110 - In case of accident or emergency all it takes is one call for help to arrive.

By Kumudini Hettiarachchi reports on Colombo’s pre-hospital service

Rring, rring………the action starts then. The person who answers the phone quickly takes down the name of the caller, the location and also the contact phone number, cuts the line and checks back, while the other officer in the same room presses the button setting off the alarm.

Within 30 seconds during the day and a minute during the night, the calls are over and the emergency team, ambulance siren screaming, is out of the gate on its way to the location.

At the scene of the accident, out they jump from the well-equipped ambulance, checking out the casualties, tagging, with colour-coding the victims, and attending to to their initial medical needs while quickly transporting them to hospital.

A typical scene from an American movie. No, this is no action-movie, this happens in the city of Colombo. The doers, of course, are a specially trained unit of personnel under the Colombo Fire Brigade, which has diversified into this crucial area of life and death, while playing their roles as fire-fighters and rescuers.

Anyone can call and they will come not just for road accidents but also for train, home, playground or workplace including construction-site accidents and also any emergency like explosions.

“Before the Avurudu, we got a call from Grandpass, about a fallen tree. When we rushed there we found that an elderly woman had got pinned down by the tree. While our rescue team began operations to cut away the tree and free the woman, the emergency team began administering to her needs, says Fire Station Officer R.G. Wijesuriya, who handles training. “Usually, the response time, if there are no major traffic jams is seven minutes.”

There are three inter-linked teams under the Colombo Fire Brigade – trained and equipped to handle the categories of “fire”, “rescue” and “emergency”. While fire engines tackle the first two categories, the third is handled by the ambulance service.

The emergency service has four well-equipped ambulances donated by Johanniter International Assistant-Germany and Lanka’s St. John’s Ambulance. Thirty Emergency Rescue Technicians (ERTs) extensively trained firstly by the National Hospital in Colombo and later by several foreign groups are on alert at the main fire station in Maradana and the sub-stations at Fort, Grandpass and Kotahena.

Plans are underway by Fire Chief J. Kannangara to set up a fire station and training centre at Wellawatte, says Mr. Wijesuriya.
On January 31, this year, R.M. Asanka Weerakkody, 24, headed a team that answered a call from the Fort Railway Station. An elderly woman had fallen off the train and was in severe pain.

Arriving in an ambulance stocked with essential and standard equipment for pre-hospital emergency rescue and transportation including oxygen, bandages, cervical collars, backboards and splints, Asanka and his team quickly strap a vacuum splint on her arm and take her to hospital.

Explaining the colour-coded tags they put around the wrists of accident victims, Asanka says red would indicate that the patient is seriously injured and needs immediate attention as well as immediate transfer to a hospital, yellow that though he/she is injured, the patient can respond to questions but cannot walk and green that they can respond as well as walk to the vehicle to be taken to hospital. Black, sadly, would indicate death.

The leading cause of death worldwide for men, women and children in the age-range five to 44 years is from trauma and up to an estimated 30% of trauma deaths could be prevented with adequate pre-hospital care. The severity of long-term disability could also be dramatically reduced by simply arresting bleeding, splinting fractures, securing the cervical spine, and preventing hypoxia (reduced amounts of oxygen reaching body tissues) by maintaining an open airway. Pre-hospital management of emergencies is the important starting point in the ‘Chain of Survival’, The Sunday Times understands.

In Sri Lanka, trauma is the number one cause of hospital admission and the 9th-10th cause of death, it is learnt.

Usually what happens in Sri Lanka is that as soon as an accident takes place, well-meaning helpers gather round, pull out the victims in whatever way they can, double them up and pack them into the nearest trishaw and send them to hospital. This could often cause secondary injury, in addition to the primary injury, an example being a leg fracture which should be splinted before the patient is moved. If such basic measures are not taken irreparable damage could be caused to nerves and blood vessels.

“Hopefully, this would change now. At least it is gradually happening in Colombo,” says Dr. Pradeep Kariyawasam Chief Medical Officer of the Colombo Municipal Council under which comes the Fire Brigade.

Dr. Kariyawasam along with National Hospital Director Dr. Hector Weerasinghe, Accident Service Director Dr. Anil Jasinghe and Consultant Anaesthetist Dr. Shirani Hapuarachchi, with the support of a host of others both locally and abroad, masterminded the plan for pre-hospital management of emergencies in Colombo.

Emergency Medical Services or pre-hospital care is an acute social need with rapid urbanization, says Dr. Jasinghe.

The foreign groups that have supported this initiative are SweRoad, a Swedish organization, Johanniter International Assistant-Germany, a British group and Medical Teams International of America, according to Dr. Kariyawasam.

Sri Lanka with its commendable state hospital services all over the country needs a pre-hospital care programme to give victims of trauma a chance of survival, like in countries such as Singapore, the Philippines and even the state of Hyderabad in India.

Tragic and searing images of the recent beer truck-bus collision at Induruwa where 23 people burned to death in front of helpless onlookers come to the fore, signalling the urgent necessity for the model in Colombo city to be replicated all over the country.