Transportation of traffic accident victims by taxis in Ho Chi Minh city

Dr David TRAN

Afravietmur

Trung Vuong Emergency Conference

November 10th 2011

Particular context of HCM

Megalopolis with about 10 millions inhabitants

About 5 millions of motorbikes and a growing

number of cars.

Un-adapted road corridors with trunks crossing the

center city

A lack of traffic control with a lot of traffic jams

Regular traffic rule violations (red lights, priority,

one way traffic etc…)

Problem of traffic jam in HCM city

A lot of motorbikes More and more cars

Traffic Accidents in Vietnam & HCM city

Traffic accident are the first cause of trauma in Vietnam

(11.499 people were killed in 2010 = 30/day)

Motorbike are involved in more than ½ of non-fatal

accidents (734/100.000 inhabitants)

From september, traffic police punished more than 88,200

people for traffic rules violations

In HCM, about 100 serious accidents/month are officially

registered (probably much more)

In HCM, 788 deaths due to traffic accidents in 2010 (more

than 2 deaths/day)

Organization of 115 system

Trung Vuong Emergency Hospital (tel 115)

24h/24 call center

A fleet of about 10 ambulances (but only 4

ambulances can operate in the same time)

About 16 calls/ day (6000 per year)

Trung Vuong Emergency Ambulances

115 HCM call center

A nurse from 115 alarm center waiting for a call

Knowledge of prehospital service 115 by HCM inhabitants

16% are aware of pre-hospital emergency service in HCM

32% are aware that 115 is the emergency response number

46% of people will transport relatives by themselves and 67% think it will be faster (than ambulance service)

The main complain is the waiting time before the arrival of the ambulance

Number of ambulances in HCM

About 60 ambulances available in HCM (?)

4 to 6 medicalized ambulance in Trung Vuong

Emergency Hospital

1 ambulance for 140.000 inhabitants (?)

1 medicalized ambulance (SMUR) for more than

1.000.000 inhabitants

Transport of victims by taxis or private cars

In 2009, a survey about pre-hospital cardiac arrest

arrived in FVHospital showed that only 17%

arrived by ambulances

83% arrived at the back of a car (most of them at

the back of a taxi)

The average of time to send the patient to the

hospital was 35 minutes

Taxi’s company in HCM

Ex. ML taxis: 2000 cars in the city (5000 drivers)

The fleet is well distributed in all districts

Time of intervention on site very short

Possibility to communicate by radio

Problems of transportation of victims by non professionals

Risk of aggravation of lesions during installation in the

taxi or on the way to the hospital (ex: spine injuries,

obstruction of airways, inhalation etc.)

Cannot be applicable for cardiac arrest…

Responsibility in case of problem on the way to the

hospital

Problem of money: who will pay the transportation?

How to solve those problems?

1. Train the taxi drivers in first-aid (short training program)

2. Equip each taxi with minimum equipment (first aid kit)

Train the taxi drivers in first aid

How to protect a victim How to take care of a wound / a fracture / stop

an hemorrhage How to put a splint, a neck collar How to carry a victim into the back of a taxi How to open the airway of a victim and insure

efficient respiration. How to put a victim in recovery position waiting

for help.

Minimum equipment required

Compresses, bandages

Splint (forearm & leg)

Neck collar

Oral canula

Disposable gloves

Problems: organization & cost-effective

Who will organize training courses ? (Hospitals, NGO,

Training centers ?)

Who will pay the expenses for training & materiel ?

Who will replace the materiel after use?

How to train so many taxi-drivers (ML taxi: 5000 drivers)

Necessity to organize refresh courses every year,

every 2 years?

Advantage of this solution

Based on an existing organization (Taxi’s

network) ➔ Could be effective quickly (< 1 year)

Represents an original solution waiting for an

efficient professional system of pre-hospital

cares (SMUR, Paramedics etc.)

Cost effective solution (training, basic equipment)

Could avoid a lot of complications and maybe a

few deaths.

Other aspects of the problem

Education of population (115, first aid)

Improve the pre-hospital system with

generalization of ambulance services with a

central decision center (intervention in less than

20 min. all over HCM)

Improve the capacity of 115 call center to be

able to give a quick and adapted answer

Vietnam has to invent original solutions to improve road safety

Even if this “taxi-ambulance” solution seems to be interesting, it is not the ideal solution…

Thank you for your attention