Inadequate budget for ambulance services and no follow-up on patients referred are some of the issues in transportation and evacuation of the patient referrals.

This was discussed during the second day of the 4th Biennial health conference at the Convention Centre in Thimphu yesterday.

Chief programme officer with the Department of Medical Services’ emergency medical services division, Jamtsho, said accessibility to ambulance services has increased with access to road over the years. He said that there were also few incidences of ambulance accidents in the country.

Health Secretary Dr Ugen Dophu urged the district health officers to control ambulance drivers. “Many investigations revealed that most of the ambulance accidents are caused by alcohol and speeding.”

Jamtsho proposed screening of ambulance drivers for controlled substance and alcohol use. He said if a driver is found to be using controlled substances, the ministry wouldn’t send them out of the service right away but provide them support with rehabilitation treatment. “The safety of the driver should also be ensured besides the patients and escorts.”

He also proposed that more funds should be provided for fuel and maintenance of old ambulances and logbook update. An ambulance of model 2014 gets Nu 0.24M (million) every year for maintenance and fuel while ambulance of model 2015 and 2016 get Nu 0.194 and Nu 0.191 respectively.

Adherence to ambulance guidelines for ambulance drivers and patient referral guideline was also suggested.

Bumthang’s district health officer, Kinga Gyeltshen, said patients from his dzongkhag have to be referred to Thimphu or Mongar and because of the bad road condition, ambulances have to be maintained frequently.

“There is a problem when it comes to maintenance of ambulance as the vehicle is a Japan brand and it’s difficult to get the spare parts,” Kinga Gyeltshen said. “Even if we get the spare parts, we don’t have any automobile workshop in the district to repair the ambulance.”

Another health official said the annual budget for maintenance and fuel is not sufficient. There are 118 ambulances in the country.

Jamtsho said a proper justification has to be put up to the finance ministry to increase the annual maintenance cost of the ambulances provided to the dzongkhags. “So far we haven’t received any justification, but only complaints.”

Dr Ugen Dophu said he will explore the possibility of establishing Toyota ambulance repair workshop through STCBL in some of the regions so that the ambulances don’t have to be driven all the way to Thimphu or Phuentsholing for repair.

A health official from Trongsa said that in a recent incidence of patient airlifting in his dzongkhag, the helicopter crew said a patient attendant is not allowed to fly with the patient. “Without a patient attendant, it is difficult for the patient, especially when the patient doesn’t have any relatives in the receiving destination.”

Dr Ugen Dophu acknowledged the difficulty that patients face in absence of an attendant and said DMS could talk with the Bhutan Emergency Aeromedical Retrieval Team (BEAR) and see what could be done.

Jamtsho said an international standard is being followed for air evacuation. “We will see what can be done.”

Dr Ugen Dophu said when people ask for helicopter service, the official concerned at the national referral hospital in Thimphu and the dzongkhag from where the patient is asking for the service should be cautious.

“Sometimes patient deserving helicopter service is not getting the service, “Dr Ugen Dophu said. “If you don’t provide helicopter service to the deserving patient and the patient dies then all of us will be in problem.”

Dr Ugen Dophu urged the official concerned to use clinical judgement to provide helicopter services. “When another judgment is used then we end up making wrong decisions. Don’t let decisions go wrong as it is a matter of life.”

Jamtsho said for every referral patient the government couldn’t afford the helicopter services so a good condition of ambulance is important for patient safety and referrals.

A total of 3,268 patients were referred by vehicle ambulance from January until August this year.

Some 84 patients were airlifted to date this year. Of the 213 patients airlifted since November 2015, 55 patients expired.

Jamtsho said the health officers in districts should report any health-related emergencies or disasters to the Health Emergency Operating Center (HEOC) as per the reporting template of Health Emergency and Disaster Contingency Plan of the health ministry while reporting to the Royal Centre for Disease Control.

Besides developing or updating all hazards approach health emergency and disaster contingency plans, Jamtsho said that the district health sector should carry out at least two mock-drills and simulation exercises a year for preparedness, responses and recoveries during and after health emergencies.

Dechen Tshomo