|Professor Nguyễn Gia Bình treats an emergency case at Bạch Mai Hospital. Photo viettimes.vn|
Professor Nguyễn Gia Bình, chairman of Vietnam National Association of Emergency, Intensive Care Medicine and Clinical Toxicology and former head of Intensive Care Unit of Bạch Mai Hospital, talks to Viettimes News and Analysis about the importance of pre-hospital emergency care.
Most countries have put pre-hospital emergency care into law and first aid has become common public knowledge. For the first time, pre-hospital emergency care has been mentioned in Việt Nam’s draft amended law on medical examination and treatment to be submitted to the National Assembly for approval at the general assembly this month. How important is pre-hospital emergency care to patients?
Out-of-hospital emergency care is very important. No matter how well we have prepared, unwanted incidents can happen anytime such as car accidents, floods, or unusual illnesses, snake bites, bee stings, electric shocks or lightning strikes. Even though the elderly are fully examined and take regular medicine, they might still face medical incidents on the way or at home.
Many countries pay attention to pre-hospital emergency care. Out-of-hospital emergency knowledge has become life skills of the community. Since high school, everyone has learned first aid in life-threatening situations, with simple operations not requiring high skills or complicated machines to respond to cases such as drowning or food choking.
In cases of sudden cardiac arrest, as long as the person next to you knows how to properly compress the heart, even without any machines, they can help patients overcome the most difficult times. Then medical workers or volunteers will come to help and transport patients to the hospital.
Việt Nam reports tens of thousands of deaths from traffic accidents every year. If pre-hospital emergency care is given the fatality rate will decrease, leading to less damage in terms of socio-economy and psychology.
Who will be responsible for pre-hospital emergency care?
If an accident happens on a highway, the driver is the first person. The second are staff who ensure traffic safety in the area, rescue workers and local healthcare workers.
If pre-hospital emergency care is legalised and those people are trained with first aid skills, more lives will be saved.
Could you elaborate on the meaning of onsite first aid?
About 50 per cent of out-of-hospital cardiac arrest cases are related to arrhythmia and cardiac arrest. In those cases, it is impossible to call for a helicopter or a doctor to arrive in time.
Because within 10 seconds of no blood supply to the brain, the brain will be deprived of oxygen and substances, leading to the patient passing out.
After only one minute, the brain starts to suffer the pain and the longer it takes, the harder the brain damage is able to recover, especially after the third minute onwards.
Therefore, in order to help the patient recover quickly, it is necessary to give first aid as soon as possible within the first three minutes, even within the first minute.
A typical example of effective first aid is the sudden collapse of Danish football player Christian Eriksen at a Euro 2020 match. Captain Simon Kjaer immediately ran over, turned Eriksen on his side and pulled his tongue. To open the airway, then, he did cardiac compression and electroshock defibrillation within 20 seconds. When the patient woke up, his heart beat again then he was taken to the hospital. It was because of the timely and proper intervention of Simon Kjaer that Eriksen was saved. This is an experience we can learn from.
So far we have not had such out-of-hospital emergency care because most of us think it is the work of medical staff. In fact, it is very practical for each person and helping others is also helping themselves.
When one person can provide the first aid, more will know. If the whole society can do it, the number of people receiving first aid on the spot will be higher. The efficiency of the work will be higher, and more people can be saved at a very low cost.
How is the pre-hospital emergency care system in Việt Nam now?
Pre-hospital emergency care plays an important role at big cities with regular traffic jams like Hà Nội and HCM City.
Among 63 provinces and cities, only 11 localities have emergency systems. However, in these 11 provinces and cities, the number of medical staff, ambulances and equipment is still limited.
Our emergency system lacks quantity. It does not have an organisational and administrational connection so the effectiveness of pre-hospital first aid is not high.
As a leading expert in emergency resuscitation who first wanted to legalise out-of-hospital emergency 25 years ago, can you share your opinion now that out-of-hospital emergency has been drafted in the amended law on medical examination and treatment?
I am pleased about that. I hope that after the amended law is enacted, we will continue to issue decrees and circulars on first aid training guidelines, then we will soon have an out-of-hospital emergency system. That will make community health activities more effective at a very low cost.
Could you give details on the out-of-hospital emergency model in other countries?
The world has two models of out-of-hospital emergency care.
The first is European model with modern equipment, high-quality roads, emergency with transport helicopter. Nearly 20 per cent of traffic accident victims in the Netherlands are rescued by helicopters. This model is probably not suitable for Việt Nam because it is very expensive.
The pre-hospital emergency models of some countries such as the UK, Australia, and the US aim to stabilise patients with minimal basic conditions, especially with the support of people right next to them. Once the patients’ conditions have been stabilised, medical staff will come to assist, then bring the patients to the hospital, making the treatment process more effective, faster and reducing costs.
I think just like in the recent COVID-19 pandemic, Việt Nam should make use of anything available on the spot. The same for pre-hospital emergency care.
If we can't give first aid on the spot, we can't expect anyone from other places to come to help.
Once pre-hospital emergency care is legalised, what solutions are needed to effectively implement the system?
We must take advantage of healthcare facilities available and medical emergency centres 115 at local level. Private sector, organisations and charity groups can join but the State must play a leading role in administering pre-hospital emergency system.
We have not had an organisation in charge of pre-hospital emergency care. I wish that someday there will be a national medical operating system which can mobilise medical forces as quickly as armed forces.
The first important thing is that medical staff have to practise first aid skills, because we have learned theory but not much the reality. Semi-professional forces including rescuers, police officers and firefighters need to be trained. Those who need to have a beginner level of first aid skills are students, volunteers, members of Red Cross, Veterans' Association, Fatherland Front. We must train them and give them certificates. VNS