Private Ambulance Operators to Augment SCDF EAS

1. From 1 June 2009, SCDF will be engaging Private Ambulance Operators (PAOs) to augment its Emergency Ambulance Service (EAS). This is part of SCDF"s on-going efforts to step up and enhance EAS resources in Singapore, especially in light of the escalating rise in EAS calls.

2. In 1995, the EAS responded to only 60,300 cases per year. This increased to 117,896 cases in 2008. By 2030 the number of calls is expected to rise to 235,800. This expanded demand is due to an increase in population, especially of those aged 65 and above. Although the number of elderly is projected to form only 18.7% of the population, they are expected to account for 44% of all calls by 2030 as a result of their medical needs.

3. To address this increasing demand, SCDF has increased its number of ambulances from 15 in 1995 to 40 currently. However, the number of public ambulances cannot be increased infinitely - contracting private ambulance operators to participate in the management of medical emergencies will therefore help to alleviate the stress on current emergency ambulances.

4. With their involvement in the pre-hospital care of medical emergencies, the private EAS will also become part of the national resource to be mobilised in a mass casualty situation. SCDF EAS ambulances will continue to play a leading role for pre-hospital care in mass casualty management incidents.

Successful PAO Tenderers

5. The two firms that have successfully won the tender to provide emergency ambulance services are:

a. Unistrong Technology (S) Pte Ltd
51 Ubi Avenue 1 #01-22 Paya Ubi Industrial Park Singapore 408933
Contact person " Mr Edward Teo, GM, 62968238

b. Lentor Ambulance Pte Ltd
51 Lentor Ave Singapore 786876
Contact Person " Mr Jonathan Koh, COO, 64516300

6. The 2 firms were selected from a pool of 6 companies which responded to SCDF"s invitation to submit tender in December 2008 based on their respective merits and proposals. The evaluation committee comprises members from the MHA and SCDF.

7. The contract awarded to the 2 firms is for a period of 3 years from 1 June 2009 to 31 May 2012 with an option to extend for 2 years from 1 June 2012 to 31 May 2014. Each firm is required to provide 5 running ambulances each fully equipped with qualified crews and equipment.

8. The private ambulances and crews would be based at SCDF"s fire stations or any other locations designated by SCDF. Operating hours are from Monday to Saturday from 0800 hrs to 2000 hrs as these are the peak periods for ambulance calls. The operating hours are also subject to adjustment as and when SCDF deems necessary.

Private EAS abide by same performance standards

9. Ambulances and crews of both companies need to adhere to the same performance standards criteria established to audit service standards of SCDF ambulances and crews. This includes the present 11-minute response time policy.

10. Stringent checks will be made to assess the competency levels of private PAO paramedics. They will be subjected to regular certification tests including a mandatory 6 monthly certification and audit tests. Performance standards, availability and movement of the ambulances will also be closely monitored by the SCDF"s 995 Call Centre.

11. The SCDF"s Medical Advisory Committee (MAC) consisting of emergency medical practitioners will continue to determine the minimum professional competencies of the ambulance crews, training standards of paramedics and life-saving equipment to be carried in the ambulances.

No change to ambulance charges

12. The current charging policy remains. There is no charge by SCDF or the PAO for all emergency cases conveyed to hospitals. However, $165 will be levied for each non-emergency case ferried to the hospital so as to discourage abuse. The final outcome of the emergency / non-emergency status of a patient will be based on the assessment of the doctor at the Emergency Department of the receiving hospital.

No change to "995" Emergency Hotline

13. The public can continue to call 995 for emergency medical cases which centrally manages all SCDF and EAS PAO ambulances.

14. The existing 1777 call line for the private ambulance service for non emergencies will also remain as this has been proven useful in reducing non- emergency calls to the EAS.

Medical Protocol System (MPS)

15. To further enhance the current emergency ambulance service, SCDF will be rolling out a new Medical Protocol System (MPS). The MPS serves to further improve the present call-taking framework with computer-aided technology to help process emergency calls. This system will be implemented from Wednesday, 15 April 2009.

16. Prior to 15 April, there will be a 2-week trial run of the system between 1 April 09 and 14 April 09.

17. With the MPS, the call-taker will be supported by a template of pre-approved medical questions pertaining to the chief complaints of the caller. This will allow him to systematically diagnose the patients" conditions and even provide useful pre-arrival instructions to aid the caller prior to the arrival of the ambulance. For example, if a caller complains of chest pains, the dispatcher will then take the caller through the structured list of key questions outlined in the template for chest pains, such as is the patient able to breathe; is the patient feeling faint, dizzy, sweaty or pale; and does the patient have any previous history of cardiac problems. Such information details will be given to the paramedic enroute to the incident site and thus better prepare him to manage the patient.

