KUALA LUMPUR, August 24 — The Ministry of Health (MOH) is considering giving medical assistants (MAs) the additional role of driving ambulances to address a shortage of drivers and to deploy two paramedics in top-priority emergency cases.
Currently, MOH’s emergency medical response sometimes sends out just one MA, also known as an assistant medical officer, while the driver is not a trained paramedic whose job is to solely drive the ambulance, unlike in the United Kingdom where the ambulance is driven by a paramedic.
“To address a shortage of drivers for pre-hospital and ambulance care services (PRPA), the Assistant Medical Officer Service Branch has suggested optimising the function of assistant medical officers, including handling the ambulance to replace drivers,” Health Minister Khairy Jamaluddin told Bandar Kuching MP Dr Kelvin Yii in a written Dewan Rakyat reply last July 28.
“This is also in line with upgrading PRPA services, especially in Priority 1 cases, by placing two MAs in one ambulance, where they will act as the first and second responder besides driving the ambulance. This matter is under consideration and will be finalised in the nearest time.”
Dr Yii had asked the health minister on whether MOH would improve its cardiopulmonary resuscitation (CPR) protocol for emergency cases on the road and measures to expedite emergency response time.
The DAP lawmaker cited the Raja Permaisuri Bainun Hospital (HRPB) case, in which a doctor from the Ipoh general hospital accused HRPB’s ambulance service of allowing his brother to die from a heart attack last April 13 by withholding CPR from the 43-year-old man, despite arriving on the scene within 10 to 15 minutes from the emergency call.
The prehospital care form signed by the HRPB MA who attended to Kumaraveloo Terpari @ Thirupathy stated that CPR was withheld, besides claiming signs of algor mortis on the patient as a “clear sign of death”. Algor mortis is the second post-mortem stage of death when the corpse cools until the body temperature matches the outside temperature.
Khairy said in his parliamentary reply that MOH will use the “Recommendations on the Minimum Standards Required for the Management of Adult Out of Hospital Cardiac Arrest in Prehospital Care Services” 2016 guidance by the College of Emergency Physicians, Academy of Medicine Malaysia, as the main reference to create a consistent and evidence-based prehospital service policy for use by all of MOH’s PRPA units nationwide.
According to that guidance by emergency physicians at the Academy of Medicine Malaysia, a group of medical specialists, CPR on adults with out of hospital cardiac arrest (OHCA) at the scene – who are unconscious and have not been breathing for more than 10 seconds (apnoeic) or have abnormal breathing – must be initiated “without delay” when indicated.
CPR interventions can only be withheld from OHCA victims with signs of “clinical irreversible death”, comprising rigor mortis (body stiffens after a few hours from death); dependent lividity (bluish-purple discolouration of skin after death); fatal injuries like decapitation, transection (cutting across, typically a tubular organ), or incineration (more than 95 per cent full thickness burns); or decomposition.
Khairy added that to improve the public ambulance response, especially for Priority 1 emergency cases, MOH is working together with non-governmental bodies like St John Ambulance of Malaysia (SJAM) and the Malaysian Red Crescent Society for a hotspot initiative, where these ambulances canvas areas that receive a high number of MERS 999 calls.
As of now, there are 20 recognised hotspots nationwide, and the initiative will be expanded in the future.
MOH is also procuring 590 new ambulances (100 type A and 490 type B) to replace old ambulances. The new ambulances are expected to arrive in the third quarter of next year.
Khairy said MOH is planning the establishment of a National Institute of Prehospital and Medical Disasters to improve governance of prehospital and disaster services in the country.
It will also serve as the uniting management body for MOH ambulance services, developing standard models of care and evidence-based medical intervention practices, as well as serve as an advocate for the drafting of legislation to regulate ambulance services in Malaysia.
Finally, the government will outsource ambulance services to the private sector to meet needs unmet by MOH. This matter is still being studied and will be decided on in the near future.
