Guyana EMS system helping to reduce maternal and neonatal mortality

Oct 07, 2018 News

---

“EMTs, they are trained how to do CPR, how to manage patients in a pre-hospital setting with trauma related illnesses, medical related emergencies and in cases where there are maternal and paediatric emergencies…they are prepared to do all of this as part of their training.”

 

By Sharmain Grainger

With sirens blaring, you might recall one or two ambulances passing you by in a given day. Usually these vehicles are someone’s only hope of reaching to a hospital fast enough so that they can access needful medical care.
However, with the advent of the Emergency Medical Services [EMS] system in 2016, persons are able to benefit from the added service of Emergency Medical Technicians [EMTs] along the way.
This therefore means that patients are not merely transported but stabilized as far as possible as they head to hospital aboard an ambulance.
The EMS system is not a regular ambulance service but rather one which is routed through the Guyana Fire Service [GFS]. Through the strategic collaboration of the Ministry of Public Health and the Fire Service which falls under the Ministry of Public Security, the EMS system was introduced with Dr. Zulfikar Bux as its National Director.
By virtue of its link to the Fire Service, persons are able to access EMS simply by dialing 912, the same number used to report a fire.
The service is currently only available in Georgetown but has been gaining traction, evident by the more than 7,500 responses to medical emergencies thus far.
It certainly was a handy option for Police Constable Delone Paul when his wife, Aleema, who is also a Police Constable, went into labour in the wee hours of August 24, last. Panicked by the sudden onset of his wife’s delivery, Paul said that he was advised by his mother-in-law to dial 912 for emergency assistance.

“I didn’t know whether to call the ambulance service or a taxi but I decided to call 912 and in like 10 minutes or so they were here,” said Paul making reference to his home at Lot 91 East La Penitence, Georgetown.
Although Paul and his wife, both 23 years old, are parents to three-year-old Anthony, they were both worried and clueless when the early signs of labour started manifesting. “When I was getting my son [Anthony], I went to the hospital and everything happened at the hospital, so when my water bag burst I didn’t even know what was going on. I went to the toilet and I felt like I wanted to defecate but instead water keep pouring out of me and this pain started; I wasn’t even able to breathe properly,” recalled Aleema.
It was this development that caused the woman to summon her husband as well as her mother. The woman’s father was also in tow and was on hand to assist EMTs who responded to take her out to the ambulance when it arrived.
“I couldn’t tell the time but I knew they reached real fast, I think faster than I have ever seen a taxi reach to our house, and we had to give them directions,” Aleema mused. Upon entry into the ambulance she recalled being given oxygen and was examined by two male EMTs. However, about two minutes into the journey, Aleema recalled indicating to the EMTs that her baby was ready to come.
“At first they told me not to push because they wanted me to wait until I reached the hospital but I told them ‘no; baby coming now’,” she recounted. This of course saw the EMTs calling on the driver to pull over as they prepped for a delivery. About four or five pushes later, baby Priyanka was crying her way into the world.
Although it was an all-male and relatively young crew giving attendance to his wife, Paul said that it didn’t take long for him to place his full confidence in them.

“The way one of the guys started speaking and explaining everything they were doing to me, I knew right away they knew what they were about,” said a smiling Paul as he reflected on how his daughter entered in to the world aboard the ambulance.
“The guys [the EMTs] they were happier than me…You could see the joy in their faces when baby came out safely,” said a beaming Aleema as she cradled her month and a half old baby during an interview.
“They talked with me all the way to the hospital after baby came and when I got there they made sure I was safe and everything before they left,” said Aleema as she recalled the patience and professionalism exhibited by the EMTs. In fact she recalled that the EMTs even checked on her a few times after she brought home her bundle of joy.
FIRST DELIVERY
And it is no surprise that they were eager to see the development of little Priyanka as she is the EMTs first delivery in their two years of being a part of the EMS system. Twenty-eight-year-old EMT, Theon Bourne, recalled that he and his colleague, 22-year-old EMT, Cleveland King, were on duty at the Central Fire Station, Stabroek, Georgetown, when a call came through that a female patient was in pain. The EMTs were dispatched at 12:45 am but at the time were not aware of the nature of the patient’s condition. They nevertheless hurriedly left to render needed assistance.

