7 MEDICAL EMERGENCY AND TRAFFIC ACCIDENT VICTIM SUPPORT DEVELOPMENT STRATEGY

Transcription

1 The Study on National Road Traffic Safety Master Plan in the Socialist Republic of Vietnam until 2020 Final Report 7 MEDICAL EMERGENCY AND TRAFFIC ACCIDENT VICTIM SUPPORT DEVELOPMENT STRATEGY 7.1 Planning Approach and Priority Issues The planning approach and priority issues for the medical emergency sector are in coordination with the forecasted traffic accident capabilities by year 2020 as well as to address requirements on medical emergency of the health sector through the undertaking of goals and priority activities in accordance with the capabilities of the country. 1) Forecast to 2020 (i) Forecast 1: By year 2020, motorization in Vietnam will reach million, with 2.62 million vehicles and 33 million motorcycles. 1 (ii) Forecast 2: By year 2020, motorization in Vietnam will be 52.6 million. With the continuing increase in rate of motorization, the country, particularly the health sector, is more and more faced with the challenge of reducing the number of traffic accidents as well as the number of fatalities. 2) Pre-hospital Care (i) First aid and Information system: (1) Delay in transfer of emergency information thus missing the golden time in trauma emergency. (2) Provision of first aid on site is relatively low, mostly provided by the people in the communes. (ii) Transportation system Many of the traffic accident victims were transferred to hospitals through use of vehicles such as taxi or even by xe-om (motorcycle taxi) due to lack of ambulances. The World Health Organization (WHO) recommends that 15 ambulances is necessary per 1 million population. This means that Hanoi, which has at present 10 units of ambulances, should have 60 units of ambulances for its 4 million population. Ho Chi Minh City should have 120 units of ambulances for its 8 million population but has only 10 units of ambulances at present and Hue should have 20 units of ambulances instead of only 2 ambulances at present. 3) Hospital Care (i) As Vietnam experiences continuing economic development, the health sector is expected to have more investments in its health facilities; hospitals in the central, provincial and district levels will be upgraded in terms of specialized facilities and equipment similar to other countries in Asia and will then have capability to provide much needed emergency services for traffic accident victims, especially during 1 Source: based on information from the Ministry of Transportation and development of the vehicle/motorcycle industry and vision to Workshop 22 Jan Hanoi I-7-1

2 Volume 2, Part I: National Road Traffic Safety Master Plan 2020 Chapter 7 mass casualty accidents (resulting in about 20 victims for district hospital and 50 victims for provincial hospitals). (ii) The health sector also forecast that private hospital system will develop not only in the urban areas but also in the districts which are also developing economically. These private hospitals will be equipped with modern facilities and highly skilled health workers who can give appropriate and efficient emergency services to the traffic accident victims. 4) Training of Health Care Personnel (i) The provincial and district hospitals have very enormous requirements in terms of human resources. Many hospitals do not have emergency specialist doctors; most of these hospitals rely on general practitioners who are sent to attend training courses in the central hospitals. There is therefore a lack doctors who have specialization, or has secondary or masteral degree, in emergency services. (ii) Most of the present medical schools in Vietnam only offer general medicine and lacks specialization courses and training. Thus, during the first 5-10 years, doctors who are general practitioners still need to be trained or acquire specialization on emergency services through actual experience in the 115 centers, provincial or district hospitals. 5) Role of Community (i) Data collected in the surveyed provinces show that nearly 70% of victims received first aid from the community while over 15% received first aid from health workers and 15% from others. (ii) Given above data, it is therefore necessary to develop guidelines and provide training on first aid techniques such as (1) techniques to stop bleeding; (2) bandaging of different body parts (e.g. head, hand, feet, chest, etc.); (3) proper techniques in handling broken bones to avoid shock and injuries in blood vessels, nervous system; (4) proper transferring of victims, particularly for victims who sustained injuries in vertebral column; and (5) resuscitation of the victim (i.e. CPR). While these five basic emergency techniques are being applied in the medical sector of northern part of Vietnam since before 1972, it is therefore necessary now to make these techniques responsive to the need of traffic accident victims. 6) Disaster and Mass Casualty Accidents (i) Traffic accidents involving passenger cars are continuously increasing such as the car collision with a train in ThuaThien Hue and passenger car accidents which occurred recently in Quang Tri, Nghe An, Khanh Hoa, Dac Lak, Binh Dinh which result in many victims being treated in hospitals. The triage area, ICU and operation wards can accommodate 20 victims at present. However, if the number of victims goes over 50, then it becomes difficult for the hospitals due to lack of manpower and medical equipment. (ii) In general, the hospital system in Vietnam still has a very weak Mass Casualty Management (MCM) awareness and capability. Based on observations, the hospitals are still lacking in capabilities in the following: (1) search and rescue I-7-2

