When There are No Ambulances

SRI LANKA - Donnie Woodyard is Medical Teams International’s EMS manager in Sri Lanka. He recently sat down with staff writer Tracey Goldner to talk about how this program began in Sri Lanka, why it is needed—and what makes it sustainable.

Q: Why does Medical Teams International have an Emergency Medical Services (EMS) program in Sri Lanka?

 
An EMS student practices advanced airway manuever as Donnie Woodyard (left) looks on. (Photo courtesy of Donnie Woodyard)

A: Traditionally, successful EMS programs need a kick-start, a reason and motivating experience for their development. In the U.S., it was the Vietnam War. In Andhra Pradesh, India, it was a car accident that killed the son of a prominent businessman. These catastrophes forced people to think about the importance of immediate care following a trauma. In Sri Lanka, it was the tsunami that paved the way for an emergency medical system.

Q: What is Medical Teams International's vision for the EMS program in Sri Lanka?

A: We want this generation and all future generations to be able to call for an ambulance, receive professional care from trained EMTs on the way to the hospital and be fully rehabilitated.

I hope this generation will be that last one that remembers fending for themselves following an injury—where it is their responsibility to get themselves to the hospital.

Q: How has the Sri Lanka government supported the creation of a national EMS system?

James Moore, Deputy Chief of Mission, U.S. Embassy, speaks at the Trauma Secretariat's first national conference. The event was held in Feb. 2008 in Colombo, Sri Lanka. (Photo courtesy of Donnie Woodyard)

A: The government has supported and collaborated with us since 2006. Many agencies are working together to create a national EMS system because of the government's coordination and support. Last year, the Sri Lanka government formed the Trauma Secretariat, a new division of the Ministry of Health, dedicated to reducing death and injury from trauma.

Q: How are the people involved?

A: Sri Lankans are used to disaster, both natural and man-made. They know what disaster looks like and they want to know how to help. Almost every person I have taught can put a face to the various emergency situations we discuss in class.

One student recently told me, “I had a patient two weeks ago and this class showed me why he died. I think I could have saved him.”

We have more than 2,000 people on the waiting list for our training right now. We’ve received requests from unions and associations, including the Sri Lankan Association of ambulance drivers who represent thousands of members.

Our training is the hot commodity. People have said to me, “Your training is the standard and we want to be there.” It is the sign of a fundamental paradigm shift for the country. It has been a thrill and an absolute joy to be involved.

Q: What was the first step for the program?

Medical Teams International has developed educational coloring books to help children learn how to access help via the telephone.

A: EMT (Emergency Medical Technician) training was the most important task. We needed to have people who could respond to a call for help before we could do anything else. So far, we have trained 500 certified EMTs.

But a national EMS system involves much more than just providing EMT training. We can’t just go in and train people and then leave. That philosophy is not sustainable. An effective system includes a national educational campaign to inform the public about this new service, ambulance guidelines, laws and legislation, advocacy, national emergency phone hotlines and medical direction. Read our Sri Lanka field reports to learn more about the people we're helping.

Q: Tell me more about how we are building a system that Sri Lankans can call their own—one that is self-sustaining.

Certified EMT patch developed for Sri Lanka's new EMS program

A: We have taken several different steps to make this project locally-owned and sustainable.

The most important is that it is government-supported.

We have found corporate sponsorship that we can count on for years to come. Eagle Insurance, one of the largest companies in Sri Lanka, has adopted the EMS project and supports it by creating national public education campaigns. They see the long-term impact of the program and want to help it succeed.

We use local people and materials whenever we can. It is not sustainable in the long-run to ship in backboards from overseas. It is expensive and does not help the local economy. So we have developed backboards made in Sri Lanka with local materials. We’ve done the same with EMT bags. They are affordable and manufactured in Sri Lanka by Sri Lankans.

We’ve written EMS training manuals in Tamil and Singhalese, the languages spoken in Sri Lanka. The textbooks meet the international best practices for EMS and the World Health Organizations Pre-Hospital Care guidelines. But they are also culturally relevant to Sri Lankans. For example, when the book discusses snake bites, the information relates to Cobras and Kraits, snakes commonly found in Sri Lanka.

In January, we released a DVD companion for the textbook. The disc includes 40 of the most critical EMS skills, features Sri Lankan EMTs actors and can switch from English to Singhalese to Tamil at the touch of a button.
Q: How long do you expect Medical Teams International to be involved?

A: Our ultimate goal is to see Sri Lanka with a sustainable, functional, quality EMS system. It is hard to estimate the time in years, but I can tell you that we are currently working on a 10-year strategic plan, and EMS will be a major focus of our work for the next decade.

Q: How has life been for you personally, as an American in Sri Lanka?

A: I like Sri Lanka. It is hard; mentally, physically and emotionally. But the work is important and I’m confident that I am in the right place. I made the decision to come here with a lot of faith and prayer. We are working to change the expectations of 20 million people. That’s a massive undertaking. Our work is creating a strong foundation that will enable Sri Lanka to establish a quality EMS system.

Author: Tracey Goldner

Emergencey Medical Services South Asia