Kumudini Dr. Hettiarachchi Ananda Gunasekera,

Involved in an accident or emergency anywhere across the country, any man, woman or child would have the best chance of survival, with the development of services in state hospitals within the next five years. Thirty Accident and Emergency (A&E) Services are to be established in state hospitals island-wide from 2014 to 2018, the Sunday Times learns.

Measures are underway to establish policy followed by concrete steps not only to rush such patients through an emergency room but also for ‘triage’ through which the treatment of accident victims may be determined and prioritized based on the severity of their condition.

Currently what happens in many hospitals is that such patients go into the “cold” Outpatients Department (OPD) like any other patient. This could mean a life-anddeath issue, points out the Deputy Director-General of Medical Services, Dr. Ananda Gunasekera who is the ‘focal point’ for the development of Accident and Emergency (A&E Services) at government hospitals.

A&E Services at present are available only at Kurunegala and Karapitiya Hospitals, with a few more such as Gampaha Hospital in the development stage.

The spadework for the establishment of A&E Services across the country began last year, according to Dr. Gunasekera, with 20 rounds of discussions with eminent physicians, surgeons and anaesthetists to sort out overlapping areas. Thereafter, the doctors’ colleges, non-governmental organizations, the World Health Organization (WHO) and the World Bank sat down to discuss draft policy.

The “polishing” of the draft policy, before submission to Cabinet, took place during an exhaustive one-day conference on May 21 at the Cinnamon Grand Hotel where a Strategic Plan as well as a Manual with protocols for clinicians manning A&E Services was drawn up. (See box)

Referring to funding, Dr. Gunasekera said part of a US$ 200 million soft loan secured by the Health Ministry from the World Bank would be utilized to turn words into deeds.

Going into detail with regard to the ‘A&E Care Plan’, he spreads the bare bones on the table. There would be Apex A&E Centres for each province, with “proper” A&E systems up to base hospital level, Emergency Room facilities for all hospitals below that, introduction of pre-hospital care with the existing ambulance fleet and also the training of the public on basic life support methods, so that they could keep victims alive until an ambulance reaches them.

Under the proposed scheme there would be three levels of A&E Services, he explains, adding that any hospital which has Specialists is entitled to have an A&E Service.

Teaching Hospitals, Provincial General Hospitals (each of the nine provinces has one), District General Hospitals and Base Hospitals have Specialists while District, Peripheral and Rural Hospitals have only visiting Specialists and Central Dispensaries at grassroots level have an OPD. The Provincial General Hospitals and the Teaching Hospitals considered the Apex Hospitals with all facilities will have A&E Service I, the highest level; with District General Hospitals A&E II; and Base Hospitals A&E III.

The A&E Service gets scaled as it goes down the line, says Dr. Gunasekera, pointing out that the next issue that they had to look at was how accident or emergency victims could be brought to hospital.

The answer would be an efficient emergency ambulance system, the Sunday Times learns.

There are 300 ambulances around the country in the state system, 250 more have just been added to this fleet while 200 more would be provided shortly, he says, adding that the A&E Services project got off the ground due to the unstinting support extended by Health Ministry Secretary Dr. Nihal Jayathilake and the assistance of the Director-General of Health Services, Dr. Palitha Mahipala; the Director of Medical Services, Dr. Lal Panapitiya;