Proposal for New Emergency Medical Services Program for Arriyadh Adviser Dr. Tatsuro Kai : Vice President, Osaka Senri Saiseikai Hospital Dr. Katsuhiko Sugimoto : Professor, Kokushikan University Dr. Noriaki Aoki : Assistant Professor, University of Texas Mr. Ryo Chida : Lecturer, University of Toyama
Introduction The Prince Sultan Emergency Medical Services Program for Arriyadh is one of the special project under the patronage of His Royal Highness, Prince Sultan bin Abdulaziz, the Crown Prince. We received the invitation letter for a bid for the professional services for this project on last May in 2011 by ADA (Arriyadh Developmet Authority). And We participated in a bid for professional consulting services on last July in 2011. But unfortunately the project bid has been canceled. Because of all prices of the submitted proposals are exceeded the allocated budget. 1
Background ADA invited 2 Japanese emergency physicians, Dr. KAI and Dr. SUGIMOTO to Riyadh in 2010. T.KAI: Vice President of Osaka Saiseikai Senri Hospital K.Sugimoto: Professor of Kokushikan University They discussed current challenges in the emergency medical system in Riyadh and some leading physicians in Saudi Arabia admired Japanese emergency medical model to reduce the number of fatalities by traffic accident. 2
Traffic Affairs in Arriyadh Traffic accidents are a major concern in Arriyadh. Compared with OECD countries, the number of death caused by traffic accidents per 100,000 population in Arriyadh is extremely high. Cause of Death in Arriyadh in 2009 Illness Pregnancy Delivery Traffic Accidents Other Accidents Others Total Male 6,220 458 1,264 475 1,481 9,898 Female 4,713 1,344 287 133 275 6,752 Total 10,933 1,802 1,551 608 1,756 16,650 Number of Death per 100,000 pop. 187.3 30.9 26.6 10.4 30.1 28.5 OECD countries: 8.2 3
Current Major Challenges The emergency system in Arriyadh is in extremely high demand. The integrated command system is not well-developed. Increasing Traffic Accidents Population Growth Imbalance between Supply and Demand Increasing Demand Existing Hospitals Overcrowded ER Beds Uneven Distribution Of the Patients 4
Basic Policy Our policies on this project follow the propositions below: A new emergency care model in Arriyadh based on the Japanese model. The establishment of Japan Saudi Arabia Emergency Medical Association. Project based on Japan s comprehensive highly developed technology. 5
Japanese emergency care model1 Severity Serious Transport Patients: Emergency transport (Doctor Helicopter) Tertiary emergency care Transfer of patients Rear hospital Moderate Patients: Emergency transport (Ambulance etc.) Transport Secondary emergency care Transfer of patients Discharge Home Patients: On foot etc. Mild Primary emergency care 6
Japanese emergency care model2 Serious 7
Japanese traffic accident fatality Qualifications and training for paramedics began in 20 years ago. The traffic accident fatality has decreased by 53% in the past 20 years. The Number of Accidents in Japan 全国の交通事故年次推移 ( 件数 死亡者 ) Annual Transition (The Number of Cases and Death) 件 Cases 数 1,000,000 900,000 800,000 700,000 600,000 500,000 400,000 300,000 200,000 100,000 0 1992 年 1993 年 1994 年 1995 年 1996 年 1997 年 1998 年 1999 年 2000 年 2001 年 2002 年 2003 年 1989 年 1990 年 1991 年 救急救命士法制定 The Enactment of The Emergency Life-saving Technicians Act 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 2004 年 2005 年 2006 年 2007 年 2008 年 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 死亡 Death 者数 件数 Cases 死亡者 Death 8
Japan Saudi Arabia Emergency Medical Association The Association will contribute to the emergency medical services and education in Arriyadh by conducting: JAPAN SAUDI ARABIA EMERGENCY MEDICAL ASSOCIATION Research and survey Exchanging Program Holding training and educational seminars policy-making support Consulting services 9
Japanese highly developed technology Japan has many specialists in: Planning for the emergency care system Operation and management of healthcare facilities Construction design and engineering for healthcare facilities IT for the integrated command system in emergency care Management of emergency and local healthcare Various types of outsourcing Preferred Model Option (PMO) Development 10
Concept of a new emergency care model ICC ECC CEMS 1~2 10 Instructions Call Triage L:1-2 L:5 Staff Training L:1-2 L:1-2 Existing Hospitals L:3-4 L:1-2 L:3-4 L:5 UCC UCC-1 UCC-15 Each UCC 2~3 Rehabilitation Hospitals Existing Hospitals Intensive Care Legend L:1 CTAS Level 1 L:2 CTAS Level 2 L:3 CTAS Level 3 L:4 CTAS Level 4 L:5 CTAS Level 5 Home 11
Developing service programs for ECC -The Outline of the Service Programs- ECC will play the central role in the emergency care system and disaster medical care in Arriyadh. The major functions of ECC assumed in the present stage are as follows: Number of beds: 500 ICU and burn beds. 10 ambulances, 1 or 2 helicopters. 24 hours a day, 7 days a week. Full range of diagnostic and support services (CT, MRI, angiography and sonography etc.) Length of stay: around 7 days. Direct admission protocols (severe and critical cases of CTAS Levels 1-2) etc. Detailed functions and configuration of each center shall be proposed after conducting field surveys of the current state of emergency care in Arriyadh. 12
Developing service programs for UCCs -The Outline of the Service Programs- UCCs will serve as a center of triage for emergency patients. The major functions of UCCs assumed in the present stage are as follows: 15 centers shall be established in Arriyadh. Number of beds: 35 2 or 3 ambulances at each UCC Triage by nurses before medical examination. 24 hours a day, 7 days a week. Full range of diagnostic and support services(ct, MRI, angiography and sonograpy etc.) Observation: 1-3 days etc. Detailed functions and configuration of each center shall be proposed after conducting field surveys of the current state of emergency care in Arriyadh. 13
Developing service programs for ICC -Conceptual Scheme of Emergency Information System- Emergency Info. Data Bank Medical Cloud Decision-Making Support Algorithm Arriyadh Development Authority Supervise ICC (image) (Co-located with ECC) 9 Data registration Hospital Information System Emergency Information system Patient acceptance information database Ambulance position information database Emergency Control Screen GPS position information Emergency Care Facilities 2 Call Triage Information of 3 Ambulance dispatch command patient acceptance 4 Instructions on destination 1 Accident Information GPS UCC ECC Accident! 997 GPS GPS 7 Patient s condition 8 Transport 6 On-site Triage 5 Rush to the site 14
Developing CEMS education programs -Basic Concept- Educational Institution Graduates CEMS Trainer Japan Trainee Existing Hospitals Medical Staff Job Training Department Classes Graduate Schools Classes Specialist Training Number of Students: 1,000 Facility Area: 50,000 m2 Indoor and Outdoor Space for Simulation 15