose charges in the Corporate Area range from $7,000 to $12,000 for a one-way trip. Outside of the Kingston Metropolitan Area, rates could go as high as $70,000 per trip.

The Pan American Health Organisation (PAHO) conducted a review of EMS legislative frameworks in the English-speaking Caribbean and concluded, in a 2010 report, that only Trinidad and the Bahamas had such needed mechanisms.

However, PAHO noted that countries without EMS legislative frameworks had “well-organised emergency medical service/emergency ambulance service facilities”.

Oversight lacking

Two years before the PAHO report was issued, emergency physicians at UWI wrote a paper highlighting the “urgent need for improvements in pre-hospital care”, even disclosing that at that time an EMS Bill was being prepared.

The National Resuscitation Council has been “tirelessly” lobbying Government for such legislation.

Chairman Dr Hugh Wong told The Sunday Gleaner that while protocols exist for the public service, “oversight is lacking” in the private sector, which means “standard of care provided varies”.

“The Government has to lead from the front, and I can tell you that there are many EMTs in the public service who have not updated their certification,” said an instructor, who requested anonymity.

“So, what you have is a situation in which the private folks can do as they want and a public system that does not set an example,” he added.

Also weighing in on the issue was Enoch Gooden, the chief executive officer of Life Call Ambulance Services, who admitted that the system “needs a whole lot of improvement”.

“There is so much red tape. I personally know that even the fire brigade has tried many times to have some changes and improvements in the service and it just never works out,” the private operator said, adding that “the buck does not stop with them (the fire brigade). It stops with the health ministry.”

“I know for my company because we do so much work with tourists, we make sure our EMTs are always up to date and certified. But not everybody is doing that,” said Gooden, who operates in St James.

That assertion highlights a finding of the probe that because lots of money can be made from servicing big corporate events, even some organised by the Government, some operators ensure they are up to ‘standard’ to win big contracts.

Based on emails between a group of EMTs and health ministry officials, seen by The Sunday Gleaner, efforts were made over the past five years to establish a regulatory framework.

However, EMS workers complain that the persistent lack of regulation not only puts members of the public at risk, it also affects their professional recognition and ability to attract the level of pay they deserve.

“You see the one day that you’re going to let your guard down, that’s when something is going to go wrong. What are the things in place to get it right?” an operator asked.

jovan.johnson@gleanerjm.com