3 The Study on National Road Traffic Safety Master Plan in the Socialist Republic of Vietnam until 2020 Final Report operations; (2) triage services; (3) information guideline to manage flow of victims in hospitals; (4) information management particularly in assigning a spokesperson responsible in issuing official statements to the public so medical staff can concentrate on providing necessary first aid and medical treatment to the victims; and (5) hospital security. 7.2 Goal and Strategy 1) Overall Goal To reduce by 50% the number of traffic accident fatalities in hospitals compared with 2007 data (i.e. lower fatality rate to 0.68/100,000 population from 1.36/100,000 population in 2007). 2) Specific Goals (i) Upgrade Capacity (and Quality of Trauma Care) in Hospitals All provincial hospitals must be upgraded both in manpower resources and medical equipment to have the capacity for treating severely injured TA victims. Provincial hospitals should be able to function as a Trauma Center of respective provinces. District hospitals must also be strengthened to have the capacity to provide accurate evaluation and perform initial treatments to severely injured patients before they are transferred to provincial hospitals, if still necessary. (ii) Improve Pre-hospital Care (1) Setting up Emergency Medical Information System Emergency medical information system will be established utilizing GPS and GIS by 2020, together with the expansion of communication infrastructure such as the mobile phone networks or receiving stations. (2) Establish 115 Ambulance Transportation System Nationwide 115 ambulance transportation systems will be established by 2020 covering more than 90% of the whole population. More than 80% of TA victims are expected to be transported to the hospitals within one hour. (iii) Establish Training System on Trauma Care All doctors of provincial and district hospitals taking care of trauma patients, as well as all 115 physicians must undergo training on trauma care. All emergency medical system personnel, school children and people in the community must receive adequate information on first-aid. Guidelines and training curricula must be prepared according to various levels of trainees and learners. A training center must be established in 3 areas: north, central and south, to provide full-scale training. (iv) Prepare for Mass Casualty Accident Hospitals must be prepared for mass casualty accident by strengthening capacity I-7-3

4 Volume 2, Part I: National Road Traffic Safety Master Plan 2020 Chapter 7 in manpower, medical equipment, facility/space, drugs, etc. Provincial hospitals and district hospitals should have capacity to receive at least 50 victims and 20 victims, respectively. (v) Improve Rehabilitation System Rehabilitation must be started as soon as patent s condition is stabilized. Various levels of rehabilitation facilities will be established in the province and the community. (vi) Establish Reporting System Establishing data reporting and recording system (Trauma Registry) is important to ensure accurate data on TA victims which are necessary for the Government to formulate policies on road traffic safety master plan as well as for academic organizations to share experiences with other countries. 7.3 Strategies for Medical Emergency Development Program 1) Development of Pre-hospital Care (i) Strengthening Emergency Information System (1) Timing is often the key in determining the quality of emergency care that can be provided, as well as the traffic accident victim s chance of full functional recovery after treatment. And during emergency cases, it is said that the first hour is the most crucial. (2) Information on how to provide first aid treatment and how to properly transfer the traffic accident victim in the nearest hospital is therefore very important. In addition, an effective information system is also key to successful development of pre-hospital care. The telephone system nowadays is relatively developed and widely available in most places nationwide. However, due to existing policy, the present reporting system does not easily allow the community to provide timely information to health facilities when traffic accident occurred. In order to make it more convenient for communities to report a traffic accident and request assistance from the hospitals, the health sector has the following recommendations: Consistent policy nationwide on a single, toll-free telephone code system for emergency (115). Once a call is placed, the system will automatically link the call to the nearest hospital (district hospitals), regardless of administrative boundary. Setting up a public telephone box along the national roads with proper guidelines and information to the community. These phone boxes will only have control button link with the police station and 115 system (or emergency units of nearest hospital). Information dissemination on the proper handling and use of this equipment to ensure a well maintained system for a long time. People s committee of the provincial/district level have issued requests to the police and health sectors to ensure immediate rescue activities right I-7-4

5 The Study on National Road Traffic Safety Master Plan in the Socialist Republic of Vietnam until 2020 Final Report after information is received. An example is the railway accident in Lang Co - Hue in 2005 where all emergency systems of the two provinces of Danang and Thua Thien - Hue participated very actively upon receiving information about the accident. The Government needs to consider investing on GPS (Global Positioning System) to identify location of vehicles involved in traffic accidents and to be able to immediately deploy rescue and emergency operations. Application of modern information system in the command post of the 115 emergency system in big cities like Hanoi, Danang, Ho Chi Minh City, and Can Tho and utilization of the digital communication map in the central emergency command post such as those found in the cities of Bangkok, Singapore, Shanghai. (ii) First Aid and Transportation (1) Based on collected data, only 30.16% of traffic accident victims received first aid onsite. Most of the victims didn t receive first aid and where transferred immediately to the hospitals. These situations however either increased the risk of fatality or more serious side effects for the victims. Therefore, first aid onsite is very important. It is necessary to apply the "4 ready in the field" principle which is command, manpower, facilities, and logistics in the application of medical emergency for traffic accident victims. (2) It is a fact that only 37.55% of traffic accident victims were transferred to the hospital by ambulances; the rest were transported by other types of vehicles which were not properly equipped for a medical emergency, thus those victims didn t receive first aid right after the accident occurred (while being transferred to hospitals). As already mentioned, this increases the risk of either fatality or more serious side effects for the victims. The following are therefore proposed: District hospitals, especially those located in areas with high traffic accident incidences need to have at least 2 ambulances which are not only properly equipped but also properly staffed with highly skilled medical emergency team which is very mobile and ready to rescue and provide emergency treatment to traffic accident victims. The health and medical facilities should have an effective plan to collaborate with the military stationed in the remote areas in providing rescue and first aid operations to the victims when a traffic accident occurs in their area. In case of mass casualty accident, there is a need to establish a field combat hospital which can provide first aid and treatment to the victims before gradually transferring them to the hospitals. Railway emergency medical stations which can provide first aid treatment in cases of accidents should be established especially along railway lines and stations which are far from residential and health facilities. (3) Strengthening emergency capacity for health worker at the grassroot level: Since health workers at the grassroot level make the first contact with the traffic accident victims, they must be highly-skilled in providing first aid I-7-5