18. The questions asked by the call-taker will not compromise on the time taken for SCDF to deploy the ambulance for the case. The ambulance will continue to be dispatched within 1 minute - once information such as the patient"s location, contact number, the patient"s chief complaint and vital signs have been ascertained

19. The MPS will therefore enhance emergency patient care even before the arrival of ambulances See Annex A for details about the MPS.

20. MPS will not be extended to the 1777 Call Centre as 1777 only handles non-emergency cases.

Annex A

ANSWERS TO FREQUENTLY ASKED QUESTIONS MEDICAL PROTOCOL SYSTEM

1. How many questions are callers expected to answer before ambulances are dispatched to the scene"

An ambulance can be dispatched once the key information such as the location of the incident, contact details and chief complaint and vital signs of the patient have been established. Further in depth questions will be asked after the ambulance has been dispatched. The additional information will be given to the paramedic enroute to the incident site to better prepare him for the case. For severe cases, the nearest hospital can also be notified to be on standby well in advance. The additional information can also be used to provide medical advisories and instructions to guide the caller to render first aid to the patient until the arrival of the ambulance. See Annex B for a list of sample MPS questions.

The list of key medical questions call-takers may use when receiving a distress call are crafted as "close-ended" questions requiring either a "Yes" or "No" answer, as opposed to "open-ended" questions, which will require more time to type and record information. Call-takers will typically ask about 9 questions to determine the condition of the patient. Currently 32 medical protocols (ie. templates of questions for a variety of medical conditions) have been developed for call-takers to base on when taking "995" calls. Upon arrival of the ambulance at the caller"s location, paramedics will still conduct a thorough on-site assessment of the patient.

2. What is the time taken for dispatch before and after the implementation of the system"

At present, it takes us on the average 1 minute to complete a call. With the MPS, it is expected that a call should take between 1.5 to 2 minutes to complete. However, an ambulance can be dispatched within 1 minute once information such as the patient"s location, contact number and the patient"s chief complaint and vital signs have been obtained and verified. The system will therefore not affect the response time of the ambulances.

ANNEX B

MEDICAL PROTOCOL SYSTEM (MPS) SAMPLE QUESTIONS

Sample 1 " Breathing Difficulty

Entry Questions

1. What is the exact location of the incident"
2. What is the phone number that you are calling from"
3. What"s the problem (Tell me exactly what happened)"

Vital Signs Questions

1. How old is the patient"
2. Is he/she alert (and able to talk)"
3. Is he/she breathing"
4. Determine the gender

(Ambulance will be dispatched once address, contact details and chief complaint and vital signs are determined.)

________________________________________________________________

Primary Questions

1. Was thing problem caused by an injury to the chest"
2. Is he/she able to talk in full sentence"
3. Is he/she choking"
4. Is he /she faint, dizzy, sweaty or pale"
5. Does he/she have any history of heart problems"
6. Does he or she suffer form asthma"

Closing Questions

1. If possible, can someone look out for the ambulance crew and direct them to
the scene"
2. If there are any dogs at scene, can someone secure them in another room
before the ambulance crew arrives"
3. If he/she is taking any medication, gather them up and hand them to the
ambulance crew when they arrive"

Sample 2 " Choking

Entry Questions

1. What is the exact location of the incident"
2. What is the phone number that you are calling from"
3. What"s the problem (Tell me exactly what happened)"

Vital Signs Questions

1. How old is the patient"
2. Is he/she alert (and able to talk)"
3. Is he/she breathing"
4. Determine the gender

(Ambulance will be dispatched once address, contact details and chief complaint and vital signs are determined.)

________________________________________________________________

Primary Questions

1. Is he/she still choking"
2. Is he/she able to speak or cough"
3. Is he/she breathing normally" (not wheezing or making funny noises)

________________________________________________________________

Medical Advisory for Caller

1. Listen carefully. I am going to tell you how to help. An ambulance is already on
the way. Can you put your phone into the speaker mode" (Yes)
2. Good. Follow my further instructions.
3. If the casualty is able to cough, ask him/her to cough as hard as he./she can to
get the foreign object out of the upper airway. Can he/she cough"(No)
4. Is he/she conscious" (Yes)
5. Is the casualty pregnant or very obese" (No)
6. Stand behind the patient and wrap your arms around him/her.
7. Position one of your feet between the patient's legs.
8. Make a fist with one hand and place the thumb side on the stomach between
the belly and the bottom of the breast bone.
9. Grab the fist with your other hand and give quick upward thrust into the
stomach. Repeat 5 times.
10. Did you see anything pop out and is he /she breathing" (Yes)
11. Stay with the patient and monitor ABCs ie. Airway, Breathing and Blood Circulation (blood circulation through pulse check).

Closing Questions

1. If possible, can someone look out for the ambulance crew and direct them to the scene"
2. If there are any dogs at scene, can someone secure them in another room before the ambulance crew arrives"
3. If he/she is taking any medication, gather them up and hand them tot he ambulance crew when they arrive"