Fragmented ambulance services evolve
into a modern system
By Nuwan Chamara Ekanayaka, EMT-I & Ken Elam, MD, MPH
Situated in the Indian Ocean, separated from India by the Palk Strait, Sri Lanka is the 25th largest island in the world
(See Figure 1, p. 51). Its complex geographical features—peaks, plateaus, valleys, rivers
and tropical forests—are subject to a variety of
natural hazards, including floods, landslides, cyclones and tsunamis. 1
With ancient cultural roots going
back to the 6th century B.C., Sri
Lanka’s modern colonial history
began with Portuguese, Dutch and
British settlements in the 16th century.
By 1815, Britain was the sole colonial power.
In 1948, Sri Lanka became an independent
country within the British Commonwealth,
and in 1972 it became a republic.
From a public health perspective, trauma
in Sri Lanka has become a significant factor.
On average, road injuries kill one person every
4. 5 hours. 2 With an aging population and an
average life expectancy at 74.9 years, Sri Lanka
is seeing an increase in the prevalence of non-communicable diseases such as heart disease,
diabetes, cancers and asthma. With coronary
heart disease and stroke as the top two
causes of death, the country faces escalating health costs and a need for
timely emergency care. 3
FIRST EFFORTS & SETBACKS
Modern initiatives to begin a compre-
hensive EMS system date back to 2003, when
a consortium of government agencies, the
National Hospital of Sri Lanka and SweRoad,
a privately-owned company of the Swedish
National Road Administration under the
Ministry of Transport and Communication,
collaborated to draft an EMS plan and begin
its implementation. 4 In 2003, Anil Jasinghe,
MD, director of accident service and Shiranee
Hapuarachchi, MD, consultant anesthetist for
the neurosurgical unit of the National Hospi-
tal, provided guidance and key leadership for
the pilot project.
Prior to these efforts, private ambulance
companies often based at hospitals, and voluntary agencies such as the Red Cross Society
and St. John Ambulance provided ambulance
transfers, but not in any coordinated way.
To support the efforts, the Colombo
Municipal Council purchased four ambulances and trained firefighters as paramedics to support the system. 89 firefighters
were chosen to participate in basic training.
Of those, 30 were selected to receive paramedic instruction. On Nov. 8, 2004, the first
three-digit emergency service line, 1-1-0,
was launched as a service of the Sri Lankan
Women participating in EMT training in Jaffna, Sri
Lanka. Photo courtesy Nuwan Chamara Ekanayaka