6 Volume 2, Part I: National Road Traffic Safety Master Plan 2020 Chapter 7 techniques such as tourniquet (to stop bleeding), bandaging, splinting broken bones, resuscitation or CPR, and transferring victim to the hospitals. Health workers must also be trained how to prepare the emergency equipment, medicines or drugs and how to swiftly mobilize the team for immediate deployment to traffic accident sites. This can be enhanced by regular drills or exercises of traffic accident situations in the area in order to effectively carry out a swift emergency response when traffic accident does occur. In addition, grassroot level health facilities should also establish close coordination mechanism with health facilities in the district and provincial levels to ensure assistance especially during mass casualty traffic accidents which result to overcapacity at the grassroot level health facilities and also when medical expertise is required for serious cases (iii) Development of 115 System (1) At present, the 115 emergency system in Vietnam is responsible for all medical emergencies caused by diseases, injuries and accidents, traffic accidents included. The rate however of traffic accident victims which have been transferred from accident sites to the hospitals were only around 10-15% of total. Many of these victims were in fact transferred to the hospitals through other transport facilities such as taxis and motorcycles, which, unfortunately, led to high likelihood of side effects or complications since first aid treatment was not available during the time of transfer of victim. (2) Ministry of Health issued Decision No 01/2008/QD-BYT dated 21 January 2008 which promulgated the regulation on health emergency, active recuperation and poisoning control which prescribes the following for out-patient hospital emergency system (115 emergency system) as follows: Establishment of out-patient hospital emergency services (115 emergency canters) at provinces/cities level which shall be a unit belonging to the provincial health service. Provinces which have not yet set up 115 emergency centers will assign a 115 emergency mobile team from the provincial hospital. As well as in district hospitals, an out-patient hospital emergency mobile team (namely 115 emergency team) shall be assigned These 115 emergency centers must have fully-equipped ambulances (WHO recommends 15 ambulances per one million population), adequate space for treatment and work area, parking space to keep ambulances, information system, medical equipment, and highly skilled manpower which should be standard in the whole country. Other localities (township, small cities and districts) can provide emergency services outside of the hospitals and emergency centers, particularly for traffic accident victims. These facilities should also never refuse anyone seeking medical treatment. Hospitals must have a 24/7 personnel on duty manning the 115 emergency hotline and dispatch emergency services whenever information is received. I-7-6

7 The Study on National Road Traffic Safety Master Plan in the Socialist Republic of Vietnam until 2020 Final Report At major intersections on major national roads, railway stations, etc., ambulances will be on close standby or should closely coordinate with district hospitals to immediately respond in transferring traffic accident victims. To further enhance a unified emergency information system throughout the country so that information will flow directly to the nearest hospital and will not be passed around the switchboard of the local area. In addition, the use of mobile phones to report traffic accident information will be allowed. This will allow communities to immediately report traffic accident and thus request for emergency assistance for traffic accident victims. (3) Social mobilization of private sector and community for 115 emergency services: In order to ease burden of government particularly in terms of state budgetary requirements, the Party and the Government s social mobilization policy to involve the private sector in the provision of health and emergency services as well as to improve capacity of people in the community in dealing with emergency situations will enable the Government to re-allocate limited resources to other health care issues particularly for the poor and to develop high-tech centers. Based on experience in Nghe An, Quang Ninh and other localities, the quality of emergency transfers have improved due to appropriate fees collected for such premium service. This has in fact provided better chances also of survival and recovery for the traffic accident victims. Properly accredited private sectors involved in the provision of 115 emergency transport service under the management of the Ministry of Health provide better and quality service compared with illegally operating groups which do not have properly equipped vehicles and manpower which can increase chances of recovery, if not survival, of the traffic accident victims. Address the issue of the very high incidence of traffic accident victims (60%) being transported by non-medical transport faciltiies. (4) Financial management of 115 emergency system: To implement a regulation wherein collection by 115 system from user fees will allocate 30% of collected fees to pay for staff directly involved in providing the emergency service (such as operator receiving information, first aid health worker, driver, etc.). This will in effect reduce the discrepancy of remuneration received by hospital and 115 system staff. To apply standard fees collected by the 115 system whihc should be equivalent to cost of transport by taxi plus related health service fees available in the localities. If the local goverment has a free of charge policy for emergency services (like Danang), the people's commitee will pay to the 115 emergency center. In the case of emergency service for traffic accident victims, priority is the I-7-7

