The Colombo Municipal Council’s EMS pilot project came to a
halt with the effects of a devastating tsunami that hit Sri Lanka on
Dec. 26, 2004. Triggered by a 9. 2 magnitude earthquake in western
Indonesia, the tsunami first arrived on Sri Lanka’s eastern coast two
hours after the quake, and subsequently refracted around the southern
point of Dondra Head. The refracted tsunami waves then inundated
the southwestern part of Sri Lanka, after some of its energy was further reflected from impact with the Maldives. The civilian casualties,
which included a train derailment which alone killed 1,700 people,
were estimated at 31,000—second only to Indonesia. 5
In 2005, with the support of Johanniter International from Germany,
efforts to establish an EMS system were relaunched. Technical support and four fully-equipped ambulances were provided, with local
implementation of the donations by St. John Ambulance Sri Lanka.
With this infusion of equipment and training, the first EMS system
was launched in August 2005, using the 1-1-0 three-digit telephone
access number. 6
U.S.-based Medical Teams International (MTI) arrived in Sri
Lanka in 2005 and signed an agreement with the Ministry of Health
to assist with expansion of EMS, which became known as the 1-1-0
Prehospital Care System. The Ministry of Health formed the Trauma
Secretariat to reduce morbidity and mortality of the injured through
prevention of secondary injury.
With the MTI partnership, the Ministry of Health Sri Lanka and
Trauma Secretariat published the first Sri Lankan edition of an EMT
textbook in two native languages, Sinhala and Tamil. An EMT skills
video was also created and released on DVD. Both the textbook and
related video series have been recognized by the Sri Lanka’s Ministry
of Health as the standard of training for EMTs.
MTI trained 2,700 EMTs in Sri Lanka from 2005 to 2010, using
the approved materials and local trainers as partners. MTI, the Ministry of Health and local government health ministries collaborated
to develop prehospital systems in nine districts outside the capital city
of Colombo. Four of the district programs—Colombo, Badulla, Galle
and Kandy—are fire-based systems. The Anuradhapura and Kurune-gala prehospital care systems are based at regional hospitals, and the
programs in Jaffna and Mannar were developed using the resources
of the regional director of health services.
In 2011, MTI departed Sri Lanka and a group of former MTI
staff started Med1 Ltd., a private company that focused on providing prehospital care services to Colombo and its suburbs. Med1Ltd.
launched their services with a different public access number
(1-9-9-0) and they were the first organization to launch motorcycle
first responders to emergency calls.
In 2013, Med1 Ltd. was bought by Falck International to launch their
services in Sri Lanka as one of the largest emergency medical service
providers in the world. They had intended to provide an island-wide
EMS as a private entity. After failing to expand their services outside
of Colombo, Falck ceased to provide service in 2015.7
A REGION AT WAR
Development of EMS in Jaffna deserves special mention. Centered in
the heart of a civil war that raged from 1983–2009, the Jaffna system
began by providing transportation to the hospital for emergencies that
occurred during wartime curfew periods. From 6:00 p.m. to 6:00 a.m.,
the ambulances were the only vehicles allowed on the road. Commu-
nications were difficult and conditions were dangerous. 7
Separated from the rest of the country by the war, the only access to
Jaffna was by air or sea. The Red Cross Society and St. John Ambu-
lance Services in Jaffna invited MTI to train their staff, who was trans-
porting patients during the curfew.
Later, MTI worked with the regional director of the Jaffna health
services office leverage their resources and establish an EMS system.
Jaffna received financial support for their efforts from the U.S. Agency
for International Development.
With the arrival of peace, the Jaffna EMS system, which charged a
nominal voluntary fee, was officially launched on Feb. 28, 2009. The
system responded to more than 2,000 emergency calls in its first 11
months of operation. By 2016, the provincial council expanded the
1-1-0 system to serve the entire northern region.
A St. John Ambulance, donated after a tsunami devastated the country in 2004.
Photo courtesy Nuwan Chamara Ekanayaka
Figure 1: Map of Sri Lanka and South India