Tuesday, October 11, 2005

A Cause for Heartache

For the First-Aid component in the standard First-Aid and Nursing Competition of the St Johns Ambulance Malaysia (SJAM), a squad is made out of 4 persons, numbered 1 - 4 (and a reserve, Number 5). Upon reaching a scene of accident, Number 1 (the leader) will look out for possible hazards, and if determined none, will command her squad members (Numbers 2, 3 and 4) to approach the victim (posed by Number 5, during training sessions). After Number 1 identified herself to the victim, she will proceed to diagnose injuries, while Numbers 2 and 3 control bleeding on any visible open wounds, and clear obstacles which may be scattered around the victim. Number 4 would meanwhile, control traffic (if we're talking about road accidents) and also control the advancing crowd of bystanders (we'll usually get a lot of ke-pohs). Once diagnosis is complete and first-aid (bandaging, treatment for shock etc) given, Number 4 will call for the ambulance, giving specific details about the location, the victim and injuries sustained. In training, the "ambulance" never arrives later than 10 or 15 minutes after Number 4 makes the call, during which Number 2 will constantly reassure the victim, Number 3 keeping a close eye on blood circulation and such stuff, Number 4 keeping back crowds and traffic, and Number 1 supervising and assisting in all. If the squad does not have enough of bandages or equipment for treatment, they can entreat the crowd to part with personal clothing items such as jackets, scarves, neckties etc. for improvision, and the crowds would be most willing to comply. And if the victim's breathing and pulse stopped, CPR is administered continuously until either the victim is revived, or the ambulance arrives. Once ambulance arrives, trained, certified parademics will take over, and the victim is in safe hands. And that, is the ideal situation - the wishful thinking of all of us.

The real thing? Let me run through the entire first-aid-giving scenario again, putting in the practical elements. First, Number 1 and her squad members approach the victim, and Number 4 tries her best to control the traffic - however, given the Malaysian drivers' love for speeding and lack of concentration on the road (not to mention the over-confidence in excellent driving skills which they don't actually possess), probably a car (or worse, a bus or truck) would come head-on and ram into the whole squad, killing all 4 first-aiders and also the victim on the spot. End of story (errr... so fast?)

OK, assuming that doesn't happen. First-aid is given - and the squad needs something to control massive bleeding from a large, open wound. They were short of gauzes and bandages - so Numbers 3 and 4 would desperately beg the onlookers to give their scarves or neckties or handkerchiefs to save the victim - and of course, in our real-world, no one would give. Anyway still, assuming the victim does not die from a loss of blood, Number 4 would then ask a bystander to allow her to call the ambulance using his mobile phone. Assuming the bystander would comply (since emergency numbers don't cost), she would dial, and probably try a few more times before she got through. And then, her call would probably be transferred, or redirected, or put on hold; or she would be asked to call other numbers from a list which she would be given. Anyhow, after a lot, a lot of effort, she would get through to a hospital which is willing to send an ambulance. Then, the first-aid squad will continue to preserve the casualty's life, while waiting for the ambulance to arrive. They'll have to work extra hard, because the ambulance most probably will not arrive until 30-40 minutes later, minimum! So, if the casualty's breathing and pulse stopped, poor Numbers 1 and 2 would have to continuously perform CPR for more than half an hour, which by the end, would probably have Numbers 1 and 2 fainting themselves! Of course, Numbers 1 and 2 can take turns with 3 and 4 on the CPR thingy (which by the way, first-aiders must not stop performing simply because the victim does not revive - we are not doctors that can "declare someone dead"), but trust me, it's not as easily done as said. Anyway, say - finally the ambulance arrives. Those who come with it, are not paramedics, but half-pail-of-water hospital attendants who know no head or tail on how to handle an injured person. Chances are, the poor victim, so carefully supported by splints and bandages by the first-aiders, will be very roughly hauled up, and dumped into the back of the ambulance. Then, the attendants will do nothing but talk and joke on the way to the hospital, while the driver, feeling important that he is in an emergency situation, will drive like a mad man - going at top speed, sirens wailing, swerving to the right and left to weave through traffic, running red lights, flying over speed bumps... you name it. Our last concern, is whether the injured person can reach the hospital in ONE(1) piece. Horrible as it may sound - this is the reality of where we live.

SJAM works very hard to train its members to handle emergencies and to extend proper and professional first-aid. That is very noble - but what happens on the arrival of the ambulance (assuming it'll eventually turn up, if you've waited long enough) and the duty of preserving life and promoting recovery is passed on from the first-aiders to the ambulance staff who couldn't care less? Could there have been victims who could have survived, but didn't, due to the lack of concern, and the tidak-apa attitude of emergency services? If there are, how many? Very disturbing? Indeed.

Ahhhem! - Disclaimer - I am NOT referring to any particular anything. This post is not a personal attack on any parties *wink*

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