8 Volume 2, Part I: National Road Traffic Safety Master Plan 2020 Chapter 7 provision of first aid followed by transfer of victim(s) to the hospital. In this case, fees will not be initially required. And if the traffic accident victim does not have a relative who can be responsible for the payment of fee, the insurance company or people's committee (local government) will pay to the 115 centre just like in Japan or Danang City. (5) Encourage favorable policies for health workers in 115 emergency system: It is a fact that the 115 emergency system is constrained in attracting highly skilled staff, particularly specialist doctors, due to several reasons: significant discrepancy in pay and allowances as compared with those of the hospitals, very few chances to receive training to upgrade skill, and long work hours which includes weekends, holidays such as lunar festival (Tet). To standardize skills/level of specialization of manpower working at the 115 emergency centers such as staff must have completed specialized training on emergency; head of emergency wards at the provincial hospitals should have primary degree specializing in emergency. Link 115 system activities with the hospitals such as the case in Trung Vuong Emergency Hospital in Ho Chi Minh City. Doctors and nurses of 115 emergency centers who are off duty can participate in medical treatments in the hospitals and receive professional fees like a regular staff of the hospital. This model, which can be applied to the district 115 emergency mobile team, can provide a very good training ground to as well as augment earning capacity of the 115 medical staff. Medical staff of the 115 emergency centers are entitled to attend the postgraduate training courses on medical emergency. If this proves to be difficulty, they should attend the preliminary course specializing on emergency in order to have upgraded skills on emergency comparable to medical staff in the hospitals. 2) Training Health Workers for Emergency System The manpower of the 115 system in general has very low level of skills in medical emergency. Most of the health workers employed by the 115 emergency systems do not have background on how to provide emergency services during a traffic accident such as rescue of victims and common first aid techniques on site. Thus, training on medical emergency should concentrate on the following items. (i) Needs Identification (1) To conduct study on actual situation of health emergency of the 115 system and emergency wards in the provincial/district hospitals. The estimated requirement of the whole emergency system is around 5,000 emergency doctors. At present, there are about 3,000 doctors all over the country who graduated from medical universities but are unemployed. Despite urgent requirement in the remote areas for doctors, they wouldn t want to work there. The Government, through the Ministry of Health, can encourage these doctors to attend special training courses on medical emergency and become I-7-8

9 The Study on National Road Traffic Safety Master Plan in the Socialist Republic of Vietnam until 2020 Final Report "emergency doctors" who will work in the 115 emergency system or ICU of the provincial or district hospitals. (2) Evaluation of training capacity in the medical colleges in the whole country; both lecturers and emergency equipment should be periodically updated with international standards to ensure that graduates of these medical colleges are adequately skilled to function well in a real hospital setting and will be capable of using modern equipment of the hospitals. (3) Hospitals and 115 emergency centers can enter into contract agreements with medical training institutions in upgrading the knowledge and skills on emergency of their medical staff/health workers through conduct of short-term training courses paid for by the hospitals and the 115 emergency centers. In the same manner, the 115 emergency system must also be able to accommodate newly graduated students of these training institutions. (ii) Standardization of Training Curriculum (1) It is necessary to have adequate time to prepare a training curriculum for emergency which is approved by the MOET. If curriculum can be completed and approved within this year (2008), then training may commence for training cycle. Otherwise, it should wait until (2) While waiting for the completion of the official emergency training curriculum, the present training curriculum for existing staff of the 115 emergency units and emergency wards of the provincial/district hospitals must immediately be updated in time for the training cycle. (iii) Formulation of Emergency Training Centers in 3 Areas of the Country (1) According to the regulation on health emergency, the 115 emergency centers are responsible for providing training on emergency techniques to the health emergency staff and members of the community in the provinces/cities. (2) Organize three emergency training centers, one each from and affiliated with a medical university in Hanoi (for Northern provinces), Hue or Danang (for central coastal area) and Ho Chi Minh city or Can Tho (for southern provinces). These centers will be responsible for providing training in the post-graduate and masteral programs of medical emergency. (3) For the period , prepare and implement a plan of cooperation with central level hospitals like Viet Duc or Cho Ray to provide special training to doctors who are general practitioners in the provincial hospitals to become emergency doctors. (4) Development of training materials for refresher courses of provincial lecturers who will provide lectures to participants of short courses such as health workers in the district level or members of the community (iv) Design, Printing and Dissemination of Training Curriculums (1) Preparation of an overall plan on training and re-training on medical emergency for health workers in the whole country until the year I-7-9

