Commentary—

Loosing Your Shirt In Kuala Lumpur

By Jimmy Crouch

People are sitting in the sidewalk café. It’s a laid back Sunday morning, a peaceful setting soon to be broken. I walk past the mango tree next to the café. Suddenly, the sound of a car approaching at high speed breaks into the air.

Something is wrong. How could such a fast-moving vehicle be coming up such a narrow and hilly street? Even before I have a chance to turn around to see the car approaching I expect to hear a crash.

I gaze upon the car screaming past, heading straight toward the sidewalk café. Mercifully, a car parked just before the café provides a buffer. The approaching car ricochets off it and flips over the mango tree.

Blood is dripping from the driver as he climbs out of his vehicle. I quickly survey the scene. Amazingly, no one has been hit.

I coax the driver to sit down. A huge crowd gathers. One of the bystanders offers to give the patient a ride to the hospital but I indicate that it is better to wait for the ambulance.

My focus is on controlling the severe bleeding from a head wound. I want to apply direct pressure without causing further injury. Also, I want to use a T-shirt to establish a barrier between my ungloved hand and the wound.

I motion to the crowd that I’m interested for someone to donate their shirt. You may wonder why I simply didn’t pull off mine? Well, it’s not that I didn’t want to lose my shirt. The problem is that I don’t want to bare my white skin in front of a crowd of Asian bystanders who all have perfectly tanned skin. But, no problem, I will donate my shirt if no one else does. I have no volunteers.

Okay, I will try one more time. “Who will give me their shirt?” I yell out. Finally a young Asian man pulls off his and gives it to me.

I provide direct pressure, obtain some vitals, pertinent information and have a bystander survey the vehicle for me. There is significant mechanism of injury and the patient presents symptoms of intoxication. The intoxication is of concern since intoxication can mask the patient’s awareness of injury.

What would only be a few minutes wait for first response of emergency medical service (EMS) care in a place like Newtown, where I grew up, turns out to be much longer in a place like Kuala Lumpur. Far longer than within the 8.59 minutes standard followed by most American cities. My faith in Kuala Lumpur’s EMS system begins to falter. I worry that this patient might not make it to the operating room in time if there is a need to stop internal bleeding.

Maybe the patient would have been better off taking that ride. The man could get to the hospital quickly and, as such, maybe I shouldn’t be worrying about spinal precautions.

My faith in the system and thoughts of an immobilization strategy return once I see an ambulance pulling up. I go back to the standard thinking that through EMS we seek to prevent further injury, and besides, I was able to stop that bleeding head wound. If I hadn’t been here, this patient might have bled to death.

My faith was short-lived. The standard of patient care from the ambulance crew left much to be desired. They simply put the patient on the ambulance cot, without any assessments or immobilizations, and rushed him off to the hospital.

Under most North American prehospital care protocols this man would have been immobilized, but that was not going to happen today.

Dare we ask how many people have unnecessarily bled to death before even reaching an Asian hospital? Or, how many people have suffered further injury from improper prehospital care?

We can view well-planned, beautiful, and modern cities rising up throughout Asia. Yet, EMS remains on the back burner, lagging far behind in standards of developed countries.

At least Thailand is making inroads. They have first responders to motor vehicle accidents and are striving to develop a better system that includes a good emergency communications network.

Since 1966 Malaysia has been able to reduce road accident fatality rates significantly. But Malaysia and the rest of the developing world still have a long way to go. The United Nations United Nations Economic and Social Commission for Asia Pacific (UNESCAP) has declared the situation “a global crisis.”

A key is improving EMS and its emergency communications systems.

Right now, reduction in severity of injury of postcrash victims is hindered due to delays in detection of a crash and delayed life-saving or poor emergency care from bystanders and EMTs.

The lack of having a single emergency telephone number (for example, 911 in the USA) contributes to the delay. And emergency responders often face problems when needing to communicate with other agencies, as communications systems are often inoperable between agencies.

Also, there are areas in Asia that are not even covered by EMS, such as most of Laos.

The world community can work to improve emergency medical response capabilities in Asia. Elements of action include offering professional training for emergency workers and equipment donations.

Readers can donate used EMT books, EMS and emergency communications trade magazines, to give to hospital directors and other Asian emergency professionals, so they can understand international standards. You can send donated publications to: Life Club Project EMS Response, EF English First, Jl. Sultan Agung Tirtayasa No. 49, Ruko Bonakarta Blok C 16, Cilegon, 42414 Indonesia.

 

(Jimmy Crouch is an instructor at EF English First, Ciligon, Indonesia. He is a former director of Newtown’s 911 emergency center and EMT with teams in Laos and Thailand. He can be reached via email at jimmy_crouch@hotmail.com.)