The directions they were given saw them arriving at a range-house in East La Penitence at 12:52 am.
Bourne who was tasked with documenting the case first headed into the residence where he saw a pregnant woman, surrounded by a few individuals, crying out in pain. “The first thing I asked them is if the water bag had broken and I was informed this happened about five minutes ago,” Bourne related.
After consulting with each other, the EMTs thought it best to have the woman quickly placed in the ambulance since they anticipated that she could shortly deliver her baby.
“We did our assessment and even though we saw spots of blood we didn’t see the crowning of the baby so we said lets transport,” Bourne related.
But according to King, it was only about two minutes into the journey that the patient was crying “baby is coming, baby is coming!”
“My adrenaline was already pumping and I looked at my colleague and I said ‘Hey we doing this delivery’,” recalled King.
Indeed, they were ready for this or just about any medical emergency when they left the Fire Station base. This is in light of the fact, King explained, that the ambulance on each journey to an emergency is outfitted with, among other things, an Obstetric kit.
“Once we knew what we were dealing with I cut open the kit put on the sterile gloves and before I knew it, there was baby crowning,” King recounted. The documented time of delivery was 1:07 am and both EMTs admitted to being overwhelmed with mixed emotions when the baby first appeared.
“When the father said thank you and the mother said thank you guys so much, that really had my emotions going,” confided King.
Recalling how it all went down, Bourne noted that he and his colleague became aware that the delivery was upon them when the patient informed them that she wanted to defecate.
“When we were in training we were told that once a woman is in labour, she would normally mention that she wants to pass stool. So when we heard that I got nervous, he [King] got nervous but we knew exactly what we had to do,” related Bourne.
“The husband was right there and we explained to him what we had to do before we did it and I think he was impressed with that,” said Bourne. “We did what we were taught to do, and we did it professionally.”
By 1:20 am the ambulance was blazing into the compound of the Georgetown Public Hospital Corporation where both mother and baby were handed over to nurses for further care.
NOT PORTERS
Although the responses now number in the thousands, many people are still learning about the EMS system. According to Bourne, having been a part of the system for the past two years he has seen far too many people deduce that EMTs are just porters.
“In many cases people don’t expect us to be able to assess the patient’s condition before we transport them but that is what we were trained to do. Many people are surprise when they see what we are doing as EMTs,” Bourne noted.
It was just a few nights ago that Bourne was on duty again when a call came through for medical assistance. On this occasion the emergency was yet another maternal one where the baby had already emerged when the ambulance arrived.
EMS records show that EMTs responded to at least six delivery cases in the past few years and this has in fact been lending support to the Ministry of Public Health’s agenda to reduce the maternal and neonatal mortality rate.
The most recent was two Fridays ago when 20-year-old EMT, Troy Forde, and 22-year-old EMT, Marcellina Guendelin, were on duty. On this occasion the caller informed that a woman was in labour and needed urgent medical assistance.
Forde related that when the ambulance arrived at the address given he observed a pregnant woman advancing. “She walked to the ambulance and we helped her in and we were surprised when we assessed her and found that her contractions were already one minute apart,” recalled Forde. It was mere minutes away from the hospital that the patient indicated that she wanted to push which saw the EMTs preparing for the inevitable.
“The water bag burst right at that moment and within 30 seconds the baby was out,” recalled Forde as he related the learnt procedure for managing such a case.
“We were very prepared, and we acted very fast. Our communication was very good which is something we were taught to do,” said Guendelin as she recalled seeing the baby girl emerge. “She was the sweetest little thing I have ever seen. Doing this job really teaches you a lot and helps you to really appreciate the role that we have as EMTs. It isn’t only about delivering babies, but we actually help to save lives. Sometimes we go out and we don’t know what to expect but we are always prepared to deal with what we are faced with,” she added.
MEANINGFUL CAREER
Although the EMTs all come from various backgrounds and villages including: Diamond, East Bank Demerara [Forde], Unity, Mahaica [Bourne], West Ruimveldt, Georgetown [King]; and Uitvlugt, West Coast Demerara [Guendelin], they all agree that the introduction of the EMS system gave them an opportunity to have a meaningful career.
Prior to their training and eventual employment, the group of four EMTs said that they were all struggling to find jobs.
“I think today we are all the embodiment of commitment and discernment having received our training. We are not still here just because we all wanted a job but because we love what we do…we want to see people be saved and recover from whatever emergency situation they may find themselves in,” said Bourne.
But according to the EMTs, the most demanding of all the cases that they have dealt with are those involving children or patients with excessive bleeding.
However, they admitted that one of the biggest challenges in carrying out their duty is distraction from members of the public. “I have gotten many reports from some of our EMTs that when they turn up at a location sometimes they are crowded and harassed by members of the public as they perform their duties.
“Some of them take out their camera phones and start videoing and threaten to circulate videos of them to the media if they mess up,” said EMS Director, Dr. Bux. He however, added, “What we would like the public to know is that these EMTs have been trained to do what they do. We need the public to stop putting pressure on them in a situation that could already be stressful; our EMTs know what they are doing because they were properly trained.”
According to Dr. Bux, while there are various levels at which EMTs can be trained, they are all generally qualified as paramedics. These level of health workers, he explained, are subjected to a rigorous 10-week training programme on the basic concept of being a medical first responder. “EMTs, they are trained how to do CPR, how to manage patients in a pre-hospital setting with trauma related illnesses, medical related emergencies and in cases where there are maternal and paediatric emergencies…They are prepared to do all of this as part of their training,” related Dr. Bux.
This, however, does not make EMTs the experts but rather capable enough to render medical assistance until the patient arrives at the hospital. According to Dr. Bux, “They have the basic emergency concept to stabilize patients and bring them to the hospital for more advanced and specialized care.”
The EMS Director noted, too, that while the programme has been yielding the desired results, whereby more people are being able to access medical services in a timely fashion, there are times that the system is overwhelmed by the limited resources.
Currently the EMS system servicing the capital city utilizes a mere three ambulances but Dr. Bux is optimistic that more resources will become available to not only improve the service in Georgetown but to expand to other regions.

---

---