10 Volume 2, Part I: National Road Traffic Safety Master Plan 2020 Chapter 7 (2) Design of training curriculums for different types of training such as official training, re-training, 1st or 2nd degree training, masteral or doctoral degree in medical emergency. These training curriculums shall be submitted to the MOET for approval. (3) Preparation and printing of special documents, protocol and handbook on the 5 key first aid techniques (bandaging, tourniquet, fixing of broken bone, resuscitation or CPR, and transferring of victim) and dissemination to the community. (v) Educating the Community and School Children (1) First aid education to the community The community is referred here as the general population residing near traffic accident areas who can participate in the rescue and provision of first aid to the victim(s) immediately after the traffic accident has occurred. Thus, their awareness and capacity on first aid techniques (e.g. applying bandage and tourniquet, proper handling of broken bones, proper transfer of victims to nearest health facilities, CPR, etc.) should be enhanced. Regular reminders for the community members through the mass media (radio, television, newspaper) on first aid techniques, proper rescue and importance of immediate provision of first aid to the victim(s). Health workers are the key persons who can serve as mentors for the community to understand simple emergency techniques; they can identify local materials available in the community which can be used in providing first aid. Periodic announcements on important numbers of the nearest health facilities or the number linked to the 115 system which should be called during a traffic accident. Guidelines for the local authority and related sectors like police, military, youth union on how they should respond during mass casualty accident in the area. (2) First aid education for the school children Close collaboration with the education/training sector which provides emergency education to the schools in the area. Education sector integrates emergency training to the official curriculum of the school system and invites health workers to give lectures in the schools in the area. 3) Disaster and Mass Casualty Accident By the year 2020, the entire country is forecasted to have almost 50 million of motorized vehicles, of which over 1 million are passenger vehicles. This therefore increases as well the risk of mass casualty accidents. The health sector and local authorities at all levels should therefore be more concerned on the issue of mass casualty accident. In the recent years, traffic accidents with over 10 victims have occurred in different road types and in several instances. Some of these accidents I-7-10

11 The Study on National Road Traffic Safety Master Plan in the Socialist Republic of Vietnam until 2020 Final Report even occurred in locations which are far from health facilities which made the requirement for first aid and immediate transfer to the hospitals very critical. To address these issues, the following measures are necessary: (i) Strengthening Emergency Capacity of the Hospitals (1) Emergency system of the provincial/cities hospitals must be upgraded and should be equipped with adequate emergency specialists and doctors, medical equipment such as monitors, electro-cardiograph, X-rays, respirators and other facilities such as patient beds which can receive at least 20 traffic accident victims all at the same time. (2) Provide appropriate and adequate space to triage victims at the consultancy ward; spaces for first aid, preparatory room prior to transfer of victim to operation wards when necessary, and for recovery and recuperation. (3) Provide more operation wards which are reserved for emergency operations to victims who need immediate surgeries. Request other hospitals (military, police, and central hospitals) located in the province/cities to provide support during emergency operation. (4) Ambulances of the hospitals must be used as 115 ambulances. Provincial/city hospital ambulances must be encouraged to transfer victims to different hospitals located within the province/city area, including military and police hospitals. (5) Supplement emergency drugs to meet the emergency requirement of mass casualty accident victims. Also develop plan on how to encourage manpower support for medical emergency team in the hospitals especially during the time when many of the victims arrive almost the same time. (6) Increase capacity of district hospitals to be able to receive 5 to 20 victims of mass casualty accident to reduce congestion of victims in the provincial hospitals. When necessary, provincial/central hospital will send mobile team support to the district hospitals. (ii) Satellite hospitals (1) Hospitals in the provinces/cities located in the focus regions such as North west, North East, north central coastal, South central coastal, highland, South east and Western South will establish an emergency satellite system by upgrading both expertise and medical equipment of the provincial hospitals located in the area. In addition, a provincial hospital will be upgraded into a regional hospital which will be responsible in receiving traffic accident victims from other provincial hospitals in the area. (2) The Ministry of Health shall closely collaborate with the Ministry of Transport in creating emergency centers in designated rest stations along national roads. It is proposed that distance between rest stations are km, with each station having restaurants, shops, rest rooms, emergency centers, and pharmacy, among others. There emergency services shall be equipped with ambulances to provide first aid to passing passengers as well as to traffic accident victim(s) in the area before transferring to the hospitals. I-7-11

12 Volume 2, Part I: National Road Traffic Safety Master Plan 2020 Chapter 7 (3) It is necessary to designate a location for this emergency center within the rest station, which will be equipped with emergency staff and has budgetary allocation for medical equipment and ambulances. During normal circumstances, this emergency center can provide health services to the community living in the area. Budget for these emergency centers may also be sourced from expected collection of service fees of business operators in the rest stations. The Ministry of Health or the Provincial Health Services shall be responsible for training of medical/health staff as well as preparation of list of required medicines, drugs and medical equipment. (4) A bidding mechanism among the private sector interests may be conducted to award private operators of the proposed rest stations. In addition, to further attract the private sector to invest in this undertaking, incentives may be provided such as tax exemptions and free lease of land for a limited period of time (5 to 10 years) until private operator starts earning profit. (iii) Provide Appropriate First Aid Techniques or Post-mortem to Accident Victims (1) Strengthening capacity of the provincial hospitals to receive and provide first aid treatment to the victims of mass casualty accident (with over 50 victims) with available resources. When necessary, support mobile team will be requested from central and regional hospitals in the region. (2) Training for leader and key staff of the local government and the local health unit on proper handling process during an emergency especially when many victims are received in the hospital all at the same time (e.g. triage, first aid, hospital security, recording/reporting system, press releases to the mass media, logistic management, etc.). (3) Morgue should have capacity of accommodating 10 to 20 dead bodies up to at least one week to be able to conduct appropriate forensic medical investigation particularly when DNA testing is required to identify the fatalities. (4) Conduct of annual drills/exercises. Budgetary allocation for these activities should be included during planning. In high risk areas where mass casualty accidents frequently occur, leaders of the local government, police, military, and insurance agencies should participate in these drills and exercises to ensure inter-sectoral close collaboration when a mass casualty accident occurs. (iv) Organization of a Disaster Medical Assistance Team (DMAT) A DMAT in all central and regional hospitals staffed with specialists equipped with modern medical equipment and ready to support the provincial and district hospitals when mass casual accident occurs. 7.4 Organization and Resource Development It is necessary to prepare a master plan on medical emergency to respond to the ever increasing impacts of traffic accidents which may be supported by JICA and other international agencies. I-7-12

13 The Study on National Road Traffic Safety Master Plan in the Socialist Republic of Vietnam until 2020 Final Report 1) Accident and Injury Prevention Project Ongoing project supported by WHO which focused on 7 provinces may be replicated to any other provinces, if not nationwide. This project will continue to receive support from WHO and other international agencies (SIDA). Estimated cost is US$800,000 for the period ) Strengthening Medical Emergency System Project This includes 3 subcomponents with total budget of US$2,000,000 recommended for JICA support: (i) Strengthening Pre-hospital Care in the Pilot National Roads Selection of 3 national roads which have high risk of traffic accidents such as NH5 (Hanoi Haiphong); NH51 (HCMC Vung Tau) and NH1 (Nha Trang Phu Yen) and related provinces/cities as pilot area. Installation of emergency telephone box system along these national roads; medical emergency units along the national roads and located in designated rest stations; ambulances and medical equipments for emergency. Development of training materials on common first aid techniques and conduct of training to the communities and school children. Estimated cost for this component is US$700,000 for the period Estimated cost for this component is US$700,000 for the period (ii) Strengthening Human Resources for Medical Emergency Conduct of training needs assessment study in order to have proper training curriculums for the training centers. Establishment of 3 training centers, one in each region of the country such as Hanoi, Ho Chi Minh City and Hue (or Danang). Design and distribution of training and information materials on medical emergency. Conduct of training for medical doctors working in the 115 system and ICU of the provincial and district hospitals. Estimated cost for this component is US$800,000 for the period (iii) Strengthening Capacities of Medical Emergency during Mass Casualty Accident Strengthening capacity of the provincial hospitals to provide first aid during mass casualty accidents to at least 50 victims with existing resources, and when necessary, request for mobile team support from central hospitals located in the region. Training for leaders and key staff on the effective process of providing emergency medical services in cases where many victims are brought to the hospitals at the same time such as triage, first aid, hospital security, recording/reporting system, press release to the public and mass media, logistic management. I-7-13

14 Volume 2, Part I: National Road Traffic Safety Master Plan 2020 Chapter 7 In the high risk areas where mass casualty accidents frequently occur, conduct of drills and exercises with the participation of the leader of the local government, police, military, and insurance agencies to ensure intersectoral collaboration when mass casualty accident occurs Estimated cost for this component is US$500,000 for the period Implementation Strategies 1) Period (Preparatory Phase) This period shall be for the preparation of all necessary conditions to implement the proposed strategies of health emergency for traffic accident. Thus, all strategies which can directly reduce fatality rate of victims such as upgraded hospitals, emergency centers on sites of accident and the number of ambulances to transfer victims to the hospitals are not yet expected to be in place. (i) Goals (1) Maintaining the number of fatalities caused by traffic accidents similar to that of 2007 since if fatality rate will not be contained from 2008 to 2010, this will become a very heavy burden on the health sector which already had a difficult time dealing with the 2007 fatality rate. (2) Establishment of the initial emergency including 115 emergency system in 20 focus provinces belonging to the central government and 8 selected regions. (3) By year 2010, there would have been 10 hospitals upgraded both in terms of specialists and medical equipment including ambulances. (4) Completion of overall plan on human resources training for medical emergency until the year (ii) Activities (1) Conduct of pre-hospital care in the pilot national roads and provinces such as NH5 (Hanoi - Haiphong); NH51 (HCMC - Vung Tau) and NH1 (Nha Trang - Phu Yen) where there are high risk of traffic accidents. (2) Consolidation and development of existing 115 emergency system; reestablishment of 115 emergency system in the selected provinces in 8 regions (each region select one pilot province). (3) Strengthening of selected regional hospitals in the 8 regions to have the capacity to receive mass casualty accident victims of 50 or more victims and provide support to all other provincial hospitals located in the region. (4) Conduct of survey on demand for manpower resources to formulate an overall plan on the appropriate training program for health emergency until the year (5) Design of training curriculum on training emergency for health workers until the year 2020 and submission to the MOET for approval. Preparation, printing and distribution of these training documents to the focus provinces. Close collaboration with the Ministry in awareness campaign on common first aid to the schoolchildren of the education system. I-7-14

15 The Study on National Road Traffic Safety Master Plan in the Socialist Republic of Vietnam until 2020 Final Report (6) Implementation of social mobilization for 115 emergency system and hospitals; encouragement of local private sector and foreign investments to the 115 emergency system and emergency hospitals. (7) Improvement of the emergency information system on traffic accident victims in the hospitals 2) Period (Start of Implementation Phase) (i) Goals (1) Reduction by 10% of number of fatalities in hospitals (based on 2007 data) resulting from traffic accidents per 100,000 population. (2) Establishment of initial emergency system (including 115 emergency system) in 50% of the provinces of the country. (3) Upgrading of additional 20 hospitals in the central and provincial levels, both in specialists and medical equipment (including ambulances), thus total number of upgraded hospitals will be 30 by end of this period, equivalent to 45% of provincial hospitals in the whole country. (4) Establishment of 3 training centers on health emergency in the 3 regions: North, Central coastal and South of Vietnam. (ii) Activities (1) Establishment of emergency system and emergency hospitals in all provinces of the country with budget coming from the state, private sector and foreign investments. (2) Strengthening capacity of the district hospitals in the focus area; each province shall select 50% of district hospitals as pilot which have capacity to receive up to 20 traffic accident victims per day and will have support from the provincial hospital level when needed. (3) Start of the official and continuing training on health emergency based on requirement of the localities. Conduct of training on first aid to health workers at grassroot levels wherein these health workers will be the key persons to provide training to the community. (4) Conduct of information dissemination and awareness campaign activities to the communities on common first aid techniques for traffic accident victims. Close collaboration with MOET in carrying out education program on first aid techniques in the entire school system of the country of which health workers in the grassroot levels will serve as lecturers. (5) Consolidation of statistics, recording and reporting system on traffic accident victims of the whole country wherein data on health system will be integrated with the national statistical system to effectively manage and monitor the traffic safety master plan. I-7-15

16 Volume 2, Part I: National Road Traffic Safety Master Plan 2020 Chapter 7 3) Period (i) Goals (1) Reduction by 30% fatality rate of traffic accident victims per 100,000 population in the hospitals. (2) Establishment of the emergency system (including 15 system) in all provinces and cities in the whole country. (3) Upgrading of an additional 20 more provincial hospitals both in terms of specialists and medical equipment (including ambulances), bringing the total number of upgraded hospitals to 50 (or 80% of total number of hospitals in the country). (4) Operation of training centers which successfully produces emergency doctors for the 115 emergency system and ICU in hospitals. (ii) Activities (1) Monitoring of effective health emergency system in the sites of traffic accident with participation of the community, related branches, local governments. (2) Conduct of pre-hospital care in the whole country ensuring that 60% of traffic accident victims have been provided appropriate first aid and transferred to the hospitals by ambulances. (3) All provincial hospitals have been upgraded and have capacity to give first aid to mass casualty accident victims (over 50 victims). (4) Complete establishment of high technology medical centers in each of the 8 economic regions of the country; these centers will also function as support for all the provincial hospitals. (5) Strengthening support of local private and international hospitals to the public hospitals in providing emergency treatment to the traffic accident victims. By the end of this period, there shall be no discrimination in selection by the community between public and private hospitals. (6) Training centers for health emergency have adapted the full requirement on human resources of the 115 and emergency hospitals in the whole country. 4) Period (i) Goals (Target completion by year 2020) (1) 100% of the provincial hospitals have been upgraded; staffed with adequately skilled human resources and has appropriate medical equipment to provide first aid and emergency treatment to victims of mass casualty accidents of at least 50 victims. District hospitals have capacity to provide first aid and emergency treatment to up to 20 victims of traffic accidents. Fatality rate of victims at hospitals is reduced by 50% based on 2007 data (< 0.5/100,000 population). (2) Fully developed and functional emergency network that provides early response and emergency treatment to the victims; community members are I-7-16

17 The Study on National Road Traffic Safety Master Plan in the Socialist Republic of Vietnam until 2020 Final Report more proactive in providing first aid treatment and transfer of victims to the hospitals. (3) 115 health emergency system coverage in all areas of the provinces/cities based on close collaboration with the public, private, and military hospitals. All district hospitals have out-patient emergency team equipped with medical equipment and ambulances to provide first aid and transfer the victims to the hospital. (4) Emergency training system integrated in all medical schools to upgrade skills of the health workers employed by the 115 system and hospitals, as well as training to the community. (5) Institutionalization and implementation of a national insurance system to ensure coverage for 100% of traffic accident victims. (ii) Activities (1) Maintaining the sustainable development of hospitals to ensure its effectiveness in providing first aid to victims in any kind of traffic accident. Enhancement of the social mobilization policy for timely emergency medical assistance of local private and international hospitals to the victims of the traffic accident. (2) Continuing development of the 115 emergency system staffed with skilled health workers and equipped with modern medical equipment to ensure that at least 80% of traffic accident victims receive initial first aid in a timely manner. Establishment of monitoring centers in the big cities to ensure timely emergency assistance to the traffic accident victims as well as victims of other disasters. (3) Conduct of emergency training at 3 regional centers of the country and effectively deploy these trained human resources to the health facilities and communities to act as trainers at the grassroot levels. (4) Development of various insurance schemes to ensure 100% of traffic accident victims receives proper support and coverage from the insurance companies (5) Strengthening of the information, reporting and recording system in the whole country to ensure an accurate data of traffic accident victims which are necessary for the central government and concerned branches to formulate appropriate policies on traffic safety master plan and share experiences to other countries. I-7-17

18 The Study on National Road Traffic Safety Master Plan in the Socialist Republic of Vietnam until 2020 Final Report 8 INSTITUTION AND RESOURCE DEVELOPMENT STRATEGIES 8.1 Planning Approach and Priority Issues Road traffic safety improvement in Vietnam has only recently been seriously considered, thus many issues have not been responded yet. Therefore, in order to ensure the sustainability of the traffic safety policy and to continue effective and efficient countermeasures, it is necessary to develop (1) institutional infrastructure, (2) human resource and (3) financial resource. The proposed Traffic Safety Audit System in the engineering sector for example, has very acceptable objectives, feasibility in terms of effectiveness and is highly agreeable for introduction to Vietnam transport sector. However, institutional framework such as organization and details of implementation, as well as the legal requirements and environment, have not been prepared yet. Moreover, human resource is not readily available and additional cost and time will be required for the audit implementation. This holds true not only in the traffic safety audit system, but as well as for other proposed measures in the other sectors. This Chapter will focus on the institutional issues in the intersectoral areas so as to (1) enhance comprehensive traffic safety measures and (2) ensure sustainability of traffic safety policy development. Three institutional development programs shall be discussed in the succeeding subsections with the respective program components: (i) Administrative Enhancement Program Enhancement of National Traffic Safety Committee Provincial/City Traffic Safety Committee Traffic Safety Department/Unit in the Transport Department Legalization of NTSC and Traffic Safety Plan (ii) Research and Development Program Traffic Safety Center Development Traffic Safety Database Development (iii) Resources Development Program Traffic Safety Foundation Development Vehicle Tax System and Other Fund Sources Traffic Safety Human Resource Development The Administrative Enhancement Program is aimed at improving the function and capacity for the sustainable and comprehensive traffic safety policy development. Lack of the organizational capacity in the field of traffic safety can be observed not only in the central government, but also in the local government levels. From another perspective, the local governments may be burdened with more critical issues and problems as an implementation agency. However, in order to implement appropriate and effective traffic safety policy across the country, at the very least, a core, capable I-8-1

19 Volume 2, Part I: National Road Traffic Safety Master Plan 2020 Chapter 8 organization in the central government level is necessary which has a legal personality that will be significant in successfully coordinating with all concerned organizations involved in the traffic safety, for both planning and implementation stages. The Research and Development Program will provide technical backstop and support for sustainable traffic safety development. The proposed Traffic Safety Center will be responsible for the periodic review of the Master Plan and Action Program based on a scientific approach. The proposed database will be the basis for this scientific evaluation and will also be an indispensable tool particularly for the modern computerized countermeasures. The Resource Development Program will include development measures for human and financial resources. Due to the current constraint in these resources, it is important to develop strategies of generating the much needed resources from other areas, such as the private sector and road users/traffic participants. International organizations such as donor organizations like JICA, WB and ADB are expected to play significant roles as well for resource development. 8.2 Administrative Enhancement Program 1) Ideal Core Organization for Traffic Safety Development One of the objectives of the program is to enhance the responsibility and function of National Traffic Safety Committee for sustainable traffic safety development in Vietnam. And critical to the success of the comprehensive traffic safety measures is for a core agency to ensure that the 4C (Communication, Cooperation, Coordination, and Corroboration) among the agencies and organizations involved in any traffic safety projects and activities are present. Figure illustrates a desirable and ideal core organization in the central government which will be responsible in promoting comprehensive traffic safety measures. To achieve its traffic safety development policy, A Kindhearted Traffic Society with no Traffic Accident, it shall require five main functions, as follows: policy development, planning/r&d, preparation of fund and human resource, implementation and monitoring of the safety measures, and finally, coordination among the concerned ministries and agencies. Another important function is to provide linkages with other sectors, such as local government agencies and NGO/private sector organizations, as well as international donors. Given the abovementioned functions of this core organization, it is more fitting that the NTSC play this role, with further enhancement of its role and functions, as well as its legalization which will be discussed more in the succeeding sections. I-8-2